Abstract
The patient was an 81-year-old man who underwent laparoscopy assisted transverse colectomy for transverse colon cancer located a little to the splenic flexure in April 2013, when the reconstruction was performed by functional end-to-end anastomosis between the transverse colon and descending colon. The patient had been given magnesium oxide and had bowel movement almost every day after the operation. He and his family were not aware of having constipation. The patient presented to our hospital because of abdominal pain and vomiting in October 2014. An abdominal contrast-enhanced CT scan showed free air in the abdominal cavity ; an intestine had dilated at the functional end-to-end anastomosis in the left upper quadrant of abdomen, and a fecal mass 6.7 cm in diameter was present within the intestine. A perforation 4 mm in diameter was suspected to be on the dorsal wall at the same area. Perforative peritonitis caused by the fecal mass at the anastomosis was diagnosed and the patient was operated on. Upon surgery, there was a rupture at the anastomosis, through which the fecal mass had exposed. The anastomosis including the perforation was resected and colostomy was performed. In creating a functional end-to-end anastomosis, we of course have to anastomose not to cause stricture of the anastomosis, however, we must also alert for a risk that an extremely great anastomosis diameter can cause a diverticulum like change, resulting in retention of fecal masses.
