Abstract
An 80-year-old man who had undergone local excision for rectal carcinoma 2 years earlier was found on endoscopy to have local recurrence, and was admitted to our hospital. Pulse in the right femoral artery was weak, and he had a history of abdominal aortic aneurysm. We therefore conducted aortography, revealing previously unrecognized infrarenal aorto-iliac occlusion. Complete obstruction of the right common iliac artery was seen, but right limb viability was maintained by collateral flow from the left femoral artery through the mesorectum. Prior to resection of the rectum, we conducted vascular reconstruction to prevent leg ischemia. The subsequent postoperative course was uneventful. Rectal carcinoma and arteriosclerosis obliterans are both more common in the elderly and may coexist. Rectal resection without revascularization could conceivable result in a high rate of fatal leg ischemia. Patients with rectal carcinoma should therefore be carefully assessed for aorto-iliac occlusive disease. Extra-anatomical arterial reconstruction before bowel resection may be important to avoid fatal complications.
