Abstract
A 61-year-old man underwent laparoscopic splenic flexure colectomy with D3 dissection for transverse splenic flexure colon cancer. The left branch of the middle colic artery, the left colic artery, and the inferior mesenteric vein were cut, but the inferior mesenteric artery was preserved. The final pathology was fT3N1M0 fStage IIIa. Five courses of UFT/UZEL were given as postoperative adjuvant chemotherapy. About 1 year and 7 months after the first operation, abdominal pain, bloating, and nausea appeared, and he was diagnosed with chronic ischemic colitis. Two and a half months of conservative medical treatment did not improve his symptoms. Hand-assisted laparoscopic necrotic colectomy, transverse colon-rectal anastomosis, and diverting ileostomy were performed. Histopathologically, necrosis from the lamina propria to the submucosa, thickening of the vein wall, and small blood vessel proliferation were observed. Three months after the operation, ileostomy closure was performed. The patient's postoperative course was uneventful. It was considered that the intestinal congestion, which was caused by the blood flow imbalance due to preservation of the inferior mesenteric artery and sacrificing of the inferior mesenteric vein, was the reason for the chronic ischemic colitis.
