A Case of Ischemic Colitis on the Anal Side of the Anastomosis after Laparoscopic Sigmoidectomy

Abstract

A 67-year-old man tested positive for fecal occult blood in a health checkup and was referred to our hospital's department of gastroenterology for further investigation. Sigmoid colon cancer in the vicinity of the junction between the descending colon and the sigmoid colon was diagnosed, and laparoscopic sigmoidectomy was performed Lymph node. Dissection was carried out as far as the origin of the inferior mesenteric artery, and the first sigmoid colic artery, which branches from the left colic artery, and the second sigmoid colic artery, which branches from the superior rectal artery, were both divided at their origins, while the vessels from the inferior mesenteric artery to the superior rectal artery were preserved. The intestinal tract was resected between the descending colon and the sigmoid colon and reconstructed with a functional end-to-end anastomosis. The postoperative pathological diagnosis was pT3N0M0 Stage IIa. After postoperative adjuvant chemotherapy, the patient was monitored at a local clinic. At 1 year and 5 months postoperatively, he developed abdominal pain and diarrhea, and since computed tomography (CT) and lower gastrointestinal endoscopy showed ischemic colitis extending from the anal side of the anastomosis to the upper part of the rectum, he was admitted to our department for treatment. His condition improved with conservative therapy, and he was discharged, but CT 1 month later showed an exacerbation of ischemic colitis. Since there was no prospect of improvement with conservative therapy, Hartmann's operation was performed. The patient's postoperative course was uneventful, and he currently continues to be recurrence-free and symptom-free.