A Case of Sigmoid Colon Cancer with Intestinal Amyloidosis

Abstract

Intestinal amyloidosis can cause ischemia and fragility of the intestinal mucosa. It disturbs blood flow at anastomosed site in the intestinal reconstruction to be a high risk of inducing suture failure. There are some cases in which immediate anastomosis is avoided and a surgical stoma is created.

A 67-year-old man with a 20-year history of chronic rheumatoid arthritis presented with anemia. Colonoscopy showed a 20-mm elevated polyp in the sigmoid colon. A biopsy of the colon revealed well differentiated adenocarcinoma. In addition, a biopsy in the normal mucosa showed that direct fast scarlet (DFS) positive substance was deposited. There was a thickening vascular wall with DFS positive. We diagnosed the case as sigmoid colon cancer and intestinal amyloidosis. He underwent endoscopic mucosal resection. Pathological findings of resected specimen showed that vertical margin was positive, and additional surgical resection was recommended. Abdominal CT revealed marking clips in the sigmoid colon. There was no evidence of distant metastases or swollen lymph nodes. We performed laparoscopic sigmoidectomy. We used indocyanine green fluorescence imaging to assess anastomotic perfusion. Blood flow of the colon using for reconstruction was confirmed good. Then we mobilized the splenic flexure to release tension of the anastomotic site. Finally, we inserted a trans anal tube. Postoperative course was uneventful, and he was discharged from our hospital on postoperative day 10.