A Case of Ischemic Enteritis in Distal Large Intestine from Anastomosis after Transverse Colon Cancer Surgery

Abstract

The patient was a 75-year-old man who underwent robot-assisted left colon resection for cancer of the splenic flexure of the transverse colon. The descending colon was poorly fixed and had persistent descending mesentery (PDM). The tumor was located in the splenic flexure and was determined to be served by the collateral middle colonic artery ; indocyanine green fluorescence confirmed good intestinal blood flow, and the bowel was dissected and reconstructed with an overlap anastomosis. Five months after surgery, the patient came to the hospital complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) showed circumferential edematous wall thickening in the anastomosis to the anorectal intestinal tract, which was diagnosed as ischemic enterocolitis. Conservative treatment with fasting and supplemental fluids was provided, but two months later, abdominal CT showed worsening ischemic enterocolitis, and an open Hartmann operation was performed. Histopathological diagnosis showed fibrosis in all layers of the thickened bowel wall on the anorectal side and gangrene in the mucosal to submucosal layers. All layers of the veins were found to be hyperemic and showed microvascular hypervascularity. In this case, the dissection of the inferior mesenteric vein was thought to have induced venous stasis, resulting in an intestinal blood flow disturbance.