Abstract
A case of rectal cancer with Leriche syndrome which was successfully operated on by considering the operative procedure in terms of both blood flows to the lower extremities and to the intestine. A 68-year-old man was seen at the hospital because of intermittent claudication and the painful left first toe. Aortography revealed that the abdominal aorta had tapered from just below the furcation of renal artery and occluded at the furcation of the inferior mesenteric artery. During a period of waiting operation, the patient developed intestinal obstruction. Close examination disclosed a rectal cancer (Borrmann type 2, Rs) and a 1.8×1.7cm solitary nodular shadow in the left upper lobe of the lung which was thought metastatic lung cancer.
A colostomy and a right axillo-bilateral femoral artery bypass were performed as the first operation. Two weeks later a low anterior resection for rectal cancer with closure of the colostomy and a resection of the lung metastasis under video assisted thoracoscopic surgery were performed. The patient has an uneventful course after the operation. In the treatment of this kind of case, it is essential to establish a blood flow to the intestines distal to the anastomosis through the internal iliac arteries.
