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. 2020 Jul 20;6(1):175.
doi: 10.1186/s40792-020-00919-5.

Congestive ischemic colitis occurring after resection of left colon cancer: 4 case series

Takatsugu Fujii  1 , Shigeo Toda  2 , Yuki Nishihara  2 , Yusuke Maeda  2 , Kosuke Hiramatsu  2 , Yutaka Hanaoka  2 , Rikiya Sato  2 , Shuichiro Matoba  2 , Masashi Ueno  2 , Hiroya Kuroyanagi  2
Affiliations
Free PMC article

Congestive ischemic colitis occurring after resection of left colon cancer: 4 case series

Takatsugu Fujii et al. Surg Case Rep. .
Free PMC article

Abstract

Background: Ischemic colitis can occur after colectomy and is sometimes difficult to treat. We report 4 cases of refractory, delayed onset, regional congestive colitis occurring on the anal side of the anastomosis after laparoscopic left hemicolectomy.

Case presentation: A total of 191 patients underwent surgery for left colon cancer (transverse, descending, and sigmoid colon cancer) at our hospital from January 2012 to December 2017. During the procedures, the left colic artery (LCA) or sigmoid colic artery (SA) was dissected, the superior rectal artery (SRA) was preserved, and the inferior mesenteric vein (IMV) was dissected at the inferior margin of the pancreas. Congestive ischemic colitis due to venous return dysfunction occurred in 4 cases (2.1%), 5 to 34 months postoperatively. The patients had diarrhea and blood in the stool. On computed tomography (CT), the patients exhibited continuous intestinal edema and high-density adipose tissue from the anastomosis site to the rectum. Contrast enhancement showed dilation of the vasa recti and arteries from the inferior mesenteric artery (IMA) to the SRA. Three patients improved with long-term intestinal rest; in 1 case, the stenosis did not improve and required colorectal resection.

Conclusion: Diagnoses were easy in these cases, but treatment was prolonged and surgery was necessary in 1 case. While this condition is rare, caution is warranted as it is difficult to treat.

Keywords: Anastomosis; Colectomy; Colon cancer; Ischemic colitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a The oral side of the anastomosis was normal colon mucosa. The arrow indicates anastomosis. b The anal side of anastomosis was full circumferential inflammation continued to the rectum
Fig 2
Fig 2
a There are continuous edematous changes from the anastomosis site to the rectum (triangular arrow). b Contrast enhancement shows the IMA (arrow). c, d The oral side of the intestines to the anastomosis seems to be normal. IMV, inferior mesenteric vein
Fig. 3
Fig. 3
a The IMV returns from the left transverse colon to the rectum. b When the SRA and SA are preserved and the IMV is dissected both at the inferior margin of the pancreas and at the root of SA (cases 2–4) level, venous blood from the anastomosis to the rectum mainly returns via the rectal vein. In case 1, the distal branches of IMV dissected at the root of LCA level
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