A Case of Necrotizing Ischemic Colitis 6 Months after Laparoscopic-assisted Left Hemicolectomy for Descending Colon Cancer

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  • 腹腔鏡補助下結腸左半切除術後6カ月目に発症した壊死型虚血性大腸炎の1例
  • 症例 腹腔鏡補助下結腸左半切除術後6カ月目に発症した壊死型虚血性大腸炎の1例
  • ショウレイ フククウキョウ ホジョ カ ケッチョウ サ ハンセツジョ ジュツゴ 6カゲツメ ニ ハッショウ シタ エシガタキョケツセイ ダイチョウエン ノ 1レイ

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Abstract

A man in his 60s had previously undergone laparoscopic left hemicolectomy for descending colon cancer, and was seen at our hospital because of diarrhea and abdominal pain during adjuvant chemotherapy. Computed tomography revealed circumferential edematous thickening and reduced enhancement of the intestinal wall from the sigmoid colon through the rectum at the anal side of the anastomosis. Colonoscopy revealed widespread, annular longitudinal ulcers in the sigmoid colon. A biopsy specimen from the ulcer demonstrated an inclusion body with immuno-histochemistry using anti-cytomegalovirus antibody. Hartmann's operation was performed because perforation of the sigmoid colon occurred two months after admission despite ganciclovir administration. Histological findings revealed necrotizing ischemic colitis. This case was complicated by various factors including arterio-sclerosis, reduced blood flow due to laparoscopic colon surgery, and an infection associated with compromised immune function caused by adjuvant chemotherapy.

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