Hamaguchi Koudai, Hashimoto Akira, Owa Hirono, Hattori Aiji, Tanaka Takamitsu, Kurebayashi Marie, Tahara Yuichi, Fuke Hiroyuki, Shimizu Atsuya, Kondou Akinobu
Department of Internal Medicine, Saiseikai Matsusaka General Hospital.
Department of Surgery, Saiseikai Matsusaka General Hospital.
Nihon Shokakibyo Gakkai Zasshi. 2022;119(3):236-244. doi: 10.11405/nisshoshi.119.236.
A Japanese male in his 50s was presented to our hospital with the chief complaint of positive fecal immunochemical test. He had a history of hypertension. He underwent colonoscopy and was diagnosed with sigmoid colon cancer. He also underwent laparoscopic sigmoid colectomy with D3 lymph node dissection for sigmoid colon cancer. The inferior mesenteric artery and inferior mesenteric vein were amputated at the root of the vessels. The patient received adjuvant chemotherapy and was recurrence-free. Eleven months after the surgery, lower abdominal pain during defecation appeared. Contrast-enhanced computed tomography (CT) and colonoscopy showed marked rectal mucosal edema and increased fatty tissue density (dirty fat sign) around the anorectal side of the anastomosis. Intestinal blood flow was maintained. There were many fine blood vessels around the rectal wall, and the amputated distal part of the superior rectal artery was retrogradely contrasted. Amputated superior rectal artery and superior rectal vein were dilated than before. Colonoscopy revealed mucosal redness, edema, and easy bleeding on the anorectal side of the anastomosis. Abdominal contrast-enhanced 3D-CT showed increased arterial blood flow and increased fine blood vessels around the rectal wall. It suggested the presence of an arteriovenous fistula and venous congestion. Conservative treatment with total parenteral nutrition and prednisolone infusion did not improve the patient's condition, and a colostomy was performed. After colostomy, the pain improved, and the CT scan of the abdomen showed improvement in arterial blood flow and venous congestion. Colostomy was closed after 10 months. There has been no relapse since the closure of the colostomy. There are few reports on ischemic proctitis on the anorectal side of the anastomosis after colon cancer resection due to impaired venous blood flow.
一名50多岁的日本男性因粪便免疫化学检测呈阳性为主诉前来我院就诊。他有高血压病史。他接受了结肠镜检查，被诊断为乙状结肠癌。他还接受了乙状结肠癌的腹腔镜乙状结肠切除术及D3淋巴结清扫术。肠系膜下动脉和肠系膜下静脉在血管根部被切断。患者接受了辅助化疗，且无复发。术后11个月，患者出现排便时下腹部疼痛。增强计算机断层扫描（CT）和结肠镜检查显示直肠黏膜明显水肿，吻合口肛门直肠侧周围脂肪组织密度增加（脏脂肪征）。肠道血流得以维持。直肠壁周围有许多细小血管，直肠上动脉切断的远端逆行显影。切断的直肠上动脉和直肠上静脉比之前扩张。结肠镜检查显示吻合口肛门直肠侧黏膜发红、水肿，且容易出血。腹部增强3D-CT显示直肠壁周围动脉血流增加，细小血管增多。提示存在动静脉瘘和静脉淤血。采用全胃肠外营养和泼尼松龙输注的保守治疗未能改善患者病情，遂行结肠造口术。结肠造口术后，疼痛改善，腹部CT扫描显示动脉血流和静脉淤血情况好转。10个月后关闭结肠造口。自结肠造口关闭以来未出现复发。关于结肠癌切除术后因静脉血流受损导致吻合口肛门直肠侧缺血性直肠炎的报道较少。
