A 47-year-old woman was admitted to our hospital for surgical treatment of sigmoid colon cancer. Barium enema and colonoscopic study demonstrated a 1.5 cm × 1.8 cm polypoid lesion in the sigmoid colon ()
. Biopsy revealed well-differentiated adenocarcinoma. Based on a diagnosis of submucosal cancer, laparoscopic-assisted sigmoid colectomy was selected for the optimal treatment. The operation was performed with curative intent using a gasless technique ()
Anastomosis was undertaken using the double stapling method. Lymph node dissection with low ligation of the inferior mesenteric artery was per-formed simultaneously. The mesenteric defect resulting from bowel resection was not completely closed because of technical difficulty.
shows the resected specimen. Pathological examination revealed submucosally invasive cancer without lymph node involvement.
Barium enema finding. Barium enema study demonstrated a 1.5 cm × 1.8 cm polypoid lesion.
Gasless laparoscopic-assisted sigmoid colectomy.
Resected specimen. Pathological examination revealed a well differentiated submucosal invasive cancer.
On the 20th postoperative day, the patient developed abdominal distension, nausea and vomiting. Plain abdominal X-ray films demonstrated a small bowel obstruction. A decompression tube (long tube) was inserted, and, on the 26th postoperative day, the bowel obstruction showed improvement. However, after initiating liquid meals, the patient again developed bowel obstruction. Abdominal X-rays after ingestion of contrast medium showed a severely dilated small bowel (). The anal edge of the dilated loop was located near the anastomosis, and laparotomy was performed. Abdominal exploration revealed a dilated loop of small bowel incarcerated within the mesenteric defect. Adhesiolysis was performed. The postoperative course was uneventful, and the patient was discharged on day 21 after the second procedure.
Abdominal X-ray after ingestion of contrast medium. A dilated loop of the small bowel is indicated by arrows. The anastomotic site is identified by the staples, as indicated by the arrowhead.