PMC4560146_01
Preoperative colonoscopy findings. a Preoperative colonoscopy showed a superficial lesion with central depression in the rectosigmoid colon. b Dye dispersion revealed central depression and mucosal unevenness
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Fig1
A 69-year-old female Japanese patient suffered from narrow stool and was determined to have a 15-mm superficial lesion with central depression in the rectosigmoid colon (Fig. 1).
Merged image of computed tomography angiography and colonography. Computed tomography angiography revealed abdominal aortic locoregional stenosis. Accompanying the descending colon, collateral circulations comprised the gastroduodenal artery (GDA) and superior mesenteric artery (SMA), with flow into the inferior mesenteric artery (IMA), and deficiency of the left colic artery
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Fig2
Unexpectedly, this revealed an approximate 5-cm stenosis from the infrarenal abdominal artery to the root of the inferior mesenteric artery (IMA) and collateral circulations, although the patient had no complaint of angiostenosis symptoms (Fig. 2).
Vascular imaging and endovascular procedure. a Obvious segmental stenosis was found at the infrarenal abdominal artery. b A self-expandable stent at the region of stenosis secured blood flow to the legs
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Fig3
Angiography revealed that the collateral circulation flowed to the IMA, as expected from the CTA (Fig. 3a). A self-expandable stent was placed in the narrow segment, and we verified the pressure gradient improvement above and below the narrow segment (Fig. 3b).
Intra and postoperative view of the abdomen. a Photograph of trocar placement. We used an EZ Access (Hakko, Nagano, Japan). b Surgical view, showing that IMA was ligated with vascular clip. c Postoperative abdominal view, showing that the umbilical incision was not extended and there was no additional lateral abdominal trocar
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Fig4
We started SLC with a 2.5-cm vertical incision in the umbilicus (Fig. 4a). We ligated IMA with a vascular clip and then completed CME (Fig. 4b). We did not need additional trocar (Fig. 4c).