PMC6037831_01
Computed tomography findings: A, circumference wall thickening accompanied by contrast effect of the transverse colon (arrow); B, semicircular wall thickening accompanied by contrast effect of the proximal rectum (arrow).
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Since we detected an elevated of carcinoembryonic antigen level, which was regularly measured to prevent the development of pancreatic cancer, contrast-enhanced computed tomography was performed, revealing circumference wall thickening of the transverse colon (Fig. 1A) and semicircular wall thickening of the proximal rectum (Fig. 1B); therefore, further examination was performed.
Colonoscopy findings: A, a 50-mm-diameter circumferential type 2 tumor in the transverse colon; B, a 30-mm-diameter type 2 tumor in the proximal rectum.
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Colonoscopy revealed a 50-mm-diameter circumferential type 2 tumor in the transverse colon (Fig. 2A) and a 30-mm-diameter type 2 tumor in the rectum (Fig. 2B), and both biopsy findings indicated moderately differentiated adenocarcinoma.
Barium enema findings: A, a 50-mm-diameter circumferential type 2 tumor, the so-called apple core sign, in the middle of the transverse colon (arrow); B, a 30-mm-diameter type 2 tumor in the proximal rectum (arrow).
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Similarly, a barium enema examination revealed a 50-mm-diameter circumferential type 2 tumor, the so-called apple core sign, in the middle of the transverse colon (Fig. 3A) and a 30-mm-diameter type 2 tumor in the proximal rectum (Fig. 3B).
Positron emission tomography findings: A, the standard uptake values was 4.6 in the transverse colon cancer (arrow); B, the standard uptake values was 5.0 in the rectal cancer (arrow).
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Positron emission tomography revealed the standard uptake levels for the transverse colon and rectum were 4.6 (Fig. 4A) and 5.0 (Fig. 4B), respectively.
A, raising the transverse colon outside the abdominal cavity through a small incision in the umbilicus and the tumor located in the middle of the transverse colon (arrow head); B, StO2 measurements were obtained at two points (proximal and distal sides of the anastomosis) on the antimesenteric position of the intestine before and after mesenteric dissection; C, after resecting the rectum, the proximal side stump was raised outside the abdominal cavity through the umbilical incision; D, StO2 of the anastomotic proximal side of the colorectum after mesenteric dissection.
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After a small incision in the umbilicus, a transverse colon resection was performed by raising the transverse colon outside the abdominal cavity (Fig. 5A). StO2 measurements were obtained at two points (proximal and distal sides of the anastomosis) on the antimesenteric position of the intestine before and after mesenteric dissection (Fig. 5B). The rectum was then resected, and the proximal side stump was raised outside the abdominal cavity through the umbilical incision (Fig. 5C). The StO2 of the anastomotic proximal side of the colorectum after mesenteric dissection was 76% (Fig. 5D); thus, we judged that the colorectal anastomosis could be performed safely.