Laparoscopic surgery for colorectal cancers complicated by Leriche syndrome: A report of three cases.

Abstract

Leriche syndrome is a disease of aortoiliac occlusion, which causes diminished femoral pulses, impotence and claudication. As blood flow to the rectum is also decreased in Leriche syndrome, reconstruction with anastomosis may be complicated by ischemia when performing rectal cancer surgery. The inferior epigastric arteries often provide collateral circulation to the lower limbs in patients with Leriche syndrome, therefore, attention should be paid not to injure them during trocar insertion when performing laparoscopic surgeries. The present study is a report on three cases of patients with colorectal cancer who were successfully treated with laparoscopic surgeries. The first case was of a 71-year-old man with rectal cancer. A preoperative computed tomography (CT) scan revealed occlusion of the aorta below the origin of the inferior mesenteric artery. The blood flow to the lower limbs was supplied through collateral arteries, including the inferior epigastric arteries and the deep circumflex iliac arteries. A laparoscopic Hartmann's operation was performed successfully following marking of the inferior epigastric arteries using ultrasonography to avoid damaging them during trocar insertion. The second case involved a 70-year-old man with three colorectal cancers of the transverse and sigmoid colon and rectum. A CT scan revealed occlusion of the aorta below the origin of the renal arteries. Laparoscopic assisted low anterior resection and left hemicolectomy with colostomy were performed. The final patient was a 61-year-old man with rectal cancer. As the right internal iliac artery was patent, the patient underwent laparoscopic assisted low anterior resection. All the patients were discharged from the hospital without complications. It is important to visualize the image the blood flow via CT angiography and to mark collateral arteries using ultrasonography preoperatively in patients with Leriche syndrome for whom laparoscopic surgery was planned for to treat colorectal cancer.