Sigmoid colon cancer with an incidental diagnosis of Leriche syndrome successfully treated without inferior epigastric artery injury

Leriche syndrome involves atherosclerotic occlusion of the infrarenal aorta and bilateral common iliac arteries, and the inferior epigastric artery is an important route for lower-extremity perfusion. A 65-year-old Japanese man with sigmoid colon cancer was scheduled to undergo laparoscopic colectomy, and three-dimensional computed tomography angiography was performed to detect the feeding artery of the tumor. The angiography incidentally showed occlusion of the infrarenal aorta and common iliac arteries with the following collateral pathways: the internal thoracic artery supplied the external iliac artery via the inferior epigastric artery and the intercostal arteries supplied the external iliac artery via the superficial circumflex iliac artery. Therefore, he was diagnosed with Leriche syndrome. We performed open colectomy with midline incision and colostomy at the midline, without drain placement to prevent inferior epigastric artery injury. In patients with Leriche syndrome, this approach might be a safe option to avoid lower extremity ischemia. Abbreviations: ITA: internal thoracic artery; IEA: inferior epigastric artery; CT: computed tomography; 3D: three-dimensional