Interposition of small bowel as replacement for the descending colon.

A 52-year-old man underwent laparoscopic resection of the sigmoid colon for recurrent sigmoid diverticulitis in another hospital. Owing to anastomotic leakage and anastomotic stenosis, several dilatations were carried out. Two months later open resection of the anastomotic stenosis was done. Three months after that, he presented to our hospital because of symptoms of subileus due to a recurrent high-grade anastomotic stenosis. A computed tomography (CT) scan revealed an inflammatory conglomerate tumour with a paracolic abscess in the lower abdomen; the loss of haustration had caused a highgrade narrowing of the descending colon. The laparotomy performed in our hospital showed a fibrotic, marginally compensated ischemia of the entire descending colon in addition to an abscessforming covered anastomotic leak. This was caused by a proximal transection of the marginal artery of the colon and a centrally ligated inferior mesenteric artery. The left transverse colon showed normal perfusion. In spite of maximum mobilization of the right colon and the right colic artery, a transversorectostomy was technically not possible. As an alternative to a permanent colostomy or an ascendoor ileorectostomy with resection of the transverse colon, a smallbowel interposition between the left transverse colon and the rectum was performed. To keep the interposition as short as possible, 2 segments of small bowel were used: a proximal jejunal segment and a terminal ileal segment. The reconstruction was protected by a temporary ileostomy, which was reversed 14 days later after an uncomplicated postoperative course with a normal radiographic appearance (Fig. 1). Thirty-six months later, enteroscopy Case Note Note de cas