[A Case of Intracorporeal Anastomosis of Transverse Colon Cancer with Subobstruction in an Elderly Patient after Mechanical Bowel Preparation with Kampo Medicine].

An 89-year-old woman was referred to our department for surgery of subobstructed transverse colon cancer. She was operated on by Pfannenstiel incision and intracorporeal anastomosis after 3 days of preoperative fasting and mechanical bowel preparation with Tokakujokito. The postoperative course was good, and the patient was discharged on the seventh postoperative day. It has been reported that intracorporeal anastomosis leads to faster recovery of peristalsis after surgery and shorter postoperative hospital stay. In addition, the Pfannenstiel incision is associated with less complaints of wound pain, and the patient is weaned off the bed more quickly, so the combination with intracorporeal anastomosis is expected to result in an even faster postoperative recovery. Intracorporeal anastomosis for advanced cancer with stenosis is currently under discussion, but there is no significant difference in postoperative abscess formation or recurrence of seeding compared to extracorporeal anastomosis in normal cases, and it may be considered if the mechanical bowel preparation is well performed. We believe that mechanical bowel preparation with Tokakujokito may lead to better evacuation of stools in advanced cancer with stenosis, and thus expand the indications for intracorporeal anastomosis. We report this case and the innovations we have made in mechanical bowel preparation with Tokakujokito in our department.