A 65-year-old male patient, smoker of 20-40 cigarettes/day and with a history of duodenal ulcus. He had undergone surgery 5 years previously for stenosing neoplasia of the rectosigmoid junction (Dukes stage B adenocarcinoma, T3N0M0, stage III-A AJCC), and underwent anterior resection followed by end-to-end anastomosis by mechanical suture using the double stapling technique. The postoperative course of the operation was uneventful and the patient was followed up in consultation every 6 months, with colonoscopy and ultrasound being performed annually. The endoscopic image of the perianastomotic region was normal in all revisions, including the last one performed the previous year (4 years after the operation).
Five years after the operation, the patient began to have soft stools, intermittent abdominal pain in the hypogastrium and later rectorrhagia. He was admitted to the internal medicine department and underwent an abdominal CT scan, which revealed no pathological findings, and colonoscopy, which revealed a stricture 10 cm from the anal margin that prevented the passage of the endoscope. A biopsy was performed which showed no histopathological signs of malignant disease and was reported as a non-specific ulcer.

Given that serum tumour markers were at normal levels, and in the absence of other signs of neoplasia, it was decided to repeat the endoscopy and perform an opaque enema. The new endoscopy and biopsy showed identical findings to the previous ones. The barium enema showed a colon stenosis of irregular appearance and 8 cm in length, and the possibility of malignant stenosis could not be ruled out with this image. In the absence of conclusive evidence of tumour recurrence, a period of treatment with corticosteroid enemas (budesonide, 2 mg enema, twice a day) was decided upon in order to reduce inflammation and thus complete the endoscopic examination.

After a month, with the patient asymptomatic, the endoscopy was repeated, finding an inflammatory and ulcerated mucosa, covering a 6-8 cm long stricture that could be passed through with the endoscope, with no signs of neoplasia and the rest of the colon appearing normal. The biopsies taken showed non-specific inflammatory signs.
The stricture was judged to be of ischaemic origin and, given that the patient was totally asymptomatic, periodic follow-up was decided.
After 6 months of follow-up, electrocardiographic alterations were detected, for which the cardiologist was consulted. Ergometry and coronary angiography revealed irregularities in the middle proximal anterior descending artery, severe involvement of the ostium of the diagonal branch, 80% stenosis of the obtuse marginal branch and 80% stenosis in the middle right coronary artery. Dilatation and implantation of a double coronary stent was decided, after which the electrocardiographic alterations disappeared.
After 16 months of follow-up, the patient has normal transit and is asymptomatic.