A 72-year-old man presented to our hospital with a chief complaint of constipation and hiccup. Computed tomography revealed a colonic obstruction due to descending colon cancer, and a transnasal ileus tube was inserted. On the 2nd day of hospitalization, we attempted transanal drainage, but it was difficult to cannulate. Abdominal findings and inflammatory response were normal; thus, the transanal drainage procedure was followed by only decompression with a transnasal ileus tube. On the 13th day of hospitalization, the tip of the ileus tube reached the vicinity of the occluded area. We performed a one-stage resection and anastomosis procedure. The patient was discharged from the hospital on the 16th postoperative day. Patients with left-sided colorectal cancer ileus are often immediately treated with colostomy when trans-anal decompression is difficult. We report a case of one-stage resection and anastomosis procedure for a descending colon cancer ileus after decompression with a transnasal ileus tube.

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