An ischemic colitis of the sigmoid colon and rectum following iliac balloon and stenting can be caused by embolism. The patient was 60 years old with a 20 year history of smoking. She had chief complaints of right calf claudication. From a lower extremity computed tomography (CT) scan, right iliac total occlusion (Trans-Atlantic Inter-Society Consensus C) and internal iliac artery occlusion were both observed. The patient had a hysterectomy history about 30 years ago. To improve right leg claudication, endovascular treatment was attempted through the right common femoral artery. There was no severe resistance to pass the occluded lesion. About 5 hours after successful stenting, she complained of a vague low abdominal discomfort and pain. There were no specific changes in the intraperitoneal organ in the follow-up CT scan. On postoperative day 1, she complained of aggravated lower abdominal pain. To confirm ischemic colitis, we performed a colonoscopy and both erythematous mucosal swelling and pethechia were present. On laparotomy, transmural infarction of the sigmoid colon and rectum were found and resected. A high level suspicion and a low threshold for performing colonoscopy are important in any patient thought to have ischemic colitis after iliac stenting.