Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
| Autor: | Kenjiro Hirai, Jun Takeshima, Jun Ichikawa, Haruku Fujita, Kosuke Toda, Akira Mitsuyoshi |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
IMA
inferior mesenteric artery IMV inferior mesenteric vein PDM persistent descending mesocolon S1 sigmoid artery first branch Robot-assisted surgery Surgery Case Report LCA left colic artery RLAR robot-assisted laparoscopic low anterior resection Persistent descending mesocolon Colorectal cancer CT computed tomography |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Introduction Persistent descending mesocolon (PDM) is a fixed abnormality in which the descending to sigmoid colon adheres to the small intestinal mesentery or right pelvic wall through right displacement. Surgery for colorectal cancer with PDM is difficult. Therefore, in addition to the anatomical characteristics of PDM, the extent of adhesion and characteristics of vascular courses need to be assessed in individual patients. The number of patients now undergoing laparoscopic or robot-assisted surgery for colorectal cancer has rapidly increased. We herein report a rectal cancer patient with PDM who safely underwent robot-assisted laparoscopic low anterior resection (RLAR). Presentation of case A 71-year-old male was referred to our hospital for a detailed examination following a fecal occult blood-positive reaction. Lower gastrointestinal endoscopy revealed a type 2 lesion of the rectum. Moderately differentiated adenocarcinoma was diagnosed based on the results of a histopathological examination. Preoperative contrast-enhanced thoracoabdominal computed tomography showed abnormalities in the colonic course and characteristic vascular courses, suggesting rectal cancer with PDM. RLAR was performed. Discussion In surgery, it is important to initially perform adhesiolysis accurately in order to reconstruct the original shape of the colonic mesentery and confirm/dissect vascular bifurcations due to the risk of marginal arterial injury. Conclusion In the present case, a detailed anatomical understanding of the site of intestinal adhesion and vascular courses, as well as surgical procedures, facilitated safe RLAR. We described this case and reviewed the anatomical characteristics of PDM and cautions for surgery. Highlights • The descending colon is not fused to the retroperitoneum in persistent descending mesocolon. • In colorectal cancer with persistent descending mesocolon, surgery is difficult. • Adhesiolysis is performed for original colonic mesentery shape recovery. • Due to the risk of marginal artery injury, vascular bifurcations are dissected. • Robot-assisted laparoscopic low anterior resection is safe for rectal cancer with persistent descending mesocolon. |
| Databáze: | OpenAIRE |
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