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Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report

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...

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Autores principales: Hirai, Kenjiro, Takeshima, Jun, Ichikawa, Jun, Fujita, Haruku, Toda, Kosuke, Mitsuyoshi, Akira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803592/
https://www.ncbi.nlm.nih.gov/pubmed/35091350
http://dx.doi.org/10.1016/j.ijscr.2022.106793
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author Hirai, Kenjiro
Takeshima, Jun
Ichikawa, Jun
Fujita, Haruku
Toda, Kosuke
Mitsuyoshi, Akira
author_facet Hirai, Kenjiro
Takeshima, Jun
Ichikawa, Jun
Fujita, Haruku
Toda, Kosuke
Mitsuyoshi, Akira
author_sort Hirai, Kenjiro
collection PubMed
description 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.
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spelling pubmed-88035922022-02-04 Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report Hirai, Kenjiro Takeshima, Jun Ichikawa, Jun Fujita, Haruku Toda, Kosuke Mitsuyoshi, Akira Int J Surg Case Rep Case Report 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. Elsevier 2022-01-24 /pmc/articles/PMC8803592/ /pubmed/35091350 http://dx.doi.org/10.1016/j.ijscr.2022.106793 Text en © 2022 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Hirai, Kenjiro
Takeshima, Jun
Ichikawa, Jun
Fujita, Haruku
Toda, Kosuke
Mitsuyoshi, Akira
Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title_full Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title_fullStr Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title_full_unstemmed Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title_short Robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: A case report
title_sort robot-assisted laparoscopic low anterior resection for rectal cancer with persistent descending mesocolon: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8803592/
https://www.ncbi.nlm.nih.gov/pubmed/35091350
http://dx.doi.org/10.1016/j.ijscr.2022.106793
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