腹腔镜切除降结肠肿瘤并右侧固定乙状结肠:病例报告。

IF 0.7 Q4 SURGERY
Shinya Ohno, Yukimasa Nagata, Tatsuki Kawahara, Yusuke Nonomura, Reo Tachikawa, Tomohito Shinoda, Kakeru Tawada, Aiko Ikawa, Bun Sano
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引用次数: 0

摘要

背景:肠旋转不良是指胎儿时期逆时针旋转并固定在腹膜和腹膜后的过程不完全。在成人中,肠旋转不良一般无症状,通常是偶然发现的。我们报告了一例因降结肠肿瘤而行腹腔镜降结肠部分切除术的病例,该肿瘤伴有罕见的肠旋转不良,肠系膜下动脉呈对称分布,乙状结肠固定于盲肠背侧和右侧腹膜后:一名 75 岁的男性因大便潜血试验呈阳性而被转诊至我院内科。下部内镜检查发现降结肠内有一个横向扩散的肿瘤,于是尝试进行内镜下粘膜下剥离,但手术难度很大,患者被转到我科接受手术治疗。对比增强计算机断层扫描显示,内镜夹位于降结肠右侧,肠系膜下动脉对称,乙状结肠位于盲肠的右侧和背侧。腹腔镜回盲肠和乙状结肠移动术从患者左侧进行。在完成乙状结肠移动术,使乙状结肠和降结肠恢复解剖正常后,进行了腹腔镜降结肠部分切除术。根据组织病理学检查结果,诊断为颗粒型横向扩散肿瘤。患者于术后第 8 天顺利出院:结论:涉及肠旋转不良的腹部手术需要详细的术前成像和手术模拟。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Laparoscopic resection of a descending colon tumor with right-sided fixation of the sigmoid colon: a case report.

Background: Intestinal malrotation is a condition in which the process of counterclockwise rotation and fixation to the peritoneum and retroperitoneum during fetal life is incomplete. In adults, it is generally asymptomatic and is often discovered incidentally. We report a case of laparoscopic partial resection of the descending colon for a tumor of the descending colon with a rare form of intestinal malrotation in which the inferior mesenteric artery ran symmetrically and the sigmoid colon was fixed to the dorsal cecum and right-sided retroperitoneum.

Case presentation: A 75-year-old man was referred to our department of internal medicine due to a positive fecal occult blood test. Lower endoscopy revealed a laterally spreading tumor in the descending colon, and endoscopic submucosal dissection was attempted; however, this procedure was difficult, and the patient was referred to our department for surgical treatment. Contrast-enhanced computed tomography revealed that the endoscopic clip was located in the descending colon on the right side, the inferior mesenteric artery was symmetrical, and the sigmoid colon was located on both the right and dorsal sides of the cecum. Laparoscopic ileocecum and sigmoid colon mobilization was performed from the left side of the patient. After the completion of sigmoid colon mobilization, which returned the sigmoid colon and descending colon to anatomical normalcy, laparoscopic partial resection of the descending colon was performed. Based on the results of a histopathological examination, a granular type of laterally spreading tumor was diagnosed. The patient was discharged uneventfully on postoperative day 8.

Conclusions: Detailed preoperative imaging and surgical simulation are necessary for abdominal surgery involving intestinal malrotation.

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