A Case of Descending Colon Cancer with Complete Situs Inversus Treated by Laparoscopy-assisted Colectomy

Abstract

A 78-year-old man, who was previously noted to have complete situs inversus, presented with a complaint of dark red stools at the Department of Gastroenterology of our hospital. Lower gastrointestinal endoscopic examination revealed a type 2 tumor in the descending colon. Biopsy resulted in a diagnosis of group 5 adenocarcinoma, and the patient was referred to our department for operative treatment. Using 3D-CT imaging, we confirmed the absence of any abnormality in the blood vessel distribution other than the inversion, and performed laparoscopic partial colectomy. The surgeon stood on the left side of the patient, and the port positioning was rotated 180°. Although the left-right inversion gave a sense of strangeness, we safely performed the operation without misidentification of anatomy. The postoperative progress was favorable, and the patient was discharged on postoperative day 12. To safely conduct laparoscopic colonic resection in cases of complete situs inversus, it is important to perform an anatomical evaluation using 3D-CT examination and a thorough preoperative simulation, and to perform the operation carefully while accurately identifying the anatomical positional relationships intraoperatively.