A Case of Gastric Cancer with Intestinal Malrotation

Abstract

A 60-year-old man with anemia was referred to our hospital. Esophagogastroduodenoscopy revealed a type 1 gastric tumor with bleeding, and endoscopic mucosal resection was performed. Pathological examination revealed that the tumor was gastric cancer, and that the vertical margin of the specimen was positive for malignancy. Total gastrectomy was performed as additional surgical treatment. Intraoperatively, we discovered that the duodenum descended to the right, and that the small intestine was situated unilaterally in the right abdominal cavity. The cecum and ascending colon were not fixed to the retroperitoneum, and the entire colon was located in the middle to left abdominal cavity. We observed formation of Laddʼs Ligament, so we diagnosed this case as intestinal malrotation. After total gastrectomy, the Laddʼs ligament was dissected. The jejunum was lifted through the right side of the ascending colon, and Roux-en-Y reconstruction was performed. Appendectomy was also performed. In cases of surgery for gastric cancer with intestinal malrotation, we need to consider surgical procedures including treatment of intestinal malrotation and reconstruction of the digestive tract. However, as similar cases are rare, there are no standard operating procedures. Here, we report our case with a review of the relevant literature.