Laparoscopic Low Anterior Resection for a Patient with Situs Inversus Totalis

Abstract

A 72-year-old woman underwent colonoscopy due to a positive fecal immunohistochemical test. A 0-Ⅱa+Ⅱc type tumor, measuring 25 mm in diameter, was identified in the anterior wall of the lower rectum. The tumor showed a VN-type pit pattern and non-lifting sign on endoscopy, and the patient was diagnosed as having invasive cancer involving the submucosal layer. Preoperative computed tomography (CT) revealed situs inversus totalis. We performed laparoscopic low anterior resection with D2 lymph node dissection and covering transverse colostomy. Preoperative three-dimensional CT angiography for blood vessel mapping, CT colonography, and image training enabled safe performance of the laparoscopic procedure.