2019 Volume 44 Issue 5 Pages 942-949
A 90-year-old man with anemia was referred to our hospital for further examination. A colonoscopy examination showed a whole circumference tumor at the transverse colon. A contrast enema revealed two apple-core signs at the transverse and the ascending colon. These findings led to the diagnosis of double colon cancer. We performed a laparoscopy-assisted right hemi-colectomy as a curative procedure. During the operation, we incidentally diagnosed intestinal malrotation because his duodenum descended directly and was joined to the jejunum with Ladd’s ligament. We found and transected the right branch of the middle colic artery at the inferior edge of the pancreas. We also transected the right colic artery and the ileocolic artery, along with the superior mesenteric artery (SMA). We achieved a D3 lymphadenectomy. Although the laparoscopic colorectal surgery proved to be very complicated with the intestinal malrotation, we successfully performed the appropriate lymphadenectomy and vessel dissections. A D3 lymphadenectomy along with the SMA from proximal to distal vessel dissection is safe and useful in laparoscopy-assisted right hemi-colectomy for the patients with intestinal malrotation.
