A Case of Hand-assisted Laparoscopic Colectomy for Chronic Idiopathic Colonic Pseudo-obstruction

Abstract

The patient was a 76-year-old woman who was admitted to the emergency department with a 2-week history of abdominal distension, loss of appetite, and fever. She had been hospitalized twice for bowel obstruction, which had been treated conservatively, in the previous two years. The patient had been undergoing periodic decompression with a transanal drainage tube inserted by the family for a year. Abdominal CT showed marked dilation of the large bowel from the transverse colon to the rectum, with no evidence of mechanical obstruction. Despite four sessions of endoscopic decompression, the abdominal distension continued to recur. The patient was diagnosed as having chronic idiopathic colonic pseudo-obstruction (CICP) and scheduled for surgery. Hand-assisted laparoscopic colectomy (HALS) of the large bowel, from the transverse colon to the sigmoid colon, and end-transverse colostomy was performed. The postoperative course was uneventful. CICP is rare and only four cases treated by laparoscopic surgery have been reported. HALS is useful for cases that show marked bowel dilatation.