A Case of Gastric Cancer Treated Using Laparoscopic Duodenal Diverticulum Resection through Retroperitoneal Approach

Abstract

An 84-year-old man underwent laparoscopic distal gastrectomy (Roux-Y reconstruction) and cholecystectomy for gastric cancer and cholelithiasis, respectively. Abdominal computed tomography revealed an unexpected duodenal diverticulum stone. Because it was diagnosed as the cause of chronic back pain and might cause complications, we decided to perform elective surgery. The duodenal diverticulum was confirmed by applying the retroperitoneal-first approach to laparoscopic right hemicolectomy. The diverticulum was excised, and a 30-mm stone was removed. After confirming the positional relationship with the duodenal papilla, the incision was sutured and closed, and the operation was completed. The course was good, and the patient was discharged on postoperative day 9. Most duodenal diverticulum stones are detected through diverticulum perforation, and emergency laparotomy is performed. No reports of laparoscopic surgery using the retroperitoneal-first approach for duodenal diverticula are available. This method is particularly useful for cases with postoperative adhesions in the upper abdomen, similar to the present case.