Laparoscopic abdominal perineal rectal resection for rectal cancer with a horseshoe kidney using preoperative 3D-CT angiography: a case report

Abstract

Background A horseshoe kidney is a congenital malformation involving the fusion of the bilateral kidneys and is often accompanied by anomalies of the ureteropelvic and vascular systems. When performing resection of colorectal cancer in a patient with horseshoe kidney, damage to the ureter or excessive renal arteries should be avoided. To achieve this purpose, comprehensive preoperative anatomical assessments and surgical planning are important. Here, we report a case of a laparoscopic abdominal perineal rectal resection for lower rectal cancer with a horseshoe kidney. Case presentation A 79-year-old woman presented with bloody stool and was diagnosed with advanced lower rectal cancer, immediately above the rectal dentate line, without metastasis. A preoperative computed tomography (CT) scan revealed a horseshoe kidney, while a three-dimensional CT (3D-CT) angiography revealed aberrant excess renal artery from the aorta to the renal isthmus. The left ureter ran in front of the isthmus of the horseshoe kidney and presented calculus formation. Laparoscopic abdominal perineal rectal resection was performed with D3 lymph node dissection. During the operation, we mobilized the sigmoid colon mesentery via a medial approach and preserved the left ureter, the left gonadal vessels, and the hypogastric nerve plexus in the retroperitoneum in front of the horseshoe kidney. Conclusions We report a rare case of rectal cancer surgery in a patient with a horseshoe kidney. We discuss the anatomical peculiarities of a horseshoe kidney, such as excess renal arteries, inferior vena cava, ureter, gonadal vessels, and nerves, that should be preserved according to the literature. We suggest that preoperative 3D-CT angiography is both useful for revealing the relationship between the vascular system and a horseshoe kidney and helpful when performing laparoscopic surgery for a left-sided colon and rectal cancer to avoid intraoperative injury.

Prevention of ureteral injury during laparoscopic colorectal cancer surgery with horseshoe kidney using fluorescent ureteral catheters: a case report

“…Many reports on surgery for colorectal cancer cases with horseshoe kidneys have described the usefulness of 3D-CT angiography to detect abnormalities in vascular supply [15][16][17][18]. Furthermore, the use of fluorescent ureteral catheters to detect abnormalities in the ureteral anatomy has enabled laparoscopic surgery to be performed more safely, as in this case.…”

Robot‐assisted laparoscopic surgery for rectal cancer in a patient with a horseshoe kidney: A case report

“…descending renal isthmus, and it is important to understand the relationship between the vasculature and the horseshoe kidney as much as possible through preoperative imaging evaluation. 1,4 Recently, laparoscopic surgery for colorectal cancer has become common, and there have been reports of laparoscopic surgery for sigmoid colon cancer and rectal cancer in patients with a horseshoe kidney. Although the magnifying effect of the scope is promising for dissection and identification of the dissected layer, the use of straight forceps and the restricted approach direction during surgery require caution when manipulating around the IMA root and interfere with the medial approach due to the protrusion of the descending renal parenchyma and isthmus.…”

“…Abnormalities of renal artery have sometimes been reported to branch off the aorta, iliac artery, or IMA and care should be taken not to damage them during medial dissection to maintain blood flow, and the site of IMA ligation should also be considered occasionally. 1,2 The ureter and gonadal arteriovenous vessels are reported to often travel anterior to the kidney, although cases involving abnormal running of the ureter or duplicate ureters have been reported. Placement of a fluorescent ureteral catheter to prevent intraoperative ureteral injury has been recommended.…”

“…Although the magnifying effect of the scope is promising for dissection and identification of the dissected layer, the use of straight forceps and the restricted approach direction during surgery require caution when manipulating around the IMA root and interfere with the medial approach due to the protrusion of the descending renal parenchyma and isthmus. 1,2 Robot-assisted surgery with the Da Vinci surgical system has a three-dimensional video imaging system and a flexible arm, which may be useful in understanding fine anatomy and protecting organs. [7][8][9] In the present case, the visibility of the hypogastric nerve was excellent, and the nerve traveled anterior to the kidney, confirming preservation of the nerve all the way to the IMA root.…”

“…Its incidence is about 0.25%, and it is often associated with vascular, ureteral, gonadal, and neural anomalies. 1 Recently, there have been some case reports of laparoscopic surgery for sigmoid colon cancer or rectal cancer with a horseshoe kidney, [1][2][3][4][5] but no reports of robot-assisted surgery were found. In this report, a case of robot-assisted, laparoscopic, low anterior resection for rectal cancer in a patient with a horseshoe kidney is described.…”