Laparoscopic sigmoidectomy for sigmoid colon cancer with left-sided inferior vena cava and persistent descending mesocolon

Abstract

Left-sided inferior vena cava (IVC) is a rare congenital malformation, as is persistent descending mesocolon, a developmental anomaly in which the colonic mesentery does not fuse with the dorsal abdominal wall. Although these anomalies are mostly asymptomatic, they should be identified preoperatively to avoid iatrogenic injury. We report a case of sigmoid colon cancer in a patient with both anomalies. The patient was an 80-year-old man whose preoperative computed tomography (CT) scan showed that the IVC ascended vertically along the left side of the abdominal aorta, and the descending colon was at the abdominal midline. Coronal CT was particularly useful for visualizing these anomalies. With this better understanding of the malpositioned anatomy, we successfully performed laparoscopic sigmoidectomy with lymph node dissection. Careful evaluation of preoperative CT imaging based on a clear understanding of such anatomical anomalies is particularly important for performing safe laparoscopic surgery.

Laparoscopic Sigmoidectomy for Sigmoid Cancer With Persistent Descending Mesocolon: Anatomical Characteristics and Technical Tips

“…Radiological features such as right-shift of the IMA, midline-shift of the descending colon, sigmoid colon located in RLQ, shortened mesentery (between the IMA and IMV or between the IMV and descending colon), and bear-claw IMA have been reported [ 2 , 5 ]. In this case, we identified PDM with atypical artery branches and the location of the sigmoid colon in preoperative CT. A routine preoperative evaluation is sufficient for diagnosis; however, understanding the risk and features of PDM cases is crucial, enabling us to plan the approach in accordance with the PDM while minimizing the complications and maximizing safety [ 5 , 9 , 14 , 15 ].…”