Our Summary

This research paper discusses a rare case where a patient had two uncommon birth defects. The first was a vein (inferior vena cava or IVC) in the wrong place on the left side of the abdomen. The second was a persistent descending mesocolon, which is when a part of the colon does not attach correctly to the abdomen wall. These issues usually don’t cause any symptoms, but it’s important to identify them before surgery to avoid accidental injury. The patient, an 80-year-old man, also had cancer in his sigmoid colon (the last part of the colon). Through a detailed CT scan, the doctors could see the misplaced vein and colon. This information helped them successfully perform a laparoscopic sigmoidectomy (surgical removal of the sigmoid colon) and lymph node dissection. The authors stress the importance of carefully studying pre-operative CT scans to understand such anomalies, particularly for safe laparoscopic surgeries.

FAQs

  1. What are the complications associated with left-sided inferior vena cava and persistent descending mesocolon?
  2. How does a preoperative CT scan assist in identifying anatomical anomalies before performing a laparoscopic sigmoidectomy?
  3. What is the significance of understanding malpositioned anatomy in performing a laparoscopic sigmoidectomy with lymph node dissection?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sigmoidectomy is to follow post-operative care instructions carefully, including proper wound care, pain management, and dietary recommendations to promote healing and prevent complications. It is also important to attend follow-up appointments with your healthcare provider to monitor recovery and address any concerns.

Suitable For

Patients who are typically recommended sigmoidectomy include those with sigmoid colon cancer, diverticulitis, inflammatory bowel disease, or other conditions that require the removal of a portion of the sigmoid colon. In the case described above, the patient had sigmoid colon cancer, which necessitated the surgical removal of the affected portion of the colon. Additionally, patients with unusual anatomical anomalies, such as left-sided inferior vena cava and persistent descending mesocolon, may also require sigmoidectomy in order to address the specific challenges posed by their unique anatomy. Overall, patients who are recommended sigmoidectomy are those who would benefit from the surgical removal of a portion of the sigmoid colon to treat their underlying condition.

Timeline

Before sigmoidectomy:

  • Patient may experience symptoms of sigmoid colon cancer, such as changes in bowel habits, abdominal pain, and rectal bleeding.
  • Patient undergoes preoperative imaging studies, such as computed tomography (CT) scans, to determine the extent of the cancer and assess for any anatomical anomalies.
  • Anomalies such as left-sided inferior vena cava and persistent descending mesocolon are identified on the CT scan.
  • Surgical team reviews the imaging studies and plans the surgical approach accordingly.

After sigmoidectomy:

  • Patient undergoes laparoscopic sigmoidectomy with lymph node dissection to remove the cancerous portion of the sigmoid colon.
  • Surgical team carefully navigates the anatomical anomalies identified on preoperative imaging to avoid iatrogenic injury.
  • Patient recovers in the hospital post-surgery and is monitored for any complications.
  • Patient undergoes follow-up appointments and monitoring to assess for recurrence of cancer and ensure proper healing.
  • With successful surgery and proper postoperative care, patient can experience relief from symptoms of sigmoid colon cancer and improved quality of life.

What to Ask Your Doctor

  1. Can you explain in detail what a sigmoidectomy is and why it is necessary in my case?
  2. How common are anomalies such as left-sided IVC and persistent descending mesocolon, and how might they impact the surgery?
  3. What specific risks or complications should I be aware of given my unique anatomy?
  4. Will the presence of these anomalies affect the surgical approach or technique used for the sigmoidectomy?
  5. How experienced are you and your team in performing laparoscopic sigmoidectomy in cases with anatomical anomalies?
  6. What is the expected recovery time and outcome following the surgery, taking into account my specific circumstances?
  7. Are there any additional tests or imaging studies that should be done to further evaluate the anatomy before proceeding with the surgery?
  8. Will I need any special post-operative care or follow-up due to these anatomical anomalies?
  9. Are there any long-term implications or considerations related to these anomalies that I should be aware of?
  10. Are there any alternative treatment options or considerations given the presence of these anatomical anomalies?

Reference

Authors: Kawakami M, Nakazato H, Tomiyama T, Tomori T, Miyagi J, Nagayoshi S, Ohmine Y. Journal: J Surg Case Rep. 2020 Jul 31;2020(7):rjaa259. doi: 10.1093/jscr/rjaa259. eCollection 2020 Jul. PMID: 32760494