Laparoscopic resection of sigmoid colon cancer with intestin
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Case :
A 53-year-old man presented with a one year history of postprandial abdominal discomfort. Past medical history was positive for diabetes mellitus treated with linagliptin. His body mass index was 27.4?kg/m2. The physical examination was unremarkable. His serum CEA and CA19-9 levels were within normal limits. Total colonoscopy showed a 14?mm sessile polyp in the sigmoid colon and polypectomy was performed. Pathological evaluation showed a well-differentiated adenocarcinoma invading more than 1000??m in the submucosa with both vertical and horizontal resection margins positive.

Laparoscopic sigmoid resection was planned and a contrast enhanced computed tomography scan was obtained preoperatively which showed the small bowel and colon on the right and left sides of the abdominal cavity, respectively. The ileocolic artery (ICA) and the inferior mesenteric artery (IMA) originated from a common channel which branched directly from the abdominal aorta (Fig. 1, Fig. 2). Laparoscopic sigmoid resection with a D2 dissection was performed using typical trocar placement (Fig. 3). Non-rotation of the intestine was confirmed at surgery. The ascending colon was free from the retroperitoneum but the descending colon was attached to the retroperitoneum and the sigmoid colon and rectum seemed anatomically normal. The IMA was divided after exposure of the common arterial channel and its branches, the ICA and the IMA. There were no technical difficulties due to intestinal malrotation. The patient did well postoperatively and was discharged on seventh postoperative day......