Hugo Bonatti, Kiran Khosha. Meritus Health, Hagerstown MD
Introduction: Cecal (CV) and sigmoid volvulus (SV) are acute surgical disorders frequently requiring emergent surgery. Colonoscopic decompression may temporize the condition; however; CV and SV may recur requiring colectomy. Only few cases of combined CV and SV have been reported and open surgery has remained the more common approach.
Case Report: A 40-year-old African-American female with cerebral palsy came to the ER with acute abdominal distention and pain. CT-scan revealed acute CV. Multiple episodes of SV had been treated nonoperatively in the past. The proximal bowel was decompressed through her PEG tube and the large bowel by colonoscopy. Laparoscopic (partial) colectomy with ostomy was planned. The patient was placed supine, trocars were placed in the left upper (U) and left lower quadrant (LQ) and into an old upper midline incision from a fundoplication. Transverse colon adhesions at the PEG tube site were lysed, the right (R) colon was completely mobilized together with 25cm terminal ileum involved in the torque; an extra corporeal ileotransverse anastomosis was created using a 4cm periumbilical incision, which was closed. Trocars were switched to the RU and RLQ. The elongated, twisted sigmoid colon was mobilized out of the pelvis, the mesentery was divided and the rectum was stapled. The specimen was removed through the colostomy site in the LLQ. The postoperative course was uneventful.
Conclusion: We report the first laparoscopic right hemicolectomy plus sigmoid colectomy preserving the transverse/descending colon for combined CV and SV. Colonoscopic decompression temporized the disorder allowing for subsequent minimally invasive surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94243
Program Number: P281
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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