Laparoscopic low anterior resection for rectal cancer wherein the inferior mesenteric artery arose from the superior mesenteric artery: a case report

Surgical Case Reports

Toshihiko Nishidate¹  Minoru Nagayama¹  Daisuke Kyuno¹  Ryo Miura¹  Takeshi Murakami¹  Koichi Okuya¹  Ichiro Takemasa¹  Masayuki Ishii¹  Emi Akizuki¹  Yu Sato¹  Atsushi Hamabe¹  Takahiro Korai¹  Tatsuya Ito¹  Masafumi Imamura¹  Kenji Okita¹  Takayuki Nobuoka¹ 

[1] Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, 291 Minami-1-jo Nishi 16-chome, Chuo-ku, 060-8543, Sapporo, Hokkaido, Japan;

关键词: Rectal cancer;    Inferior mesenteric artery;    Superior mesenteric artery;   

DOI  :  10.1186/s40792-021-01254-z

来源: Springer

【 摘 要 】

BackgroundFew cases have been reported of colorectal cancer with inferior mesenteric artery (IMA) branching abnormalities; therefore, the lymphatic flow in such cases remains unknown. We report the first case of locally advanced rectal cancer in which the IMA arose from the superior mesenteric artery (SMA) in which we achieved to visualize the lymphatic flow.Case presentationA 65-year-old woman complaining of bloody stools was investigated in our hospital and suspected with rectal cancer. Colonoscopy and abdominal enhanced computed tomography (CT) revealed a circumscribed, localized ulcerative tumor in the rectum. 3-Dimensional contrast-enhanced computed tomography (3D-CT) showed that the IMA arose from the SMA. The patient was diagnosed with rectal cancer (cT3N0M0, cStage IIa) and laparoscopic low anterior resection was performed. The sigmoid colon was resected using the medial approach. Only the plexus of the colic branch of the lumbar splanchnic nerve was observed at the site where the root of the IMA usually exists and showed interruption of the indocyanine green (ICG) fluorescence-illuminated lymphatics. The root of the IMA was ligated, and Japanese D3 lymphadenectomy was performed, preserving the accessory middle colic artery. All fluorescent lymph nodes were resected. The pathological diagnosis was pT4aN1aM0 stage IIIb. The patient’s postoperative course was uneventful. Adjuvant chemotherapy was administered, and the patient was recurrence-free at 1.5 years after surgery.ConclusionsWe were able to perform safe and appropriate surgery oncologically, despite abnormal vascular anatomy, due to preoperative identification using 3D-CT and intraoperative navigation using ICG administration.

【 授权许可】

CC BY