with Dr. Raquel Bravo, Dr. María Fernández-Hevia
A 61 year old woman who consulted the emergency unit with abdominal pain and rectal bleeding. Her past medical history revealed one mild episode of biliary pancreatitis, with posterior cholecystectomy, and a colonoscopy from 4 years ago, finding a 3cm lipoma 60cms from the anal verge that was asymptomatic.
She had recurrent abdominal pain for more than 2 weeks and episodes of rectal bleeding. No fever was documented. On physical examination, her abdomen was soft and non-tender, with little pain on the left iliac fossa. Digital rectal digital examination was positive for hematochezia.
Due to persistent abdominal pain a CT scan was ordered, diagnosing an intussusception of the descending colon, there was a 55mm nodular mass located between both colonic walls. There were no signs of bowel suffering.
The endoscopist attempted to reduce the intussusception, but due to lack of success, minimally invasive surgery was performed.
A total of three trocars were used. One of 12mm at the umbilicus for a 30º scope, another 12mm trocar introduced in the right iliac fossa, and one of 5mm in the right flank.
The surgeon was positioned at the right side of the patient, with the assistant taking care of the 30º camera. Another assistant was at the left side of the patient.
After performing a general exploration of the abdominal cavity, the surgeon focuses on the left abdomen, locating the intussusception in the descending colon near the splenic flexure. One attempt to reduce it intracorporeally was made without success, so the next step was to mobilize the descending colon, first taking down the Told´s fascia.
There was a lesion that depended on the ovary, it was already known and diagnosed of an benign ovarian cyst. Detachment of the descending colon continued, leaving the left kidney and Gerotta´s fascia at the retroperitoneal plane.
After a successful dissection of the colonic segment, the surgeon prepares it for the externalization through a incision of assistance. A wound protector was used and the colon was externalized.
The colon was sectioned respecting 2cm of proximal and distal margin and was delivered to deferred pathological analysis. The Mesocolon was sectioned and a mechanical side-to side anastomosis was performed. No drain was used.
Final pathological examination revealed lipoma tissue with no signs of malignancy. Postoperative course lacked complications and the patient was discharged 3 days after surgery. Nowadays, she is completely asymptomatic.
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