J Korean Surg Soc.  2013 Apr;84(4):256-260. 10.4174/jkss.2013.84.4.256.

Right side fixation of sigmoid colon with a hepato-sigmoidocolic fistula in patient with hepatocellular carcinoma and midgut malrotation

• Choi NG
• Moon OI
• Kim JH
• Lim S
• Lim SC
• Lee J
• Kim KJ

• KMID: 2212472
• DOI: http://doi.org/10.4174/jkss.2013.84.4.256

Abstract

The location of the sigmoid colon varies within the abdominal cavity, but its mesocolon is fixed to the left side. Right side fixation of the sigmoid colon is a very rare congenital positional anomaly. In addition, it has been reported that hepatocolic fistula is also a very rare disease that may present lower gastrointestinal bleeding. Here, the authors describe a case of a 71-year-old man who underwent surgery for hepato-sigmoidocolic fistula complicated by hepatocellular carcinoma and the right side fixation of the sigmoid colon.

Keyword

Right side fixation of sigmoid colon; Hepato-sigmoidocolic fistula; Hepatocellular carcinoma; Midgut malrotation

MeSH Terms

Abdominal Cavity
Carcinoma, Hepatocellular
Colon, Sigmoid
Fistula
Hemorrhage
Humans
Mesocolon
Rare Diseases

Figure

• 

  Fig. 1 Colonoscopic findings of the bleeding lesion of the colon. There was no active bleeding but 2 cm sized, solitary ulcerative lesion with dark-brown and dirty base at the sigmoid colon, about 30 cm from the anal verge, in which endoclips were applied (left side).

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  Fig. 2 Abdominopelvic computed tomographic scan showing a exophytic growth of the tumor from the right hepatic lobe. Endoclips applied in the bleeding lesion of the sigmoid colon during previous colonoscopy were visible very close to the hepatic tumor, but that finding was not noticed preoperatively.

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  Fig. 3 Schematic drawing of the operation finding. Sigmoid colon and upper rectum were fixed to the right side of parietal peritoneum. Proximal part of the sigmoid colon was strongly adhered to the low surface of liver. And cecum and ascending colon was placed inner part of abdominal cavity and not fixed, consistent with midgut malrotation.

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  Fig. 4 Gross specimen and microscopic findings; (A) outer side of the gross specimen showing segmentally resected sigmoid colon together with hepatic tissue; (B) inner view of the gross specimen, showing the fistula opening; (C) microscopically in lower power field, tumor is seen in inked serosa margin (H&E, ×40); (D) in high power field, metastatic hepatocellular carcinoma is expanding from serosa to mucosa (H&E, ×100).

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