J Gastric Cancer.  2013 Sep;13(3):188-191.

Laparoscopic Total Gastrectomy in a Gastric Cancer Patient with Intestinal Malrotation

• Lee J
• Lim JS
• Cho I
• Kwon IG
• Choi YY
• Noh SH
• Hyung WJ

Abstract

As the incidence of early gastric cancer increases, laparoscopic surgery has become one of the treatments of choice for gastric cancer. With the increase of laparoscopic surgery, the chance of discovering aberrant anatomy during the operation also increases. We present a case of laparoscopic total gastrectomy in gastric cancer patients with intestinal malrotation. Intestinal malrotation occurs in one in every 500 births. We found that laparoscopic total gastrectomy in such patients can be performed successfully when it is performed with a proper Roux limb orientation through an alternative minilaparotomy.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy; Intestinal malrotation, familial

MeSH Terms

Extremities
Gastrectomy
Humans
Incidence
Intestinal Volvulus
Laparoscopy
Laparotomy
Orientation
Parturition
Stomach Neoplasms

Figure

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  Fig. 1 Preoperative evaluation. (A) Esophagogastroduodenoscopy. (B) Computed tomography axial view. Small bowel is located on the right side of the abdomen. The superior mesenteric vein (long white arrow) is located on the left side of the superior mesenteric artery (short white arrow). (C) Coronal view. Ileocecal valve (arrow) is on the left side of the abdomen.

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  Fig. 2 Operative findings. (A) Small bowel on the right side. (B) Appendix is found on the left side of the abdomen. (C) Anvil approach for esophagojejunostomy. (D) Roux limb in clockwise rotation.

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  Fig. 3 (A) The modified minilaparotomy scar (arrow) on the right lower abdomen. (B) Follow-up computed tomography (CT) shows jejunojejunostomy (arrow) in the left side of the abdomen.

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