Downloads: 58

Files in This Item:
File Description SizeFormat 
s40792-019-0606-9.pdf10.58 MBAdobe PDFView/Open
Title: Laparoscopic distal gastrectomy for gastric cancer patient with intestinal malrotation: report of a case
Authors: Inamoto, Susumu
Obama, Kazutaka  kyouindb  KAKEN_id
Asai, Satsuki
Mizuno, Rei  kyouindb  KAKEN_id
Itatani, Yoshiro  kyouindb  KAKEN_id  orcid (unconfirmed)
Hashimoto, Kyoichi
Hisamori, Shigeo
Tsunoda, Shigeru  kyouindb  KAKEN_id
Hida, Koya  kyouindb  KAKEN_id  orcid (unconfirmed)
Kawada, Kenji
Sakai, Yoshiharu
Author's alias: 稲本, 将
小濵, 和貴
水野, 礼
板谷, 喜朗
橋本, 恭一
久森, 重夫
角田, 茂
肥田, 侯矢
河田, 健二
坂井, 義治
Keywords: Gastric cancer
Congenital anomalies
Intestinal malrotation
Laparoscopic distal gastrectomy
Roux-en-Y reconstruction
Issue Date: 25-Mar-2019
Publisher: Springer Nature
Journal title: Surgical Case Reports
Volume: 5
Thesis number: 45
Abstract: Background: Intestinal malrotation, which arises from incomplete rotation of the embryonic midgut, is one of the congenital anomalies usually diagnosed in infancy. On the other hand, intestinal malrotation detected in asymptomatic adults is very rare. It is frequently diagnosed incidentally during abdominal surgery. We report a case of asymptomatic intestinal malrotation diagnosed during laparoscopic distal gastrectomy for gastric cancer. Case presentation: A 59-year-old female was diagnosed with early-stage gastric cancer during health screening and admitted to our hospital for radical surgical treatment. Physical examinations and blood tests revealed nothing of note. The type 0-IIc gastric cancer was located in the posterior wall of the mid-body of the stomach. The histological type was poorly differentiated adenocarcinoma. Esophagogastroduodenoscopy and computed tomography (CT) suggested that the depth of tumor invasion was the submucosal layer without regional lymph node swelling. The clinical stage according to the TNM 7th edition was cT1b N0 M0, cStage I. Laparoscopic distal gastrectomy with D1+ lymph node dissection and Billroth-I method reconstruction was planned. During the infrapyloric lymph node dissection, a part of the pancreatic head showed unusual adherence to the first part of the duodenal wall. For safe and accurate lymphadenectomy while avoiding pancreatic injury, we deliberately focused on tracing the dissectible layer between the pancreatic parenchyma and fatty tissues including lymph nodes. Also, we changed the reconstruction procedure from Billroth-I to Roux-en-Y. After distal gastrostomy, we could not find the ligament of Treitz or jejunum on the left side below the transverse colon. Based on a review of the CT image, this patient was diagnosed with intestinal malrotation. Although the detection of malrotation during the operation was incidental, we could complete radical surgery and Roux-en-Y reconstruction safely. The type of malrotation was non-rotation (90°). She was discharged from our hospital without any complications. Conclusion: We encountered a case of adult asymptomatic intestinal malrotation with gastric cancer. Even when encountering such a case during laparoscopic gastrectomy, reviewing CT images carefully to reconsider the anatomical anomalies, and tracing the dissectible layer accurately with adequate countertraction can facilitate safe and successful surgery.
Rights: © The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
DOI(Published Version): 10.1186/s40792-019-0606-9
PubMed ID: 30911866
Appears in Collections:Journal Articles

Show full item record

Export to RefWorks

Export Format: 

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.