1. Laparoscopic right hemicolectomy for A-colon cancer with midgut malrotation
中國醫學大學附設醫院 大腸直腸外科
謝明皓
國軍台中總醫院 大腸直腸外科
巫旻憲 岳德政

2. Case Report Chief Complaint Present illness
Intermittent bloody stool for 2 days.
Present illness
This is a 72 year-old male with history of
Acute gastric ulcer with recent bleeding
Eng-stage renal disease under regular hemodialysis
Hypertensive cardiovascular disease
He has been troubled by intermittent bloody stool about c.c., abdominal pain for 2 days. So he was sent to our ER and was admitted to GI section.

3. Case Report Arrange CTA for identified bleeding source CTA:
Mid-gut malrotation (nonrotation type)
Active contrast extravasation in proximal ascending colon.
TAE was performed after identified bleeding site, and active GI bleeding was control next day

4. Type of malrotation

5. Case Report

6. Case Report Colonoscopy:
An ulcerative tumor 3-4 cm in size, located at 5cm distal to ileocecal valve, no active bleeding.
Biopsy: Adenocarcinoma with moderate differentiation.

7. Case Report
Circulation
for T colon
SMA
IMA
Ileocecal
artery

8. Case Report Laparoscopic right hemicolectomy video
malrotation第二版.mp4
Operation time: 190 min
Blood loss: 20ml

9. Case Report Pathology: Adenocarcinoma with moderate differentiation
LNs: 0/17
Surgical base, cecum and A colon: free from the tumor involvement.
pT3N0M0, stage IIA

10. Case Report
Upper GI bleeding at POD4 due to cougulopathy-> upper GI endodscopy
Discharge at POD15

11. Discussion
Reported cases of intestinal malrotation with colon carcinoma[Hiroya, et al. Laparoscopic Surgery for the Transverse Colon Carcinoma associated with Non-rotation Type Intestinal Malrotation. Jikeikai Med J 2014; 61: 87-92]

12. Discussion
Variations of intestinal malrotation [Hiroya, et al. Laparoscopic Surgery for the Transverse Colon Carcinoma associated with Non-rotation Type Intestinal Malrotation. Jikeikai Med J 2014; 61: 87-92]
69.2%
15.4%
15.4%

13. Discussion
Conversion [高橋 玄,et al.腹腔鏡下手術を施行した腸回転異常症を伴った上行結腸癌の1例.日本臨床外科学会雑誌 75(5), , 2014]

14. Conclusion
Pre-operative survey
Anatomy
Conversion

15. Questions & Recommendation