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Case Reports
. 2022 Oct 18;14(10):e30442.
doi: 10.7759/cureus.30442. eCollection 2022 Oct.

Medial-to-Lateral Approach to the Splenic Flexure Resection and End Transverse Colostomy: A Case Report and Operative Video

Lorna Kang  1 , Truong Ma  2
Affiliations
Case Reports

Medial-to-Lateral Approach to the Splenic Flexure Resection and End Transverse Colostomy: A Case Report and Operative Video

Lorna Kang et al. Cureus. .

Abstract

Splenic flexure cancer is relatively rare among colon cancers. We present a case of a 76-year-old female with a partially obstructing tumor in the proximal descending colon and pulmonary metastasis who underwent a laparoscopic resection of the splenic flexure with end transverse colostomy due to clinical symptoms of obstruction. This case highlights several important technical considerations in safely performing the laparoscopic resection of the splenic flexure through the medial-to-lateral approach starting at the plane below the inferior mesenteric vein (IMV), taking care to preserve the tail of the pancreas. We present a narrated video demonstrating our approach, taking care to highlight important anatomic landmarks.

Keywords: colon cancer; colostomy; laparoscopy; minimally invasive; obstruction; splenic flexure.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The tattooed mass is visualized in the left upper quadrant, adherent to the anterolateral abdominal wall (white arrow).
Figure 2
Figure 2. The dissection is carried out through the plane between the mesocolon and retroperitoneum at the anterior border of the pancreas (blue line). The IMV has been divided to facilitate this dissection (red arrow).
IMV, inferior mesenteric vein
Figure 3
Figure 3. The posterior margin of the splenic flexure mass invades the Gerota's fascia (white arrow).
Figure 4
Figure 4. The anterior margin of the splenic flexure invades into the anterolateral abdominal wall (white arrow).
See this image and copyright information in PMC

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