EP191 - Laparoscopic right hemicolectomy in a patient with malrotation of bowel and ascending colon tumour

Abstract Aims Ascending colon (AC) tumour in a patient with malrotation of bowel can present diagnostic and surgical challenges. We present such a case managed by laparoscopic resection, and share the difficulties encountered and our preparation to achieve a good outcome Methods A 72-year-old female with iron deficiency anaemia underwent CT colonography after an incomplete optical colonoscopy. The scan revealed malrotation, a pelvic caecum and a midline ascending colon, and a lesion suspicious of cancer in ascending colon with a CT staging of T3N0M0. Patient was scheduled for elective laparoscopic right hemicolectomy. Results Review of vascular anatomy was carried out with radiologist. Several modifications to standard procedure was used – first port-entry site, number of ports, plan of dissection, and site of specimen extraction. Additional challenges were due to the high BMI (40 kg/m2). Patient was discharged on day-7 without major complications. Conclusion Multidisciplinary discussion, optimal pre-operative preparation, and thorough understanding of the vascular profile leads to successful management of these rare presentations by minimally invasive surgery. Pre-operative CT-scan is essential before planning surgical management. Laparoscopic right-hemicolectomy although challenging, can be successfully performed with appropriate expertise.