A colovesical fistula with a persistent descending mesocolon due to partial situs inversus: A case report

Mochizuki, Tetsuya; Tazawa, Hirofumi; Hirata, Yoshihiro; Kuga, Yoshio; Miwata, Tomohiro; Fukuhara, Sotaro; Imaoka, Kouki; Fujisaki, Seiichiro; Takahashi, Mamoru; Fukuda, Saburo; Nishida, Toshihiro; Sakimoto, Hideto

doi:10.1016/j.ijscr.2017.06.029

Cited by 7 publications

(9 citation statements)

References 17 publications

(19 reference statements)

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“…For example, there was anastomotic leakage after sigmoid colon resection for a colovesical fistula in a patient with PDM due to insufficient blood flow caused by the absence of marginal vessels in a previous case report. 6 Thus, our finding further supports that the LCA should be divided after confirming the feeding vessels to the descending colon.…”

Section: Discussionsupporting

confidence: 80%

“…Indeed, there are several case reports of surgery in patients with PDM, 3-10 some of which described the difficulty in performing surgical procedures and the importance of understanding the anatomical features. [6][7][8]10 In addition, a recent study demonstrated that PDM is associated with the difficulty of laparoscopic resection of the sigmoid colon or rectal cancer based on the surgical time and blood loss. 11 On the other hand, several vascular features in PDM were reported such as radial branching pattern of the IMA, short LCA, and short distances between the IMA and inferior mesenteric vein (IMV) and between the IMV and descending colon.…”

Section: Introductionmentioning

confidence: 99%

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Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon

Nozawa

Okamoto

Kawai

et al. 2022

ANZ Journal of Surgery

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Background: Persistent descending mesocolon (PDM) is a fetal abnormality in which the left-sided colon is not fused to the retroperitoneum, and it is often accompanied by the adhesion between the mesocolon and small bowel mesentery. Due to its rarity, whether PDM exhibits anatomical characteristics of the inferior mesenteric artery (IMA) and left colic artery (LCA), and how the anomaly affects laparoscopic surgery are largely unknown. We investigated the branches of these arteries and outcomes of patients who underwent laparoscopic surgery. Methods: Based on computed tomography (CT) and three-dimensional CT angiography, branching patterns of the IMA, LCA and branches originating from the LCA were analysed in 954 patients with left-sided colon or rectal cancer. PDM was diagnosed by preoperative CT colonography, and confirmed at time of surgery. The anatomical features of the vessels and short-term outcomes of laparoscopic surgery were compared between patient groups stratified by PDM. Results: Twelve patients (1.3%) were diagnosed with PDM. No branching pattern of the IMA specific to PDM was noted. On the other hand, patients with PDM had fewer branches (mean: 1.0) from the LCA than those without PDM (mean: 1.8, p = 0.009). In patients undergoing laparoscopic surgery, outcomes such as operative time, intraoperative blood loss, and number of harvested nodes were comparable between the two patient groups. Conclusion: Few branches of the LCA characterize PDM. PDM does not complicate laparoscopic surgery of the left-sided colon and rectum. However, the above anatomical feature increases the risk of poor colonic perfusion when dividing the LCA.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon

Nozawa

Okamoto

Kawai

et al. 2022

ANZ Journal of Surgery

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“…1,2 Due to the characteristic anatomy of PDM, complications such as intestinal volvulus, intussusception, and colovesical fistula have been reported. [3][4][5] In PDM, several branches of the sigmoid colon artery are in close proximity to the LCA and radiate into the pelvis, and the first branch of the sigmoid colon artery often shares a common trunk with the LCA. Additionally, in PDM the descending colon artery, sigmoid colon artery, and superior rectal artery often branch radially from the inferior mesenteric artery (IMA) and are referred to as the radial pattern IMA.…”

Section: Discussionmentioning

confidence: 99%

“…PDM has been described as a failure of fusion of the descending colon mesentery with the posterior and lateral wall peritoneum during this developmental process 1,2 . Due to the characteristic anatomy of PDM, complications such as intestinal volvulus, intussusception, and colovesical fistula have been reported 3–5 …”

Section: Discussionmentioning

confidence: 99%

Persistent Descending Mesocolon as An Intraoperative Risk Factor in Laparoscopic Surgery for Left‐Sided Colon and Rectal Cancer

Hamada

Sumida

Ozeki

et al. 2021

Asian J Endoscop Surgery

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Introduction Persistent descending mesocolon (PDM) represents a failure of fusion of the descending mesentery, leading to anatomical abnormalities. This study aimed to examine the effects of anatomical features of PDM on laparoscopic surgical outcomes. Methods Patient backgrounds, surgical outcomes, anatomical characteristics, and operative findings were retrospectively compared between 186 patients classified into PDM and non‐PDM groups who underwent primary resection for left‐sided colon and rectal cancer at our hospital from January 2019 to December 2020. Results PDM was diagnosed in nine patients (4.8%). The operative time (337 ± 165 vs 239 ± 107 min, p = 0.010) was significantly different between PDM and non‐PDM groups, but bleeding loss was not different (108 ± 97 ml vs 53 ± 142 ml, p = 0.259). In PDM patients, in addition to abnormal fixation of the sigmoid‐descending colon junction, adhesion of the mesentery of the colon and small intestine in 100%, and adhesion between the mesocolon in 33% patients was confirmed intraoperatively. Ileus was more common in the PDM group (two cases, 22%) and in the non‐PDM group (10 cases, 5.6%), but there was no significant difference in overall postoperative complications between the two groups (p = 0.215). The duration of postoperative hospital stay (28 ± 20 vs 16 ± 11 days, p = 0.002) was significant between the two groups. The left colonic artery (LCA) could not be preserved in six patients in the PDM group, one of whom had anastomotic leakage and two of whom required additional resections due to intraoperative intestinal blood flow failure. Conclusion PDM prolonged operative times and duration of postoperative stay in laparoscopic surgery for left‐sided colon and rectal cancer. Division of the LCA in PDM patients should be considered an intraoperative risk factor for injury to the marginal artery.

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“…Situs inversus may due to a possible abnormality in rotation in early embryonic life. [ 6 ] Situs inversus totalis is quite compatible with life while situs inversus incompletus often accompanies with cardiopulmonary anomalies.…”

Section: Discussionmentioning

confidence: 99%

A case report of pulmonary artery sling and situs inversus incompletes

Xu¹,

Xu²,

Cheng³

et al. 2021

Medicine

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Rationale: Pulmonary artery sling (PAS) is a rare congenital anomaly. Associated airway anomalies and/or those of the cardiovascular system are present in about half the patients. Situs inversus is a rare disease in which organs of the chest and/or abdomen are arranged in a mirror image reversal of their normal position. Herein, we report a rare case of pulmonary artery sling and situs inversus incompletus, which has not yet been reported. Patient concerns: A 10-year-old girl was admitted because of heart murmur for more than 9 years. On physical examination, the second heart sound was prominent, and a grade 2/6 systolic murmur was heard at the left mid-sternal border. Echocardiography revealed PAS and atrial septal defect (8.6 mm). A chest computer tomography angiograph demonstrated that she had lung inversus, right aortic arch, and right lung hypoplasia in addition to PAS, with a normal positioning of the heart. The PAS intersected and twisted across the bronchus, which was obviously narrowed. The PAS was type II B, since the carina was at the T6 level without a separate right upper lobe bronchus. Diagnoses: Her final diagnosis was that of PAS, tracheal stenosis, situs inversus incompletus, right lung hypoplasia, right aortic arch, ASD and PDA. Interventions: She underwent one-stage total correction for her initial cardiovascular defects through median sternotomy under cardiopulmonary bypass support. Outcomes: She had an uneventful recovery and completely healthy following the procedure. Lessons: A thorough examination before PAS surgery was essential in discovering and carefully evaluating complicated heart and lung anomalies.

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A colovesical fistula with a persistent descending mesocolon due to partial situs inversus: A case report

Cited by 7 publications

References 17 publications

Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon

Anatomical features of inferior mesenteric and left colic arteries and surgery in colorectal cancer patients with persistent descending mesocolon

Persistent Descending Mesocolon as An Intraoperative Risk Factor in Laparoscopic Surgery for Left‐Sided Colon and Rectal Cancer

A case report of pulmonary artery sling and situs inversus incompletes

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