Splenodiaphragmatic colonic interposition and left hemidiaphragmatic elevation in a patient undergoing robot-assisted radical prostatectomy: a case report

Abstract

Intestinal interposition occurs when a segment of the bowel is temporarily or permanently interposed between two organs. In most cases, this condition is asymptomatic and represents an incidental radiologic finding, but in rare cases abdominal and even respiratory symptoms have been described. We report the case of a 53-year-old man with normal BMI, candidate to robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer, who had an incidental finding of splenodiaphragmatic colonic interposition and left hemidiaphragmatic elevation. These findings raised concern about possible problems for intraoperative ventilation, since the position of the patient during RARP and the use of pneumoperitoneum invariably restrict diaphragmatic and chest wall excursion, which can adversely affect respiratory gas exchange. Anyway, no problem occurred, and the procedure was carried out as usual with a 27° Trendelenburg position and a slightly reduced pneumoperitoneum of 10mmHg.