VM100 - Funky Flexure: An Atypical Presentation of an Uncommon Cancer

Purpose/Background: In this video, we report a laparoscopic segmental colonic resection of the splenic flexure for obstructing colon cancer in a morbidly obese patient. Fewer than 10% of colon cancers are found at the splenic flexure. A standardized surgical approach to these cancers has not been defined. The presentation of this particular case is unusual for an already uncommon problem. We demonstrate a methodical approach to this atypical case.

Methods/Interventions: We manage a morbidly obese patient (BMI 55) who presents with complicated colonic splenic flexure cancer with obstruction and a necrotizing soft tissue infection.  We achieve a successful oncologic outcome via a staged approach performed in a minimally invasive fashion.

Results/Outcomes: The patient was discharged on post-operative day two.  He did not suffer any post-operative complications.  We were able to harvest an adequate lymph node yield for accurate staging, with three out of fifteen lymph nodes positive.  His ileostomy was subsequently taken down six weeks later to restore intestinal continuity.

Conclusion/Discussion: This challenging case of a morbidly obese patient presenting with obstructive colonic cancer and a soft tissue infection was managed successfully via minimally invasive surgery and the benefits it provides patients with a higher BMI.  A staged approach was used here by first diverting the patient with an ileostomy.  We then proceeded with definitive resection once his obstruction resolved.  His ileostomy was subsequently taken down without issue.  The patient’s oncologic outcome from a surgical perspective were adequate and he received adjuvant chemotherapy in a timely fashion.  An exploratory laparotomy would have increased complication risks in this morbidly obese patient and his oncological outcome may have been inadequate due to the technical difficulties of the operation if done in an open fashion.