Ainize Ibarzabal (Gastrointestinal Surgery Senior Specialist) Gabriel Díaz (Gastrointestinal Surgery Specialist) Victor Turrado (Gastrointestinal Surgery Specialist) Hospital Clínic, Barcelona – Spain
A 68-year-old man with a medical history of neoplasia of the bladder treated with transurethral resection, renal insuficiency treated with hemodyalisis, hypertrophic myocardiopathy and ankylosing spondylitis, came the outpatient clinic complaining of two months’ centro-abdominal pain. The preoperative workup consisted of a colonoscopy that showed diverticulosis, a gastroscopy in which a small hiatal hernia was discovered, a CT (FIG1) that showed a 19mm intramural tumour of the jejunum and several mesenteric lymphadenopaties, and a enteroclysis with a filling defect in the jejunum.
The patient was positioned supine, with open legs. Three trocars were used: a 12 mm umbilical trocar for the camera, and two 5 mm trocars: one in an infraumbilical and one in a subxiphoid position. Several jejunal diverticula were found intraoperatively. The jejunum was explored but the tumour was not found and a midline accessory incision was performed. The jejunal loops were exteriorized using the incision and the tumour was found and resected. A side-to-side mechanic anastomosis was performed.
In the postoperative period the patient presented with fever, and an abdominal CT was performed that found no postoperative complications. Afterwards, evolution was satisfactory and the patient was discharged on the 10th postoperative day.