SEGMENTAL LEFT HEMICOLECTOMY AT THE SPLENIC FLEXURE: ANATOMICAL LANDMARKS AND INTRACORPOREAL ANASTOMOSIS TECHNIQUE

Introduction Tumors located at the splenic flexure present a challenge for surgeons due to the absence of a defined standard approach. Differences in vascularization and drainage areas (between mesenteric territories) create the possibility for different techniques, and even the definition of the splenic flexure boundaries can vary in the literature.

Objectives To provide a standardized surgical description of segmental left colectomy with anatomical landmarks and the performance of an intracorporeal anastomosis.

Methods A 66-year-old patient presented with colicky abdominal pain, associated with hematochezia and a weight loss of 6kg in 1 month. A colonoscopy revealed a stenosing lesion in the descending colon – with an adenocarcinoma diagnosis. Staging CT scans showed the tumor located at the splenic flexure of the colon, and a decision was made to perform a segmental left colectomy via minimally invasive surgery. A standard dissection was performed with ligation of the inferior mesenteric vein and left colic artery, followed by an intracorporeal isoperistaltic anastomosis between the medial transverse colon and lateral sigmoid colon.

Results The standardized approach with ligation of the inferior mesenteric vein and only the left colic artery allows for adequate colon mobilization while preserving critical vascularization at the drainage point, which is the splenic flexure. The anastomosis was performed without tension, and the patient had a good postoperative outcome.

Conclusion A standardized technique for approaching tumors at the splenic flexure may lead to better outcomes, with lower rates of surgical complications in patients with tumors at the splenic flexure.

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Artikel online veröffentlicht:
25. April 2025