Total laparoscopic surgery for treatment of leiomyoma of the transverse colon in a patient with an abdominal mesh: A case report.

Fujimoto, Goshi; Osada, Shunichi

INTRODUCTION Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract; however, gastrointestinal leiomyomas are relatively rare. Surgical resection is recommended for leiomyomas and gastrointestinal stromal tumors of the colon. We present a case in which we performed laparoscopic right hemicolectomy with intraabdominal anastomosis for treating leiomyoma of the transverse colon in a patient with an abdominal mesh. PRESENTATION OF CASE A 64-year-old woman with a history of right subtotal adrenalectomy and right mastectomy was incidentally found to have an abdominal mass on a follow-up computed tomography (CT) scan, which was confirmed as a gastrointestinal stromal tumor of the mesentery following abdominal contrast-enhanced CT. We planned surgical resection for preoperative diagnosis because the tumor was >5 cm in diameter. However, she had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstruction after right mastectomy, in which the TRAM flap was replaced with an abdominal mesh; hence, total laparoscopic surgery was performed to avoid damaging the mesh owing to the risk of mesh infection. Laparotomy revealed that the tumor originated from the transverse colon; thus, transverse colectomy with intraabdominal anastomosis was performed. The total operative time and blood loss were 3 h 32 min and 5 mL, respectively. No postoperative leakage or mesh infection was observed. The resected specimen revealed a leiomyoma without malignancy. DISCUSSION We successfully performed colectomy that minimized the resection range and intraabdominal anastomosis. CONCLUSION Total laparoscopic surgery was effective for colonic leiomyoma with an abdominal mesh to avoid mesh-related complications.