Thomas Lehnert, MD, Roland Boehm, MD, Steffi Mayer, MD, Ina Sorge, MD, Thomas Richter, MD, PhD, Holger Till, MD, PhD
Department of Pediatric Surgery, University Hospital of Leipzig, Leipzig, Germany (Drs. Lehnert, Boehm, Mayer, Till). Department of Pediatric Radiology, University Hospital of Leipzig, Leipzig, Germany (Dr. Sorge). Department of Pediatrics, Hospital St. Georg, Leipzig, Germany (Dr. Richter). Department of Pediatric and Adolescent Surgery, Medical University of Graz, Austria (Dr. Till).
Introduction: Venous malformations in the bowel are extremely rare in children. A few case reports recommend the laparoscopic assisted mobilization of the lesion and conversion to an external resection and anastomosis. However, in infants with large tumors of the descending and sigmoid colon, this strategy would require a laparotomy.
Case Description/Technique Description: A 2-year-old girl presented with painless rectal bleeding and anemia. Ultrasonography and magnetic resonance imaging (MRI) revealed a 5 3 3-cm angiodysplastic lesion of the distal bowel. Colonoscopy verified a vascular malformation of the sigmoid with exophytic growth. Performing a 4-port laparoscopy (3–5 mm), we identified the lesion along with grossly distended blood vessels in the sigmoid colon. After hitching it to the anterior abdominal wall, we carefully mobilized the lesion. To avoid a laparotomy of equivalent size or significant bleeding during externalization, the mass was resected laparoscopically using the LigaSure device (Covidien, Mansfield, Massachusetts). Finally an all-in laparoscopic anastomosis was fashioned (4–0 Vicryl, interrupted stitches; Ethicon, Somerville, New Jersey). The inspection of both remaining colonic margins showed no macroscopic evidence of the disease. The specimen was placed in a bag and morcellated with forceps through one slightly extended port site until it could be extracted. Operative time was 269 minutes. Histology described a venous malformation. The postoperative course was uneventful, and after a follow-up of more than 1.5 years, the girl remains free of symptoms.
Conclusion: An all-in laparoscopic resection of a vascular malformation of the colon can be performed successfully and with excellent cosmetic results in children and even infants.
Key Words: Laparoscopy, colonic resection, venous malformation, infant, child.