title: Laparoscopic resection of sigmoid colon cancer with intestinal malrotation: A case report.
abstract: BACKGROUND
  Intestinal malrotation is a congenital abnormality which occurs due to a failure of the normal 270° rotation of the midgut. The non-rotation type is usually asymptomatic and discovered incidentally on imaging studies. Intestinal malrotation accompanied by colon cancer is extremely rare.
  
  
  METHODS
  A 53-year-old male presented with postprandial abdominal discomfort. Colonoscopy showed a 14mm polyp in the sigmoid colon and endoscopic polypectomy was performed. Pathological evaluation revealed an adenocarcinoma invading the submucosa more than 1000μm with positive vertical and horizontal margins. A contrast enhanced computed tomography scan showed an anatomic variant of the ileocolic and inferior mesenteric arteries originating from a common channel branching from the abdominal aorta. Laparoscopic sigmoid colon resection was performed. The patient did well post operatively.
  
  
  CONCLUSIONS
  The usual trocar placement for laparoscopic left side colectomy was used, and we found no difficulties intraoperatively. To secure safe ligation, the divisions of the common channel branching from the abdominal aorta were exposed as in a usual D3 dissection, and the inferior mesenteric artery was ligated after confirmation of the bifurcation of the ileocolic and inferior mesenteric artery.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first report of laparoscopic resection of a sigmoid colon cancer with intestinal malrotation. It was performed without difficulty using the usual trocar placement, with appropriate attention to the variant in vascular anatomy.
authors.affiliation: Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan. Electronic address: pandadebanda4@gmail.com.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nishida
authors.affiliation: Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan. Electronic address: t.kato0522@gmail.com.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, 329-0498, Japan. Electronic address: alefor@jichi.ac.jp.
authors.forename: Alan Kawarai
authors.initials: AK
authors.lastname: Lefor
authors.affiliation: Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa, 238-8567, Japan. Electronic address: tsuganum@gmail.com.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Suganuma
keywords: Case report; Ileocolic artery; Intestinal malrotation; Laparoscopic; Sigmoid colon cancer; Trocar placement