Laparoscopic total gastrectomy for gastric cancer with adult intestinal malrotation: a case report
We herein report a rare case of gastric cancer with adult intestinal malrotation successfully treated by laparoscopic total gastrectomy (LTG) considering an adequate design of Roux-en-Y reconstruction. A 67-year-old man with cStage IV advanced gastric cancer had been treated with platinum-fluoropyrimidine chemotherapy and was eventually down-staged to ycStage I; thus, radical resection was planned. During the exploration in staging laparoscopy, non-rotation type intestinal malrotation was incidentally found. LTG with D2 dissection was employed followed by Roux-en-Y reconstruction. Because of the abnormal orientation of the intestines, the Roux limb was brought up in reverse C-shape to assume natural contours. Intracorporeal esophagojejunostomy was done using a linear stapler, unusually introduced from a left lower abdominal port to adjust its axis to the intestine. When gastric surgery is required for such patients it is important to design an adequate Roux limb in consideration of the anatomical relevance of the intestines.