Laparoscopic left hemicolectomy with ICG fluorescence angiography for diverticular disease in patient with intestinal malrotation. A video vignette

Intestinal malrotation (IM) is defined as a congenital incomplete rotation and fixation of the gastrointestinal tract. It is frequently asymptomatic and it is diagnosed incidentally during radiological tests. In these cases, surgery is a challenge for surgeons due to the intraoperative anatomical alterations observed. Moreover, an anomalous intestinal vascularization can be associated, so the development of new technologies to assess the anastomotic blood supply during surgery can be determinant to improve the postoperative results. We report a case of a 63-year-old woman who underwent to Computed Tomography scan for acute diverticulitis of the sigmoid colon and incidentally a type II IM is detected. Due to the several episodes of diverticulitis a surgery is planned. By laparoscopy, the IM is recognized, being the entire colon on the left and the entire small bowel on the right. A sigmoid segmental resection is performed dividing the sigmoid and the upper rectal arteries and the left parietocolic space. The left colon is then extracted and Indocyanine Green (ICG) fluorescent angiography was performed. Twenty cm of left colon were not vascularized and were further resected including the splenic angle and the adhesion between the left and right colon, together to the division of the inferior mesenteric vein and artery at its origin. After another angiography assessment an end-to-end anastomosis is performed with a circular stapler. The ICG fluorescent angiography is a useful, fast and safe test, mostly in complex cases in which the colon vascularization may be abnormal or the anatomy is difficult to identify This article is protected by copyright. All rights reserved.