3D for D3: Role of Imaging for Right Colectomy in a Case with Congenital Superior Mesenteric Vein Aneurysm and Co-Existing Anomalous Irrigation
S. Kiil, B.V. Stimec, M. Spasojevic, J.H.D. Fasel, D. IgnjatovicClinical case, no. 2, 2013
Background: The D3 right colectomy for cancer requires
dissection in the vicinity of the superior mesenteric vessels,
which requires preoperative 3D imaging in these patients.
Case report: We present a patient with a caecum adenocarcinoma
cancer which underwent D3 resection of the
right colon, preceded by pre-operative MDCT with 2D
multiplanar reconstruction and 3D volume rendering.
Results: The dataset analysis revealed a rare congenital
aneurysm of the superior mesenteric vein below the splenomesenteric
confluence and a co-existing anomalous irrigation
in the form of an ileo-mesenteric trunk. The surgical procedure
was carried out as planned and the patient presents no signs of
recurrence of the disease one year after the intervention.
Conclusions: The case presented – with a rare and complicated
vascular situs – illustrates particularly well that multimodal
post-processing of the CT dataset for volume rendering allows
proper assessment of the arrangement of pertinent blood vessels, and, consequently in the planning, setup and
accomplishing the delicate operation, avoiding the surgical
pitfalls and iatrogenic injuries.