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Laparoscopic Right Colectomy with Ileocolic Anastomosis

David Rattner, MD
Massachusetts General Hospital

Abstract

Colonic polyps are projections from the surface of the colonic mucosa. Most are asymptomatic and benign. Over time, some colonic polyps develop into cancers. Colorectal polyps are classified as non-neoplastic and neoplastic. Non-neoplastic polyps include hyperplastic, inflammatory, and hamartomatous polyps. They are typically harmless and do not become cancerous. Neoplastic polyps include adenomas and serrated polyps. They are premalignant lesions that may progress to colon cancer over time. In general, the larger the polyp, the greater the risk of cancer, especially with neoplastic polyps. Polyps are diagnosed using colonoscopy and are removed via polypectomy if they are small and pedunculated. If the polyps are too large or cannot be removed safely, they may be removed by colonic resection.

Carcinoid tumors develop from a type of neuroendocrine cell that secretes hormones that regulate digestion. They are slow-growing cancers that most commonly arise in the gastrointestinal tract and are located (in decreasing order of frequency) in the appendix, ileum, rectum, stomach, and colon. Carcinoid tumors of the colon are extremely rare, comprising less than 11% of all carcinoid tumors and one only 1% of colonic neoplasms. The majority of patients diagnosed with carcinoid tumors have no symptoms and are found incidentally during endoscopy. Treatment of these tumors depends on the size, location, and presence of metastatic disease. Tumors less than 1 cm can often be treated locally either by endoscopy or a transanal approach, while tumors greater than 2 cm require formal oncologic resection.

Here we present a middle-aged male who had an unresectable polyp in the ascending colon and a carcinoid tumor in the ileocecal valve. The patient underwent laparoscopic right colectomy with ileocolic anastomosis to remove both lesions.

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