A 56 year old lady presented to Aster Hospital, Mankhool with change in bowel consistency with a pattern of 10 days duration and blood in motions. Patient noticed her stools became loose 10 days go, this was associated with forceful passage of flatulence and associated with passage of dark, altered blood. She was seen by Consultant Gastroenterologist Dr. Amal Upadhyay and was advised to undergo colonoscopy.
On colonoscopy a polyp was seen at 30 cms from anal verge. Base of the polyp was wide-sessile. Excision of polyp was attempted but it could not be lifted from underlying tissues and instead multiple biopsies were taken to rule out malignancy. Site of the polyp was tattooed for aid laparoscopic location.
The biopsy showed in situ adenocarcinoma and patient was advised to undergo laparoscopic Sigmoidectomy (Dr. Abhay). The patient was further evaluated for locoregional and distant spread which was negative.
She underwent laparoscopic resection of sigmoid colon and stapled colorectal anastomosis under general anesthesia. The procedure was aided by the use of state-of-the-art Laparoscopic instrumentation, latest energy devices like ultrasonic shears and use of staplers for bowel resection and anastomoses. The procedure took 2 hours and patient was ambulated in the evening of surgery. She was started on liquid diet on day 1 of surgery and was discharged from the hospital on the 4th day post-surgery. Her final histopathology revealed tumor limited to mucosa with no involvement of lymph nodes.
Laparoscopic colorectal surgery for malignancies is a minimally invasive technique which ensures good oncological clearance due to better visibility. It also helps the patient recover faster due to smaller incisions and less pain post operatively. High index of suspicion on the part of primary care physician with prompt referral for early colonoscopy while evaluating PR bleeding especially in elderly patients will go long way in detecting the malignancies at an earlier stage.
Specialist General & Laparoscopic Surgeon
Aster Hospital, Mankhool