Left hemicolectomy is a surgical procedure in which splenic flexure, descending colon, and a portion of the sigmoid colon are removed for radical treatment of various pathologies affecting the descending colon.
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Indications
isolated left diverticular disease
perforation of the left colon
left colon malignant polyp
left-sided ischemic colitis
Contraindications
uncomplicated metastatic cancer
patients with comorbidities, intolerable for general anesthesia
Procedure
The procedure is done either classically as open surgery in emergencies and patients with complications or laparoscopically in an elective non-emergency setting.
Technique
The technique includes the following steps 3:
mobilization of the splenic flexure
division of the inferior mesenteric vein
mobilization of the descending colon
division of the inferior mesenteric artery
mobilization of the sigmoid colon
rectal dissection and transection
specimen exteriorizastion
anastomosis creation
Complications
A left hemicolectomy can have the following complications 4:
injury to adjacent structures (e.g. ureter)
bleeding
wound infection
wound dehiscence and evisceration
Radiographic features
The following imaging appearances described here are of the normal postoperative status without complication or recurrent disease process.
Plain radiograph
The absence of a normal gas pattern of the left colon and metallic surgical clips may be visible at the anastomotic region.
CT/MRI
In normal post-op status the splenic flexure, descending colon and part of the sigmoid colon will be absent, and other mobile abdominal structures may have moved to occupy the resulting space.
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