ABSTRACT

Portal hypertension in cirrhosis causes mesenteric congestion and edema. These mesenteric changes can be predicted by computerized tomography and may lead some problems during colorectal surgery. A 58 year old male patient with Child A cirrhosis underwent a laparoscopy assisted extralevator abdominoperineal excision. Secondary to mesenteric venous stasis and perivasculary fibrosis, the dissection of the inferior mesenteric vein was problematic. The removal of the giant, edematous specimen out of the abdomen could hardly be completed through the extralevator excision defect. The management of colorectal cancer patients with cirrhosis is challenging. Mesenteric fibrosis and mesorectal edema seems to be the main per-operative problem in the surgical treatment of rectal cancer and both can be predicted preoperatively by computerized tomography. Gastrointestinal surgeons must be aware of these mesenteric changes. Extralevator excision of the perineum may provide a larger perineal space and saves the patient from an additional laparotomy for the removal of giant specimen.