A video guide of five access methods to the splenic flexure: the concept of the splenic flexure box.

AIM: The aim of this study was to describe all the possible approaches for laparoscopic splenic flexure mobilization (SFM), each suitable for specific situations, and create an illustrated system to show SFM approaches in an easy and practical way to make it easy to learn and teach. METHODS: Two different phases. First part: Cadaver-based study of the colonic splenic flexure anatomy. In order to demonstrate the different approaches, a balloon was placed through the colonic hepatic flexure in the lesser sac without sectioning any of the fixing ligaments of the splenic flexure. Second part: A real case series of laparoscopic SFM. RESULTS: First part: 11 cadavers were dissected. Five potential approaches to SFM were found: anterior, trans-omentum, lateral, medial infra-mesocolic, and medial trans-mesocolic. The illustrative system developed was named: Splenic Flexure "Box"(SFBox). Second part: One of the types of SFM described in first part was used in five patients with colorectal cancer. Each laparoscopic approach to the splenic flexure was illustrated in a video accompanied by illustration aids delineating the access. CONCLUSION: With the cadaver dissection and subsequent demonstration in real-life laparoscopic surgery, we have shown five types of laparoscopic splenic flexure mobilization. The Splenic Flexure "Box" is a useful way to learn and teach this surgical maneuver.

Lanthanum carbonate has a radiopaque appearance on the plain abdominal radiography.

An 84-year-old woman presented to her local emergency department for abdominal pain. Her medical history included hemodialysis in the treatment of chronic renal failure, Parkinson's disease, chronic atrial fibrillation, chronic constipation, appendicectomy and cholecystectomy. The patient complained of diffuse abdominal pain for 4 days, associated with nausea and vomiting in the last 24 hours. Physical examination revealed a soft and depressible abdomen, diffusely painful, without signs of peritoneal irritation. A digital rectal exam revealed large amount of stool in the rectal vault without palpable masses. Blood tests showed a creatinine level of 2.7 mg/dl due to chronic renal failure and the plain abdominal radiography revealed a dolichocolon completely contrasted. The patient denied the realization of any medical imaging-proofs with oral or rectal contrast. Reviewing home treatment, the patient was taking lanthanum carbonate (2 tablets of 750 mg per day) since 1 month ago, a drug that contrasts the digestive tract. Appreciating contrast in the colon, intestinal subocclusion was excluded and the clinical picture was attributed to her chronic constipation. In conclusion, it should be noted that lanthanum carbonate contrasts the digestive tract, with radiopaque appearance on the plain abdominal radiography and without any pathological significance.