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VIDEO
Laparoscopic Approach of Obstructing Tumor of the
Splenic Flexure: Surgical Strategies
Francisco Rodríguez Estévez1; Lucas J. Caram2; Esteban González Salazar2
1Department of General Surgery
2Section of Colon and Rectal Surgery
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
LINK
To cite:
Rodríguez Estévez F, Caram LJ, González
Salazar E. Laparoscopic Approach of
Keywords: splenic flexure; colon cancer; colonic obstruction; laparoscopy; subtotal colectomy; anastomotic tension
Obstructing Tumor of the Splenic Flexure:
Surgical Strategies. Rev Argent Coloproctol.
2026; 37(2):33-34. doi:10.46768/vr0c3215
was performed. The surgical procedure involved a
partial en bloc omentectomy due to tumor extension.
The initial surgical plan involved a segmental
resection of the splenic flexure, with meticulous
vascular control of the left colic artery, inferior
mesenteric vein, and left branch of the middle colic
artery.
Following the resection, the feasibility of a side-to-
side isoperistaltic transverse-to-descending colon
anastomosis was assessed. However, the proximal
colon exhibited significant dilation, shortening, and
mesocolic thickening, suggesting potential tension
during anastomosis, despite adequate mobilization.
In view of these findings, the surgical strategy was
modified to optimize reconstruction. A laparoscopic
subtotal colectomy was performed, completing right
colectomy and resection of the remaining transverse
INTRODUCTION
u
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Tumors of the splenic flexure are relatively
uncommon, accounting for less than 5% of all
colorectal cancers. Their surgical management is
challenging due to their anatomical location,
vascular supply, and lymphatic drainage.1,2 These
characteristics partly explain the lack of consensus
regarding the optimal extent of resection. The
following options are available for consideration:
segmental resection of the splenic flexure, extended
left colectomy, and, in selected cases, subtotal
colectomy.3,4
In the setting of large bowel obstruction, these
challenges are amplified by proximal colonic
dilation, mesocolic edema, and tissue fragility.
These factors increase the risk of anastomotic
complications. In this context, intraoperative
assessment of anastomotic tension is critical, and the
surgeon's ability to adapt the extent of resection or
the reconstructive strategy is essential to ensure
procedural safety and minimize morbidity and
mortality.
Received: December 26, 2025
Accepted: January 21, 2026
colon.
An
isoperistaltic
ileo-descending
anastomosis was fashioned without tension.
Counterclockwise orientation was adopted due to
limited reach of the terminal ileal mesentery for a
clockwise configuration. The specimen was
extracted via a Pfannenstiel incision. The patient
exhibited an uneventful postoperative course and
was discharged on postoperative day 5.
This video presents the laparoscopic management of
an obstructing tumor of the splenic flexure. It
highlights the technical aspects of the procedure, the
intraoperative decision-making process, and the
adaptation of the surgical strategy in response to
findings that compromised anastomotic safety.
© 2026 Los autores. Publicado por Revista
Argentina de Coloproctología. Este artículo
se distribuye bajo licencia Creative
Commons Atribución–NoComercial–
SinDerivadas 4.0 Internacional (CC BY-NC-
ND 4.0).
CONCLUSIONS
In obstructing tumors of the splenic flexure, a
laparoscopic approach is feasible and safe in
experienced centers. Intraoperative assessment of
anastomotic tension is a critical determinant in
surgical decision-making, and the ability to adapt
the operative strategy based on intraoperative
findings is essential to minimize complications.
This case demonstrates that timely conversion from
a segmental resection to a more extended colectomy
can facilitate the construction of a tension-free
anastomosis and achieve an optimal postoperative
outcome.
Careful evaluation of anastomotic tension should
guide the reconstructive strategy in obstructing
tumors of the splenic flexure. Intraoperative
flexibility toward more extensive resections may be
decisive in ensuring a safe and durable anastomosis.
CASE DESCRIPTION
A 68-year-old male patient with no significant
medical history or prior endoscopic evaluations was
admitted to the emergency department with
abdominal pain and distension. Laboratory tests
revealed leukocytosis (15,000/mm³), with no other
abnormalities. Given the suspicion of acute
Correspondence to
Francisco Rodriguez Estévez
obstructive
abdomen,
a
contrast-enhanced
abdominopelvic CT scan was performed, showing
segmental wall thickening at the splenic flexure
associated with proximal bowel dilation and gastric
distension.
The surgical intervention was performed via a
laparoscopic approach. Following an initial
exploratory procedure, mobilization of the left
colon, distal transverse colon, and splenic flexure
