Ureteral Preservation Using Fluorescent Ureteral Catheter during Laparoscopic Resection of an Appendiceal Inflammatory Pseudotumor: A Case Report.

INTRODUCTION

When a bulky intra-abdominal tumor cannot be clearly distinguished from a malignancy, careful surgical planning is required to preserve adjacent organs.

CASE PRESENTATION: A 31-year-old female presented to our hospital with lower abdominal pain. Contrast-enhanced CT revealed a 67-mm mass in the cecum. Colonoscopy revealed a raised lesion; however, biopsy results were inconclusive. Laparoscopic ileocecal resection with D2 lymphadenectomy was performed because of a suspected malignancy. Given the proximity of the tumor to the right ureter on preoperative imaging, a fluorescent ureteral catheter (FUC) was inserted preoperatively. Intraoperatively, near-infrared light enabled a clear ureteral visualization, thereby facilitating safe dissection and successful preservation. Her postoperative course was uneventful. Pathological examination revealed a spindle cell lesion with suppurative inflammation, and immunostaining indicated myofibroblastic differentiation consistent with an appendiceal inflammatory pseudotumor.

CONCLUSIONS

This case highlights the utility of FUC-guided navigation for ureteral preservation during minimally invasive surgery for bulky intra-abdominal masses.