Laparoscopy-assisted distal gastrectomy in a patient with early gastric cancer and polysplenia.

A 44-year-old woman is presented who was referred for further evaluation and surgical treatment of gastric cancer detected on a routine health evaluation. Endoscopic examination with biopsy revealed about a 1-cm early gastric cancer of signet-ring cell type at the lesser curvature side of the antrum. A computed tomography scan of the abdomen confirmed the findings of intestinal malrotation, polysplenia, and a large enhancing mass in the uterus. The results of blood testing and echocardiography were within normal limits. The patient underwent laparoscopy-assisted distal gastrectomy and transvaginal hysterectomy for early gastric cancer and uterine myoma. A lobulated spleen in several parts, intestinal malrotation, and a very large uterine mass were identified during the laparoscopic surgery. The postoperative course was uneventful. This case illustrates the importance of thorough preoperative anatomic assessment, especially for laparoscopic surgery in patients with anatomic abnormalities.