Left hemicolectomy is a surgical procedure in which splenic flexure, descending colon, and a portion of the sigmoid colon are removed for radical treatment of various pathologies affecting the descending colon.

Indications

• colon cancer

• inflammatory bowel disease

• isolated left diverticular disease

• perforation of the left colon

• left colon malignant polyp

• left-sided ischemic colitis

Contraindications

• uncomplicated metastatic cancer

• patients with comorbidities, intolerable for general anesthesia

Procedure

After taking written informed consent, the procedure is done either as open surgery in emergencies, or laparoscopically in elective non-emergency settings.

Technique

The technique includes the following steps ³:

• mobilization of the splenic flexure

• division of the inferior mesenteric vein

• mobilization of the descending colon

• division of the inferior mesenteric artery

• mobilization of the sigmoid colon

• rectal dissection and transection

• specimen exteriorisation

• anastomosis creation

Complications

A left hemicolectomy can have the following complications ⁴:

• anastomotic leak

• injury to adjacent structures (e.g. ureter)

• bleeding

• wound infection

• wound dehiscence and evisceration

• pulmonary embolism

Radiographic features

The following imaging appearances described here are of the normal postoperative status without complication or recurrent disease process.

Plain radiograph

The absence of a normal gas pattern of the left colon and metallic surgical clips may be visible at the anastomotic region.

CT/MRI

In normal post-op status the splenic flexure, descending colon and part of the sigmoid colon will be absent, and other mobile abdominal structures may have moved to occupy the resulting space.