Laparoscopic-assisted sigmoid resection for colonic ectasia in a neonate Aayed R. AlQahtani Division of Pediatric Surgery, College of Medicine, King Saud University, Riyadh 1167, Saudi Arabia Received 2 December 2009; revised 11 April 2010; accepted 12 April 2010 Key words: Colonic ectasia; Neonate; Laparoscopic; Malrotation Abstract A 2.7-kg, 2-day-old girl was diagnosed to have a colonic ectasia and malrotation. She underwent laparoscopic resection of the ectatic segment and Ladd procedure. To our knowledge, such a laparoscopic resection of a colonic ectasia in a neonate has not been reported previously in the English literature. The clinical features, management, and surgical technique will be discussed in this report. © 2010 Elsevier Inc. All rights reserved. Colonic ectasia is a rare entity in neonates characterized by a segmental dilatation of variable length, with the proximal and distal bowel of normal caliber. It was first described by Swenson and Rathauser in 1959 [1]. The clinical and radiological features may resemble that of Hirschsprung disease [1-4]. These patients will be cured by resection of the diseased segment and restoring the continuity of the bowel. In this report, we will present a case with such an entity undergoing laparoscopic resection. 1. Patient and methods 1.1. Case report A 2.7-kg, 2-day-old girl, born at 38 weeks of gestation, presented with significant abdominal distension. She passed normal meconium once at 12 hours of age. Examination revealed typical dysmorphic features of Down's syndrome. No other anomalies were found. The abdomen was significantly distended, with a smooth 6 × 6-cm left lower quadrant (LLQ) abdominal mass. Plain abdominal x-rays showed a gas-filled cyst in the LLQ . Abdominal ultrasound showed a cystic mass in the LLQ of unknown nature or origin. Computed tomography scan with contrast enema confirmed the diagnosis of a segmental dilatation of the rectosigmoid area, connected to a normal rectum distally and a normal descending colon proximally (Figs. 1-3). The radiological diagnosis was so convincing to the extent of not doing a rectal biopsy. The small bowels were on the right side, and the large bowels were on the left, suggesting a malrotation. A rectal tube was inserted, and complete evacuation of the mass was achieved. 1.2. Surgical technique The patient was put in supine position under general anesthesia with endotracheal intubation. A Foley's catheter and nasogastric tube were inserted. The surgeon and the assistant were on the right side of the patient, and the monitor was just across the left side. A Veress needle was inserted at the umbilicus and pneumoperitonium created at a pressure of 10 mm Hg. A 5-mm trocar was then placed, through which a www.elsevier.com/locate/jpedsurg E-mail address: qahtani@yahoo.com. 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2010.04.005 Journal of Pediatric Surgery (2010) 45, 1714–1716