A 42-year-old man was worked up with colonoscopy for fatigue and anemia. He had a strong family history of colon cancer (father and three paternal uncles, all in their 40s). He was found to have this partially circumferential lesion at the hepatic flexure. Biopsy showed adenocarcinoma.
The patient underwent abdominal CT scan, which showed the lesion at the splenic flexure as well as an incidental right renal lesion caudal to the renal pelvis. CT-guided biopsy of the renal lesion showed renal cell carcinoma. No other abdominal pathology was seen on the CT scan. A diagnosis of hereditary non-polyposis colon cancer (HNPCC, see Lynch syndrome discussion), type II (atypical since the renal lesion is usually transitional cell), was made and the patient was prepared for surgery to resect both lesions.
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The relationship of the right kidney to the hepatic flexure of the colon and right lobe of the liver is shown in this reconstruction. A subtotal colectomy (with a short rectal stump for easy surveillance) was planned through a midline incision. The urology team proposed a separate flank incision for optimal renal exposure if a partial nephrectomy were elected, but decided on an anterior approach when the patient opted for a total nephrectomy.