Laparoscopic Excision of an Intra-Abdominal Schwannoma

Abstract

While under investigation for symptomatic cholelithiasis, a32-year-old Saudi female was incidentally found to have a 4.7cm solid and cystic mass in the right subhepatic region on anultrasound scan. A plain abdominal X-ray and routinehematological and biochemical investigations were all normal.Barium enema demonstrated extrinsic pressure on the hepaticflexure of the colon. Contrast-enhanced CT scan confirmedthe presence of a well-defined round, low density,heterogenous mass related to the anterior and mesentericaspect of the hepatic flexure (Figure 1). This was confirmedby MR imaging (Figure 2).Laparoscopy was performed using a 10-mm umbilicalport, a 10-mm epigastric port and two 5-mm ports; one in theright midclavicular line and another in the right anterioraxillary line. The mass was found to be arising from thegreater omentum and adherent to, but not infiltrating, the wallof the hepatic flexure of the colon. A routine laparoscopiccholecystectomy was performed first. The mass was thenmobilized from the colon and the greater omentum withrelative ease, using a combination of sharp dissection andelectrocautery, and a large feeding vessel was clipped anddivided. Once free, the tumor was placed in an endopouchintroduced through the epigastric port. The epigastric portincision was extended to 4 cm and the tumor was deliveredthrough it intact. The patient made an uneventful recovery