Discovery of vascular transposition during gastrectomy

The congenital anomalies of the large vessels are rare, of which the left inferior vena cava and the aorta on the right, occupies the 2nd rank after the duplicity. They represent a challenge in some visceral, urological and vascular surgeries. We report the case of an incidental finding during the operative exploration of a patient who has a gastric adenocarcinoma with isolated cells and who has benefited from a total gastrectomy and this transposition confirmed by a postoperative CT scan.

We report a case of strong discovery of vascular transposition during gastrectomy in the department visceral surgery A1 of the ibn Rochd Hospital in Casablanca.

Our patient admitted for episodes of small hematemesis with esophageal syndrome. The clinical examination was unremarkable. FOGD showed ulcerated tumor of the angulus with at the anatomical pathology examination: medium to poorly differentiated gastric adenocarcinoma with an isolated cell component. The preoperative radiological workup made of an abdominal CT scan showed a non-stenotic circumferential irregular gastric parietal thickening of the antropyloric region measuring 15 mm of maximum thickness extended over 60 mm without any other abnormalities. During the surgical exploration we fortuitously found the presence of an anatomical variety: a left IVC and the aorta on the right; postoperatively the patient benefited from a postoperative scan which confirmed the presence of an anatomical variety: a left IVC and the aorta on the right.

The presence of a left IVC does not contraindicate any surgical procedure; however, knowledge of this type of variant remains essential, requiring a good radiological analysis in order to avoid possible intraoperative surprises.