Ann Coloproctol.  2023 Apr;39(2):178-182. 10.3393/ac.2021.00178.0025.

Multivisceral resection for colonic splenic flexure malakoplakia: a case report of a minimally invasive approach

• Díaz ARL
• Pezet SG
• González OS
• Trueba MG
• Alonso IAM
• Ramirez MAL

• KMID: 2541838
• DOI: http://doi.org/10.3393/ac.2021.00178.0025

Abstract

Malakoplakia is a rare granulomatous inflammatory disorder. Its diagnosis depends on histopathological findings; however, high-quality literature regarding proper medical/surgical treatment is lacking. A 38-year-old diabetic female patient was admitted to the emergency room with a history of lower gastrointestinal hemorrhage. Colonoscopy revealed a lesion in the descending colon, and abdominal computed tomography revealed a splenic flexure mass involving the lower pole of the spleen and upper pole of the left kidney. Biopsies confirmed the diagnosis of malakoplakia. After completing antibiotic treatment, a restaging computed tomography revealed a discrete mass increase; hence, the patient underwent laparoscopic en bloc colectomy and partial nephrectomy. Postoperatively, the patient developed a pancreatic fistula, which was successfully treated with percutaneous drainage and antibiotics. The presence of pathognomonic Michaelis-Gutmann inclusions on histopathology is frequently reported as the key to diagnosing malakoplakia. Herein, we present a successful, minimally invasive surgical treatment for colonic malakoplakia.

Keyword

Malakoplakia; Minimally invasive surgical procedures; Colectomy; Nephrectomy; Type 2 diabetes mellitus