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Sigmoid volvulus is a common cause of colon obstruction, while volvulus of the transverse colon rarely causes bowel obstruction. The occurrence of transverse colon volvulus after resection of the sigmoid colon volvulus is extremely rare. This report presents a 73-year-old man who presented with abdominal pain and peritonitis. The patient underwent exploratory laparotomy, and sigmoid volvulus and cecum perforation were confirmed. A right hemicolectomy, end-to-side ileotransverse colon anastomosis for the cecal perforation, and sigmoidectomy with end-colostomy (Hartmann's procedure) for the sigmoid volvulus were performed. A month later, the patient returned to the emergency room with abdominal distention and the blockage of colostomy. Abdominal CT revealed a transverse colon volvulus. A transverse and descending colon resection and ileorectal anastomosis were performed. The patient’s condition was stable at the time of discharge from the hospital. The management of metachronous colon volvulus should include surgical intervention. If patients are not diagnosed immediately, their condition may deteriorate dramatically because of bowel infarction or peritonitis. It is essential to highlight this case, as many surgeons may not have attended a transverse colon volvulus after sigmoid volvulus, which might lead to high morbidity or mortality. Overall, metachronous colonic volvulus must be considered in the differential diagnosis of bowel obstruction, particularly in patients with significant risk factors.

Se presenta el caso de un paciente masculino de 55 años sin antecedentes personales patológicos ni quirúrgicos conocidos que acude con cuadro de dolor en flanco y fosa iliaca izquierda de 48 horas de evolución asociado a cambios en los hábitos evacuatorios. En la serie de abdomen agudo se visualizan asas intestinales marcadamente dilatadas. Se le realiza una tomografía de abdomen y pelvis contrastada donde se reconoce marcada dilatación de asas colónicas con la apariencia de frijol (signo del grano de café) condicionando el signo de la superposición hepática. A nivel del tercio proximal del colon sigmoides se identifica cambio abrupto (signo del pico de pájaro) asociado a un aspecto arremolinado del mesenterio (signo del remolino). El paciente es llevado al salón de operaciones donde se le realiza laparotomía exploratoria y sigmoidectomía

Introduction Metastases to the female genital tract from extragenital primary tumors are unusual. We report a rare case of uterine cervix metastasis from colon adenocarcinoma and discuss diagnostic and therapeutic issues. Case report We report a case of a 38-year-old North African Caucasian woman treated for a non-metastatic colon adenocarcinoma. She had a sigmoidectomy and incomplete adjuvant chemotherapy. Six months later, she consulted with vaginal bleeding caused by a cervical tumor, which was confirmed to be metastatic disease, and the patient underwent decompressive and hemostatic radiotherapy. Conclusion Uterine cervix metastasis from primary colon adenocarcinoma is rare. The resection remains the standard protocol for the local treatment of resectable metastatic disease. Otherwise, systemic therapy is the preferable option.

Background: Sigmoid volvulus (SV) is the commonest cause of large bowel obstruction in sub Saharan Africa. However few studies have been done in our country. Our goal was to describe the presentation, management outcome of adult SV and to evaluate our therapeutic methods in a context of non availability of endoscopic decompression.Methods: It was a retrospective, descriptive review of all adult patients, admitted in the visceral surgery department of Hospital Principal of Dakar for SV, from January 2014 to August 2018. We studied demographics variables, clinical and paraclinical features, treatment and outcome. The data were entered and analyzed using Excel 2017 software and Epi-info version 7.2.2.6.Results: We collected 103 cases of SV for 86 patients, representing 45.9% of intestinal obstruction. The mean age was 54.9 years. There were 82 males and 4 females. The mean duration of symptoms was 3.8 days. The triad acute abdominal pain, inability to pass gaz and feces, abdominal meteorism was noted in 52.4%. Plain abdominal X-ray (n=55; 53.3%) showed the classical ‘coffee bean’ sign in 69%. CT scan (n=77; 74.7%) confirmed the diagnosis in 100%. It revealed signs of intestinal gangrene in 8 cases confirmed at laparotomy in 6 cases. In 4 cases imaging was not performed.Detorsion was spontaneous in 2 cases. Faucher rectal tube decompression was performed in 81 cases with a success rate of 86.4% representing 53 patients. Elective sigmoidectomy was realized in 33 patients (31 after successful rectal tube decompression, 2 after spontaneous decompression). After elective sigmoidectomy mortality and morbidity were nil.In those with successful rectal tube decompression, 7 did not have elective sigmoidectomy for comorbidities, 12 refused the elective sigmoidectomy.Emergency surgery was performed in 34 patients: 20 patients for suspicious of complicated SV, 14 patients after failure of rectal tube decompression. It was 9 (26.4%) one stage sigmoidectomy, 24 (70.5%) 2 stage sigmoidectomy, 1 surgical detorsion without pexy. Mortality and mortality after emergency surgery were respectively 8.3% and 14.7%. After 2 stage sigmoidectomy, 86.3% benefited from a restoration of digestive continuity.During the follow-up, no recurrence occurred in patients who were operated. Conclusion: SV is a middle-age man pathology in sub Saharan Africa. In uncomplicated SV rectal tube decompression followed by elective sigmoidectomy is a good option.

Background: Colonic stricture is a feared complication with varied etiology ranging from malignant obstruction to benign diseases. One such condition is recurrent diverticulitis-related strictures. Objectives & Methods: We report a case of a 48-year-old male patient with stricture of the sigmoid colon. The patient refused Sigmoid colon resection. He underwent stent placement and Two weeks later presented with constipation and abdominal discomfort. On Computed Tomography (CT) we discovered stent migration and consequent large bowel obstruction. Patient agreed on undergoing sigmoidectomy with a colostomy. Conclusion: Indication of SEMS for benign lesions remains unclear. Based on the current data, in benign colorectal obstructive lesions, SEMS is a viable option as a bridge to surgery when no other alternative option is available. However, the ASCRS 2020 guidelines did not point to SEMS as an option given the high rate of complications. Our patient was treated with a stent because he refused the resection surgery and found relief for a certain period before developing stent migration. Hence, the patients should be educated about the short and long-term potential effects of stenting before performing the procedure in benign strictures.

Background: Colorectal surgery has gained wide acceptance, especially in the treatment of cancer colon. Several techniques and modifications have been proposed to improve morbidity and mortality associated with left hemicolectomy. Objective: To evaluate the technique of superior rectal artery preservation in sigmoidectomy for sigmoid colon cancer, as regard impact on both radicality and vascularization in the remaining rectum. Patients and Methods: A prospective study had been conducted on Bab El Sharia University Hospital and El-Sahel Teaching Hospital from March 2019 to March 2020. Thirty patients who are posted for sigmoidectomy with preservation of superior rectal artery had been included in the study. Results: That mean of intraoperative blood loss was 35.64 ml and 6.7% of patients have intraoperative bleeding. The mean of harvested lymph nodes was 19.27. One patient needed conversion to open surgery. As regard mean of operation time, it was 190.73 min. Conclusion: Superior rectal artery preservation sigmoidectomy for colon cancer was a beneficial technique guarding against post-operative anastomosing leakage, important oncologic principles as lymph node (LN) metastasis and recurrence should be taken in consideration should be kept in mind before performing that procedure.

Background Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy. Case presentation The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years. Conclusions While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.

Introduction Natural orifice specimen extraction is the next step in minimally invasive colorectal surgery but can be technically challenging, with additional risks, especially for oncologic surgery. For several key reasons, sigmoid volvulus is well suited for natural orifice specimen extraction surgery. We describe our method and experience with double-stapled anastomosis transrectal natural orifice specimen extraction for sigmoid volvulus. Technique Using 3- or 4-port laparoscopy, the mesentery is separated from the long sigmoid loop. After the distal bowel is tied off and washed out, the rectum is completely transected and the proximal bowel delivered transrectally through a wound protector. Proximal transection is performed externally, and the circular stapler anvil is set before the bowel is returned into the abdominal cavity. The rectum stump is closed with an endoscopic linear stapler, and a circular-stapled anastomosis is performed. Results After successful endoscopic decompression, 6 patients underwent elective laparoscopic sigmoidectomy with natural orifice specimen extraction for volvulus at China Medical University Hospital from 2015 to 2020. The median operative time was 179 minutes (range, 151-236 min). No intraoperative complications were encountered. The median postoperative length of stay was 4 days (range, 2-9 d). One patient experienced postoperative small-bowel ileus resulting in readmission. The median follow-up duration was 12 months (range, 2-49 mo). One recurrence of volvulus was recorded 27 months postsurgery. Conclusion Uncomplicated sigmoid volvulus can be treated effectively with sigmoidectomy and natural orifice specimen extraction. Surgeons who attempt this procedure should be well versed with conventional laparoscopy but do not necessarily need to be experienced with natural orifice specimen extraction for successful surgery.

Alpha-fetoprotein (AFP) has been widely used as a tumor marker for detecting hepatocellular carcinoma and yolk sac tumors. Recently, cases of gastrointestinal cancer with elevated serum AFP levels have been reported. However, AFP-producing colon cancer is considered rarer than other AFP-producing gastrointestinal cancers. In this study, we report on a case of a 47-year-old woman who was diagnosed with sigmoid colon cancer and underwent sigmoidectomy and lymph node dissection. Postoperative adjuvant chemotherapy (AC) was performed after the curative surgery. After the seventh course of AC, multiple liver masses and enlarged systemic lymph nodes were detected; these were later diagnosed as liver metastases from sigmoid colon cancer. Laboratory examination revealed high AFP levels (14,657.8 ng/mL). After confirming the recurrence, her condition worsened rapidly, and she eventually died 8 months after the operation. Autopsy and histopathological findings showed that the liver mass was positive for AFP staining, but the sigmoid colon cancer tissue was not. We then determined that liver metastases of the colon cancer were more likely than germ cell carcinoma according to the clinical course and pathological findings. We assumed that colon cancer cells can rapidly expand by dedifferentiation, and we diagnosed AFP-producing colon cancer with liver metastases. Despite curative surgery and AC for AFP-producing colon cancer, the patient died of liver and systemic lymph node metastases.

Background An accurate diagnosis of the primary cancer or metastatic tumor is quite important because misdiagnosis may lead to the selection of incorrect adjuvant therapy and worse long-term outcomes after surgery. Here, we present a rare case with an unusual metastatic pattern mimicking a hilar cholangiocarcinoma originated from colon cancer Case presentation A 69-year-old man was referred to our hospital because of an upper bile duct stenosis. He had the past history of the sigmoidectomy for the primary colon cancer and the partial hepatectomy with radiofrequency ablation (RFA) for synchronous liver metastases 4 years ago. After 2 years from the initial operation, he had experienced the local recurrence of post-RFA lesion and had undergone a partial hepatectomy. According to the radiological findings of the bile duct stenosis, we diagnosed a hilar cholangiocarcinoma (Bismuth type II), and then he underwent the extended right hepatectomy with extrahepatic bile duct resection. Histological findings including the immune-histochemical examinations (CK7−, CK20+, CDX2+ and SATB2+) uncovered the metastatic tumor into extrahepatic bile duct originated from the primary colon cancer. Conclusion We experienced an extremely rare case with a colon cancer metastasis mimicking a hilar cholangiocarcinoma. In this case with a past history of colon cancer, an immunohistochemical staining led us to distinguish the primary hilar cholangiocarcinoma and the mimicking tumor.

We present the case of a diabetic patient on treatment with acarbose who had presented a sigmoid volvulus with localized cystic pneumatosis of the sigmoid colon. A 72-year-old patient with a medical history of atrial fibrillation, DNID in treatment since 10 years by acarbose. The patient was admitted to the emergency for abdominal pain and occlusive syndrome since 48 h without fever or nausea or vomiting. A CT scan was performed that showed a dolichocolon with a sigmoid volvulus. The colonic wall was thickening as well as submucosal and subserosal gas, without extra digestive air or collections. A rectosigmoidoscopy was achieving that showed a sigmoid volvulus with multiple small projections like a submucosa gas bubbles. A laparoscopic non-oncologic sigmoidectomy with primary termino terminal colorectal anastomosis was performed. During the surgical procedure, an aspect of PCI of the sigmoid colon was found. The sigmoid colon was long like a dolichocolon, dilated, and partially twisted. PCI is a rare condition characterized by the presence of multiple pneumokystes at different layers of the colonic wall. In emergency setting, the presence of colonic pneumatosis precludes the differential diagnosis between the PCI and mesenteric ischemia or ischemic colitis. It can be the cause of unnecessary explorative laparotomy. PCI is rare disease, in emergency setting, we had to consider in differential diagnosis with colonic vascular disorders.

Sigmoid volvulus is an uncommon cause of abdominal pain and obstruction in the pediatric population, with most physicians not considering it in the differential diagnosis. History of Autism Spectrum Disorder (ASD) with concomitant volvulus of the sigmoid colon is a rare occurrence that presents with communication challenges that can impair diagnosis and treatment. This is the case of a 10-year-old male patient with ASD who presented with abdominal pain, obstipation, and vomiting. Plain abdominal radiograph showed an intestinal obstructive pattern subjective for sigmoid volvulus. The patient was successfully decompressed with a nasogastric and rectal tube and underwent an open sigmoidectomy with end-to-end coloproctostomy during the same admission. Communication impairment made it difficult to assess subjective parameters such as pain, and nausea. On post-operative day #8 extensive pneumoperitoneum was observed on a chest radiograph and the patient was taken for emergency laparotomy that resulted in a partial colectomy with end colostomy. Sigmoid volvulus is an exceptionally rare occurrence in the pediatric population. High suspicion should be kept for prompt diagnosis and treatment in patients with ASD. Particular attention to objective information such as physical examination, vital signs, laboratories, and imaging studies should be maintained since communication is usually impaired.

Introduction Intrabiliary growth of colorectal liver metastasis determines their capability of dissemination and relapse. Case report 65-year-old woman underwent sigmoidectomy (2011) and left hepatectomy due to liver metastases affecting the bile tract (2014). In 2020 she developed a 2cm tumour in the union of both hepatic ducts. Cholangiocarcinoma was suspected so resection of the main bile duct, the caudate lobe and lymphadenectomy were performed. On immunohistochemical examination, colorectal liver metastasis was confirmed. Conclusions Liver metastases should be considered as the most likely diagnosis when bile duct dilatation or intrabiliary growth is seen in patients with a history of colorectal cancer.

Although the implantation of urothelial carcinoma from the upper urinary tract to the bladder occurs frequently, the involvement of cancers of other histologic types is rare. Here, we present an unusual case of intravesical recurrence, following ureteral invasion, by colorectal cancer. A 69-year-old woman developed a local recurrence of colorectal cancer involving the sigmoid colon and left ureter. The patient underwent a sigmoidectomy and left nephroureterectomy. Six months later, bladder tumors were observed, and a transurethral resection was performed. Histological examination of the bladder tumors revealed adenocarcinoma consistent with the findings of the colorectal cancer that had been previously resected. The most probable mechanism of intravesical recurrence would be the implantation of colorectal cancer cells from the upper urinary tract to the bladder via urine.

Informed by our experiences with reduced-port surgery for colorectal cancer, we performed the first single-incision plus two-port robotic sigmoidectomy for cancer with the Senhance robotic system. A 70-year-old woman presented to our department for the treatment of sigmoid colon cancer. We performed single-incision two-port robotic sigmoidectomy. A wound protector was inserted through a 3.0-cm transumbilical incision, a multiport access device was mounted on top of it, and then a camera port and a 5-mm assistant's port were placed in the multiport access device. Two extra ports were placed on the central line of the abdomen. Lymph node dissection around the inferior mesenteric artery and mobilization of the left-sided colon were completed without any perioperative complications. The total operative time was 204 minutes, and the console time was 113 minutes. The estimated blood loss was 75 mL. The patient was discharged on postoperative day 8 without any complications.

Introduction: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. Methodology: The study was conducted in the surgery “A” department of the Teaching Hospital of Point G in Bamako. The study is retrospective and descriptive, over 5 years, ranging from January 2014 to December 2018. We conducted a comprehensive recruitment of all patients operated on for sigmoid volvulus during the study period. The only criterion for inclusion was patients operated on for volvulus of the sigmoid colon in the surgery “A” department of the Point G Hospital and the non-inclusion criteria were all patients operated on for other sigmoid pathologies without volvulation and patients operated on for other types of occlusions. Result: We conducted an exhaustive recruitment of 55 patients operated on for sigmoid volvulus during the study period. Sigmoid volvulus accounted for 13.75% of intestinal obstructions. The average age of patients was 48.013 ± 18.042 years with extremes of 24 years and 82 years. The age group 40 - 49 was the most represented at 21.8%. The sex ratio (M/F) was 8 in favour of male sex. The duration of the disease was less than 1-day in 50.94% of patients. There were two cases of ileo-sigmoid nodes. Immediate anastomosis resection was performed in 27 patients or 49.2% of cases. The time to restore continuity when specified was between 60 - 90 days and the median incision was the most common route of recovery at 80.8% of cases. The average length of hospitalization was 9 days with extremes of 2 days and 42 days. The morbidity rate was 7.3%. In our study we had 3 deaths or 5.5% of the cases. Conclusion: The volvulus of the sigmoid colon is the twist of the sigmoid handle on its mesocolic axis, achieving a low occlusion by strangulation. The volvulus of sigmoid is a serious surgical emergency that requires early diagnosis and management. In Mali, there is no validated consensus for the choice between immediate anastomosis resection if possible and multi-stage surgery. The purpose of this study is to evaluate the different surgical approaches carried out in the surgery “A” department of the Point G Hospital.

Resumen Introducción: En la endometriosis el compromiso intestinal afecta hasta al 12% de las pacientes, comprometiendo al recto y a la unión rectosigmoidea en el 90% de los casos. Objetivo: Describir la experiencia del equipo de Coloproctología y Ginecología de Clínica Alemana de Santiago en el tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal. Material y Métodos: Estudio retrospectivo a partir de la base de datos de pacientes con endometriosis tratados entre enero del año 2015 y abril de 2018. Los criterios de inclusión fueron pacientes con clínica de endometriosis pélvica profunda, que tuviesen compromiso colorrectal y hayan sido tratados con shaving rectal, resección discoide o resección segmentaria. Se revisaron fichas clínicas electrónicas, protocolos operatorios y biopsias definitivas. Resultados: Se reclutaron 25 pacientes con una mediana de edad de 35 años. El síntoma principal de consulta fue dismenorrea y el síntoma digestivo más frecuente fue disquecia. En 8 pacientes se realizó un shaving rectal, en 7 una sigmoidectomía, en 9 una resección discoide y en 1 paciente una tiflectomía. La complicación posoperatoria reportada fue la hemorragia digestiva baja en 4 pacientes (Clavien-Dindo I y IIIa). Con una mediana de seguimiento de 13 meses, a la fecha 3 pacientes se les ha diagnosticado algún tipo de recidiva. Conclusión: Es importante que la cirugía a realizar, garantice una morbilidad y recurrencia baja. Los resultados en nuestro centro son alentadores, lo que nos hace creer que el tratamiento quirúrgico podría ser una buena alternativa en la endometriosis pélvica profunda con compromiso colorrectal.

We report the case of a 65-year-old male with a metachronous abdominal wall metastasis secondary to colorectal cancer. The patient had presented 5 years ago to another facility with a perforated sigmoid colon cancer (pT4a[SE], N0, M0, pStage II), rectal cancer (T2[MP], N0, M0, pStage I), and Fournier gangrene. He had then undergone sigmoidectomy and rectal resection along with S-1 adjuvant chemotherapy. No relapse was observed thereafter. However, currently, 5 years after initial surgery, the patient noticed a palpable mass in the left lower abdomen and was referred to our hospital for further assessment and treatment. Percutaneous echo-guided needle biopsy of the tumor revealed an adenocarcinoma tissue. Following 6 courses of FOLFOX plus cetuximab chemotherapy, laparoscopic resection for abdominal wall metastasis was successfully performed. The resected tissue was pathologically characterized as adenocarcinoma, which was compatible with the recurrence of the primary colorectal carcinoma resected 5 years ago. The abdominal wall metastasis was attributed to the cancer cell implantation secondary to the perforated sigmoid colon cancer treated 5 years ago.

Background Metastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma. Case presentation A 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB. Conclusion This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.

Injury to the inferior epigastric artery is infrequent and iatrogenic in most cases, which can be fatal and life-threatening in some cases due to unnoticed excessive hemorrhage. We present a 23-year-old male who underwent sigmoidectomy, end-to-end colorectal anastomosis with covering loop ileostomy for sigmoid volvulus. He developed intra-abdominal pus collection one week following surgery, for which ultrasound-guided aspiration was attempted. Post aspiration, the patient developed abdominal distension, pain with a significant drop in hemoglobin. Imaging showed active bleed from the branch of the inferior epigastric artery with massive intra-abdominal hematoma. The hematoma was evacuated, and the bleeding artery was identified and ligated. Postoperatively, there was no further drop in hemoglobin, and the patient was stable and hence discharged.

Introducción: Aunque está descrito el tratamiento simultáneo de defectos de la pared abdominal asociado a cirugía visceral (colecistectomía, resección intestinal, reconstrucción de Hartmann), sin embargo, no está documentado el tratamiento simultáneo de una neoplasia de colon asociado a defecto complejo de la pared abdominal. Reporte del caso: Presentamos el caso de una mujer de 64 años, con obesidad mórbida y dos hernias de larga evolución, no tratadas previamente, que fue diagnosticada de Neoplasia de colon. Tras la valoración multidisciplinar del caso se inició optimización de las comorbilidades y dada la complejidad de la patología herniaria se realizó preparación preoperatoria con: Toxina botulínica en la pared abdominal y neumoperitoneo progresivo preoperatorio. Posteriormente, se realizó intervención quirúrgica: sigmoidectomía y reparación con malla de poliporpileno del defecto de la pared abdominal El curso postoperatorio fue favorable y fue dada de alta al 7mo día postoperatorio. A las 48hrs del alta, reacudió a urgencias por fiebre que se atribuyó a infección de seroma subcutáneo que se trató con antibióticos evolucionando favorablemente. El resultado definitivo de Anatomía patológica fue Adenocarcinoma, tipo intestinal, moderadamente diferenciado, pT2 N0 (0/21), sin signos de mal pronóstico. Actualmente, la paciente se encuentra libre de enfermedad neoplásica y sin recidiva herniaria. Discusión: Consideramos que mediante un manejo multidisciplinar, optimización y preparación previa del paciente es posible realizar una intervención quirúrgica de colon y reparación de patología de la pared abdominal, en un solo tiempo, con éxito y baja morbilidad.

Background: Constipation is the most common childhood condition occurring in about 3% of children. Patients who have intractable idiopathic or functional constipation (FC) with pseudo encopresis that is unresponsive to bowel management program with no underlying organic cause constitutes a serious medicosocial problem in the pediatric age group. Objective: Evaluation of effectiveness of sigmoidectomy with partial proctectomy in solving the problem of intractable idiopathic constipation in children with megarectosigmoid. Patient and Methods: This was a Prospective case series study for evaluation of the effect of sigmoid resection with partial proctectomy in improving children with intractable idiopathic constipation with megarectosigmoid. The study was conducted on 20 patients. That was selected from more than 250 of idiopathic constipation children. All patients were operated at the Pediatric Surgery Department, Al-Azhar University Hospitals. The study was of 30 months duration(Feb 2018-July 2020). We used Rome III criteria and Pediatric Incontinence Constipation Score to evaluate constipation and incontinence pre and post operatively. Detailed history taking, clinical examination(including rectal examination) and investigations(including laboratory tests, radiologic examinations, rectal biopsy). Results: The study included 20 patients, 7 females and 13 males. Patients ages ranged from 4-13 years(mean=7.2). Constipation was the main complain in all patients followed by soiling. Sigmoidectomy with partial proctectomy recorded 90% success in improving constipation and consequently soiling; the results of Sigmoidectomy without partial proctectomy was disappointing. Conclusion: Rectosigmoidectomy is the best surgical management for the children suffering from intractable functional constipation with Megarectosigmoid, Partial removal of the rectum is very crucial in improving results.

Background: In the conventional radical treatment of sigmoid colonic cancer, the ligation of root of inferior mesenteric artery is performed to verify harvesting of D2 and D3 lymph nodes (I.e. intermediate and central lymph node groups) and improve the surgical prognosis. IMA ligation may compromise the blood supply at site of anastomosis and risk injury of autonomic nerve plexus, so preservation of superior rectal artery (SRA) may lead to increase blood flow and decrease postoperative bowel complications. Aim of the study: evaluation of SRA preservation in open sigmoidectomy for sigmoid colon cancer as regard impact on both radicality and vascularization in the remaining rectum. Patients and Methods: In this prospective study we do open radical sigmoidectomy on (30 patients) with preservation of SRA for sigmoid colonic cancer to preserve blood supply to the anastomotic site. In the operation, we dissect the trunk of IMA and lymphatic tissue around is dissected out with the tumor. Results: Lymph nodes harvested 15.2, hospital stay average 8 days (7 d-15 d). There was one case of Post operative leak treated conservatively. There were 5 cases complicated of wound infection treated by antibiotics and daily dressings. Recurrence rate (0%), mean follow up time 18 months. Conclusion: SRA can be preserved. Although the operation time is slightly increased, but dissected out lymph nodes are comparable with IMA high ligation surgery. Preservation of the SRA seems to be associated with lowering incidence of anastomotic leakage in sigmoid colonic cancer surgery

Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

At present, with the increasing incidence of colorectal cancer, the incidence and diagnosis rates of multiple primary colorectal cancer (MPCRC) are also increasing. Patients with right colon cancer complicated with sigmoid colon cancer need to receive radical resection for both right colon cancer and sigmoid colon cancer, which involve many organs. In addition, since the right colon has many adjacent organs, complicated vasculature, and high incidence of anatomical variations, this procedure is a very difficult technique in NOSES. When NOSES is performed in the right colon alone, the vagina is the preferred route of specimen extraction. When the patient is complicated with cancer in other parts of the colon, the specimen can be extracted along with the right colon specimen through the vagina. The main operating features of right colon cancer resection include complete dissection and transection of the right hemicolon in the abdominal cavity, totally laparoscopic functional end-to-end anastomosis between the terminal ileum and transverse colon, and transvaginal specimen extraction. The specimen extraction methods for sigmoid colon resection vary based on the different tumor sizes, but the principles of CME should be strictly followed. Anatomy and dissection should be performed at the correct operating plane, which is a prerequisite for the rapid and safe operation. The operating difficulties of this procedure mainly involve three aspects. Firstly, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesentery resection, ligation of vessels at the root of the mesentery and dissection of lymph nodes, and the exposure and protection of important tissues and organs. Secondly, the technical difficulty of NOSES in the right colon cancer and sigmoid colon cancer is totally laparoscopic digestive tract reconstruction for twice, which is more difficult than other procedures. Thirdly, this procedure requires surgeons and assistants to have better cooperation. In the process of specimen extraction, the precise application of aseptic and tumor-free techniques is crucial.

Barbara H Johnson,1 Pragya Rai,1 Se Ryeong Jang,2 Stephen S Johnston,1 Brian Po-Han Chen3 1Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA; 2College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA; 3Health Economics and Market Access, Ethicon Inc., Somerville, NJ, USACorrespondence: Stephen S JohnstonMedical Device Epidemiology and Real-World Data Analytics and Research, Johnson & Johnson, New Brunswick, NJ, 08901, USAEmail sjohn147@its.jnj.comPurpose: Open colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon’s STRATAFIXTM Symmetric PDSTM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery.Methods: Retrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015–September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective.Results: The overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions.Conclusion: The rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.Keywords: open colorectal surgery, barbed sutures, sigmoidectomy, surgical site infections, wound dehiscence

Background Although a larger proportion of colorectal surgeries have been performed laparoscopically in the last few years, a steep learning curve prevents us from considering laparoscopic colorectal surgery as the gold standard technique for treating disease entities in the colon and rectum. The purpose of this single centre study was to determine, using various parameters and following a well-structured and standardized surgical procedure, the adequate number of cases after which a single surgeon qualified in open surgery but with no previous experience in laparoscopic colorectal surgery and without supervision, can acquire proficiency in this technique. Methods From 2012 to 2019, 112 patients with pathology in the rectum and colon underwent laparoscopic colorectal resection by a team led by the same surgeon. The patients were divided into two groups (group A:50 – group B:62) and their case records and histopathology reports were examined for predefined parameters, statistically analysed and compared between groups. Results There was no significant difference between groups in the distribution of conversions (p = 0.635) and complications (p = 0.637). Patients in both groups underwent surgery for the same median number of lymph nodes (p = 0.145) and stayed the same number of days in the hospital (p = 0.109). A statistically important difference was found in operation duration both for the total (p = 0.006) and for each different type of colectomy (sigmoidectomy: p = 0.026, right colectomy: p = 0.013, extralevator abdominoperineal resection: p = 0.050, low anterior resection: p = 0.083). Conclusions Taking into consideration all the parameters, it is our belief that a surgeon acquires proficiency in laparoscopic colorectal surgery after performing at least 50 diverse cases with a well structured and standardized surgical procedure.

Intestinal tuberculosis is a frequent disease in developing countries, causing considerable morbidity and mortality. However, tuberculosis of the colon is rarer, and it also appears to be more common in immunosuppressed patients. We report the case of a 71-year-old immunocompetent man who was admitted to the emergency department with an acute abdomen and features of perforation peritonitis. A sigmoid perforation on cancer was suspected on computed tomography (CT) scan and surgical exploration. A standard sigmoidectomy with end colostomy (Hartmann's procedure) and peritoneal toileting was done. The pathological assessment of the surgical specimen revealed the sigmoid colon tuberculosis, complicated by perforation and peritonitis. Thus, the unexpected diagnosis of sigmoid colon tuberculosis was only made after the histopathological examination. Then, he received anti-tuberculosis treatment for six months. Therefore, a complete colonoscopy was performed at the end of the treatment, which returned to be normal. Thereafter, the restoration of intestinal continuity was performed. Colon tuberculosis is a rare disease and even rarer in people without immunodeficiency or on immunosuppressive therapy. If diverticulitis is the most common cause of sigmoid perforation, sigmoid perforation because of tuberculosis is extremely rare. However, an isolated primary sigmoid perforation of tubercular origin is not reported. We report this exceptional case of sigmoid colon tuberculosis complicated by perforation and generalized peritonitis to sensitize the medical team to its rare occurrence, which will be of paramount importance due to the increasing incidence of tuberculosis worldwide.

We report the case of a 71-year-old man who complained of abdominal distension, pedal edema, respiratory discomfort, and weight gain. Computed tomography revealed a giant, poorly enhancing tumor occupying the entire abdomen, with abdominal ascites. The tumor was causing hydronephrosis, compression of the inferior vena cava, and elevation of the diaphragm. The patient exhibited deterioration of performance status (PS3 on the ECOG scale) and required oxygen; therefore, emergency surgery was performed. Operative findings included bloody abdominal ascites and peritoneal dissemination. The large tumor arose from the small bowel mesentery, and infiltrated into the cecum and sigmoid colon. Tumor excision with ileocecal resection and sigmoidectomy was performed. Histopathological examination revealed dedifferentiated liposarcoma. The patient was discharged on postoperative day 22, but pre-discharge CT revealed a recurrent liposarcoma in the retroperitoneum. Therefore, chemotherapy was initiated and the treatment has been continued for over 6 months after surgery. Due to the rarity of this disease, there is no consensus regarding treatment strategies for DDLPS with peritoneal dissemination or in patients with a poor general condition, especially in the setting of oncologic emergency. In this case, multimodal treatment was used to successfully manage this life-threatening state and obtain satisfactory therapeutic results.

Background/aim Right ventricular cardiac metastasis from colorectal cancer (CRC) is rare and clinically silent. There is no standardised treatment. To date, only twelve cases have been reported in the literature. This is a case report and literature review of right ventricular cardiac metastasis from CRC. Case report A 75-year-old woman with a history of CRC treated with sigmoidectomy followed by liver and lung metastasectomy presented with a right ventricle tumour. Biopsy showed metastatic adenocarcinoma not suitable for resection because multiple lung metastases coexisted. The metastases were controlled for a prolonged duration by chemotherapy with capecitabine plus bevacizumab. According to the review of 13 cases, the median age of metastatic CRC that involves the right ventricle is 71 years and the primary site is half the colon and rectum. Half of cases have non-cardiac metastases at cardiac metastasis diagnosis. Chemotherapy is more suitable than resection in cases with metastases other than heart because resection of the right ventricle has a high risk. Conclusion Cardiac right ventricular metastasis from CRC can be controlled by capecitabine plus bevacizumab.

Objectives Colonic diverticular disease is widespread in Western countries and its associated with aging. In Japan, diverticulitis and colovesical fistula are also occurring more frequently. Colonic resection for diverticula-related fistulas is frequently technically demanding because of associated acute or chronic inflammation. We evaluated the safety and efficacy of a standardized laparoscopic procedure. Methods Data from 39 consecutive patients who had undergone laparoscopic surgery for colovesical fistula between October 2006 and August 2017 were retrospectively reviewed. Results The patients' median age was 60 years and comprised 35 men and four women. Sigmoidectomy was performed in 33 patients, Hartmann's procedure in four, and anterior resection in two. The median operative time was 203 minutes and estimated blood loss 15 mL. There were no intraoperative complications or conversion to open surgery. No patients required bladder repair; three had minor postoperative complications, and none had recurrent diverticulitis or fistula at a mean follow-up of 5.1 years. Conclusions The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.

Background Intestinal endometriosis is rare and most frequently involves the rectum and sigmoid colon. Case presentation Here, we report a case series of 5 patients who underwent laparoscopic resection for intestinal endometriosis. None of the patients developed postoperative complications, and all were discharged at 5–8 days after surgery. The diagnosis of intestinal endometriosis is difficult to obtain before surgery. Only 2 of 5 patients were diagnosed preoperatively. Among 1 of the 2 patients, the symptoms at the time of menstruation were obvious. In patients with submucosal tumors, the preoperative diagnosis can be difficult. Additional imaging examinations at the time of menstruation might be useful for obtaining a diagnosis. D2 dissections were performed for 3 patients, because malignancy could not be ruled out as a preoperative diagnosis. The surgical findings of 1 patient did not appear to be endometriosis. Surgery for intestinal endometriosis usually encounters advanced pelvic adhesions and fibrosis. For patients undergoing sigmoidectomy, the mean operative time was 152 min and mean blood loss was 10 mL. For patients undergoing rectal resection, the mean operative time was 282 min and mean blood loss was 17 mL. Two cases had severe pelvic adhesions, and the residual rectum could not be straightened. Therefore, side-to-side anastomosis was performed. For intestinal endometriosis surgery, flexible planning for the anastomosis method used for residual intestine should be undertaken. Conclusion Laparoscopic surgery for intestinal endometriosis was safe but technically difficult, because of fibrosis and adhesions. An accurate diagnosis should be attempted based on the clinical symptoms, imaging findings, and intraoperative findings. The method used for anastomosis should be decided on a case-by-case basis.

Highlights • Postsurgical necrobiotic granulomas of the bowel present a diagnostic challenge. • Granulomas with “active” necrobiosis can occur as late as 3 years after colon cancer surgery. • Postsurgical necrobiotic granulomas of the bowel can be a serious diagnostic pitfall., Introduction Postsurgical necrobiotic granulomas present a diagnostic challenge and have been described in organs such as the urinary bladder, prostate, and uterus. However, occurrence of these granulomas is rare in the bowel. Presentation of the case In this report, we present the case of a 28-year-old woman with recurrent multifocal colonic adenocarcinoma 3 years after sigmoidectomy. Intraoperatively, the ileum was suspicious for tumor deposits. Total colectomy with segmental small bowel resection was performed, and the histopathological findings of the small bowel specimen were consistent with necrobiotic granulomas with no evidence of malignancy. Infectious disease workup was negative. The patient was administered adjuvant chemotherapy and had no negative outcomes at 8 months after the surgery. Discussion This is a rare and challenging case of postsurgical necrobiotic granulomas of the bowel. Conclusion Granulomas with “active” necrobiosis can occur as late as 3 years after colon cancer surgery and can be a diagnostic pitfall that significantly affects the management.

Mesh migration and penetration into abdominal viscera rarely occur after laparoscopic inguinal hernia repair. We present the first case of mesh migration into the sigmoid colon identified as a colonic polyp at initial colonoscopic examination. The patient complained of mild abdominal distention in the lower abdomen over the previous year without changes in bowel habits or stool appearance and without weight loss. By complementary endoscopic ultrasonography, a cavity-like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely revealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra-abdominal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh material were diagnosed based on histological examination of the surgical specimen after sigmoidectomy. In this patient, nonspecific endoscopic and imaging outcomes during clinical work-up led to the diagnostic dilemma of mesh migration. Therefore, the clinical, radiological and endoscopic challenges specific to this case as well as the underlying reasons for mesh migration are discussed in detail.

Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction. A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail. Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay. Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.

Giant colonic diverticula are uncommon in all age groups and are especially rare within the pediatric population, with only one known previously reported case in a child. In this case presentation, we report a rare case of a pediatric GCD, review relevant epidemiology and histology, and discuss diagnostic and treatment options. The patient was an 11-year old female with worsening chronic constipation, abdominal pain, and vomiting. CT found a large pelvic mass that was removed via sigmoidectomy and found to be a Type 3 (true diverticula) GCD, which make up only 12% of all GCD's. Pediatric GCD's can be mistaken for the much more common enteric duplication cyst, but both pathologies require surgery. Because of the uncommon nature of GCD, the authors recommend CT as the diagnostic modality of choice because of its high sensitivity and ability to aid in preoperative planning. The authors also recommend treating pediatric GCD with segmental colectomy to avoid recurrence and even a remote risk of colonic adenocarcinoma.

Malakoplakia is a rare granulomatous disease of the genitourinary system. Gastrointestinal tract is the second most common site of involvement. It usually mimics a malignancy but its association with adenocarcinoma has been rarely reported. A 59-year-old male patient with the history of weight loss and rectal bleeding for two months prior to administration was referred to our hospital. Pre-operative CT scan revealed a large sigmoid colon mass with the extension and invasion to the serosal surface as well as multiple regional metastatic lymph nodes. The patient underwent sigmoidectomy with the primary pathologic diagnosis of adenocarcinoma. Pathologic examination revealed a moderately differentiated adenocarcinoma invading peri-colic adipose tissue and inflammatory reaction compatible with malakoplakia at the invasive borders of the tumor with the extension to the serosal surface. In the patients with gastrointestinal malakoplakia, the presence of possible adjacent malignancy should be screened. The possibility of over-staging should also be considered for adenocarcinoma cases in association with malakoplakia.

Primary Leiomyosarcoma of the seminal vesicle is a very rare condition. We report a case of a 74-year-old man with a tumour detected by rectal symptoms with pelvic pain and dysuria at ultrasonography. Computed tomography and magnetic resonance imaging suggest an origin in the left seminal vesicle and did not show a clear cleavage plan with the rectum and a right hydroureteronephrosis was also present. A radical vesiculo-cystoprostatectomy with ileal conduit and bilateral pelvic lymphadenectomy was performed, a sigmoidectomy with end colostomy was performed also. Pathological examination showed a high grade (G3) leiomyosarcoma of the seminal vesicle.

Introduction Curative resection generally has a good prognosis if the tumor is a locally advanced colorectal tumor. However, resection of a primary tumor that has invaded the aortoiliac artery is controversial. Herein, we report a case of successful resection of advanced cecal cancer invading the external iliac artery. Case report A 29-year-old male patient had advanced cecal cancer invading the right external iliac artery and vein, right ureter, iliopsoas muscle, and sigmoid colon. We collected the patient's pre-/intra-/postoperative, clinical, and histological data. We reviewed the factors that may have contributed to curative resection without complications. We performed a palliative terminal ileum-sigmoid anastomosis for the prevention of intestinal obstruction. The patient received neoadjuvant chemotherapy, and the tumor patently regressed. After arterial reconstruction was performed with a femoral-femoral bypass, we performed radical resection: right hemicolectomy; partial sigmoidectomy; and partial resection of the right ureter, iliopsoas muscle, right testicular, and external iliac vessels. Pathologically, 99% of the tumor cells disappeared after chemotherapy. The patient was discharged on postoperative day 9. No recurrence has been noted 24 months after surgical resection, and the patient is receiving adjuvant chemotherapy. Conclusions Thus, we successfully resected advanced cecal cancer without complications. Reconstruction with femoral-femoral arterial bypass and neoadjuvant chemotherapy are useful methods for curative resection without complications., Highlights • Our patient had advanced caecal cancer invading the external iliac artery. • We performed reconstruction with femoral-femoral arterial bypass. • The patient underwent neoadjuvant chemotherapy. • We successfully resected the advanced caecal cancer without complications.

In 7 years, we brought together 100 cases of volvulus of the colon sigmoid to the hospital Somine Dolo of Mopti among which the handle volvule was found without necrosis in 66 cases and necrosis 34 cases. Seventy-six patients benefited from a sigmoidectomy followed by a colorectal anatomize at a time, twenty one patients of an intervention of Hartmann. A surgical distortion was realized at 3 patients. All the patients operated by these last two techniques had a restoring of the digestive continuity for an average deadline of 90 days. The post-operative complications consisted of 11 cases of parietal suppuration and a case of evisceration. The average duration of follow-up was of 210 days. The post-operative mortality was 14%. It was about a state of toxic shock with visceral multi-failure (n = 13), and of a pulmonary embolism (n = 1). The treatment of the volvulus requires a fast diagnostic and therapeutic coverage. The best treatment consists of a resection of the sigmoid as a matter of urgency followed by an immediate anastomosis if the following conditions are carried achieved: state general voucher, experimented surgeon and if the resuscitation meadow, per and post-operative can be assured.

Background: The prognostic significance of identifying lymph node metastasis in cancer colon and rectum is of great importance. There is an association between the number of lymph nodes in the resection specimen and survival particularly in node negative cancer. Aim: This study aims at comparing the number of lymph nodes harvested in open and laparoscopic colorectal surgery for colorectal cancer. Patients and methods: This is a prospective study involving 40 patients with left sided colonic cancer and rectal cancer. The patients were divided into equal 4 groups: Group (1A): patients who underwent open left hemicolectomy or sigmoidectomy Group (1B): Patients who underwent laparoscopic left hemicolectomy or sigmoidectomy Group (2A): Patients who underwent open anterior or low anterior resection Group (2B): Patients who underwent laparoscopic anterior or low anterior resection Histopathological examination of the retrieved specimens and assessment of the number of lymph nodes was done. Data was compared among different groups. Results: In laparoscopic procedures, more lymph nodes were retrieved than in open surgery with statistically significant difference (p-value 0.019). The mean SD of number of lymph nodes retrieved was 14 in the laparoscopic group versus 10.5 in the open group. Conclusion: Laparoscopic resection of left sided colorectal cancer yields adequate samples of lymph nodes number that are comparable to those obtained by open surgery.

A 78-year-old man with a history of open sigmoidectomy for sigmoid cancer presented with abdominal pain and vomiting. Abdominal multi-detector CT revealed an obstructive ileocecal tumor with distended small bowel on the oral side. We performed emergency drainage using a transnasal decompression tube, and 2 days later, we conducted a colonoscopic examination, which lead to a provisional diagnosis of obstruction with a malignant tumor invading the ileocecal valve. We then placed a self-expanding metallic stent (SEMS) through the ileocecal valve. We confirmed patency of the ileocecal valve and removed the transnasal decompression tube 2 days after SEMS placement. We then performed elective laparoscopic colectomy 8 days after SEMS placement. To the best of our knowledge, there has been only one previous report of laparoscopic colectomy after decompression with SEMS placement through the ileocecal valve for right-sided malignant colonic obstruction.

Background The role of surgery in treating children with functional constipation (FC) is controversial, because of the efficacy of bowel management programs. This case series is comprised of failures: 43 children, spanning 25 years' practice, who had megarectosigmoid (MRS) and unremitting constipation. Purpose To determine whether these children were helped by surgery, and to contribute to formulating a standard of care for children with megarectum (MR) and/or redundancy of the sigmoid colon (MS) who fail medical management. Method We describe our selection criteria and the procedures we utilized – mucosal proctectomy and endorectal pull-through (MP) or sigmoidectomy (SE) with colorectal anastomosis at the peritoneal reflection. The internet (social media) allowed us to contact most of these patients and obtain extremely long follow-up data. Results 30/43 patients had MP and 13/43 had SE. Follow-up was obtained in 83% MP and 70% SE patients. 60% of MP and 78% of SE patients reported regular evacuations and no soiling. 20% MP patients had occasional urgency or soiling or episodic constipation. 12% MP and 22% SE patients required antegrade continence enemas (ACE) or scheduled cathartics and/or stool softeners. 4% MP had no appreciable benefit, frequent loose stools and soiling, presumably from encopresis. Conclusion MR is characterized by diminished sensation, poor compliance and defective contractility. Patients with MR do better with MP, which effectively removes the entire rectum versus SE, where normal caliber colon is anastomosed to MR at the peritoneal reflection; furthermore, MP reliably preserves continence; whereas total proctectomy (trans-anal or trans-abdominal) may cause incontinence., Highlights • Intestinal peristalsis stagnates in a dilated segment. • Megarectosigmoid (MRS) may present during infancy or later in life. • It may occur in association with anorectal malformations or as an isolated abnormality. • Unlike dilatation secondary to outlet dysfunction, MRS persists even after a diverting colostomy. • MRS does not respond to bowel management programs. • Intestinal peristalsis improves following extirpation of MRS.

Endometriosis can affect any portion of the gastrointestinal tract. A preoperative definitive diagnosis of intestinal endometriosis is difficult, because there is no characteristic endoscopic finding and the endoscopic biopsies usually sample insufficient endometrial tissue for pathologic diagnosis. To our knowledge, the magnifying endoscopic features of intestinal mucosal endometriosis have not been well documented. In this study, we report a case of intestinal endometriosis diagnosed preoperatively by magnifying image-enhanced colonoscopy and target biopsy. A 45-year-old woman was referred to our hospital with abdominal pain in the left lower quadrant. Colonoscopy showed a submucosal tumor-like lesion of approximately 30 mm in diameter exhibiting surface reddening and granular changes in the sigmoid colon. Magnifying endoscopy revealed sparsely distributed round pits in the granules. The mucosal biopsy specimen from the granule provided the diagnosis of intestinal endometriosis. Segmental sigmoidectomy was performed, and pathological examination revealed that the surface colonic mucosa was partially replaced by endometrial tissue, which accounted for the granular change detected in the colonoscopy. It can be speculated that the round pit might reflect the endometrial glands surrounded by endometrial stroma. This case illustrated the characteristic finding and utility of magnifying endoscopy for mucosal intestinal endometriosis.

Highlights • The increased screening results in more pick up multiple primary tumors and that they are being reported more. • Diagnosis and treatment of multiple primary tumors is usually difficult. • A cancer board can be useful for this process., Introduction Multiple primary neoplasms are relatively rare, but their incidence has increased because of aging and improvements in diagnostic imaging. Presentation of case A 67-year-old man presented with epigastric pain. On upper gastrointestinal endoscopy, an ulcer was seen at the gastric angle, and biopsy showed moderately differentiated adenocarcinoma (AC). Colonoscopy demonstrated a 15-mm lesion in the sigmoid colon and a submucosal lesion in the lower rectum. The biopsy showed well differentiated AC and neuroendocrine tumor (NET). In addition, abdominal CT and MRI showed a 14-mm nodular lesion in the pancreatic body suggesting pancreatic duct cancer. Based on the above findings, four synchronous cancers, including the pancreas, stomach, sigmoid colon and rectum, were diagnosed, and surgery was performed. A midline incision was made in the upper abdomen, and a distal gastrectomy, pancreatic body and tail resection, and sigmoidectomy were performed. Trans-anal tumor resection was performed for the rectal lesion. Histopathology showed invasive pancreatic duct cancer, moderately differentiated AC of the stomach, moderately differentiated AC of the sigmoid colon, and NET G1 of the rectum. The patient had no postoperative complications, 4 years 3 months after resection, and he was disease-free from all of the cancers. Discussion The strategy of perioperative diagnosis and treatment for multiple primary tumors is usually difficult. This process was performed by consulting a cancer board, which could be useful as a practice guideline. Conclusion This patient in whom four tumors were completely resected at the same time and who has had a good clinical course was reported.

Summary Introduction Prune Perineum Syndrome (PPS) is rare, with only three cases described in the literature. Treatment requires abdominal and pelvic surgeries. Our goal is to provide a video with steps of the surgical corrections of this syndrome. Materials and methods We present a case of an 8 months-old boy with PPS. At our first evaluation, he had already been submitted to a colostomy with mucous fistula and a vesicostomy. Results By the time of this publication, he had been submitted to six surgical procedures. First, osteotomy, followed by colostomy, cystoscopic evaluation, cystoplasty, perineal and abdominal correction with a dual mesh, bilateral orchidopexy, treatment of the vesicocolonic fistula, sigmoidectomy and appendicectomy. He is 6 years old, walks with no assistance, has satisfactory abdominal tonus which allows him to void with Valsalva Maneuver. Clean intermittent catheterization is also performed. He had no UTI since his first surgery. Although submitted to several procedures, treatment is not yet concluded. A future urethral dilation together with a genitoplasty might improve his quality of life. Conclusion PPS is a very rare condition, with scarce literature concerning its treatment. Multiple procedures might be necessary to correct malformations and improve patient's quality of life.

Sigmoid perforation is a common surgical problem at the emergency department. It usually appears with abdominal pain of sudden onset and free abdominal air in the X-ray. Nevertheless, there are a few rare cases where retroperitoneal air is the first sign of sigmoid perforation. An 82-year-old female patient visited the emergency department due to abdominal pain and blood in her stool. The patient was afebrile and no signs of rebound tenderness were revealed. The abdominal X-ray did not reveal any sign of free intraperitoneal air. An abdominal computed scan tomography was performed which revealed a large quantity of retroperitoneal air. The patient underwent diagnostic laparotomy. Her sigmoid colon had ruptured toward its mesosigmoid with no indications of diverticulitis. Sigmoidectomy was performed. Her postoperative course was uneventful and the patient was discharged 10 days after. Sigmoid perforation toward the retroperitoneal space is an extremely rare clinical scenario, which can be promptly managed only with high clinical suspicion.

Rationale: Intestinal hypoganglionosis most commonly presents in infancy or childhood, with only a few cases reported in adults. Those are mainly diagnosed after elective surgery for long-standing constipation and megacolon. Patient concerns: We report a case of a 48-year-old female from China who presented with symptoms of discontinuation of bowel movements for 2 months. A hard, round mass could be felt in her right lower abdomen. Diagnosis: The following examination methods diagnosed acquired segmental sigmoid hypoganglionosis. An abdominal computed tomography revealed a dilatation of the colon and suspicious wall thickening of the sigmoid colon. Anorectal manometry revealed relaxation of the anal sphincter. Histological examination revealed lower numbers and the degeneration of ganglion cells. Interventions: Sigmoidectomy and transverse colostomy. Outcomes: The patient recovered well from surgery. Three months after the surgery, barium enema revealed a recovery in colorectal dilatation. Lessons: This case could help raise awareness of acquired segmental hypoganglionosis. Resection of TZ and enterostomy presents an effective remission strategy for patients at risk of anastomotic leakage due to poor intestinal conditions.