BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon iden...BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.展开更多
BACKGROUND The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences.It may initiate ventricular tachycardia or ventricular fibrillation,which can result in syncope or sudde...BACKGROUND The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences.It may initiate ventricular tachycardia or ventricular fibrillation,which can result in syncope or sudden cardiac death.This manifestation poses a great challenge for anesthesiologists.However,it is rarely encountered in the perioperative setting.CASE SUMMARY We herein present a case in which the R-on-T phenomenon was incidentally revealed by 24-h Holter monitoring in a patient diagnosed with sigmoid colon cancer.Careful evaluation and treatment with mexiletine were carried out preoperatively under consultation with a cardiovascular specialist,and surgery was uneventfully performed under general anesthesia after thorough preparation.CONCLUSION Physicians should be vigilant about this infrequent but potentially fatal arrhythmia.Our experience suggests that the anesthetic process can be greatly optimized with careful preparation.展开更多
BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture.Giant inguinoscrotal hernias are rare in developed countries because of their...BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture.Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment.However,they can develop in patients who refuse surgery or ignore their condition.Intervention is inevitable because strangulation and organ perforation can occur,leading to peritonitis and sepsis.Common surgical approaches include open abdominal and inguinal approaches or a combination of both.CASE SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications.Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon.Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected.The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach.The incarcerated organs,which included the ileum and sigmoid colon,had relatively good intestinal perfusion without perforation or ischemic changes.They were successfully reduced into the abdomen,and bowel resection was not necessary.A tension-free prosthetic mesh was used for the hernia repair.Two weeks after the initial surgery,and with adequate antimicrobial therapy,the patient recovered and was discharged from our hospital.No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.CONCLUSION Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.展开更多
BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcino...BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcinoma in a right-sided sigmoid colon revealed by a preoperative computed tomography(CT).CASE SUMMARY A 56-year-old Chinese man was admitted to the hospital with abdominal pain.CT revealed a redundant sigmoid colon with a mass on the right side of the cecum and ascending colon.Laparoscopy confirmed an abnormal course in the descending colon and sigmoid colon.Subsequently,hemicolectomy was performed in an open manner after laparoscopic exploration.Pathological examination revealed an infiltrative mucinous adenocarcinoma with two lymph node metastases.The patient was discharged without any complications after a week.There were no signs of recurrence or metastasis during the 3-month followup period.CONCLUSION We report a rare anomaly of a right-sided sigmoid colon with carcinoma,which should be differentiated from ascending colon cancer and pericecal hernia to prevent errors and other surgical complications.展开更多
Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting...Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting cases of polyposis with various pathologic components, mainly located in the left side of the colon with no associated inflammatory bowel disease, intestinal tuberculosis or histiocytosis X. Multiple finger-like polypoid lesions with the appearance of stalactites were noted on the left side of the colon, especially in the sigmoid area, at the time of colonoscopy. The polyps had a variety of sizes and shapes and were shown to have various histopathologic components among the different patients. Although filiform polyposis localized in the sigmoid colon appears not to have high oncogenic potential, periodic follow-up seems to be needed.展开更多
BACKGROUND Distant metastasis of colorectal cancer to the anus is very rare,with only 30 related cases published in PubMed thus far.Therefore,recurrence of colorectal cancer derived anus metastases is rarely seen and ...BACKGROUND Distant metastasis of colorectal cancer to the anus is very rare,with only 30 related cases published in PubMed thus far.Therefore,recurrence of colorectal cancer derived anus metastases is rarely seen and less presented.CASE SUMMARY Here we report an 80-year-old male patient who underwent radical resection for sigmoid colon cancer in January 2010 and another surgery for anal fistula resection in December 2010.Postoperative pathology of the anal fistula revealed a metastatic moderately differentiated adenocarcinoma.The patient subsequently received chemotherapy and radiotherapy.In May 2020,after the patient reported symptoms of anal swelling and pain,computed tomography and magnetic resonance imaging revealed a perianal abscess.Perianal mass biopsy was performed,and the postoperative pathological diagnosis was metastatic moderately differentiated adenocarcinoma.CONCLUSION This case highlights that there is a risk of recurrence of anal metastasis of colorectal cancer even after 10 years of follow-up.We also reviewed the literature and discuss potential mechanisms for anal metastasis of colorectal cancer,thus providing some suggestions for treatment of these cases.展开更多
We report a case of sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloo...We report a case of sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloody stools. She had a significant past medical history of asymptomatic schistosomiasis japonica and constipation. A colonoscopy showed an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon. During the radical operative procedure, we noted the partially encircling tumor was located in the distal sigmoid colon, and extended into the serosa. Succedent pathological analysis demonstrated the diagnosis of sigmoid colonic ulcerative tubular adenocarcinoma, and showed deposited ova of Schistosoma japonicum in both tumor lesions and mesenteric lymph nodes. Three days after surgery the patient returned to the normal bowel function with one defecation per day. These findings reveal that deposited schistosome ova play a possible role in the carcinogenesis of colorectal cancer.展开更多
Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alter...Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.展开更多
Mesh migration and penetration into abdominal visce-ra 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 initia...Mesh migration and penetration into abdominal visce-ra 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 co-lonoscopic 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 complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial 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.展开更多
Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species.The ileo-cecal region is most commonly affected,while the left side of the colon is more rarely involved.The infection has a ten...Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species.The ileo-cecal region is most commonly affected,while the left side of the colon is more rarely involved.The infection has a tendency to inf iltrate adjacent tissues and is therefore rarely confined to a single organ.Presentation may vary from non specif ic symptoms and signs to an acute abdomen.A computed tomography scan is helpful in identifying the inflammatory process and the organs involved.It also allows visual guidance for percutaneous drainage of abscesses,thus aiding diagnosis.Culture is difficult because of the anaerobic character and slow growth of actinomycetes.Colonoscopy is usually normal,but may shows signs of external compression.Preoperative diagnosis is rare and is established only in less than 10% of cases.In uncomplicated disease,high dose antibiotic therapy is the mainstay of treatment.Surgery is often performed because of a difficulty in diagnosis.Surgery and antibiotics are required in the case of complicated disease.Combined medical and surgical treatment achieves a cure in about 90% of cases.The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology,and a review of the literature is presented.展开更多
Plasmablastic lymphoma(PBL) is a rare form of nonHodgkin's lymphoma that is associated with human immunodeficiency virus(HIV) infection. Although PBL is most commonly observed in the oral cavity of HIV-positive pa...Plasmablastic lymphoma(PBL) is a rare form of nonHodgkin's lymphoma that is associated with human immunodeficiency virus(HIV) infection. Although PBL is most commonly observed in the oral cavity of HIV-positive patients, it can also be observed at extra-oral sites in HIV-negative patients. This report represents an unusual case of HIV-negative PBL that occurred in the sigmoid colon. This patient had a history of systemic lupus erythematosus and an underlying immunosuppressive state from long term steroid therapy. The lymphoma cells were positive for CD138, kappa light chain restriction and Epstein-Barr virus and negative for CD20/L26, CD3, CD79 a, UCHL1(CD45RO) and cytokeratin(AE1/AE3). The patient died approximately 2 mo after the operation. In the present paper, we review cases of PBL of the colon in HIVnegative patients.展开更多
BACKGROUND Melanotic Xp11-associated tumors are rare mesenchymal-derived tumors. So far,most primary melanotic Xp11-associated tumors have been reported in the kidney, and reports of this tumor in the gastrointestinal...BACKGROUND Melanotic Xp11-associated tumors are rare mesenchymal-derived tumors. So far,most primary melanotic Xp11-associated tumors have been reported in the kidney, and reports of this tumor in the gastrointestinal tract are rare.CASE SUMMARY Here we describe the case of a 25-year-old woman who presented with a melanotic Xp11-associated tumor in the sigmoid colon. Colonoscopy revealed a large mucosal bulge in the sigmoid colon, approximately 32 cm inside the anus.The surface was rough with local erosion. The tumor was brittle on biopsy and bled easily. Computed tomography revealed thickening of the rectal wall with edema. Postoperative pathology indicated the likelihood of a perivascular epithelioid cell tumor. Histologically, the tumor comprised plump epithelioid cells with abundant clear to lightly eosinophilic cytoplasm and round nuclei arranged in an alveolar or trabecular pattern. The tumor cells were strongly positive for HMB-45, Melan-A, Cathepsin K, and TFE3 but negative for vimentin,smooth muscle actin, S100 protein, CD10, CK20, and desmin. The tumor cells had a low Ki-67 labeling index(approximately 2%). Fluorescence in situ hybridization revealed TFE3 fracture. Based on these histologic and immunohistochemical features, a diagnosis of melanotic Xp11-associated tumor of the sigmoid colon was made.CONCLUSION In summary, we report the clinicopathological features of a primary tumor that is extremely rare in the sigmoid colon and review the clinicopathological characteristics of melanotic Xp11-associated tumors, compatible with the very rare tumor termed "melanotic Xp11 translocation renal cancer" in all aspects.展开更多
<span style="font-family:Verdana;">Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. A...<span style="font-family:Verdana;">Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. An intraoperative finding of transverse colon volvulus associated with sigmoid colon volvulus was made. Left and transverse colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful.</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">S</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ynchronous volvulus of the transverse and sigmoid colon is a surgical emergency. The clinical signs are not specific and the discovery is often intraoperative. It is necessary to know how to evoke the diagnosis in a case of sigmoid colon volvulus, to avoid inadequate management with dramatic consequences.</span></span></span>展开更多
BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve tr...BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve trunks,with rarity in the gastrointestinal tract.Among gastrointestinal locations,the stomach harbors the majority of nerve sheath tumors,while such occurrences in the sigmoid colon are exceptionally infrequent.CASE SUMMARY This study presented a clinical case involving a 60-year-old female patient who,during colonoscopy,was diagnosed with a submucosal lesion that was later identified as a nerve sheath tumor.The patient underwent surgical resection,and the diagnosis was confirmed through immunohistochemistry.This study highlighted an exceptionally uncommon occurrence of a nerve sheath tumor in the sigmoid colon,which was effectively managed within our department.Additionally,a comprehensive review of relevant studies was conducted.CONCLUSION The preoperative diagnosis of nerve sheath tumors poses challenges,as the definitive diagnosis still relies on pathology and immunohistochemistry.Although categorized as benign,these tumors have the potential to demonstrate malignant behavior.Consequently,the optimal treatment approach entails the complete surgical excision of the tumor,ensuring the absence of residual lesions at the margins.展开更多
Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcome...Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.展开更多
Objective To observe the influence of the artificial plastic vagina on overall patient health Methods Length and width of the artificial vagina were measured Histological studies were performed under light and el...Objective To observe the influence of the artificial plastic vagina on overall patient health Methods Length and width of the artificial vagina were measured Histological studies were performed under light and electron microscope Vaginal bacterial flora were analyzed using the drop implant method Vaginal HPV and ER were detected with ABC histochemical staining Results According to the results of anatomic measurements, artificial vagina was similar to normal vagina The reductions of glands in the mucosa and collagen fibers as well as interstitial tissue hyperplasia in the lower segment of artificial vagina were documented Four kinds of bacteria indigenous to the sigmoid colon were found in artificial vagina and were studied microbiologically with only differences in the amount and detection rates of bacteria flora The positive presentation of HPV was not significantly different from that in the control group The positive presentation of estrogen receptor (ER) in the epithelium of artificial vagina was not found Conclusion The reconstruction of artificial vagina with sigmoid colon is a safe, effective and satisfactory procedure for the patient展开更多
Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perfo...Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma.展开更多
BACKGROUND The pathological type of simple squamous carcinoma in colorectal malignancies is rare.Simple squamous cell carcinoma of the colorectum occurs most frequently in the rectum.The clinicopathological features a...BACKGROUND The pathological type of simple squamous carcinoma in colorectal malignancies is rare.Simple squamous cell carcinoma of the colorectum occurs most frequently in the rectum.The clinicopathological features and biological behaviors of squamous colorectal carcinoma are unclear,and its prognosis may be worse than that of simple adenocarcinoma.Studies on squamous colorectal cancer are currently limited to case reports,and there is no standard treatment protocol.Therefore,more case reports are required to fully understand squamous colorectal cancer.CASE SUMMARY We reported the case of a 56-year-old woman who complained of constipation for 2 years.Colonoscopy revealed a sigmoid colon tumor,and the pathological result of colonoscopy was squamous carcinoma.After completing the relevant assessment,the patient was clinically diagnosed with cT4aN0M0,stage IIB,and surgery was performed.Based on postoperative pathological results,the patient was diagnosed with pT4bN0M0,stage IIC.Six cycles of adjuvant chemotherapy were administered after surgery.Liver metastasis and abdominal wall mass were found more than 1 mo after the end of the last chemotherapy session.Targeted local treatment was not performed because the liver had multiple metastases,but I^(125) particle implantation of the abdominal wall mass was performed.Two cycles of first-line chemotherapy were administered after the surgery.The patient underwent 14 mo of treatment and eventually died from the tumor.CONCLUSION Squamous carcinoma of sigmoid colon is a rare tumor with unclear pathogenesis.Its clinicopathological diagnosis should be paid close attention.展开更多
文摘BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.
文摘BACKGROUND The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences.It may initiate ventricular tachycardia or ventricular fibrillation,which can result in syncope or sudden cardiac death.This manifestation poses a great challenge for anesthesiologists.However,it is rarely encountered in the perioperative setting.CASE SUMMARY We herein present a case in which the R-on-T phenomenon was incidentally revealed by 24-h Holter monitoring in a patient diagnosed with sigmoid colon cancer.Careful evaluation and treatment with mexiletine were carried out preoperatively under consultation with a cardiovascular specialist,and surgery was uneventfully performed under general anesthesia after thorough preparation.CONCLUSION Physicians should be vigilant about this infrequent but potentially fatal arrhythmia.Our experience suggests that the anesthetic process can be greatly optimized with careful preparation.
文摘BACKGROUND Giant inguinoscrotal hernias are huge inguinal hernias that extend below the midpoint of the inner thigh in the standing posture.Giant inguinoscrotal hernias are rare in developed countries because of their better medical resources and early treatment.However,they can develop in patients who refuse surgery or ignore their condition.Intervention is inevitable because strangulation and organ perforation can occur,leading to peritonitis and sepsis.Common surgical approaches include open abdominal and inguinal approaches or a combination of both.CASE SUMMARY We present the case of a 73-year-old man who visited our emergency department with a huge mass in his left scrotum and septic complications.Abdominal computed tomography revealed a large left inguinoscrotal hernia that contained small bowel loops and the colon.Emergency surgical intervention was performed immediately because intestinal strangulation was highly suspected.The operative repair was performed using a combination of mini-exploratory laparotomy and the inguinal approach.The incarcerated organs,which included the ileum and sigmoid colon,had relatively good intestinal perfusion without perforation or ischemic changes.They were successfully reduced into the abdomen,and bowel resection was not necessary.A tension-free prosthetic mesh was used for the hernia repair.Two weeks after the initial surgery,and with adequate antimicrobial therapy,the patient recovered and was discharged from our hospital.No evidence of hernia relapse was noted during the outpatient follow-up examination 3 mo after surgery.CONCLUSION Emergency surgery involving combined mini-exploratory laparotomy and the inguinal approach should be performed for serious incarcerated giant inguinoscrotal hernias.
文摘BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcinoma in a right-sided sigmoid colon revealed by a preoperative computed tomography(CT).CASE SUMMARY A 56-year-old Chinese man was admitted to the hospital with abdominal pain.CT revealed a redundant sigmoid colon with a mass on the right side of the cecum and ascending colon.Laparoscopy confirmed an abnormal course in the descending colon and sigmoid colon.Subsequently,hemicolectomy was performed in an open manner after laparoscopic exploration.Pathological examination revealed an infiltrative mucinous adenocarcinoma with two lymph node metastases.The patient was discharged without any complications after a week.There were no signs of recurrence or metastasis during the 3-month followup period.CONCLUSION We report a rare anomaly of a right-sided sigmoid colon with carcinoma,which should be differentiated from ascending colon cancer and pericecal hernia to prevent errors and other surgical complications.
文摘Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting cases of polyposis with various pathologic components, mainly located in the left side of the colon with no associated inflammatory bowel disease, intestinal tuberculosis or histiocytosis X. Multiple finger-like polypoid lesions with the appearance of stalactites were noted on the left side of the colon, especially in the sigmoid area, at the time of colonoscopy. The polyps had a variety of sizes and shapes and were shown to have various histopathologic components among the different patients. Although filiform polyposis localized in the sigmoid colon appears not to have high oncogenic potential, periodic follow-up seems to be needed.
基金Supported by Nanjing Municipal Health Bureau,No.NWQR-201702Nanjing Translational Medicine Base of Chinese Medicine,No.ZHZD201802.
文摘BACKGROUND Distant metastasis of colorectal cancer to the anus is very rare,with only 30 related cases published in PubMed thus far.Therefore,recurrence of colorectal cancer derived anus metastases is rarely seen and less presented.CASE SUMMARY Here we report an 80-year-old male patient who underwent radical resection for sigmoid colon cancer in January 2010 and another surgery for anal fistula resection in December 2010.Postoperative pathology of the anal fistula revealed a metastatic moderately differentiated adenocarcinoma.The patient subsequently received chemotherapy and radiotherapy.In May 2020,after the patient reported symptoms of anal swelling and pain,computed tomography and magnetic resonance imaging revealed a perianal abscess.Perianal mass biopsy was performed,and the postoperative pathological diagnosis was metastatic moderately differentiated adenocarcinoma.CONCLUSION This case highlights that there is a risk of recurrence of anal metastasis of colorectal cancer even after 10 years of follow-up.We also reviewed the literature and discuss potential mechanisms for anal metastasis of colorectal cancer,thus providing some suggestions for treatment of these cases.
文摘We report a case of sigmoid colonic carcinoma associated with deposited ova of Schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloody stools. She had a significant past medical history of asymptomatic schistosomiasis japonica and constipation. A colonoscopy showed an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon. During the radical operative procedure, we noted the partially encircling tumor was located in the distal sigmoid colon, and extended into the serosa. Succedent pathological analysis demonstrated the diagnosis of sigmoid colonic ulcerative tubular adenocarcinoma, and showed deposited ova of Schistosoma japonicum in both tumor lesions and mesenteric lymph nodes. Three days after surgery the patient returned to the normal bowel function with one defecation per day. These findings reveal that deposited schistosome ova play a possible role in the carcinogenesis of colorectal cancer.
基金supported by the Grants from National Natural Science Funding of China (No.81071891)Guangdong Provincial Science and Technology Funding (No.2010B080701)
文摘Background: Complete resection of locally advanced sigmoid colon cancer(LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemora?diotherapy(neo CRT) followed by surgery as treatment of selected patients with unresectable LASCC.Methods: We studied the patients with unresectable LASCC who received neo CRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external?beam radiotherapy to 50 Gy and capecitabine?based chemotherapy every 3 weeks. Surgery was scheduled 6–8 weeks after radiotherapy.Results: Twenty?one patients were included in this study. The median follow?up was 42 months(range, 17–57 months). All patients completed neo CRT and surgery. Resection with microscopically negative margins(R0 resection) was achieved in 20 patients(95.2%). Pathologic complete response was observed in 8 patients(38.1%). Multivisceral resection was necessary in only 7 patients(33.3%). Two patients(9.5%) experienced grade 2 postopera?tive complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0(yp M0) disease, the cumulative probability of 3?year local recurrence?free survival, disease?free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3?year overall survival was 95.2% and bladder function was well preserved.Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.
基金Supported by Zhejiang Provincial Natural Science Foundation of China,No.LQ16H030001
文摘Mesh migration and penetration into abdominal visce-ra 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 co-lonoscopic 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 complement-ary endoscopic ultrasonography, a cavity--like structure beneath the suspected polyp was further confirmed. Enhanced abdominal computed tomography merely re-vealed local bowel wall thickening and inflammation of the colosigmoid junction. The migrating mesh, which was lodged in the sigmoid colon and caused intra--abdomi-nal adhesion in the lower abdominal cavity, was finally identified via exploratory surgery. The components of inflammatory granulation tissue around the mesh mate-rial 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.
文摘Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species.The ileo-cecal region is most commonly affected,while the left side of the colon is more rarely involved.The infection has a tendency to inf iltrate adjacent tissues and is therefore rarely confined to a single organ.Presentation may vary from non specif ic symptoms and signs to an acute abdomen.A computed tomography scan is helpful in identifying the inflammatory process and the organs involved.It also allows visual guidance for percutaneous drainage of abscesses,thus aiding diagnosis.Culture is difficult because of the anaerobic character and slow growth of actinomycetes.Colonoscopy is usually normal,but may shows signs of external compression.Preoperative diagnosis is rare and is established only in less than 10% of cases.In uncomplicated disease,high dose antibiotic therapy is the mainstay of treatment.Surgery is often performed because of a difficulty in diagnosis.Surgery and antibiotics are required in the case of complicated disease.Combined medical and surgical treatment achieves a cure in about 90% of cases.The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology,and a review of the literature is presented.
文摘Plasmablastic lymphoma(PBL) is a rare form of nonHodgkin's lymphoma that is associated with human immunodeficiency virus(HIV) infection. Although PBL is most commonly observed in the oral cavity of HIV-positive patients, it can also be observed at extra-oral sites in HIV-negative patients. This report represents an unusual case of HIV-negative PBL that occurred in the sigmoid colon. This patient had a history of systemic lupus erythematosus and an underlying immunosuppressive state from long term steroid therapy. The lymphoma cells were positive for CD138, kappa light chain restriction and Epstein-Barr virus and negative for CD20/L26, CD3, CD79 a, UCHL1(CD45RO) and cytokeratin(AE1/AE3). The patient died approximately 2 mo after the operation. In the present paper, we review cases of PBL of the colon in HIVnegative patients.
基金Supported by The Key Research & Development and Transformation Project of Qinghai Province for 2018(No.2018-SF-113)
文摘BACKGROUND Melanotic Xp11-associated tumors are rare mesenchymal-derived tumors. So far,most primary melanotic Xp11-associated tumors have been reported in the kidney, and reports of this tumor in the gastrointestinal tract are rare.CASE SUMMARY Here we describe the case of a 25-year-old woman who presented with a melanotic Xp11-associated tumor in the sigmoid colon. Colonoscopy revealed a large mucosal bulge in the sigmoid colon, approximately 32 cm inside the anus.The surface was rough with local erosion. The tumor was brittle on biopsy and bled easily. Computed tomography revealed thickening of the rectal wall with edema. Postoperative pathology indicated the likelihood of a perivascular epithelioid cell tumor. Histologically, the tumor comprised plump epithelioid cells with abundant clear to lightly eosinophilic cytoplasm and round nuclei arranged in an alveolar or trabecular pattern. The tumor cells were strongly positive for HMB-45, Melan-A, Cathepsin K, and TFE3 but negative for vimentin,smooth muscle actin, S100 protein, CD10, CK20, and desmin. The tumor cells had a low Ki-67 labeling index(approximately 2%). Fluorescence in situ hybridization revealed TFE3 fracture. Based on these histologic and immunohistochemical features, a diagnosis of melanotic Xp11-associated tumor of the sigmoid colon was made.CONCLUSION In summary, we report the clinicopathological features of a primary tumor that is extremely rare in the sigmoid colon and review the clinicopathological characteristics of melanotic Xp11-associated tumors, compatible with the very rare tumor termed "melanotic Xp11 translocation renal cancer" in all aspects.
文摘<span style="font-family:Verdana;">Synchronous transverse and sigmoid colon volvulus are very rare. We report the case of a 23-year-old man who underwent emergency surgery for sigmoid colon volvulus. An intraoperative finding of transverse colon volvulus associated with sigmoid colon volvulus was made. Left and transverse colectomy was performed followed by colorectal anastomosis. The postoperative period was uneventful.</span><span><span><span style="font-family:;" "=""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">S</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">ynchronous volvulus of the transverse and sigmoid colon is a surgical emergency. The clinical signs are not specific and the discovery is often intraoperative. It is necessary to know how to evoke the diagnosis in a case of sigmoid colon volvulus, to avoid inadequate management with dramatic consequences.</span></span></span>
文摘BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve trunks,with rarity in the gastrointestinal tract.Among gastrointestinal locations,the stomach harbors the majority of nerve sheath tumors,while such occurrences in the sigmoid colon are exceptionally infrequent.CASE SUMMARY This study presented a clinical case involving a 60-year-old female patient who,during colonoscopy,was diagnosed with a submucosal lesion that was later identified as a nerve sheath tumor.The patient underwent surgical resection,and the diagnosis was confirmed through immunohistochemistry.This study highlighted an exceptionally uncommon occurrence of a nerve sheath tumor in the sigmoid colon,which was effectively managed within our department.Additionally,a comprehensive review of relevant studies was conducted.CONCLUSION The preoperative diagnosis of nerve sheath tumors poses challenges,as the definitive diagnosis still relies on pathology and immunohistochemistry.Although categorized as benign,these tumors have the potential to demonstrate malignant behavior.Consequently,the optimal treatment approach entails the complete surgical excision of the tumor,ensuring the absence of residual lesions at the margins.
文摘Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome).Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.
文摘Objective To observe the influence of the artificial plastic vagina on overall patient health Methods Length and width of the artificial vagina were measured Histological studies were performed under light and electron microscope Vaginal bacterial flora were analyzed using the drop implant method Vaginal HPV and ER were detected with ABC histochemical staining Results According to the results of anatomic measurements, artificial vagina was similar to normal vagina The reductions of glands in the mucosa and collagen fibers as well as interstitial tissue hyperplasia in the lower segment of artificial vagina were documented Four kinds of bacteria indigenous to the sigmoid colon were found in artificial vagina and were studied microbiologically with only differences in the amount and detection rates of bacteria flora The positive presentation of HPV was not significantly different from that in the control group The positive presentation of estrogen receptor (ER) in the epithelium of artificial vagina was not found Conclusion The reconstruction of artificial vagina with sigmoid colon is a safe, effective and satisfactory procedure for the patient
文摘Intrauterine contraceptive device (IUCD) is relatively safe but still with some serious risks. Uterus perforation is rare and would be fatal. A case of Cu-7 IUCD invading into the sigmoid colon through uterine perforation caused by a pelvic blunt trauma was presented. Our case showed that uterus perforation by an IUCD could induce utero-sigmoid fistula which is likely to be missed. Imaging is required when the patients with IUCD present abdominal pain, particularly with a history of trauma.
基金Supported by Hebei Province Talent Training Project,No.A201902016.
文摘BACKGROUND The pathological type of simple squamous carcinoma in colorectal malignancies is rare.Simple squamous cell carcinoma of the colorectum occurs most frequently in the rectum.The clinicopathological features and biological behaviors of squamous colorectal carcinoma are unclear,and its prognosis may be worse than that of simple adenocarcinoma.Studies on squamous colorectal cancer are currently limited to case reports,and there is no standard treatment protocol.Therefore,more case reports are required to fully understand squamous colorectal cancer.CASE SUMMARY We reported the case of a 56-year-old woman who complained of constipation for 2 years.Colonoscopy revealed a sigmoid colon tumor,and the pathological result of colonoscopy was squamous carcinoma.After completing the relevant assessment,the patient was clinically diagnosed with cT4aN0M0,stage IIB,and surgery was performed.Based on postoperative pathological results,the patient was diagnosed with pT4bN0M0,stage IIC.Six cycles of adjuvant chemotherapy were administered after surgery.Liver metastasis and abdominal wall mass were found more than 1 mo after the end of the last chemotherapy session.Targeted local treatment was not performed because the liver had multiple metastases,but I^(125) particle implantation of the abdominal wall mass was performed.Two cycles of first-line chemotherapy were administered after the surgery.The patient underwent 14 mo of treatment and eventually died from the tumor.CONCLUSION Squamous carcinoma of sigmoid colon is a rare tumor with unclear pathogenesis.Its clinicopathological diagnosis should be paid close attention.