BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial ...BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.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
Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or divertic...Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.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
Introduction: Recurrent sigmoid volvulus is a medical and surgical emergency. It is the recurrence of a twisting of the sigmoid loop around its mesenteric axis initiating an occlusion by strangulation. The risk factor...Introduction: Recurrent sigmoid volvulus is a medical and surgical emergency. It is the recurrence of a twisting of the sigmoid loop around its mesenteric axis initiating an occlusion by strangulation. The risk factors of colonic volvulus are: a dolichosigmoid, a chronic constipation, a tumor, …In Western countries, recurrences of sigmoid volvulus after surgery are rare and due to a non resection of a dolicho-megacolon. Most African studies do not report any recurrence of sigmoid volvulus after sigmoidectomy. This work aims to describe three original cases of recurrence of sigmoid volvulus after sigmoidectomy recorded at the University Hospital of Brazzaville and to analyze their causes and surgical management. Clinical Observation: We studied the cases of three male patients, whose average age was 73 years, each of them having a history of chronic constipation and sigmoidectomy for sigmoid volvulus with an average delay of recurrence of 5.3 years. They all underwent emergency laparotomy for acute intestinal obstruction on scarred abdomen. The surgery permitted to unfold a recurrent volvulus of the sigmoid associated with circumferential scar fibrosis on the volvulated sigmoid loop. A second colectomy was performed. The histological results of the surgical specimens were normal for two patients and revealed signs of tissue necrosis for the third patient. The postoperative outcome was without incident for two patients. The third patient died after developing a septic shock. Conclusion: Recurrent sigmoid volvulus after sigmoidectomy is rare. The etiological factors for our three patients were incomplete sigmoidectomy during the first operation and chronic constipation.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
文摘BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.
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.
基金This study was supported by the National Natural Science Foundation of China(Nos.81870721)the Major Program of National Natural Science Foundation of China(Nos.82192862).
文摘Objective: Tinnitus-a common clinical symptom-can be categorized into pulsatile tinnitus(PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.Methods: We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinusassociated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Postoperative tinnitus grading and surgical efficacy were determined.Results: After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient.During the follow-up period of 12-18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.Conclusion: Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.
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Introduction: Recurrent sigmoid volvulus is a medical and surgical emergency. It is the recurrence of a twisting of the sigmoid loop around its mesenteric axis initiating an occlusion by strangulation. The risk factors of colonic volvulus are: a dolichosigmoid, a chronic constipation, a tumor, …In Western countries, recurrences of sigmoid volvulus after surgery are rare and due to a non resection of a dolicho-megacolon. Most African studies do not report any recurrence of sigmoid volvulus after sigmoidectomy. This work aims to describe three original cases of recurrence of sigmoid volvulus after sigmoidectomy recorded at the University Hospital of Brazzaville and to analyze their causes and surgical management. Clinical Observation: We studied the cases of three male patients, whose average age was 73 years, each of them having a history of chronic constipation and sigmoidectomy for sigmoid volvulus with an average delay of recurrence of 5.3 years. They all underwent emergency laparotomy for acute intestinal obstruction on scarred abdomen. The surgery permitted to unfold a recurrent volvulus of the sigmoid associated with circumferential scar fibrosis on the volvulated sigmoid loop. A second colectomy was performed. The histological results of the surgical specimens were normal for two patients and revealed signs of tissue necrosis for the third patient. The postoperative outcome was without incident for two patients. The third patient died after developing a septic shock. Conclusion: Recurrent sigmoid volvulus after sigmoidectomy is rare. The etiological factors for our three patients were incomplete sigmoidectomy during the first operation and chronic constipation.
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.
