A case report of inflammatory pseudotumor of the urinary bladder due to diverticulitis of the sigmoid colon

A 65-year-old female presented to our hospital with a 6-month history of pollakuria, low-grade fever and urgent incontinence. Cystoscopy revealed a nonpapillary bladder tumor that was 50 mm in diameter in the trigon. Computed tomography showed the abscess between the urinary bladder and sigmoid colon. Transurethral resection was performed and the histology consisted of inflammatory lesions with inflammatory cell infiltration, which was diagnosed as an inflammatory pseudotumor due to diverticulitis of the sigmoid colon. Sigmoidectomy was subsequently performed. A fistula between the urinary bladder and the sigmoid colon was not detected. Cystoscopy 2 months after the operation revealed no signs of a bladder tumor.     

A case of vesicosigmoidal fistula secondary to diverticulitis of the colon

A case of vesicosigmoidal fistula secondary to the diverticulitis of colon is reported. A 63-year-old man was admitted to our clinic with the chief complaint of pneumaturia. Cystoscopy revealed an edematous, papillomatous lesion at the left posterior bladder wall. Although multiple diverticulosis of descending and sigmoid colon were demonstrated by barium enema, the presence of a fistula from the intestine to bladder was not confirmed. The presence of fistula was confirmed by detecting the orally administered charcoal in the urine. Resection of sigmoid colon with partial cystectomy was performed. Removed specimen revealed multiple sigmoidal diverticula and a fistula from a sigmoidal diverticulum to bladder through a firm mass. Histological examination of mass demonstrated inflammatory changes. This was the 58th case of vesicosigmoidal fistula due to diverticulitis of colon reported in the Japanese literature.     

Gastric adenocarcinoma of Meckel's diverticulum as a cause of colonic obstruction

A 45-year-old-female patient with no prior surgical history presented with bowel obstruction. At laparotomy, a bulky tumor arising from the ileum, which completely obstructed the sigmoid colon, was found. A left hemicolectomy followed by a transverse colostomy and a Hartman's pouch were performed. Pathological examination of the specimen revealed gastric adenocarcinoma arising from a Meckel's diverticulum in the ileum. Malignant transformation from a Meckel's diverticulum is an uncommon occurrence. This case illustrates that successful management of a symptomatic Meckel's diverticulum, even with malignant transformation, can be achieved by surgical resection.     

Inflammatory pseudotumor of the urinary bladder diagnosed using 3D-CT cystoscopy

Inflammatory pseudotumor of the urinary bladder is a rare benign entity of the submucosal stroma that can easily be mistaken for a malignant neoplasm both clinically and histologically. We report a case of an inflammatory pseudotumor of the urinary bladder in which 3D-CT cystoscopy aided in the diagnosis. A 38-year-old man presented with persistent miction pain, penile pain, and dysuria despite symptomatic treatment at another hospital. Cystoscopic examination, MRI and 3D-CT cystoscopy revealed a 3.0 X 3.0 cm wide-based nonpapillary tumor located at the anterior dome of the urinary bladder. Transabdominal biopsy and transurethral resection were performed and the tumor was suspected to be transitional cell carcinoma. A partial cystectomy and urachus excision were then performed for suspected urachal tumor based upon the radiological examinations. Careful examination of the specimen revealed an inflammatory pseudotumor. We discuss 20 cases of inflammatory pseudotumor of the urinary bladder including ours.     

Ileovesical fistula due to Crohn's disease: a case report

A 24-year-old male first experienced pollakisuria, dysuria, pneumaturia and diarrhea in May 1988. Intravenous pyelography showed a normal upper urinary tract but bladder wall irregularity at the dome was observed. Cystoscopic examination revealed bullous edema, erythema and presence of a mucous-like substance. Barium enema X-ray examination revealed inflammatory changes at the terminal ileum but no fistulous connection was noted. Mild ulceration was observed on colon fiberscopic examination. At operation, a severely inflamed lower ileum firmly adherent to the dome of bladder as well as to the sigmoid colon was observed. Fistulous communication between bladder and ileum was also noted. Resection of diseased ileum, sigmoid colon and partial cystectomy were carried out. The patient remains well, without enteric or bladder symptoms.     

Giant diverticulum of the sigmoid colon with perforation. Report of a case

We present a case of perforated giant diverticulum of the sigmoid colon. This condition is extremely rare and only a few cases have so far been reported in the literature. Our case involved a 55-year old woman. Diagnosis was easy with barium enema and CT scan examination. Laparotomy revealed a giant diverticulum of the sigmoid colon compressing adjacent structures with signs of inflammation. An en bloc resection of the sigmoid colon, ovary and fallopian tube was performed with primary colon-rectal anastomosis.The post-operative course was uneventful.     

Sliding inguinal hernia with incarceration of urinary bladder diverticulum in a child

Although inguinal herniorrhaphy is generally safe, certain complications can occur even with an experienced pediatric surgeon. We present a case of sliding right inguinal hernia with incarceration of urinary bladder diverticulum in a 2-year-old boy. A small perforation at the anterior wall of the urinary bladder, peritonitis, and kinking of the sigmoid colon occurred after the herniorrhaphy. He received exploratory laparotomy for repairing the urinary bladder perforation hole and drainage of the ascites. An anal tube was inserted to keep the sigmoid colon patent. The patient recovered from this insult gradually with an uneventful postoperative course 10 months after the operation, until the writing of this study. Surgeons should be aware of the possibility of urinary bladder diverticulum incarceration at the inguinal canal and should perform the operation meticulously.     

A case of vesicosigmoidal fistula

The clinical course of a case of vesicosigmoidal fistula is presented. The patient, a 76-year-old woman, became aware of terminal micturition pain and pollakisuria in February, 1985. She was first treated under the diagnosis of cystitis to be relieved of her subjective symptoms, although there was no improvement of pyuria. She also began to feel lower abdominal pain on April 3, 1985. After various examinations including intravenous pyelography, enteroclysis and cystoscopy the diagnosis of vesicosigmoidal fistula originating from sigmoid diverticulitis was established. Careful observation at operation revealed remarkable adhesion among the sigmoid colon, bladder, uterus and left ovary. The sigmoid colon, was resected followed by end-to-end anastomosis. Because of considerably extensive inflammatory changes over the mucosal membrane of the bladder, the hole of fistula on the vesical wall was simply closed from outside of the bladder without performing partial cystectomy. Histological examination only demonstrated non-specific inflammatory changes without evidence of malignancy. She had a favorable progress postoperatively.     

Giant sigmoid diverticulum: A rare entity of high clinical significance

Aim-Background

Affecting about 35% of patients above the age of sixty, diverticular disease represents a common entity. However, giant colonic diverticulum is a rare complication of this disease with variant clinical presentation and high complication rate. This report describes one such case and includes a short review of the literature.

Case report

An 83-year-old Caucasian man was transferred to our Unit after having been hospitalized in the Department of Internal Medicine for 15 days due to high fever with chills and vague left lower abdominal pain. The clinical examination was normal and showed no signs of peritonitis or palpable mass, other than a mild abdominal tenderness in the left iliac fossa. The patient’s medical history included diabetes mellitus, hyperlipidaemia, and distal arteriopathy. The patient had undergone endovascular repair of abdominal aortic aneurysm five years earlier. Blood tests indicated hypochromic anaemia and a hemoccult test was positive for haematochezia. Blood, urine, and faeces cultures were negative.

Results

Diverticulosis of the sigmoid colon was diagnosed by colonoscopy. The abdominal CT revealed a large air density mass adjacent to the sigmoid colon and diverticulosis of the sigmoid colon was diagnosed by colonoscopy. We performed sigmoid resection followed by end-to-end colorectal anastomosis with protective loop ileostomy so as to eliminate the risk of septic complications. A giant pseudodiverticulum was confirmed by histology.

Conclusion

Giant colonic diverticulum is a rare complication of colonic diverticular disease with unclear aetiology and variable clinical presentation. Due to the substantial risk of complications and the low mortality associated with surgical treatment, elective surgical therapy has been recommended. Conservative management of an asymptomatic giant colonic diverticulum should be reserved only for high-risk elderly patients who cannot tolerate surgery or who are unwilling to undergo surgery.     

结肠憩室的外科治疗

目的探讨外科治疗结肠憩室的方式及疗效。方法回顾性分析手术治疗的14例结肠憩室患者的临床资料。憩室位于盲肠5例,升结肠3例,降结肠2例,乙状结肠4例,均行手术治疗,包括行憩室切除结肠吻合术5例,回盲部切除+回肠升结肠端端吻合术3例,右半结肠切除术2例,乙状结肠憩室切除、造口+直肠残端闭合4例(Hartmann术,6周后行二期吻合)。结果手术均获成功,无手术并发症,效果满意。结论结肠憩室出现穿孔、出血、脓肿及腹腔感染等并发症时宜行手术治疗,应根据憩室部位、大小、并发症及腹腔感染程度选择不同手术方式。     

Regression of inflammatory pseudotumor of the bladder in a child with medical management

Inflammatory pseudotumor of the bladder is a benign proliferative lesion of the submucosal stroma that cannot be distinguished from malignant tumors of the bladder either endoscopically or radiographically. Although benign, the proliferative nature of the inflammatory pseudotumor histopathology has led others to recommend open surgical removal or complete transurethral resection for definitive treatment. A limited number of case reports have described inflammatory pseudotumor of the bladder in either adults or children. This is a case of biopsy-proven inflammatory pseudotumor in the bladder of a child that regressed after medical management alone.     

Inflammatory pseudotumor of the retroperitoneum removed via a retroperitoneoscopic approach

Background:

Inflammatory pseudotumors were mostly encountered in the lung. Retroperitoneal inflammatory pseudotumors are relatively rare. Although laparoscopic surgery with a modified flank position is widely performed for retroperitoneal tumors, we placed the patient in the supine position to maintain the normal anatomical view of the retroperitoneal space. We report a case of retroperitoneal inflammatory pseudotumor extracted via retroperitoneoscopic surgery in the supine position.

Methods and Results:

A 53-year-old man presented with back pain and frequent urination. Ultrasonographic examination revealed a solid tumor above the urinary bladder. This tumor was diagnosed as a primary retroperitoneal tumor by computed tomography, magnetic resonance imaging, and angiography. The retroperitoneoscopic procedure was adopted to remove this tumor. Histopathologic examination revealed an inflammatory pseudotumor. There was no evidence of recurrence 5 years after surgery.

Conclusions:

The diagnosis of the inflammatory pseudotumor is rarely made before histologic examination. Only pathologic examination allows the correct diagnosis. Consequently, most patients undergo surgical treatment. A recurrence rate of 25% has been reported for inflammatory pseudotumors. Thus, radical resection is needed. The retroperitoneal laparoscopic approach with the patient in the supine position is useful for surgically treating these primary retroperitoneal tumors located below the level of the renal vessels.     

Ruptured giant colonic diverticulum

Giant colonic diverticulum (GCD) is a rare complication of diverticular disease with less than 150 cases reported in the English literature. The clinical presentation ranges from asymptomatic to that of an acute abdomen. In most cases, giant colonic diverticulum is found in the sigmoid colon. The ideal treatment is elective resection of the sigmoid colon with primary anastomosis. When the diverticulum presents with perforation or obstruction, however, the treatment is a sigmoid colectomy with diverting colostomy (Hartmann procedure).     

Inflammatory pseudotumor of the spleen: Report of a case

A case of an inflammatory pseudotumor arising in the spleen of a 60-year-old Japanese male is described herein. This benign lesion is extremely rare, with only 12 cases, including our own, having been reported in the world literature. We preoperatively diagnosed the splenic tumor as a metastasis, due to the coexistance of advanced stage carcinoma in the sigmoid colon. However, after splenectomy, histopathological examination of the mass revealed aninflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiologic findings are suggestive of malignancy. The clinical and pathological features of cases previously reported are reviewed following the presentation of this case.     

Pseudomalignant spindle cell proliferation of the urinary bladder: an unusual cause of voiding symptoms in a young patient

A case of an unusually large pseudomalignant spindle-cell proliferation (or inflammatory pseudotumor) of the urinary bladder in a young man is presented. The only symptom was urinary frequency. The clinical and radiologic evaluation (ultrasonography, computed tomography, and magnetic resonance imaging) revealed a massive tumor (11 x 7.5 x 5.5 cm) arising from the bladder wall that was eventually resected without compromising bladder function. Although the histologic findings initially suggested a sarcoma, the immunohistochemical findings were consistent with that of an inflammatory pseudotumor. The patient remained asymptomatic, without evidence of recurrence, after 12 months of follow-up. Awareness of this inflammatory pseudotumor and its immunophenotypic characteristics is important to avoid an erroneous diagnosis and unnecessarily aggressive therapy.     

Perforated congenital diverticulum of the sigmoid colon

A case of perforation of a congenital sigmoid diverticulum producing diffuse peritonitis in a 4-year-old boy is presented. Physical examination showed an acute abdomen despite a normal computed tomography study. Successful surgical treatment was achieved by excision of the diverticulum, adjacent bowel, and an end-to-end anastomosis.     

Adenocarcinoma of the sigmoid segment 38 years after sigmoidcystoplasty : a case report

A 60-year-old woman presented at another hospital with a complaint of voiding difficulty. She had had left nephrectomy and bladder augmentation using the sigmoid colon for treatment of urinary tract tuberculosis 38 years ago. Left ovarian tumor was found by computed tomography and she was referred to our hospital. Another tumor which involved the uterus, bladder, and urethra was revealed by magnetic resonance imaging. An anterior pelvic exenteration was performed with preoperative diagnosis of left ovarian cancer with peritoneal dissemination. Histopathological examination revealed a clear cell adenocarcinoma of the left ovary and a sigmoid cancer arising in the augmented bladder. The sigmoid cancer arose from the anastomotic site between the bladder and sigmoid segment. This is the 34th case of neoplasms following augmentation enterocystoplasty reported in Japan.     

Inflammatory pseudotumor of the prostate: a case report

We report a rare case of inflammatory pseudotumor of the prostate. A 42-year-old man with a history of hematospermia and chronic prostatitis presented with difficulty in voiding. Cystoscopy demonstrated a large non-papillary tumor occupying the prostatic urethra along with two bladder stones. Magnetic resonance imaging (MRI) demonstrated a 7-cm prostatic mass protruding toward the bladder and the rectum. Transrectal biopsy of the prostate demonstrated a fibrous lesion containing inflammatory cells without evidence of malignancy. We performed transurethral resection of the prostatic lesion to release the bladder outlet obstruction, followed by cystolithotripsy. Histopathological examination of the surgical specimen demonstrated a benign fibromuscular lesion with spindle cell proliferation, leading to a diagnosis of inflammatory pseudotumor. Postoperatively, the patient voided normally without any signs of recurrence on follow-up at five months. Inflammatory pseudotumor is an unusual benign lesion of unknown etiology. Only 10 previous cases of the disease involving the prostate have been reported in English and Japanese literature. Prostatic involvement of inflammatory pseudotumor may show a presentation similar to malignant prostatic sarcoma. Thus, accurate identification of this benign process is important in order to avoid unnecessary radical surgery.     

Gastric diverticulum preoperatively diagnosed as one of two left adrenal adenomas

A 47-year-old man was diagnosed with primary aldosteronism due to two left adrenal adenomas, suggested on computed tomography (CT) to be located at the upper and lower adrenal portion. However, adosterol scintigraphy revealed negligible uptake at the upper portion of the left adrenal. Laparoscopic left adrenalectomy was performed, but macroscopic examination of the specimen revealed only one adrenal tumor. Continued surgical exploration detected another mass between the spleen and the stomach, which was demonstrated to be continuous with the stomach and was eventually diagnosed as a gastric diverticulum. Postoperatively, aldosteronism resolved and repeat CT revealed staining of the adrenal pseudotumor when oral contrast was administered. Since organs located near the adrenals can simulate adrenal tumors, caution must be exercised in interpreting suprarenal masses on CT. To our knowledge, this is the first reported case of concurrent pseudotumor and true tumor of the ipsilateral adrenal.     

Surgical management of localized left ventricular aneurysm associated with acute myocarditis.

We present a case of a localized left ventricular (LV) aneurysm in a 72-year-old woman with sudden onset of severe chest pain. A left ventriculogram revealed a small saccular outpouching protruding from the apex accompanied with narrow neck connection to the ventricular cavity. Both coronary arteries and global function were normal. We preoperatively diagnosed her as having an impending rupture in the congenital LV diverticulum because no inflammatory myocardial disease was suggested by general laboratory tests. After successful surgical treatment, microscopic examination for the myocardial specimens was performed and revealed diffuse lymphocytic infiltration associated with focal necrosis of myocardium. Histological findings were consistent with those of acute lymphocytic myocarditis. Without histological confirmation, an aneurysm caused by silent myocarditis might be misdiagnosed as a diverticulum.