"Needlescopic" sigmoid resection

Minimally invasive surgical techniques and procedures continue to evolve with the trend toward fewer and smaller instruments. To our knowledge, this is the first reported case of sigmoid colon resection utilizing needlescopic technology. The patient was a 53-year-old woman diagnosed with a malignant lesion in the midsigmoid colon at 30 cm. A subsequent needlescopic sigmoid colon resection was performed and the patient was discharged home after an uneventful postoperative course. This case demonstrates that colon procedures that require major reconstruction may be performed needlescopically in selected patients.     

Surgical Management of Adult Sigmoid Colon Intussusception Caused by a Malignant Tumor: Report of a Case

A 67-year-old man was admitted for investigation of bloody stools. The sigmoid colon was found to be intussuscepted into the rectum very close to the anus, making reduction difficult. After dividing the peritoneum, the surgeon inserted his hands below the peritoneal reflection along the rectum and pushed the intussusceptum back from the distal to the proximal rectum using a milking action. The rectum was divided 5cm from the peritoneal reflection, and the sigmoid colon was divided 10cm proximally from the intussusception. The proximal end of the sigmoid colon was brought out as a colostomy. The residual rectum and the descending colon were anastomosed 5 months after the first operation. We present a case of adult intussusception of the sigmoid colon caused by a well-differentiated adenocarcinoma, which was successfully treated by manually reducing the intussusception, whereby abdominoperineal resection was avoided.     

Evaluation of "instant" preparation of the colon with povidone-iodine.

The antimicrobial effect of 20 minutes exposure to 10% povidone-iodine solution and to 5% neomycin-erythromycin solution was evaluated in vitro in 6 suspensions of dog feces. Povidone-iodine eliminated aerobic growth (P less than 0.001) and reduced anaerobes 4.01 +/- 1.06 (P less than 0.02); C. perfringens was the only anaerobic organism grown. Forty unprepared dogs underwent resection of the sigmoid colon and primary anastomosis. Twenty received normal saline and 20 povidone-iodine injected intraluminally immediately before resection. The colon contents of povidone-iodine treated dogs grew only 0.07 +/- 0.07 aerobes and 3.74 +/- 0.49 anaerobes (all Clostridia) (log10/ml colon contents) (P less than 0.001). All povidone-iodine dogs survived 3 weeks with no anastomotic leaks; three controls died from anastomotic leak within the first week (P = 0.12). Reexploration of survivors revealed less perianastomotic reaction in the povidone-iodine group. Twenty minutes exposure to povidone-iodine produced a significant decrease in bacterial counts in vitro and in unprepared sigmoid colon. No adverse effects were demonstrated.     

Volvulus of the colon. Apropos of 37 cases]

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.     

Feasibility of Single-Port Laparoscopic Surgery for Sigmoid Colon and Rectal Cancers and Preoperative Assessment of Operative Difficulty

Purpose

Single-port laparoscopic surgery is more difficult for sigmoid colon and rectal cancers than for right-sided colon cancer. We sought to analyze the feasibility of this procedure for sigmoid colon and rectal cancers and to estimate its difficulty.

Methods

We analyzed prospectively collected data from 63 consecutive patients with sigmoid colon or rectal cancers who underwent single-port laparoscopic surgery at our institution from June 2009 to December 2011. Patient and tumor characteristics, including patients’ pelvic anatomy which was assessed on CT scan imaging, were evaluated to elucidate what factors would affect the difficulty of the procedure and the necessity of using an additional trocar.

Results

Overall, the median operative duration was 190 min and blood loss was 20 ml, with no postoperative complications. The median number of lymph nodes harvested was 17 and the distal margin was 58 mm. The tumor was located significantly closer to the anus in cases in which an additional trocar was required in the right lower quadrant (9.5 vs 18 cm, p?<?0.0001). Procedural difficulty was significantly increased in cases in which the sacral promontory protruded ventrally (odds ratio 0.779 [95 % confidence interval 0.613 to 0.945], p?=?0.0236).

Conclusions

Depending on tumor location and sacral promontory shape, the introduction of an additional trocar might render single-port laparoscopic surgery feasible for sigmoid colon and rectal cancer resection.     

The difficulty of urethral anastomosis in sigmoid neobladder--the role of preoperative X-ray of an air-contrast barium enema

BACKGROUND: Sigmoid neobladder (Reddy method) is one of the representative neobladder after radical cystectomy. Occasionally we experienced difficulty on urethral anastomosis in sigmoid neobladder. Here we investigated preoperative X-ray of air-contrast barium enema and clarified what type could be easily anastomosed in sigmoid neobladder. MATERIAL AND METHODS: We performed five cases of total cystectomy with sigmoid neobladder replacement. Of the five, we can easily make a urethral anastomsis in three cases but not easily in other two cases. We investigated sigmoid colon length, it's internal diameter, it's form and it's mobility that was substituted for elevation level of rectosigmoid using preoperative X-ray of air-contrast barium enema. We also studied seventy five cases of X-ray of air-contrast barium enema who visited our hospital with various complaints such as lower abdominal pain. RESULTS: The length of three cases with easily anastomosed were 45.7 cm in diameter other two cases 33.5 cm in diameter.(over all 47.5 cm) The internal diameter were 49 mm and 33.5 mm respectively.(over all 44.4 mm) It was considered that Reddy method was indicated who had at least averaged sigmoid colon length and internal size. Sigmoid colon form were classified into 3 groups (type N. type l and others). There were no difference on colon length regarding sigmoid form, but others was considered to be improper form because significant difference was observed between type N and others in internal diameter. Three cases with easily anastomosed demonstrated a positive correlation of the elevation of the sigmoid colon over promontorium in the air contrast barium enema, other two cases negative. The elevation cases of the sigmoid colon in X-ray of air contrast barium enema had long sigmoid colon than other types.(p < 0.0001) Tha mean length of them was 51.6 cm in diameter. CONCLUSION: Sigmoid neobladder was at least indicated in men who had averaged sigmoid colon length. The sigmoid colon elevation sign in X-ray of air contrast barium enema did not require the measurement of sigmoid colon length and that sign implied good indication for sigmoid neobladder.     

乙状结肠扭转的CT诊断(附23例分析)

目的:探讨乙状结肠扭转的多排螺旋C T表现特征。方法:回顾手术中证实为乙状结肠扭转的23例,分析腹部C T扫描图和横断面扫描特征,总结乙状结肠扭转的C T影像学特征。结果:在C T定位像上,最敏感的表现是扩张的乙状结肠倒U征(21/23,91%),不成比例乙状结肠扩张(19/23,83%),其次为咖啡豆征(17/23,74%),Y征(12/23,52%)。在横断面扫描上,最敏感的是不成比例的乙状结肠扩张(21/23,91%)和圆腹征(20/23,87%),其次为近端结肠扩张(15/23,65%),漩涡征(15/23,65%),鸟嘴征(13/23,57%)。在C T定位像和横断面扫描上,典型的乙状结肠扭转影像表现分别占57%(13/23)和83%(19/23)。在定位像上,咖啡豆征与Y征在显著相关(P0.05)。横断面扫描上肠管损害的C T征象与临床肠管损害显著相关(P0.05)。结论:多排螺旋C T对乙状结肠扭转的诊断具有重要价值。在定位像上,乙状结肠扭转的主要影像学表现为倒U征,特征性表现为Y征;在横断面扫描上,主要影像学表现为不成比例的乙状结肠扩张,特征性表现为漩涡征和鸟嘴征。     

Inflammatory pseudotumor of the urinary bladder and sigmoid colon.

We report an unusual case of an inflammatory pseudotumor of the bladder. A biopsy specimen prior to surgical treatment suggested leiomyosarcoma, and computerized tomography and magnetic resonance imaging strongly suggested bladder tumor with sigmoid colon invasion. Accordingly, radical surgical treatment consisting of total cystectomy, anterior resection of the sigmoid colon, and ileal conduit was performed. After operation, however, histological examination revealed an inflammatory pseudotumor of bladder and sigmoid colon. These findings were confirmed by immunohistochemical staining for smooth muscle specific actin, desmin, S-100, and vimentin. Histological examination revealed a diverticulum of the sigmoid colon in the middle of the pseudotumor, and this diverticulum may have ruptured to cause the inflammatory pseudotumor of bladder and sigmoid colon.     

Laparoscopic sigmoidopexy by extraperitonealization of sigmoid colon for sigmoid volvulus: two cases

Sigmoid colectomy-open or laparoscopic-has been advocated as the treatment of sigmoid volvulus. This has a higher incidence of morbidity and mortality. We have successfully treated 2 cases of recurrent sigmoid colon volvulus with laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon. Laparoscopic sigmoidopexy by this technique has not been reported before. The first patient was a 20-year-old male and the second was a 72-year-old female. In both patients, initial detorsion of volvulus was achieved by rectal tube. As the colon was nongangrenous, elective laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon was performed 4 days after the detortion. Operative times were 50 minutes and 70 minutes. Both patients were discharged from the hospital on the third postoperative day. There has been no recurrence of volvulus over a period of 6 and 7 months. There were no complications. In conclusion, laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon may become a superior alternative for the treatment of sigmoid volvulus with nongangrenous colon.     

Combined intercolic and external fistula caused by carcinoma of the sigmoid

We have presented a case of carcinoma of the sigmoid with an intercolic fistula to the transverse colon, and an external fistula with abscess formation. Resection of the transverse colon, splenic flexure, descending colon, and sigmoid was carried out. A primary anastomosis was made between the proximal transverse colon and distal sigmoid. No metastases were found and recovery was uneventful.     

Laparoscopic colectomy for persistent descending mesocolon in sigmoid colon cancer: A case report

A 55-year-old-man underwent laparoscopic sigmoidectomy for sigmoid colon cancer. Preoperative barium enema showed a slightly medial displacement of the descending colon, and the sigmoid colon was quite long. The operative findings showed that the descending colon was not fused with the retroperitoneum and shifted to the midline and the left colon adhered to the small mesentery and right pelvic wall. Thus, a diagnosis of persistent descending mesocolon (PDM) was made. The left colon, sigmoid colon, and superior rectal arteries often branch radially from the inferior mesenteric artery. The sigmoid mesentery shortens, and the inferior mesenteric vein is often close to the marginal vessels. By understanding the anatomical feature of PDM and devising surgical techniques, laparoscopic sigmoidectomy for sigmoid colon cancer with PDM could be performed without compromising its curative effect and safety.     

Perforation of the Sigmoid Colon and Massive Ischemia of the Small Intestine Caused by Amyloidosis Associated With Multiple Myeloma: A Case Report

Amyloidosis is a metabolic disease that results in organ dysfunction because of the deposition of amyloid proteins in body tissues and organs. Amyloid accumulation in the gastrointestinal tract can lead to severe complications with poor outcomes. We report a case showing simultaneous perforation of the sigmoid colon and massive segmental intestinal ischemia caused by amyloidosis associated with multiple myeloma. A 75-year-old woman presented to the emergency department in our hospital with a chief complaint of abdominal pain. Results of several examinations indicated sigmoid colon perforation and acute generalized peritonitis. She underwent an emergency exploratory laparotomy. Operative finding was a perforation of the sigmoid colon and many segmental discoloration sites appeared intraoperatively in the small intestine. A loop colostomy was performed by employing a double-barrel ileostomy with a massive resection of the segmentally discolored small bowel. Pathological findings suggested that the causative factor was amyloidosis with multiple myeloma. The patient was successfully treated with adequate surgery and with melphalan and prednisone after the operation. Meticulous and appropriate treatment for severe complications involving amyloidosis associated with multiple myeloma can prevent a fatal outcome.Key words: Intestinal amyloidosis, Multiple myeloma, Perforation of sigmoid colon, Intestinal ischemiaIschemic intestinal disease is caused by various disease states such as thrombi, emboli, arteriosclerosis, vasculitis, incarcerated hernia, adhesive bands, and systemic illness.^1,2 Acute massive gastrointestinal (GI) ischemia often induces severe sepsis and subsequent life-threatening conditions such as GI perforation, which can be caused by local disease such as ulcer and neoplasm, as well as by systemic illness.^3–5 Emergency surgery is frequently required for both perforations and ischemic intestinal diseases.Amyloidosis, a systemic disease, involves multiple organ dysfunction as a result of amyloid protein accumulation. However, GI complications are relatively rare in patients with amyloidosis, and only a few GI complications including bleeding and perforation have been reported.^6,7 Herein, we report the successful treatment of a notable case involving a simultaneous perforation of the sigmoid colon and massive segmental intestinal ischemia caused by amyloidosis associated with multiple myeloma (MM). Pathological findings suggested that accumulation of amyloid protein in the vascular wall of the sigmoid colon and small intestine by amyloidosis with MM led to ischemia of those and perforation of sigmoid colon.This case is rare in terms of beginning with a sigmoid perforation and intestinal ischemia rapidly progressing during operation. According to a MEDLINE search with a combination of keywords relating to intestinal amyloidosis with MM such as AL-type amyloidosis, intestinal amyloidosis, perforation, and ischemia, there are no reported cases beginning with a perforation and intestinal ischemia progressing during operation.     

Small Solitary Pulmonary Metastasis Detected Before Primary Sigmoid Colon Cancer: Report of a Case

We report the case of a 60-year-old woman referred to us after chest X-ray and mobile computed tomography screening detected an 8-mm nodule in right S2. Transbronchial aspiration cytology suggested a pulmonary metastasis from colorectal cancer. Therefore, we performed a colonoscopy and found a polypoid lesion, 2cm in diameter, in the sigmoid colon. An analysis of a biopsy specimen from this polypoid lesion confirmed adenocarcinoma. Surgical resection of the primary sigmoid colon cancer was subsequently performed, followed 4 weeks later by a right S2 segmentectomy to remove the lung metastasis. The patient is currently well without any clinical signs of recurrence, 44 months after her operation.     

"Fast-track" and elective, laparoscopic colo-rectal surgery

The aim of this prospective clinical evaluation was to investigate the influence of "Fast-track"-treatment in patients undergoing laparoscopic colorectal operations and its effect on morbidity, hospital stay and recovery. PATIENTS AND METHODS: Bowel cleaning under enteral hypercaloric nutrition (Biosorb Energie, Fa. Nutricia, Germany) was achieved with Fleet (Ferring Arzneimittel, Germany) one day prior to surgery. A peridural catheter was placed preoperatively. Intraoperative electrolyte substitution should not exceed 12 ml/kg KG/h. In case of decreasing intraoperative blood pressure hydroxyethylstarch 6% was substituted. The nasogastric tube was removed immediately after the operation, the urinary catheter was removed on the first postoperative day. The patients stayed on the intermediate care department for one night and started already there with oral feeding and mobilisation (for 2 h). The following days mobilisation increased to 4 h daily under normal enteral nutrition without infusions. RESULTS: Between June 2003 and January 2006, 147 patients undergoing elective colorectal surgery were included in this study. Diverticulitis (n = 114), malignant tumors of the sigmoid colon (n = 6) or rectal cancer (n = 13), colonic adenomas (n = 5), stenotic Crohn's disease (n = 4) and small bowel carcinoid (n = 1), rectal prolaps (n = 1) and elongated colon sigmoideum (n = 4) were indications for surgical treatment. Laparoscopic sigmoid resection (n = 117), left hemicolectomy (n = 11), ileocecal resection (n = 8), anterior resection with total mesorectal excision (n = 9), abdomino-perineal exstirpation (n = 1) and anterior-segmental resection of the rectum (n = 1) were performed. Drainages were removed on the 2nd, peridural catheter on the 3rd postoperative day. Defecation occurred in all patients until the 2 (nd) postop. day. Early postoperative complication rate was 15% (22/147 patients) without mortality. 8 patients (5%) with anastomotic leakage were reoperated. The mean hospital stay was 6 days. The re-admission rate was 3% (4/147 patients) and included one patient with anastomotic leakage. CONCLUSION: "Fast-track"-treatment in combination with minimal-invasive surgery is a safe and comfortable perioperative treatment for patients with elective colorectal operations.     

Prolapsed epiploica of the sigmoid colon after total laparoscopic hysterectomy

Prolapsed epiploica of the sigmoid colon through the vaginal cuff is a rare finding that has never been reported after total laparoscopic hysterectomy. We encountered a case of prolapsed epiploica of the sigmoid colon in a 40-year-old female, 4 months status after total laparoscopic hysterectomy. Diagnostic laparoscopy demonstrated prolapsed epiploica of the sigmoid colon through a dehisced vaginal cuff.     

成人乙状结肠冗长症的诊断与治疗八例分析

目的探讨成人乙状结肠冗长症的临床特点和诊治方法。方法总结4年来收治的8例成人乙状结肠冗长症患者的临床资料，并结合文献进行分析。结果经1年随访择期行冗长肠襻切除术的病例均获满意疗效；仅行肠减压术不能缓解临床症状。结论成人乙状结肠冗长症主要表现是顽固性便秘和反复发作的急性肠梗阻；钡剂灌肠检查可明确诊断；治疗方法首选择期冗长肠襻切除术。     

乙状结肠扭转的诊断及治疗(附57例分析)

目的：总结乙状结肠扭转的诊治经验。方法：对57例乙状结肠扭转患者的临床表现及治疗方法进行回顾性分析。结果：32例行腹部X线平片检查,其中28例明确诊断,19例系钡灌肠检查显示“鸟嘴征”而作出诊断,7例通过结肠镜检查获得诊断,3例经剖腹探查证实本病;4例误诊或漏诊。非手术疗法9例,7例成功,50例行手术治疗,其中乙状结肠单纯复位15例,乙状结肠复位后固定6例,一期切除吻合术19例,10例行一期坏死肠袢切除结肠造口、二期降结肠直肠吻合术。治愈53例,死亡4例,复发2例。结论：老年腹痛、腹胀和便秘应考虑本病的可能。X线为首选检查。对于无肠坏死及腹膜炎的患者,行结肠镜检查有明显优点,对于有肠坏死及腹膜炎的患者,应及时手术治疗,一期肠切除吻合术宜慎用。     

腹腔镜乙状结肠癌根治术15例

目的探讨腹腔镜乙状结肠癌根治术的临床价值。方法回顾性分析2008年5月至2013年5月腹腔镜下乙状结肠癌根治术15例的临床资料。结果全组15例均在腹腔镜下完成手术,其中9例经体外行端端吻合,5例经肛门行直肠-乙状结肠端端吻合,1例行降结肠端造瘘。术后无吻合口瘘、吻合口出血等并发症发生,手术时间（192．8±33．5）min,平均186．8min,术中出血量（68．5±14．6）ml,平均59．6ml,术后住院时间（8．6±2．5）d,平均9．1d。结论腹腔镜乙状结肠癌根治术手术创伤小、术后恢复快,是治疗乙状结肠癌安全、可行的方法,但术者需有丰富的腹腔镜手术和结肠外科手术经验。     

Malignant sigmoidoduodenal fistula

INTRODUCTION

Duodenocolic fistula is a rare complication of malignant colonic disease especially when involving and originating from the sigmoid colon. We aim to discuss the unusual clinical presentation of this case as well as the investigation and management of duodenocolic fistulas.

PRESENTATION OF CASE

A 91 year old lady presented as an emergency to a general surgical service at a District General Hospital with diarrhoea, vomiting and weight loss. Computed Tomography (CT) reported a large ovarian cyst elevating the sigmoid colon into immediate proximity of the duodenum. Adenocarcinoma was confirmed on histology obtained by colonoscopy. A classic apple core lesion with fistulating tract from the sigmoid colon to the duodenum was synchronously demonstrated on barium enema.

DISCUSSION

Sigmoido-duodenal fistulae represent a complex manifestation of gastrointestinal pathologies.

CONCLUSION

Management options must be considered in the context of patient wishes, their co-morbidities, and predicted post-operative outcome. In most cases this is likely to represent a non-operative approach, however surgical resection may benefit selected cases on occasion.     

An incarcerated internal hernia of the sigmoid colon through a defect in the broad ligament: A case report

Introduction and importanceHernias through a defect of the broad ligament are rare, accounting for only 1.6–5% of internal herniations [1]. This report describes a rare case of sigmoid colon obstruction due to hernia through a defect of the broad ligament, which was diagnosed before surgery.Case presentationA 78-year-old multiparous woman presented with lower abdominal pain and nausea. Contrast-enhanced multi-detector CT (MDCT) demonstrated a dilated sigmoid colon and edematous mesentery of the sigmoid colon in the left Douglas' fossa, the uterus was compressed dorsally to the right and the left ovary was compressed ventrally. We diagnosed an internal broad ligament defect hernia with incarceration of the sigmoid colon, and performed emergency laparotomy. The necrotic sigmoid colon was resected and anastomosis was performed by the double stapling technique. The postoperative course was uneventful.Clinical discussionWe consider the treatment of hernia of sigmoid colon through a broad ligament defect.ConclusionWe recognize that there is a possibility that, in addition to the small intestine, proximally located organs may be incarcerated. In the case of the colon, we should choose the treatment method carefully according to whether or not the colon is expected to be necrotic.