Circular Suture Ligation of Presacral Venous Plexus to Control Presacral Venous Bleeding During Rectal Mobilization

Background

Presacral venous bleeding during rectal mobilization is uncommon but potentially life-threatening. Various methods have been proposed for controlling the bleeding, but each has some obvious limitations in clinical practice. We report a simple technique that was designated as circular suture ligation. This technique was efficient in controlling presacral venous bleeding encountered during rectal mobilization.

Methods

The key point of circular suture ligation was to control the bleeding by suture ligating the venous plexus in one or more circles in the area with intact presacral fascia that surrounds the bleeding site while the bleeding site was temporarily controlled with fingertip pressure. From September 2007 to December 2011, 258 patients underwent rectal surgery in our department because of rectal cancer. Uncontrolled presacral venous bleeding with traditional methods was encountered in eight patients (3 %) with estimated blood loss from 300 to 5,000 ml.

Results

Bleeding was successfully controlled in all eight patients with the circular suture ligation. None of the patients required reoperation for bleeding or other issues. No patients developed chronic pelvic pain after the operation.

Conclusions

Our experience suggests that circular suture ligation of venous plexus in the area with intact presacral fascia that surrounds the bleeding site is an effective and simple technique to control presacral venous bleeding when traditional techniques fail.     

Mesh fistulation into the rectum after laparoscopic ventral mesh rectopexy

INTRODUCTION

Laparoscopic ventral mesh rectopexy (LVMR) is an effective method of management of functional disorders of the rectum including symptomatic rectal intussusception, and obstructed defaecation. Despite the technical demands of the procedure and common use of foreign body (mesh), the incidence of mesh related severe complications of the rectum is very low.

PRESENTATION OF CASE

A 63 year old woman presented with recurrent pelvic sepsis following a mesh rectopexy. Investigations revealed fistulation of the mesh into the rectum. She was treated with an anterior resection.

DISCUSSION

The intraoperative findings and management of the complication are described. Risk factors for mesh attrition and fistulation are also discussed.

CONCLUSION

Chronic sepsis may lead to ‘late’ fistulation after mesh rectopexy.     

Giant rectal villous adenoma: Surgical approach with rectal eversion and perianal coloanal anastomosis

INTRODUCTION

Colorectal cancer is an important cause of death. Most cases of colon and rectal cancer arise from a preexisting adenomatous polyp. However, if colorectal polyps are very large or not accessible for endoscopic ablation, or if they cannot be removed without an increased risk of perforation, surgical procedures are required.

PRESENTATION OF CASE

The case of a patient with a giant villous adenoma of the rectum is described. The patient had diarrhea for 2 years associated with asthenia. Colonoscopy revealed a sessile lesion in the rectum measuring 14 cm in the largest diameter. Rectal eversion technique was used, resecting the lesion under direct visibility and an external coloanal anastomosis was performed. Surgery was satisfactory and the resection margins were free.

DISCUSSION

Removal of these polyps should be performed aiming to reduce the incidence of colorectal cancer, as well as to control local and systemic symptoms, such as diarrhea and fluid and electrolyte disorders, mainly in villous adenomas. Various surgical techniques are proposed, but in extensive circumferential lesions of the rectum they are difficult to apply. The rectal stump eversion technique was described by Maunsell (1892), for rectal cancer.

CONCLUSION

Eversion of the rectal stump and external coloanal anastomosis may be a good surgical alternative for resecting giant rectal adenomas.     

MRI evaluation of not complicated Tailgut cyst: Case report

INTRODUCTION

The Tailgut cyst (cystic hamartoma) is an uncommon congenital disease of presacral retrorectal space and is embryologically part of some forms of enteric cysts. It is a benign malformation, although cases have been described in neoplastic degeneration.

PRESENTATION OF CASE

A caucasian 24 year old female presented shortly after childbirth with hypogastric abdominal discomfort associated with rectal tenderness, bleeding and moderate urinary symptoms for about three weeks. No previous similar episodes were reported. The patient was not suffering from haemorrhoids or inflammatory disease of the gastrointestinal tract.Clinical examination revealed no significant abnormalities or in the perianal area and gluteal surface.Digital rectal examination was suspicious of the presence of a presacral retrorectal mass. However, it could not exclude a trans-sphinteric perianal fistula. There was no fistulous communication with the exterior and the pain seemed to be more pronounced in the rectum.MRI, which has a diagnostic accuracy of 76–100% for the detection of any perianal fistulae, was performed and demonstrated the presence of a retrorectal cystic hamartoma (Tailgut cyst).

DISCUSSION

The most common retrorectal space cystic lesions includes epidermoid cysts, dermoid cysts and enteric cysts. It presents with pelvic pain, and sometimes with local abscess, secondary to a sinus cyst. There can also be a communication between Tailgut cyst and fistula; in the absence of primary infection may develop postinflammatory fibrosis. Radiological investigation is carried out by TRUS, CT and MRI. During MRI, on T1-weighted images, the signal intensity may change from hypointense to hyperintense as protein concentration increases, as well as in the case of bleeding. On T2-weighted images, signal intensity of mucinous fluids can decrease from highly hyperintense to hypointense with increasing protein concentration and viscosity.

CONCLUSION

MRI is a non-invasive useful imaging investigation with high diagnostic accuracy when a retrorectal cyst is suspected. Despite its rarity, Tailgut cyst should be considered, both for acute complications, like infection or bleeding, and for the risk, however infrequent, of neoplastic degeneration.     

Squamous cell carcinoma of middle rectum: Literature review

INTRODUCTION

Squamous cell carcinoma SCC of the rectum is a distinct entity. We report a very rare case of squamous cell carcinoma of the middle rectum.

PRESENTATION OF CASE

The patient was a 62-year-old woman who presented with a history of rectal bleeding and discomfort. Colonoscopy revealed a polypoid tumour of the middle rectum. Biopsies of this mass revealed a poorly differentiated SCC of the rectum. CT scan of the chest, abdomen and pelvis was negative for distal metastases. The patient received combined chemo-radiation followed by surgical excision. The postoperative period was uncomplicated.

DISCUSSION

The pathogenesis of rectal SCC remains unclear and diagnosis is often delayed. Diagnostic criteria have been proposed. MRI of the rectum and trans-rectal endoscopic ultrasound R-EUS provide essential information to plan a therapeutic approach. The squamous cell carcinoma antigen level is not suitable for initial diagnosis of rectal SCC. Most authors conclude that the surgery is the gold standard treatment. Tumour stage is the most important prognostic predictor of SCC.

CONCLUSION

Squamous cell carcinoma of the rectum is a distinct entity. Before the final choice of treatment is made, digestive surgeons should bear in mind this rare tumour.     

Rectal obstruction due to endometriosis: A case report and review of the Japanese literature

INTRODUCTION

Colorectal obstructive endometriosis is relatively rare in Japan and its differentiation from malignancy is often difficult. We report a case of rectal obstructive endometriosis.

PRESENTATION OF CASE

A 37-year-old woman was referred to our hospital with a suspected ileus. Her chief symptoms were left lower abdominal pain and vomiting. Colonoscopy showed an intraluminal mass of redness in the upper rectum. A proctectomy was performed because of the bowel obstruction. The rectum was filled with an intraluminal mass measuring 5 cm × 4 cm, and endometriosis was diagnosed pathologically.

DISCUSSION

A preoperative diagnosis of colorectal obstructive endometriosis is often difficult because of the lack of definite diagnostic, clinical, sonographic, or radiological findings that are characteristic of this disease. Medical treatment is not always effective for colorectal obstructive endometriosis, and surgery is often performed.

CONCLUSION

Colorectal obstructive endometriosis should be considered as a differential diagnosis in cases of various gastrointestinal symptoms in women who are of reproductive age.     

Control of presacral venous bleeding during rectal surgery

Background

Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis.

Methods

From September 2007 to March 2009, 83 patients underwent rectal surgery for cancer, ulcerative colitis, or familial adenomatous polyposis. Three patients (3.6%) had severe presacral hemorrhage, which was controlled by the combined use of a hemostatic matrix (FloSeal; Baxter, USA) and an absorbable hemostat (Surgicel Fibrillar; Ethicon, USA).

Results

Intraoperative blood transfusion was required in 1 patient. Postoperative blood loss was minimal and drain was removed on day 4 in all 3 patients.

Conclusions

The use of synthetic hemostatic agents is an effective and simple way to arrest presacral bleeding where conventional methods fail.     

Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer

INTRODUCTION

An infiltration of urological organs is found in 5–10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach.

PRESENTATION OF CASE

Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease.

DISCUSSION

This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed.

CONCLUSION

En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient''s quality of life in comparison to total pelvic exenteration.     

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

INTRODUCTION

Intractable haemorrhage after endoscopic surgery, including transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP), is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention.

PATIENTS AND METHODS

We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding.

RESULTS

Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed.

CONCLUSIONS

Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent bleeding post-endoscopic prostatic surgery should be treated promptly to prevent the risk of rapid deterioration. We demonstrated that the technique of open prostate packing may be life-saving.     

A Reproducible Ex Vivo Model for Transanal Minimally Invasive Surgery

Background:

Rectal tumors can be excised through a number of minimally invasive transanal techniques including transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery (TAMIS). Specialty training is often required to master the nuances of these approaches. This study aimed to create a reproducible transanal excision training model that is suited for laparoendoscopic techniques.

Methods:

Frozen porcine rectum and anus with intact perianal skin were commercially obtained. Thawed specimens were then cut to approximately 20 cm in length. The proximal end of the rectum was then everted and suction applied to the mucosa to create pseudopolyps of various sizes (sessile and pedunculated). Larger pedunculated lesions were made by tying the base of the pseudopolyps with 5–0 monofilament sutures to gather more tissue. Methylene blue dye was injected submucosally into the lesions to simulate tattoos. The proximal rectum was then closed with sutures. The model was suspended in a trainer box by clamping the distal end in a ringed clamp and the proximal end to the box. Transanal excisions using TAMIS were then performed. The procedures were done by trained community colorectal surgeons attending courses on transanal minimally invasive surgery.

Results:

Both partial- and full-thickness excisions of sessile and pedunculated rectal lesions were successfully performed during simulated TAMIS by trained community surgeons learning this laparoendoscopic technique.

Conclusion:

Transanal laparoendoscopic procedures to excise rectal tumors can be successfully and reproducibly performed in an ex vivo porcine anorectal model.     

Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique,results and reflection

Background

The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life.

Aim

To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy.

Method

Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010.

Results

The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis.

Conclusion

The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.     

Effect on hemostasis of an absorbable hemostatic gelatin sponge after transrectal prostate needle biopsy

Objectives

To examine the usefulness of an absorbable hemostatic gelatin sponge for hemostasis after transrectal prostate needle biopsy.

Subjects and Methods

The subjects comprised 278 participants who underwent transrectal prostate needle biopsy. They were randomly allocated to the gelatin sponge insertion group (group A: 148 participants) and to the non-insertion group (group B: 130 participants). In group A, the gelatin sponge was inserted into the rectum immediately after biopsy. A biopsy-induced hemorrhage was defined as a case in which a subject complained of bleeding from the rectum, and excretion of blood clots was confirmed. A blood test was performed before and after biopsy, and a questionnaire survey was given after the biopsy.

Results

Significantly fewer participants in group A required hemostasis after biopsy compared to group B (3 (2.0%) vs. 11 (8.5%), P=0.029). The results of the blood tests and the responses from the questionnaire did not differ significantly between the two groups. In multivariate analysis, only “insertion of a gelatin sponge into the rectum” emerged as a significant predictor of hemostasis.

Conclusion

Insertion of a gelatin sponge into the rectum after transrectal prostate needle biopsy significantly increases hemostasis without increasing patient symptoms, such as pain and a sense of discomfort.     

Massive per rectal bleeding following blunt abdominal trauma: First presentation of Crohn's disease

Introduction

Inflammatory bowel disease is a chronic and relatively common disorder with heterogeneous presentation. Peak incidence occurs in the second and third decades of life. We present a patient with Crohn''s disease whose first presentation was profuse bleeding/rectum following blunt abdominal trauma.

presentation of case

A 29 year old previously healthy man presented one hour after sustaining relatively mild abdominal trauma, due to fall onto the ball during a rugby match. He complained of abdominal pain and one episode of large fresh rectal bleeding. He was pale and distressed with hypotension, tachycardia and abdominal guarding & fresh blood on digital rectal examination. With a provisional diagnosis of intestinal injury he was taken to theatre. Right hemi-colectomy was done for a thickened and inflamed segment of distal ileum, a large adjacent mesenteric haematoma & mesenteric lymph nodes and blood in distal bowel. Histology confirmed the features of Crohn''s disease.

discussion

Crohn''s disease is unusual cause of massive lower gastrointestinal bleeding occurring in 0.9–6% of patients. Rectal bleeding associated with diarrhoea is relatively more common than massive bleeding. The presence of Crohn''s disease in young patients presenting like this is unlikely to be suspected and diagnosis could only be made after laparotomy.     

Results of local excision for rectal carcinoma

Objective

To determine the results peranal excision for rectal carcinoma.

Design

Retrospective case series.

Setting

A university-affiliated hospital.

Patients

Of 178 patients who presented for curative resection of rectal carcinoma between 1975 and 1993, 19 (10.7%) were deemed suitable for local excision. There were 10 men and 9 women with a mean age of 71.2 years. The follow-up ranged from 13 to 184 months.

Intervention

Peranal excision.

Main Outcome Measures

Histologic differentiation, gross morphology, depth of invasion and size of the carcinoma, adequacy of margins of excision, complications of operation, rates of recurrence, results of salvage therapy and 5-year survival.

Results

There were no intraoperative complications. Postoperative complications included urinary retention (one patient) and bleeding (one patient). There were five local recurrences (26%). Salvage operations were performed in three (60%) patients and were successful in two of them. The 5-year cancer-specific survival rate was 82%. The recurrence rate was higher in patients with inadequate margins of excision and ulcerative lesions. Neither size nor grade of the carcinoma correlated with recurrence.

Conclusions

Local excision of rectal carcinoma can be performed successfully in selected patients. Diligent follow-up is required, because up to 60% of local recurrences can be treated successfully.     

A case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery

INTRODUCTION

Malignant transformation of intestinal endometriosis occurring in the extraovarian sites is extremely rare. We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum.

PRESENTATION OF CASE

An 83-year-old woman was admitted with the complaint of hematochezia. Colonoscopy revealed a tumor around about half of the rectal circumference. Biopsy of the tumor revealed a well-differentiated adenocarcinoma. Low anterior resection was undergone laparoscopically under the diagnosis of rectal carcinoma. Histopathological examination revealed clear cell adenocarcinoma, invading the sub-serosa of the rectum, but no metastasis of the lymph nodes. Immunohistochemical staining showed strong positivity for cytokeratin 7, but no staining for cytokeratin 20 and CDX2. The tumor existed adjacent to the endometrial glands, which were stained positive for Estrogen receptor. Ultimately, the patient was diagnosed with clear cell adenocarcinoma arising from endometriosis. Eighteen months after surgery, there are no signs of tumor recurrence.

DISCUSSION

Clear cell adenocarcinoma arising from intestinal endometriosis has been reported in 7 cases, including our case. Careful observation is required because the prognosis of endometriosis after malignant transformation remains poor.

CONCLUSION

We report a very rare case of clear cell adenocarcinoma arising from endometriosis of the rectum treated by laparoscopic surgery.     

Perioperative tranexamic acid in day-case paediatric tonsillectomy

Introduction

Tranexamic acid has been used for many years to minimise blood loss during surgery and, more recently, to reduce morbidity after major trauma. While small studies have confirmed reduction in blood loss during tonsillectomy with its use, the rate of primary haemorrhage following tonsillectomy has not been reported. In the UK, less than 50% of children having a tonsillectomy are managed as day cases, partly because of concerns about bleeding during the initial 24 hours following surgery.

Methods

A retrospective review of clinical records between January 2007 and January 2013 produced 476 children between the ages of 3 and 16 years who underwent Coblation™ tonsillectomy, with or without adenoidectomy and/or insertion of ventilation tubes. All children were ASA (American Society of Anesthesiologists) grade 1 or 2 and anaesthetised using a standard day surgery protocol. Following induction of anaesthesia, all received intravenous tranexamic acid at a dose of 10–15mg/kg.

Results

Two children (0.4%) had minor bleeding within two hours of surgery. Both returned to theatre for haemostasis and were discharged home later the same day with no further complications. The expected rate for primary haemorrhage in the UK using this technique for tonsillectomy is 1%.

Conclusions

Perioperative tranexamic acid in a single, parenteral dose might reduce the incidence of primary haemorrhage following paediatric tonsillectomy, facilitating discharge on the day of surgery. The results from this observational study indicate a potential benefit and need for a large, prospective, multicentre, randomised controlled trial.     

Hyperamylasaemia and ischaemic colitis

INTRODUCTION

Ischaemic colitis is a differential diagnosis to be considered in patients who have a high cardiovascular risk. Presentation of severe ischaemia is usually that of an acute abdomen with passage of fresh blood per rectum, and hyperamylasaemia.

PRESENTATION OF CASE

A 66-year-old gentleman was admitted to A&E with a short history of central abdominal pain, nausea, vomiting and fresh bleeding per rectum. A diagnosis of ischaemic colitis was made by the computed tomography (CT) scan findings of colonic thickening and pneumatosis, in addition to colonoscopy demonstrating sloughy mucosa and ulceration. Symptoms did not resolve with conservative management, therefore laparotomy + Hartmann''s procedure was performed. Histology showed extensive areas of both partial and full thickness ischaemia with stricture.

DISCUSSION

Amylase is an indicator of intra-abdominal inflammatory processes. Hyperamylasaemia (normal <100 U/l) is most frequently associated with pancreatitis; however, causation is not exclusive and other differentials including bowel ischaemia must be considered, although amylase is not a specific marker for ischaemic colitis. It is important to distinguish between ischaemic and ulcerative colitis.

CONCLUSION

Intestinal ischaemia is a serious acute abdominal pathology that is associated with hyperamylasaemia, and frequently requires prompt surgical intervention to prevent subsequent mortality.     

Large gastrointestinal stromal tumor and advanced adenocarcinoma in the rectum coexistent with an incidental prostate carcinoma: A case report

INTRODUCTION

Gastrointestinal stromal tumors (GISTs) are the leading mesenchymal neoplasia in the gastrointestinal tract, but GIST arising from the rectum is rare. When a secondary neoplasia coexists in the vicinity of a rectal GIST, more aggressive treatment strategies may be needed to cure the diseases.

PRESENTATION OF CASE

We herein describe a 76-year-old man with a large gastrointestinal stromal tumor along with an advanced adenocarcinoma in the rectum that coexisted with prostate carcinoma. Preoperative examination revealed an advanced adenocarcinoma of the upper rectum and a large pelvic mass suggestive of a GIST or a neuroendocrine tumor arising from the anterior wall of the lower rectum. To eradicate the tumor, total pelvic exenteration with ureterocutaneous fistula was carried out after obtaining written informed consent. Immuhistochemical studies revealed the concurrence of an advanced rectal cancer (T3, N1, M0) and a malignant GIST (c-kit-positive, CD34-positive, vimentin-positive, and CAM5.2-negative), and an incidental prostatic acinar adenocarcinoma. The patient was given adjuvant chemotherapy with imatinib and remains disease-free as of 12 months after surgery.

DISCUSSION

A PubMed search for the case of coexistence of GIST with two other malignancies revealed only four cases, making this very rare condition.

CONCLUSION

Radical surgery with perioperative adjuvant chemotherapy using tyrosine kinase inhibitors is the choice for treatment of large GISTs with a malignant potential. Our report suggests that aggressive surgical approach would be feasible, when a secondary tumor is present near the GIST.     

Colorectal cancer in aged patients. Toward the routine treatment through laparoscopic surgical approach

Aim

Colorectal cancer is one of the most common malignancies in general population. The incidence seems to be higher in older age. Surgery remains the treatment of choice and laparoscopic approach offers numerous benefits. We report our personal experience in elderly patients operated on for colorectal cancer with laparoscopic resection.

Patients and methods

From January 2003 to September 2013, out of 160 patients aged 65 years or older and operated with minimally invasive techniques, 30 cases affected by colorectal cancer and operated on with laparoscopic approach were analyzed in this study.

Results

Male/female ratio was 1.35 and mean age 72 years. Constipation, weight loss, anemia and rectal bleeding were the most commonly reported symptoms. Lesions involved descending-sigmoid colon in 53% of cases, rectum in 37% and ascending colon in 10%. Among laparoscopic colorectal operations laparoscopic left colectomy was the most frequently performed, followed by right colectomy, abdominoperineal resection and Hartmann procedure. Operative times ranged from 3 to 5 hours depending on surgical procedure performed. Mean hospital stay was 6 days (range 4–9). Conversion to open approach occurred only in a case of laparoscopic right colectomy (3%) for uncontrolled bleeding. A single case of mortality was reported. In two cases (7%) anastomotic leakage was observed, conservatively treated in one patient and requiring reoperation in the other one.

Conclusions

Laparoscopic colorectal surgery is feasible and effective for malignancies in elderly population offering several advantages including immunologic and oncologic ones. However an experienced surgical team is essential in reducing risks and complications.     

Local excision of rectal schwannoma using transanal endoscopic microsurgery: A case report

INTRODUCTION

Schwannoma is a neoplasm originating from the neural crest cells (schwann cells) that form nerve sheaths. These tumors are thought to be benign with little risk of malignant transformation. They rarely affect the gastrointestinal tract, and primary rectal involvement is extremely rare. Until 2013, only 11 cases of anorectal schwannoma have been reported. Optimal surgical treatment of rectal schwannoma has not been established.

PRESENTATION OF CASE

We herein describe a 70-year-old woman with a submucosal tumor arising from the posterior wall of the rectum with features mimicking a gastrointestinal stromal tumor. After discussing the operative procedures and obtaining written informed consent, we attempted local excision of the tumor using a transanal endoscopic microsurgery (TEM). The tumor was proved to be S-100 positive schwannoma on immuhistochemical studies. Her postoperative course was uneventful, and there is no evidence of tumor recurrence as of 6 months after surgical excision.

DISCUSSION

An extremely rare rectal schwannoma was successfully treated using a TEM without compromising anorectal function.

CONCLUSION

TEM is a feasible approach for local excision of rectal tumors with low risk of malignancy.