Cases reported "Sigmoid Neoplasms"

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1/85. Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy.

    BACKGROUND AND OBJECTIVES: Laparoscopic-assisted surgery has been applied for a variety of colonic surgery. The objective of this paper is to demonstrate a possible and avoidable complication of laparoscopic colonic surgery. CASE PRESENTATION: A 47-year-old woman underwent gasless laparoscopic-assisted sigmoid colectomy. On the 20th postoperative day, she developed bowel obstruction. decompression with a long tube failed to resolve the bowel obstruction. Open laparotomy was performed. Abdominal exploration revealed a loop of the small bowel incarcerated in the mesenteric defect caused by the previous operation. Adhesiolysis was performed, and the postoperative course was uneventful. DISCUSSION: Despite technical difficulty, complete closure of the mesentery after bowel resection is strongly recommended for prevention of transmesenteric incarcerated hernia after laparoscopic surgery.
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ranking = 1
keywords = operative
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2/85. Endoscopic preoperative colonic tattooing: a clinical and surgical complication.

    Endoscopic colonic tattooing is the simplest and most economic technique for identifying small lesions or polypectomy sites during open and laparoscopic surgery. Moreover, it is useful for the endoscopic follow-up of polypectomy sites. india ink is the agent of choice because of its long-lasting stain and the low risk of adverse reaction and toxicity. Very few cases of complications have been reported. We report here the case of a patient in whom colonic tattooing in preparation for surgical resection was followed by clinical complications such as fever and abdominal pain. An abscess-type inflamed pseudotumor was found at laparotomy. Histological examination revealed chronic granulomatous inflammation.
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ranking = 2
keywords = operative
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3/85. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.

    patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.
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ranking = 1.5
keywords = operative
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4/85. Knot formation in a long tube used in the treatment of a post-operative adhesive small bowel obstruction.

    The complications specific to the management of the nasointestinal long tubes for small bowel obstruction are not generally appreciated. We report here of a case of knot formation of the long tube which was inserted for a 60 year-old male. Because it was difficult to place the tube in the distal stomach despite frequent changes in patient position, two coiled loops were noted at the fornix as the tip of the tube reached the antrum. The tube was gently removed without injury to the esophagus or stomach under fluoroscopic control. This case illustrates that when a long tube is used, the formation of multiple coils in the stomach should be avoided during placement to prevent knotting. Furthermore, a knotted tube can be gently removed non-operatively without esophageal injury. A short tube may be superior to a long tube because most of the complications can be avoided.
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ranking = 2.5
keywords = operative
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5/85. Herniation of the small bowel through the port site following removal of drains during laparoscopic surgery.

    BACKGROUND/AIMS: Generally, the port site is used as the delivery route for drainage after laparoscopic abdominal surgery. We report this case because of the rarity of the complication related to laparoscopic procedures. methods: A 75-year-old woman underwent a laparoscopic-assisted sigmoid colectomy for early stage cancer. RESULTS: After the operation, her postoperative course was uneventful. However, just after removing the drains, the small bowel was found to have herniated through the port site used as the insertion route for the drains. An emergency relaparotomy was done and a segment of the necrotic small bowel had to be resected. CONCLUSION: To prevent this complication, we suggest that, first of all, in elderly and thin patients smaller trocar insertion sites (<10 mm) should be utilized as insertion routes for the drains and, secondly, the fascial defect should be closed just after removing the drains whenever the defect measures 10 mm or more in size.
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6/85. Isolated splenic metastasis of sigmoid colon cancer: a case report.

    We report the case of a 62-year-old man who developed isolated splenic metastasis of sigmoid colon cancer. The patient underwent left hemicolectomy for Dukes C sigmoid colon cancer in February 1997. In March 1999, an abdominal CT scan revealed a tumor 3 cm in size at the inferior pole of the spleen. The tumor was hyperechoic on ultrasonography. The serum carcinoembryonic antigen level was normal. Since no other site of recurrence was identified, a splenectomy was performed with a curative intent. At laparotomy, neither hepatic metastasis, peritoneal dissemination, lymph node metastasis nor local recurrence was detected. Histological findings of the splenic tumor were compatible with metastasis of the previously resected sigmoid colon adenocarcinoma. The patient has been disease-free for 19 postoperative months. Immunohistochemical staining for urokinase-type plasminogen activator was positive in primary sigmoid colon cancer and splenic metastasis, but negative in lymph node metastasis; results that possibly reflect the difference in progenitor cells between splenic metastasis and lymph node metastasis or the difference in the microenvironment of cancer cells between the spleen and lymph nodes. Based on the present case, we recommend that clinicians pay close attention to the spleen for the early diagnosis of isolated splenic metastasis when routinely evaluating abdominal CT scans and abdominal ultrasonography following curative resection of primary colorectal cancer.
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keywords = operative
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7/85. Reconstruction of urinary tract utilizing transverse colon conduit for a cystectomized patient with post-ureterocutaneostomy complications and sigmoid colon cancer.

    A seventy-four years old man had been suffering from symptomatic and infectious complications associated with conjoined cutaneoureterostomy following the radical cystectomy for advanced transitional cell carcinoma of the bladder 3 years ago. He underwent urinary reconstruction using transverse colon conduit after diagnostic exclusion of recurrent urothelial tumor in the upper urinary tract, evaluation of performance status and endoscopic examination of the colon. Enteroscopy incidentally revealed he had an early stage adenocarcinoma in his sigmoid colon to be resected, and the resection was followed by the urinary diversion. Postoperatively he is satisfied to be free from urinary complications and frequently visits the outpatient clinic for painful and troublesome ureteral catheter exchange.
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ranking = 0.5
keywords = operative
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8/85. diffusion-weighted MR imaging of Carmofur-induced leukoencephalopathy.

    Carmofur (1-hexylcarbamyl-5-fluorouracil), a derivative of 5-fluorouracil (5-FU), has been widely used in japan as a postoperative adjuvant chemotherapy agent for colorectal and breast cancer. Periventricular hyperintensity on T2-weighted MR images in carmofur-induced leukoencephalopathy confront the physician with a broad range of differential diagnoses. We describe two cases of carmofur-induced leukoencephalopathy in which diffusion-weighted MR imaging revealed periventricular hyperintensity. We compared their findings with those of age-related periventricular hyperintensity in five patients and found discrepancies in signal intensity of periventricular areas. Our results suggest that diffusion-weighted MR imaging may be useful to differentiate carmofur-induced leukoencephalopathy from age-related periventricular hyperintensity.
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ranking = 0.5
keywords = operative
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9/85. "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.
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ranking = 0.5
keywords = operative
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10/85. Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance.

    Colonic lipomata are rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 75-year-old man who suffered from nonspecific recurrent abdominal pain in the left upper and lower quadrants and had variable episodes of diarrhea and constipation of 4 weeks' duration. During colonoscopy, a giant intraluminal polyp was diagnosed at 35 cm. Abdominal helical computed tomography (CT) revealed a constipating colonic tumor with a diameter of >or=50 mm and density values equal to fat. During laparoscopic surgery in the lithotomy position, the sigmoid and the descending colon were mobilized using a Harmonic scalpel. The origin of the polyp was localized precisely under colonoscopic guidance. The former 12-mm incision in the left lower quadrant was expanded to approximately 70 mm for extracorporal tumor resection. The left and sigmoid colon resections were carried out, and the polyp was removed by full-wall excision. After closure with a single-layer suture, the colon was pushed back into the peritoneal cavity. The patient had an uneventful recovery and was discharged 10 days postoperatively. histology confirmed a benign lipoma of the descending colon. Laparoscopic-assisted resection under endoscopic guidance proved to be suitable for the removal of large colonic polyps without complications.
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ranking = 0.5
keywords = operative
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