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Aim This study reports a successful minilaparoscopic treatment of a 62 years old male patient with a Grynfeltt hernia, and outlines a new minimally invasive way to do the procedure. A patient presented with a left lumbar herniation of two years duration with no other symptoms. Physical examination showed a 5 cm soft mass on the left lumbar region, which was confirmed as a hernia by an ultrasound. Method A minilaparoscopic approach to surgery was chosen, using a 10 mm trocar inserted in the umbilical region for pneumoperitoneum and the optics, a 3 mm minilaparoscopy trocar inserted in the preperitoneal region in the left iliac region and another 3 mm trocar inserted more dorsally in the lumbar region. Results The polypropylene mesh was placed in the preperitoneal space without need for any mesh fixation. The total time of surgery was 41 min and the patient was discharged on the next day. Conclusion The proposed novel approach is not only feasible, but offers advantages as it appears to be safer, less invasive, cost-effective and above all eminently reproducible.

Malignant peripheral nerve sheath tumor (MPNST) is a soft-tissue sarcoma arising from or differentiating toward peripheral nerve sheath cells. It accounts for 5%–10% of soft-tissue sarcomas. The most common sites of origin are proximal portion of upper, lower limbs and trunk. MPNST arising from the nerve plexus of gastrointestinal tract is extremely rare, and only very few cases have been reported in literature. In this report, we are describing a case of MPNST from mesocolon. An 82-year-old male presented to hospital with complaint of pain abdomen and feeling of lump on the left side of lower abdomen for the past 2 months. On contrast-enhanced computed tomography (CECT) of chest and abdomen, there was 15 cm × 10 cm mass palpable in left lumbar region without ascites and multiple random subpleural nodules in bilateral lung. Intraoperatively, there was 15 cm × 10 cm hard irregular mass in left paracolic gutter infiltrating mesentry of descending colon. Left hemicolectomy was performed with end-to-end anastomosis. Histopathological examination revealed malignant peripheral nerve sheath tumor, and on immunohistochemistry, tumor cells were positive for S-100 and negative for C-kit and Smooth Muscle Actin (SMA). The patient was started on tamoxifen in view of old age and lung metastasis. The patient is on follow-up from 2 years with stable disease. In this report, we highlight the possibility of clinical differential diagnosis of MPNST arising from mesocolon should be kept while dealing with mesenchymal tumors of colon. Radical surgery with negative margins is required for achieving palliation, and adjuvant tamoxifen could offer advantage in patient who cannot tolerate chemotherapy.

Spontaneous colocutaneous fistula is a rare clinical entity usually associated with diseases like diverticulitis, crohn's disease and post radiotherapy treated malignancy. This case illustrates the challenges of diagnosis and management of such patients. We present a 60-year old lady who had a lump in left lumbar region which started discharging feculent material ten day prior to presentation. There was history of progressively worsening constipation and weight loss but no rectal bleeding or jaundice. There was a necrotic patch with feculent discharge from left lumbar region with underlying lump that was 5 Χ 4 cm, firm, non-tender and immobile. Following complete evaluation including abdomino-pelvic ultrasound that revealed an ill-defined mass arising from sigmoid colon, a diagnosis of colocutaneous fistula secondary to colonic malignancy was made. After resuscitation, the patient had exploration and Hartmann's procedure. Histopathology confirmed growth as adenocarcinoma and patient was placed on chemotherapy. We present this case to illustrate the challenges of diagnosis and management of such patients.