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When obstructive colitis becomes fulminant, it is known as 'acute necrotizing colitis'. We report a rare case of acute necrotizing colitis due to sigmoid colon cancer, in which shock status occurred within ten hours of onset. A 79-year-old female with acute abdominal pain was transported to our hospital with acute shock. Abdominal enhanced computed tomography revealed thickening of the wall of the sigmoid colon and marked dilation of the proximal colon. Emergency surgery was performed with the intraoperative findings of severe sigmoid colon stenosis and proximal dilation of the colon without perforation, and a large volume of putrid ascitic fluid. The intestine was proximally dilated and black in color, from the sigmoid colon to the ileum 60 cm proximal to the terminal ileum, suggesting acute necrosis. Total colectomy with 80 cm resection of terminal ileum and ileostomy was performed. Whereas acute necrotizing colitis is a rare condition and its etiology remains obscure, the chronic ischemic state must play some role. Our patient was of advanced age and had diabetes mellitus and hypertension. These factors might lead to a chronic ischemic state of the bowel due to arteriosclerosis. In addition to the underlying condition, massive bacterial reflux into the ileum from the colon might cause the capillary vasoconstriction of the bowel that led to her critical state.

Background: Endovascular aneurysm repair (EVAR) is still now a controversial technique, which remains the subject of a number of prospective randomised trials. Although questions remain regarding its long-term durability, objective evidence exists which demonstrates its reduced physiological impact compared with conventional open repair, especially for older population and for the concomitant treatment of aortic abdominal aneurysm (AAA) and abdominal neoplas, such as colo-rectal cancer (CRC). In these patients it may reduce the high perioperative mortality., Patients and Methods: Abdominal aortic aneurysm and colo-rectal neoplasm are occasionally discovered concurrently. Simultaneous operative treatment may be in these cases an effective management strategy, alternative to a staged procedure. The medical record of three consecutive patients undergoing mini-invasive colectomy for cancer and abdominal aortic aneurysm repair were reviewed. Data collected included mode of presentation, preoperative evaluation, colo-rectal pathology and in-hospital morbidity and mortality. Long term follow-up was obtained through office records and telephone contact., Results: In one patient a asymptomatic colo-rectal mass was identified in the course of CT-scan evaluation for AAA; in the other two patients AAA was discovered during CT-scan oncological evaluation for symptomatic CRC. All patients underwent successfully concomitant repair of AAA and CRC by means of EVAR procedure and mini-invasive colo-rectal resection. Pathology revealed adenocarcinomas in all three cases. Perioperative follow-up revealed minor postoperative complications. Two years follow-up showed no cases of graft infection, and no interference of vascular procedure on oncological course of the colo-rectal malignancies., (Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer., Materials and Methods: Records of patients with colorectal cancer and a suspicion of bladder invasion, who underwent tumor resection with partial or total cystectomy between 2002 and 2013 at the Faculty of Medicine Siriraj Hospital, were reviewed. Correlations between preoperative urinary symptoms, urinalysis, cystoscopic finding, CT imaging and final pathological reports were analyzed., Results: This study included 90 eligible cases (71% male). The most common site of primary colorectal cancer was the sigmoid colon (44%), followed by the rectum (33%). Final pathological reports showed definite bladder invasion in 53 cases (59%). Significant features for predicting definite tumor invasion were gross hematuria (OR 13.6, sensitivity 39%, specificity 73%), and visible tumor during cystoscopy (OR 5.33, sensitivity 50%, specificity 84%). Predictive signs in CT imaging were gross tumor invasion (OR 7.07, sensitivity 89%, specificity 46%), abnormal enhancing mass at bladder wall (OR 4.09, sensitivity 68%, specificity 66%), irregular bladder mucosa (OR 3.53, sensitivity 70%, specificity 60% ), and loss of perivesical fat plane (OR 3.17, sensitivity 81%, specificity 43%). However, urinary analysis and other urinary tract symptoms were poor predictors of bladder involvement., Conclusions: The present study demonstrated that the most relevant preoperative predictors of definite bladder invasion in patients with colorectal cancer are gross hematuria, a visible tumor during cystoscopy, and abnormal CT findings.

A 71-year-old man operated for a sigmoid tumour remained in the surveillance after adjuvant chemotherapy. After 3 years, a left axillary lymph node was visible on CT scan. The biopsy revealed a necrotising and abscessed granulomatous lymphadenitis, suggestive of cat scratch disease. The patient confirmed having been scratched by a cat and the serology for Bartonella henselae was IgM+/IgG-. Direct and culture examinations for tuberculosis were negative. The patient was treated for cat scratch disease. One year later, the CT scan showed increased left axillary lymph nodes and a left pleural effusion. Direct and cultural examinations to exclude tuberculosis were again negative. Interferon-γ release assay testing for tuberculosis was undetermined and then positive. Lymph node and pleural tuberculosis were diagnosed and treated with a good radiological response. This article has provides evidence of the importance of continued search for the right diagnosis and that two diagnoses can happen in the same patient.

Background: Rectal bleeding is a sign of colorectal cancer (CRC). Its early diagnosis decreases mortality and improves survival. In young population with no risk factors for the disease, CRC is infrequent. Moreover, benign anorectal disorders are most frequent causes of bleeding and generally, when anal pathology is identified, it is assumed as the origin of the sign. For all these reasons, rectal bleeding sometimes is sub-assessed in young patients., Objective: Estimate the prevalence of adenomas and adenocarcinomas in sigmoid and rectum in patients younger than 50 years old referred for proctorrhagia., Methods: The study design was descriptive, retrospective and cross-sectional. Procedures were performed under sedation and Olympus CF 160 y CF 180 scopes were used. Proctorrhagia was considered as rectal bleeding registered as indication of the procedure. Histology was established according to Vienna classification. Informed consent was signed before the procedures. Colonoscopy reports were reviewed. The study took place in an outpatient clinic in Buenos Aires city, between October 2010 and October 2011. High risk patients for CRC were excluded, Results: We included 1,203 from 1,257 reviewed VCC, 49% were female and the median age was 38 years old (range: 18-49 years old). The prevalence of adenomas and adenocarcinomas in sigmoid and rectum was 67% [95% confidence interval (95% CI): 5.4-8.3] and 1.6% (95% CI 1-2.5), respectively., Conclusions: Adenocarcinomas and adenomas are infrequent in a young population without risk factors for CRC. However, even when benign anal disorders are the most frequent cause for rectal bleeding, miss evaluation of this sign could have a serious impact in almost 10 of 100 individuals.

We report a case of advanced colon cancer after closure of a colostomy. A 77-year-old man suddenly began experiencing abdominal pain and pan-peritonitis due to perforate diverticulum of the sigmoid colon. A Hartmann operation was urgently performed, and closure of the colostomy was performed 6 months later. The patient had no history of colonoscopy. Colonoscopy was performed 45 months after the closure of the colostomy to examine the colon. Advanced colon cancer was detected near the anastomotic region. In conclusion, older patients, including those with numerous disease complications such as diabetes and hypertension, should undergo early colonoscopy as a preventative measure.

We encountered a case of colorectal cancer with pelvic abscess treated with radical surgery following colostomy and chemotherapy. The patient was a man in his 60s with advanced rectal cancer. The tumor had expanded locally and formed an abscess. We evaluated the primary lesion as unresectable, and performed chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin( mFOLFOX) plus bevacizumab after colostomy. After 13 courses of chemotherapy, the tumor shrank remarkably. We performed a low anterior resection followed by adjuvant chemotherapy with capecitabine. The patient has had no recurrence for 18 months after surgery.

A 63-year-old man underwent colonoscopy owing to a positive fecal occult blood test, and he was diagnosed as having advanced sigmoid colon cancer. Esophagogastroduodenoscopy( EGD), performed as a preoperative examination, revealed an 8 mm early gastric cancer in the lower body of his stomach. We performed laparoscopic sigmoid colon resection and D3 lymphadenectomy first because the patient had advanced sigmoid colon cancer. The histopathological diagnosis was Stage II; however, vascular invasion was apparent. Some authors have reported that chemotherapy with 5-fluorouracil (FU) is effective against early gastric cancer; therefore, we administered postoperative adjuvant chemotherapy comprising uracil and tegafur( UFT)+Leucovorin( LV) tablets before ESD for early gastric cancer. Two months later, follow-up EGD showed that the gastric cancer had become flat and small. Five months later, it resembled a scar, and examination of a biopsy showed no malignant finding. We continued to administer chemotherapy to the patient for 6 months. Nine months after the discontinuation of chemotherapy, EGD showed only a scar and biopsy revealed no malignant finding.

A 75-year-old woman with a chief complain of anal pain visited the emergency department. She was diagnosed as having S-colon cancer perforation accompanied by an intra-abdominal abscess. Computed tomography (CT)-guided drainage was applied to the intra-abdominal abscess. Six days after drainage, the patient's condition progressed to acute respiratory failure due to heart failure, and ventilator support was provided temporarily. The patient's cardiopulmonary function improved with conservative management. S-colon cancer was detected during colonoscopy examination, and biopsy indicated a tub2 tumor. Next, S-colon resection with D3 lymph node dissection was performed. The postoperative course was uncomplicated. Two months after surgery, liver metastases were detected on CT. Since the patient's performance status (PS) was 3, it was impossible for her to undergo chemotherapy. Four months after surgery, her PS was restored to 2 and the liver metastases were exacerbated, as seen on CT. The patient began chemotherapy (XELOX plus bevacizumab, 30% reduced dose). Eight months after the start of chemotherapy, 9 courses had been administered, the carcinoembryonic antigen (CEA)/carbohydrate antigen (CA) 19-9 level had decreased to the reference value, and the decrease in size of the liver metastases indicated a partial response (PR), as assessed by CT.

We present the case of a patient who was admitted because of acute pan-peritonitis but was found to have locally advanced rectal cancer that was successfully excised after preoperative chemotherapy. A 68-year-old man was transferred to our hospital via an ambulance because of severe lower abdominal pain. His abdominal computed tomography scan showed a huge tumor in the pelvis. An emergency sigmoid colostomy was performed because of panperitonitis. However, his postoperative examinations indicated locally advanced rectal cancer accompanied with extensive urinary bladder invasion but without distant metastasis, and chemotherapy was started. Eventually, the tumor reduced to 47% of its maximum size after 4 courses of FOLFOX6 and 2 courses of FOLFOX6+panitumumab, and radical excision( low anterior rectal resection, partial urinary bladder resection, D3 lymph node dissection, and total mesorectal excision) was performed on the 154th day since the first operation. No cancer cells were detected on microscopic analysis of the margins of the excised specimen. Thus, preoperative chemotherapy is useful for treating locally advanced rectal cancer.

Primary colorectal choriocarcinoma is an extremely rare neoplasm and is usually associated with a poor prognosis. Only 13 cases of colorectal choriocarcinoma have previously been reported. There is no standard chemotherapeutic regimen for this tumor type. A 68-year-old man presented with melena and was diagnosed with sigmoid colonic adenocarcinoma with multiple liver metastases. He underwent a laparoscopic sigmoidectomy. Pathology revealed choriocarcinoma with a focal component of moderately differentiated adenocarcinoma of colon origin. Based on the collagen gel droplet-embedded culture drug sensitivity test (CD-DST) results, mFOLFOX6 and bevacizumab were administered, which suppressed aggressive tumor growth for 4 mo. The patient died 9 mo after the initial diagnosis. Our study results suggest that the standard chemotherapy regimen for colorectal cancer might have suppressive effects against primary colorectal choriocarcinoma. Moreover, CD-DST may provide, at least in part, therapeutic insight for the selection of appropriate antitumor agents for such patients.

Inguinal (inguinoscrotal) hernia and colon cancer are common conditions. However, it is rare for primary colon cancer to exist in an inguinal hernia sac and even rarer for it to perforate. We report such an event in our patient, who had an irreducible left inguinoscrotal hernia containing a sigmoid colon carcinoma that had perforated. This clinical picture can be easily confused with hernia strangulation unless the clinician is alert to the presence of certain sinister symptoms and signs.

Introduction: Colorectal carcinoma (CRC) ranks as the fourth most frequent cancer in men (after lung, prostate and stomach cancer), and third in women (after cancers of breast and uterine cervix).Adenocarcinoma of the colon is the most common malignancy of the GI tract and is a major cause of morbidity and mortality worldwide. It is also one of the most common cancers in Nepal., Methods: A descriptive study was conducted in a Kathmandu based Hospital. This study included 50 cases of colorectal carcinoma diagnosed on colonoscopic/sigmoidoscopic biopsies over a period of two years., Results: A total of 50 patients were studied out of these, 29 (58%) patients were male, whereas 21 (42%) were with male:female ratio of 1.3:1. Age ranged was from 20 years to 80 years. Maximum number of cases were observed between the ages of 61-70 years. The most common histological type of colorectal carcinoma was moderately differentiated adenocarcinoma and seen in 37(74%) cases. Left sided tumor constituted 40 (80%) cases of all tumors and rectum was the predominant site with 26 (52%) cases followed by sigmoid colon with 7 (14%) cases., Conclusions: Colorectal carcinoma (CRC) is not an uncommon disease in this part of the world. The use of sigmoidoscopy and colonoscopy along with biopsy when required should be encouraged as a screening program for colorectal carcinoma in an elderly age group for the detection of CRC at an earlier stage.

An 81-year-old woman with adenocarcinoma of the rectosigmoid presented with progressive muscle weakness and difficulty swallowing, with symptoms worsening following successful resection of the tumor. On examination, she had weakness primarily of lower limb proximal muscles, with no other abnormal findings. Laboratory tests showed significant elevation of creatine kinase, and EMG findings indicated myositis of the proximal muscles. While MRI showed increased signal intensity on T2-weighted images of the leg muscles, indicating inflammation, muscle biopsy found widespread necrosis with only weak and focal lymphocytic infiltration. A diagnosis of paraneoplastic necrotizing myopathy (PNM) was made, and immunomodulatory treatment initiated, with little response. Four months later she returned with exacerbation of symptoms, this time with skin changes pathognomonic of dermatomyositis (DM). A repeat MRI showed progression of inflammation, as well as necrotic foci. It is important to distinguish between paraneoplastic myopathies such as DM and PNM, with implications regarding treatment and prognosis.

Background: Necrotizing colitis (NC) is a rare complication of the obstructive cancer of the left colon and it is the result of intramural ischemia due to impairment of blood supply secondary to increased endoluminal pressure., Case Presentation: A 70 years old patient with significant comorbidities (ASA 4) was admitted for intestinal obstruction.The extensive necrosis of the entire proximal colon secondary to an obstructive sigmoid colon cancer has been diagnosed intraoperatively. Total colectomy and terminal ileostomy have been performed. The postoperative course was uneventful and the ileostomy closure with ileo-rectal anastomosis was performed 7 months later. A review of the literature discussing the epidemiology, pathogenesis, diagnosis and therapeutic approach of this type of colitis, was performed., Conclusions: NC implies diagnosis and therapeutic difficulties,especially from point of view of surgical strategy. We advocate of large colic resections, beyond the macroscopic limits of the necrosis in order to avoid the postoperative complications. We also consider seriate surgical procedures as a good choice for the high risk patients.

Severe aortic stenosis was found by preoperative echocardiography in a 79-year-old female patient with sigmoid colon cancer. Staged operation was planned. First, bioprosthetic aortic valve replacement was performed by minimally invasive cardiac surgery. She underwent concomitant colostomy to avoid malnutrition which may have occurred in case of colon obstruction. On 25th day after cardiac surgery, curative sigmoidectomy was performed. One year after the operation, she is doing well without any major complications.

We present a case with a 46-year-old woman who had experienced six days of abdominal pain and some days of anal bleeding. She had no prior medical history. At the clinical examination it was found that she had a soft abdomen, but there was tenderness in the lower part. A computed tomography showed an intussusception of the sigmoideum into the rectum. An oncological resection was performed, since it could not at the time of the operation be determined if it was a malignant proces. The histology showed a benign submucosal lipoma.

Lower gastrointestinal bleeding is a common general surgical presentation in acute and chronic settings. Vascular anomalies account for 2% of such cases and can therefore be missed. We discuss a rare vascular anomaly in one of our patients where the diagnosis was not established for a ten-year period. We describe the subsequent management and a brief review of the literature of this uncommon condition.

Total situs inversus (SIT) is a rare congenital disorder in which all abdominal and thoracic organs are in reversed position. A 57-year-old man with SIT presented with change in bowel habits and rectal bleeding.Colonoscopy and abdomino-pelvic CT scan confirmed a constricting sigmoid lesion with normal tumor-marker levels. In our department the elective laparoscopic colon resection with lymphadenectomy is the preferred alternative of open surgery and is the chosen method in about 60 percent of cases. This is the first documented case report in Hungarian of a laparoscopically resected sigmoid tumour in a patient with SIT. We believe that with appropriate knowledge of anatomy and advanced routine in laparoscopic surgery laparoscopic resection can be a safe method even in a special case like this one was.

Entero-cutaneous fistula resulting from a locally invasive large bowel carcinoma is a difficult surgical challenge. En-bloc resection of the involved organs and the entero-cutaneous fistula tract with a healthy tissue margin will result in a composite abdominal wall defect that requires closure. Reconstructive surgical options include primary closure, components separation and the use of local, regional or free flaps with or without prosthetic mesh. We report a case of an abdominal enterocutaneous fistula secondary to a locally invasive sigmoid carcinoma, which was reconstructed with a pedicled antero-lateral thigh perforator (ALT) flap. To our knowledge, this is the first case of a malignant entero-cutaneous fistula, which was reconstructed with an ALT flap.

A relationship between infective endocarditis and colon cancer was established in 1950, and Streptococcus bovis was successfully isolated in 1970. However, this association and its pathogenesis still remain unclear. In this paper, we describe the clinical case of a patient with a history of colon cancer and infective endocarditis caused by Streptococcus bovis. The role of S bovis as an aetiological agent in the development of colon cancer is intriguing but uncertain. S bovis infection should be considered a silent sign of gastrointestinal malignancy or hepatic disease. We believe that in order to demonstrate the presence of colon cancer, all patients with S bovis infection require an endoscopic investigation of the colon.

Background: The aim of the present study was to analyze the results of our experience with elective placement of self-expandable metallic stents (SEMS) in patients with stage IV obstructing colorectal cancer. A systematic review of the literature was also carried out to analyze the factors influencing the results of SEMS placement and to determine if there has been any improvement in the more recent period., Materials and Methods: The results of a personal series of 100 patients were analyzed. There was no case of mortality or major morbidity. The systematic review included 27 articles published from April 2007 to December 2011., Results: In our experience the technical success rate was 96% and the clinical success rate was 92%. During the follow-up period a repeat colonoscopy was needed in 31% of the patients for recurrent symptoms of obstruction due to fecal impaction (19%), tumor growth (8%), or stent dislodgment (4%). Review of the literature showed similar results, with a significant improvement in the reports of the last 6 years; procedures performed on an emergency basis had poorer results., Conclusions: Self-expandable metallic stent placement offers a valid alternative to surgery in patients with obstructing stage IV colorectal cancer, but careful follow-up is required.

Invagination in adults is rare compared to children. We experienced 3 sigmoid colon cancers in which symptoms of invagination were discovered. Because the tumors in 2 of the 3 cases could be reduced, operations were electively performed. The tumor in the remaining case could not be reduced and an urgent operation was required. Because all cases responded in the early stage, their postoperative progress was good. Invagination in adults is typically caused by an organic disease, particularly cancer. It is necessary to consider not only reduction of the invagination but also treatment of the primary disease causing invagination. It is important that the malignant symptoms be detected promptly in order to develop a suitable treatment strategy.

Cedecea spp. represent a new member of the Enterobacteriaceae family, and although they are commonly described, they have rarely been reported as causes of invasive infection. The species' inherent resistance to antibiotics makes their management extremely challenging, especially in the context of immunocompromise when infections occur. We hereby report a rare case of Cedecea davisae bacteraemia in a patient with stage IV sigmoid colon cancer followed by a brief review of the literature., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We relate the first case in the Republic of Ireland of Cronkhite Canada Syndrome (CCS). The patient presented with weight loss, alopecia, nail dystrophy, taste disturbance and classic radiologic and endoscopic features of CCS. She continued to dramatically lose weight and early repeat colonoscopy showed the interim development of an invasive sigmoid adenocarcinoma.J

We experienced a rare case of intussusception due to sigmoid colon cancer during chemotherapy. A-62-year-old female was started on mFOLFOX6 due to sigmoid colon cancer and hepatic metastases(stage IV). After 2 courses, she had abdominal pain and bloody stool. Abdominal ultrasonography showed a target sign, and abdominal CT showed edema of the mucosa of the sigmoid colon and invagination. She was diagnosed with intussusception due to sigmoid colon cancer, and underwent a bloodless reduction. However, because it was unavailable, we performed an emergency operation. The sigmoid colon invaginated 10 cm to the anal side. We then performed sigmoidectomy and lymphadenectomy(D2). The histopathological diagnosis was mucinous carcinoma, stage I. There was no report of intussusception with the chemotherapy. It is important to consider the intussusception of colon cancer even during chemotherapy.

A 65-year-old man presented to the general surgical outpatients with an incarcerated left inguinal hernia. Initial investigations revealed an iron deficiency anaemia that was investigated with a colonoscopy and gastroscopy. This revealed a sigmoid cancer and the staging CT scan confirmed a tumour incarcerated in the sac of the left inguinal hernia. We proceeded with a laparoscopic high anterior resection using the inguinal hernia as the extraction site. The hernia was repaired using Permacol mesh. No postoperative complications occurred.

Background: Survival in patients with stage IV unresectable rectosigmoid cancer is significantly reduced, and when patients are seen with symptoms of obstruction, it is advisable to perform a diverting colostomy before acute obstruction occurs. The aim of this study was to compare the results of endoscopic stent placement with diverting proximal colostomy in patients with stage IV rectosigmoid cancer and symptoms of chronic subacute obstruction., Methods: In a prospective randomized trial, 22 patients with stage IV unresectable rectosigmoid cancer and symptoms of chronic subacute obstruction were randomized to either endoscopic placement of an expandable stent or diverting proximal colostomy. Patients were followed until death., Results: There was no case of mortality or major postoperative complications. Oral feeding and bowel function were restored within 24 hours after endoscopic stent placement and within 72 hours after diverting colostomy. Hospital stays were shorter (mean, 2.6 days) in patients with endoscopic stent placement than in those with diverting stomas (mean, 8.1 days) (P < .05). Mean long-term survival was 297 days (range, 125-612 days) in patients who had stents and 280 days (range, 135-591 days) in patients with stomas (P = NS). No case of mortality during follow-up was related to the procedures. All patients with stomas found them quite unacceptable. The same feelings were present in family members. None of the patients with stents or their family members found any inconvenience about the procedure., Conclusions: Endoscopic expandable stent placement offers a valid solution in patients with stage IV unresectable cancer and symptoms of chronic subacute obstruction, with shorter hospital stays. The procedure is much better accepted, psychologically and practically, by patients and their family members., (Copyright © 2012 Elsevier Inc. All rights reserved.)

History and Admission Findings: We report on a 65-year-old female patient with a recent diagnosis of adenocarcinoma of the sigmoid colon and massive hematochezia in the context of a general bleeding disorder., Investigations: Disseminated malignant disease with hepatic metastases as well as bone marrow involvement was demonstrated. Moreover, circulating tumor cells were demonstrated by flow cytometry. The patient had right lower quadrant abdominal pain due to a spontaneous psoas intramuscular hematoma., Diagnosis, Treatment and Course: At the time of admission to our hospital, the patient displayed microangiopathic hemolytic anemia and secondary hyperfibrinolysis with a pronounced bleeding tendency. Moreover, there was an acute renal failure which improved with fluid resuscitation. With immediate chemotherapy consisting of 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX regimen) and cetuximab initiated with the second course, plasmatic coagulation could be stabilized. Consequently, treatment with tranexamic acid, fibrinogen, fresh frozen plasma as well as red blood cell and platelet infusions could be stopped. Continuation of chemotherapy was possible on an outpatient basis and the further course was associated with a good quality of life until her near end. The patient died at home 7 months after initial diagnosis of her colon cancer due to progressive disease with CNS metastases., Conclusions: Disseminated intravascular coagulation with microangiopathic hemolysis and secondary hyperfibrinolysis is a rare albeit possible event in disseminated colorectal cancer, especially when the bone marrow is involved. Treatment of the underlying cause is the most important therapeutic measure., (© Georg Thieme Verlag KG Stuttgart · New York.)

The incidence of colonic diverticulosis with or without diverticulitis has increased in the Japanese population due to the modernization of food and aging. The rate of diverticulitis in colon diverticulosis ranges from 8.1% to 9.6%. However, few cases of stenosis due to diverticulitis have been reported. These reports suggest that the differentiation between sigmoid diverticulitis and colon cancer is difficult. This report describes two cases of colon stenosis due to diverticulitis that were difficult to differentiate from colon cancer. Case 1 was a 70-year-old woman with narrowed stools for 1 month who underwent colonofiberscopy (CFS). CFS revealed a diverticulum and circumferential stenosis in the sigmoid colon. Barium enema revealed a marked, hourglass-shaped, 2-cm circumferential stenosis in the sigmoid colon. Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography (CT) revealed an increased FDG uptake at the affected portion of the sigmoid colon. Sigmoid colon cancer was suspected, and laparoscopic sigmoidectomy was performed. Pathological examination demonstrated active inflammation with no evidence of malignancy. Case 2 was a 50-year-old man who presented to a nearby clinic with reduced stool output despite the urge to defecate. CFS detected severe stenosis in the sigmoid colon approximately 25 cm from the dentate line. Contrast-enhanced abdominal CT revealed multiple diverticula, wall thickening, and swelling of the lymph nodes around the peritoneal aorta and the inferior mesenteric artery. A partial sigmoidectomy was performed. Pathological examination of the resected specimen revealed no changes in the mucosal epithelial surface, but a marked infiltration of inflammatory cells was observed.

Double inferior vena cava is a rare congenital anomaly, usually detected by computed tomography or magnetic resonance imaging. Although asymptomatic, it may have a clinical significance, as it may mimic a para-aortic lymphadenopaty. A case of left-sided duplication of the inferior vena cava in a patient with sigmoid colon cancer is presented. The diagnostic pitfalls and clinical implications are discussed. Accurate preoperative assessment of such an anatomical variant is of utmost importance, this way potentially life-threatening surgical complications, particularly when a minimally invasive approach is planned, are prevented.

A 61-year-old complaining of anorexia and general fatigue was admitted to our hospital for further examination. She was diagnosed as advanced sigmoid colon cancer with multiple metastases of lung, liver, and left hydronephrosis. Since curative surgery was not deemed possible, we started chemotherapy with bevacizumab/FOLFOX6 (bi-weekly drip infusion). After the 6th course, colonoscopy revealed a significant tumor reduction and changes to the scar tissues. CT did not reveal a complete disappearance, but found some reductions in metastases of lung and liver. Sigmoidectomy and lymph node resection (D1) were performed. We did not disappeared any dissemination and the histological diagnosis revealed a complete disappearance of cancer cells in the main tumor. She was discharged 13 days after surgery, following chemotherapy which included bevacizumab and XELOX. The chemotherapy using bevacizumab/FOLFOX6 is a candidate for the standard treatment strategy for inoperable advanced colon cancer. Herein we report this rare case with a review of the literature.

We hereby report a case of use of biological mesh to repair one large, contaminated abdominal wall defect due to a sigmoid tumour presented as an abscess infiltrating the abdominal wall. Our patient was a 48-year-old woman. Her medical history was negative for any previous disease or surgical procedure. Because of the abscence of neoplastic secondarism an en-bloc resection of the interested sigmoid colon and of the infiltrated abdominal wall was performed, thus resulting a large wall defect in the left inguinal region. In order to close the wall defect a biological porcine collagen mesh was used. In our case we used a Permacol mesh made of porcine acellular dermal collagen. Reconstruction of complicated abdominal wall defects is a challenging surgical problem and primary repair is often difficult to achieve without excessive tension in the abdominal wall. The use of a syntethic mesh in this patient could have been inappropriate due to the possibility of creating adhesions with intra-abdominal viscera and fistula formation. We chose to use a biological mesh because of its safer properties in case of infected, inflamed or infiltrated surgical fields, as demonstrated in the literature.

Lipomas of the colon are rare and usually presenting in the later ages of life. This case describes and discusses the symptoms and signs of lipomas, recommendations and rationale for treatment.

We report an unusual case of Clostridium septicum aortitis with associated adenocarcinoma of the sigmoid colon. An 87-year-old man with multiple medical comorbidities presented with a 1-week history of severe abdominal pain in the left lower quadrant of his abdomen. Abdominal computed tomography showed, in addition to a mass in the sigmoid colon, a gas density within the wall of the abdominal aorta with extensive periaortic fat stranding and some additional gas densities in the proximal left common iliac artery. The patient refused surgery, and was treated with intravenous antibiotics. He died 5 weeks later. The development of Clostridiumsepticum aortitis, an extremely rare but life-threatening infection, is highly associated with an underlying colonic malignancy and demands immediate surgical intervention., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)