1.Vesico-ileosigmoidal Fistula Caused by Diverticulitis: Report of a Case and Literature Review in Japan.
Hidefumi NISHIMORI ; Koichi HIRATA ; Rika FUKUI ; Mayumi SASAKI ; Takahiro YASOSHIMA ; Futoshi NAKAJIMA ; Fumitake HATA ; Kenji KOBAYASHI
Journal of Korean Medical Science 2003;18(3):433-436
Enterovesical fistula is a relatively uncommon complication of colorectal and pelvic malignancies, diverticulitis, inflammatory bowel disease, radiotherapy, and trauma in Asian countries. A case of vesico-ileosigmoidal fistula and a literature review of this disease in Japan are presented. A 70-yr-old male was referred with complaints of urinary pain and pneumaturia. On admission, urinary tract infection and pneumaturia were presented. A barium enema demonstrated multiple diverticulum in his sigmoid colon and the passage of contrast medium into the bladder and ileum. Under the diagnosis of vesico-ileosigmoidal fistula due to suspected diverticulitis of the sigmoid colon, sigmoidectomy and partial resection of the ileum with partial cystectomy were performed. The histopathology revealed diverticulosis of the sigmoid colon with diverticulitis and development of a vesico-ileosigmoidal fistula. No malignant findings were observed. Until the year 2000, a total of 173 cases of vesico-sigmoidal fistula caused by diverticulitis had been reported in Japan. Pneumaturia and fecaluria are the most common types, presenting symptoms in 63% of the cases. Computed tomography, with a sensitivity of 40% to 100%, is the most commonly used diagnostic study. For patients with vesico-sigmoidal fistula, resection of the diseased sigmoid colon and partial cystectomy with primary anastomosis are the safest and most acceptable procedures, leading to the best results.
Aged
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Anastomosis, Surgical
;
Bladder Fistula/*etiology/*pathology/surgery
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Colon, Sigmoid/pathology
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Cystectomy
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Diverticulitis/*complications/*pathology/surgery
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Human
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Ileum/pathology
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Male
2.Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy.
Yong Wook JUNG ; Jung Hyun YOO ; Jung Soo LEE ; Byung Ik JANG ; Kyeong Ok KIM ; Sang Hun JUNG
The Korean Journal of Gastroenterology 2011;58(5):284-287
Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.
Aged
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Colon, Sigmoid/*pathology
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Diverticulitis/complications/*surgery
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Humans
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Intestinal Fistula/*diagnosis/etiology/surgery
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Male
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Sigmoidoscopy
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Tomography, X-Ray Computed
3.Adult rectosigmoid junction intussusception presenting with rectal prolapse.
Jing Zeng DU ; Li Tserng TEO ; Ming Terk CHIU
Singapore medical journal 2015;56(5):e78-81
Most cases of intussusception in adults present with chronic and nonspecific symptoms, and can sometimes be challenging to diagnose. We herein report on a patient with the rare symptom of colonic intussusceptions presenting with rectal prolapse and review the existing literature of similar case reports to discuss how to reach an accurate diagnosis. A 75-year-old woman with dementia presented with per rectal bleeding, rectal prolapse and lower abdominal pain. An operation was scheduled and a large sigmoid intussusception with a polyp as a leading point was found intraoperatively. She subsequently recovered well and was discharged. As large sigmoid intussusceptions may present as rectal prolapse, intussusception should be considered as a differential diagnosis for immobile patients, especially when the leading point is a lesion.
Abdominal Pain
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Aged
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Colectomy
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Colon, Sigmoid
;
pathology
;
surgery
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Dementia
;
complications
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Diagnosis, Differential
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Female
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Hemorrhage
;
complications
;
Humans
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Intussusception
;
complications
;
diagnosis
;
surgery
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Necrosis
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Prolapse
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Rectal Prolapse
;
diagnosis
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Rectum
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pathology
;
surgery
4.Surgical technique of en bloc pelvic resection for advanced ovarian cancer.
Suk Joon CHANG ; Robert E BRISTOW
Journal of Gynecologic Oncology 2015;26(2):155-155
OBJECTIVE: The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus, pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients with widespread pelvic involvement. METHODS: The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacent pelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic disease within this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying the bladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vessels are divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon is divided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesentery is ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed and dissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to the left of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in a retrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosis was completed using stapling device. RESULTS: En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvic disease leaving no gross residual disease was possible using en bloc pelvic resection. CONCLUSION: En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic disease in advanced primary ovarian cancer patients with extensive pelvic organ involvement.
Anastomosis, Surgical
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Colon, Sigmoid/pathology/surgery
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Disease Progression
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Female
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Humans
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Hysterectomy/*methods
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Neoplasm Invasiveness
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Neoplasm, Residual
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Neoplasms, Glandular and Epithelial/*pathology/*surgery
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Ovarian Neoplasms/*pathology/*surgery
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Ovary/pathology/surgery
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Pelvic Exenteration/*methods
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Pelvis/pathology/surgery
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Rectum/pathology/surgery
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Salpingectomy
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Surgical Stapling
5.Neuroendocrine Carcinoma of the Sigmoid Colon.
The Korean Journal of Gastroenterology 2008;52(6):335-337
No abstract available.
Aged
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Antigens, CD56/immunology
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Carcinoma, Neuroendocrine/complications/*diagnosis/pathology/surgery
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*Colon, Sigmoid
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Colonoscopy
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Diagnosis, Differential
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Humans
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Liver Neoplasms/etiology/surgery
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Male
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Neoplasm Invasiveness
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Sigmoid Neoplasms/complications/*diagnosis/pathology
;
Tomography, X-Ray Computed
6.Clinical Analysis of Stercoral Perforation of the Colon.
Jung Kwang NAM ; Byung Seok KIM ; Kyung Soo KIM ; Duk Jin MOON
The Korean Journal of Gastroenterology 2010;55(1):46-51
BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.
Aged
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Aged, 80 and over
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Colon, Sigmoid/pathology
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Colonic Diseases/*diagnosis/radiography/surgery
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Female
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Humans
;
Intestinal Perforation/*diagnosis/radiography/surgery
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Middle Aged
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Postoperative Complications
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Respiratory Distress Syndrome, Adult/etiology
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Retrospective Studies
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Sepsis/etiology
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Tomography, X-Ray Computed