A 25-year-old female visited the clinic with abdominal pain and poor oral intake. She was diagnosed with Crohn’s disease and had a history of using infliximab for 4 years. She had no previous operative history. Magnetic resonance enterography demonstrated the progression of a penetrating complication that involved the distal ileum and complex entero-enteric fistula between the terminal ileum and sigmoid colon. Surgery was conducted using the da Vinci SP surgical system. In the operative field, severe adhesion was observed between the terminal ileum, adjacent ileum, cecum, and the sigmoid colon. After adhesiolysis of the small bowel and right colon was performed, the fistula tract between the sigmoid colon and terminal ileum was identified and resected. Then, simultaneous ileocecectomy and anterior resection was performed. The operation was completed without any intraoperative complications and patient’s recovery was uneventful. She was discharged postoperatively, after 8 days.

The primary objective in the treatment of early rectal cancer is to achieve optimal oncological control while minimizing the long-term impact of therapeutic interventions on patients' quality of life. The current standard of care for most stage I and II rectal cancers involves radical surgery, specifically total mesorectal excision. Although total mesorectal excision is generally curative for early rectal cancers, it can significantly affect patients' quality of life by potentially necessitating a permanent colostomy and causing bowel, bladder, and sexual dysfunction. Given the morbidity associated with radical surgery, alternative approaches to managing early rectal cancer, such as local excision through transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery, have been investigated. If these surgical approaches are applied cautiously to carefully selected cases of early rectal cancer, it is anticipated that these local procedures will achieve comparable oncological outcomes to the established standard of radical surgery, potentially offering superior results regarding morbidity, mortality, and overall quality of life.

Alcohol is well-recognized systemic toxin that causes numerous adverse effects, including psychosocial problems, fatal myocardial infarction, stroke and atherosclerosis. The intra-abdominal complications caused by acute alcohol consumption have not been defined. We report an 80-year-old man with sub-acute small bowel and colonic ischemia after heavy alcohol intake in one sitting. We performed a resection of gangrenous bowel segments. Microscopically, there were diffuse infarction, with vasoconstriction of the mesenteric vessels in the ileum and colon without any thrombotic occlusion of the intestinal vessels. The clinicians should always be assured by confirmation of a history of recent substance abuse in patients with unexplained abdominal pain, and mesenteric ischemia should be considered in the differential diagnosis of acute or chronic abdominal pain in consumers of alcohol.
Abdominal Pain ; Aged, 80 and over ; Alcohol Drinking ; Alcohols ; Atherosclerosis ; Colon ; Diagnosis, Differential ; Humans ; Ileum ; Infarction ; Ischemia ; Myocardial Infarction ; Stroke ; Substance-Related Disorders ; Vasoconstriction

No abstract available.
Anemia

No abstract available.
Colon ; Lipoma

Recurrent colonic perforation in patients already having colostomy is extremely rare and only a few cases had been reported. Herein, we report 2 cases of recurrent colonic perforation at the proximal part of the colostomy in geriatric patients resulting from different causes, which might be caused by stercoral perforation and recurrent colonic ischemia, respectively. Based on our experience, surgeons should consider correcting chronic constipation even in patients who already have a colostomy.Additionally, transverse colostomy should be considered as a surgical treatment in patients with sigmoid colostomy for recurrent perforation due to colonic ischemia.

PURPOSE: Tumors at the level of the anorectal junction had required total levator-ani muscle excision to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle and intact external sphincter, en bloc resection of rectum with levator-ani muscle including tumor would be possible. This hemilevator excision (HLE) technique enables preserving the anal sphincter function while obtaining oncologic clearance and avoiding permanent colostomy in those patients. This study aimed to evaluate the surgical outcomes and feasibility of HLE. METHODS: Data on 13 consecutive patients who underwent HLE for pathologically proven low rectal cancer were retrospectively collected. All 13 patients presented low rectal cancer at the anorectal ring level that was suspected to invade or abut to the ipsilateral side of the levator-ani muscle. RESULTS: A secure resection margin was achieved in all cases, and anastomotic leakage occurred in 2 patients. During follow-up, 3 patients experienced tumor recurrence (2 systemic and 1 local). Among 6 patients who underwent diverting ileostomy closure after the index operation, 2 complained of fecal incontinence. The other 4 patients without fecal incontinence showed <10 times of bowel movement per day. Accessing their incontinence scale, mean Wexner score was 9.4. CONCLUSION: HLE is a novel sphincter-preserving technique that can be a treatment option for low rectal cancer invading ipsilateral levator-ani muscle, which has been an indication for abdominoperineal resection (APR) or extralevator APR. However, the long-term oncologic and functional outcomes of this procedure still need to be assessed to confirm its validity.
Anal Canal* ; Anastomotic Leak ; Colostomy ; Fecal Incontinence ; Follow-Up Studies ; Humans ; Ileostomy ; Pelvic Floor* ; Rectal Neoplasms* ; Rectum ; Recurrence ; Retrospective Studies

No abstract available.
Child ; Choledochal Cyst ; Humans

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to perform pure single-incision surgery in 2018. This new surgical platform demonstrated favorable performance compared with the positive aspect of single-incision laparoscopic surgery and robot surgery. To date, its use has mainly been in urological and gynecological procedures. We report a case of successful robotic single-incision right hemicolectomy for cecal cancer with the dVSP.
Cecal Neoplasms ; Laparoscopy

The da Vinci SP Surgical System (dVSP; Intuitive Surgical, Sunnyvale, CA, USA) was introduced to overcome this limitation of single-incision laparoscopic surgery. This new surgical platform has been demonstrated favorable performance in colorectal surgery and its use has been increasing. And, in accordance with the increment of adoption of dVSP, the indication to apply this platform has been expanding. Herein, we report a technique of right hemicolectomy with extended lymphadenectomy beyond conventional lymph node dissection using dVSP.