We present the case of young female patient presenting with acute onset abdominal pain. Abdominopelvic CT revealed herniation through the foramen of Winslow. The patient was transferred to our hospital and underwent laparoscopic exploration. Though spontaneous reduction was detected, segmental resection of the impacted small bowel was inevitable due to ischemic change. Our case suggests that reducing the time until surgery is very important to lower the probability of bowel resection in case of small bowel herniation through the foramen of Winslow.
Abdominal Pain ; Female ; Humans ; Intestine, Small

Total mesorectal excision (TME) has gained worldwide acceptance as a standard surgical technique in the treatment of rectal cancer. Ever since laparoscopic surgery was first applied to TME for rectal cancer, with increasing penetration rates, especially in Asia, an unstable camera platform, the limited mobility of straight laparoscopic instruments, the two-dimensional imaging, and a poor ergonomic position for surgeons have been regarded as limitations. Robotic technology was developed in an attempt to reduce the limitations of laparoscopic surgery. The robotic system has many advantages, including a more ergonomic position, stable camera platform and stereoscopic view, as well as elimination of tremor and subsequent improved dexterity. Current comparison data between robotic and laparoscopic rectal cancer surgery show similar intraoperative results and morbidity, postoperative recovery, and short-term oncologic outcomes. Potential benefits of a robotic system include reduction of surgeon's fatigue during surgery, improved performance and safety for intracorporeal suture, reduction of postoperative complications, sharper and more meticulous dissection, and completion of autonomic nerve preservation techniques. However, the higher cost for a robotic system still remains an obstacle to wide application, and many socioeconomic issues remain to be solved in the future. In addition, we need more concrete evidence regarding the merits for both patients and surgeons, as well as the merits compared to conventional laparoscopic techniques. Therefore, we need large-scale prospective randomized clinical trials to prove the potential benefits of robot TME for the treatment of rectal cancer.
Asia ; Autonomic Pathways ; Fatigue ; Humans ; Laparoscopy ; Postoperative Complications ; Rectal Neoplasms ; Robotics ; Sutures ; Tremor

No abstract available.

Purpose: Previous studies have demonstrated that the serum creatinine level and skeletal muscle index (SMI) (correlated with the overall survival [OS] of patients with colorectal cancer [CRC]). However, the combined significance of these 2 factors is not fully understood. The goal of this study was to investigate the prognostic potential of the combination of these two factors in patients with CRC. Methods: The patients were categorized into subgroups based on preoperative serum creatinine level, with a cut-off value of 1.01 mg/dL for males and 0.80 mg/dL for females. The patients were further categorized into 4 groups based on SMI. Data were analyzed using the Cox proportional hazards model and Harrell’s concordance index (C-index). Results: Poor 5-year OS was observed in patients with high SMI and high serum creatinine levels (hazard ratio [HR]=1.676, 95% confidence interval [CI]=1.110–2.529, P=0.013), low SMI and low serum creatinine levels (HR=1.916, 95% CI=1.249–2.938, P=0.002), and low SMI and high serum creatinine levels (HR=2.172, 95% CI=1.279–3.687, P=0.004) compared to those of patients with high SMI and low serum creatinine levels. Grouping patients based on both SMI and serum creatinine levels led to improved prognostic stratification (C-index, 0.626; 95% CI=0.587–0.666) compared to grouping based on SMI (CI difference=0.062, 95% CI=0.031–0.103, P=0.0011) or serum creatinine (CI difference=0.043, 95% CI=0.017–0.081, P=0.0072) alone. Conclusion Incorporating both SMI and serum creatinine levels enhances the prognostic stratification for 5-year OS in patients with CRC, surpassing the prognostic power of grouping solely based on SMI or creatinine.

This is a case report on a stercoral perforation of the descending colon that was not adequately treated in the first operation. Re-operation was required in order to revise the primary repair site and to remove the impacted fecaloma.
Colon, Descending

No abstract available.
Atrophy ; Pityriasis* ; Tinea Versicolor*

We present a patient diagnosed with skin sarcoidosis, breast cancer, pulmonary tuberculosis, and peritoneal sarcoidosis with a past history of colorectal cancer. During stage work up for breast cancer, suspicious lesions on peritoneum were observed in imaging studies. Considering our patient's history and imaging findings, we initially suspected peritoneal carcinomatosis. However, the peritoneal lesion was diagnosed as sarcoidosis in laparoscopic biopsy. This case demonstrates that abdominal sarcoidosis might be considered as a differential diagnosis when there is a lesion suspected of being peritoneal carcinomatosis with nontypical clinical presentations.
Biopsy ; Breast Neoplasms ; Carcinoma* ; Colorectal Neoplasms ; Diagnosis, Differential ; Humans ; Peritoneum ; Sarcoidosis* ; Skin ; Tuberculosis, Pulmonary

Traditionally, cancer treatment has focused on the stages of the disease; however, recent studies have highlighted the importance of considering the overall health status of patients in the prognosis of cancer. Loss of skeletal muscle, known as sarcopenia, has been found to significantly affect outcomes in many different types of cancers, including colorectal cancer. In this review, we discuss the guidelines for diagnosing sarcopenia, with a specific focus on CT-based assessments. Many groups worldwide, including those in Europe and Asia, have introduced their own diagnostic guidelines for sarcopenia. Seemingly similar yet subtle discrepancies, particularly in the cutoff values used, limit the use of these guidelines in the general population, warranting a more universal guideline. Although CT-based measurements, such as skeletal muscle index and radiodensity, have shown promise in predicting outcomes, the lack of standardized values in these measurements hinders their universal adoption. To overcome these limitations, innovative approaches are being developed to assess changes in muscle mass trajectories and introduce new indices, such as skeletal and appendicular muscle gauges. Additionally, machine learning models have shown superior performance in predicting sarcopenic status, providing an alternative to CT-based diagnosis, particularly after surgery. CT has tremendous benefits and a significant role in visually as well as quantitatively retrieving information on patient body composition. In order to compensate for the limitation of standard cutoff value, 3-dimensional analysis of the CT, artificial intelligence-based body composition analysis, as well as machine learning algorithms for data interpretation and analysis have been proposed and are being utilized. In conclusion, despite the varying definitions of sarcopenia, CT-based measurements coupled with machine-learning models are promising for evaluating patients with cancer. Standardization efforts can improve diagnostic accuracy, reduce the reliance on CT examinations, and make sarcopenia assessments more accessible in clinical settings.

PURPOSE: Compared to the stapling technique, the fold-over technique (FO) has the benefit of avoiding the sacrifice of the bowel segment. The aim of this study was to compare short-term outcomes between the FO and a conventional resection. METHODS: Between June 2008 and March 2012, a total of 242 patients who underwent a diverting ileostomy reversal after rectal cancer surgery were selected. Among them, 29 patients underwent the FO. Using propensity scores to adjust for body mass index, previous abdominal surgery history, rectal cancer surgery type (open vs. minimally invasive), and reason for ileostomy (protective aim vs. leakage management), we created a well-balanced cohort by matching each patient who underwent the FO, as the study group, with two patients who underwent a stapled or a hand-sewn technique with bowel resection (RE), as the control group (FO : RE = 1 : 2). Morbidity and perioperative recovery were compared between the two groups. RESULTS: Twenty-four and forty-eight patients were allocated to the FO and the RE groups, respectively. The mean operation time was 91 +/- 26 minutes in the FO group and 97 +/- 34 minutes in the RE group (P = 0.494). The overall morbidity rates were not different between the two groups (12.5% in FO vs. 14.6% in RE, P = 1.000). The rate of postoperative ileus was similar between the two groups (8.3% in FO vs. 12.5% in RE, P = 0.710). Although time to resumption of soft diet was shorter in the FO group than in the RE group, the lengths of hospital stay were not different. CONCLUSION: The FO and the conventional resection have similar short-term clinical outcomes for diverting ileostomy reversal.
Body Mass Index ; Cohort Studies ; Diet ; Humans ; Ileostomy* ; Ileus ; Length of Stay ; Propensity Score ; Rectal Neoplasms*

Surgery is the standard treatment for a primary gastrointestinal stromal tumor (GIST); however, surgical resection is often not curative, particularly for large GISTs. In the past decade, with imatinib mesylate (IM), management strategies for GISTs have evolved significantly, and now IM is the standard care for patients with locally advanced, recurrent or metastatic GISTs. Adjuvant therapy with imatinib was recently approved for use, and preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. IM neoadjuvant therapy for primary GISTs has been reported, but there is no consensus on the dose of the drug, the duration of treatment and the optimal time of surgery. These are critical because drug resistance or tumor progression can develop with a prolonged treatment. This report describes two cases of large rectal malignant GISTs, for which a abdominoperineal resection was initially anticipated. The two patients received IM preoperative treatment; we followed-up with CT or magnetic resonance imaging to access the response. After 9 months of treatment, a multi-disciplinary consensus that maximal benefit from imatinib had been achieved was reached. We determined the best time for surgical intervention and successfully performed sphincter-preserving surgery before resistance to imatinib or tumor progression occurred. We believe that a multidisciplinary team approach, considerating the optimal duration of therapy and the timing of surgery, is required to optimize treatment outcome.
Benzamides ; Consensus ; Drug Resistance ; Gastrointestinal Stromal Tumors ; Humans ; Imatinib Mesylate ; Magnetic Resonance Imaging ; Mesylates ; Neoadjuvant Therapy ; Piperazines ; Pyrimidines ; Treatment Outcome