We reported a case of irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.The patient complained about a right groin mass for more than 60 years with progressive enlargement for 3 years and pain for half a month.Abdominal CT examination at admission showed rectum and sigmoid colon hernia in the right inguinal area and thickening of sigmoid colon wall.Electronic colonoscopy and pathological diagnosis showed sigmoid colon cancer.Therefore,the result of preliminary diagnosis was irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.We converted laparoscopic exploration to laparotomy followed by radical sigmoidectomy and employed end-to-end anastomosis of descending colon and rectum in combination with repair of right inguinal hernia.The patient recovered well after operation and was discharged.
Colon, Sigmoid/surgery* ; Groin ; Hernia, Inguinal/surgery* ; Humans ; Laparoscopy ; Sigmoid Neoplasms/surgery*

Anastomosis, Surgical ; Colon, Sigmoid/surgery* ; Colorectal Neoplasms/surgery* ; Humans ; Robotics

Laparoscopic sigmoidectomy for cancer is considered as a simple surgical approach, which is suitable for primary laparoscopic surgery. However, the success of laparoscopic sigmoidectomy is closely related to the anatomical characteristics of the sigmoid colon. The length, adhesion and morphology of the sigmoid colon vary greatly. The differences of the length, width, adhesion and morphology of the mesentery are large. The distribution of vessels is diversified. The high ligation or the low ligation is still controversial. The location of the sigmoid colon cancer is also not constant. These problems have great influence on the operation. Before operation, the tumor must be accurately located and the anatomical characteristics of the sigmoid colon must be fully evaluated. The operation can be carried out smoothly and the complications during and after the operation can be reduced.
Colectomy ; Colon, Sigmoid ; anatomy & histology ; Humans ; Laparoscopy ; methods ; Sigmoid Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo evaluate the effect of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery on 5-year overall survival rate and operative mortality.

METHODSThe results of several literatures from different countries on high or low ligation of the inferior mesenteric artery and prognosis were analyzed using meta-analysis.

RESULTSSeven studies were included. The 5-year overall survival rate was compared between low and high ligation. The odd ratio (OR) for 5-year survival was 0.87 (95% CI=0.76-0.98, P=0.02), and the OR for perioperative mortality was 1.28 (95% CI=0.94-1.75, P=0.19).

CONCLUSIONSHigh ligation of the inferior mesenteric artery may improve 5-year overall survival rate. Perioperative mortality may not be influenced by the level of ligation.

Humans ; Mesenteric Artery, Inferior ; surgery ; Prognosis ; Rectal Neoplasms ; diagnosis ; surgery ; Sigmoid Neoplasms ; diagnosis ; surgery

Self-expandable metallic stents are widely used to relieve acute colorectal obstruction that's secondary to malignancy. They are utilized for both palliation and preoperative decompression prior to colorectal surgery. Although stents have been documented as a relatively safe therapeutic modality, procedure-related complications such as perforation, bleeding, stent reobstruction and migration can occur during or after colonic stent placement. Therefore, clinicians must be aware of the various complications associated with colonic stent placement. We present here a very rare case of sigmoidorectal intussusception that developed after fluoroscopic placement of a self-expandable metallic stent for preoperative decompression of sigmoid colon cancer. We misdiagnosed the intussusception as a distal stent migration on the plain radiography. On the sigmoidoscopic examination to evaluate the unrelieved colonic obstruction, we diagnosed a sigmoidorectal intussusception of the stent-implanted malignant tumor. The patient was successfully treated by laparoscopic partial reduction, followed by a curative anterior resection. This case demonstrates that careful examination must be done in cases of unrelieved colonic obstruction with suspicious stent migration, and intussusception must be considered as a rare complication of self-expandable metallic stent placement in the colon.
Colon ; Colonic Neoplasms ; Colorectal Surgery ; Decompression ; Hemorrhage ; Humans ; Intussusception ; Sigmoid Neoplasms ; Stents

OBJECTIVETo explore the safety and feasibility of reduced-port laparoscopic-assisted resection for cancer at the sigmoid colon and upper rectum.

METHODSClinical data of 70 patients with sigmoid colon or upper rectal cancer undergoing laparoscopic-assisted resection in our department from February 2013 to July 2014 were retrospectively reviewed. Patients were divided into reduced-port group (44 cases, 3 or 4 ports) and conventional group (26 cases, 5 ports). The operative time, blood loss, retrieved lymph nodes, postoperative exhaust recovery, dietary recovery, hospital stay and morbidity of complication were compared between two the groups.

RESULTSNo significant differences were observed in operative time [(144.0 ± 40.1) min vs. (115.8 ± 30.8) min], blood loss [(72.9 ± 50.2) ml vs. (45.5 ± 52.4) ml], number of retrieved lymph nodes [(10.2 ± 8.4) vs. (12.0 ± 5.6)], time to bowel function return [(3.2 ± 0.7) d vs. (2.8 ± 0.8) d], time to liquid diet [(4.2 ± 1.1) d vs. (3.8 ± 0.9) d], time to semisolid diet [(8.6 ± 2.1) d vs (8.1 ± 1.7) d], and postoperative hospital stay [(13.0 ± 3.4) d vs. (12.8 ± 7.2) d] between two groups (all P>0.05). Complication rate of conventional group and the reduced-port group was 15.4% and 7.2% without significant difference (P=0.233).

CONCLUSIONSFor cancer at the sigmoid colon and upper rectum, reduced-port laparoscopic surgery is feasible, safe and radical as the five-port in terms of technical and oncologic issues. These two procedures have the same short-term outcome.

Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Operative Time ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Sigmoid Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the safety and feasibility of laparoscopic extraperitoneal sigmoid colostomy.

METHODSThirty-six patients with low rectal cancer undergoing laproscopic abdominoperineal resection from July 2011 to July 2012 were prospectively enrolled in the study and randomly divided into extraperitoneal colostomy group(EPC, n=18) and internal peritoneal colostomy group(IPC, n=18). Follow-up period was 4-16 (median, 7) months and postoperative complications were compared between two groups.

RESULTSOne case in EPC group was converted to IPC because of poor blood supply of the proximal sigmoid, who was eliminated from the subsequent analysis. Compared with the IPC group, the surgery time was longer in EPC group [(25.3±8.5) min vs. (14.7±6.4) min], while the difference was not statistically significant(P>0.05). Each group had 1 case of stoma ischemia, who both received the colostomy reconstructive surgery. The incidence of stoma edema was significantly higher in EPC group[35.3%(6/17) vs. 0, P<0.05). The early postoperative complications rate did not significantly different between the two groups[58.8%(10/17) vs. 27.8%(5/18), P>0.05]. The late postoperative complications rate was 22.2%(4/18) in IPC group, including 1 case of stoma prolapse, 1 case of stoma stenosis and 2 cases of parastomal hernia. No later postoperative complication occurred in EPC group.

CONCLUSIONExtraperitoneal sigmoid colostomy is an easy and safe procedure with lower late complications as compared to internal peritoneal sigmoid colostomy.

Abdomen ; Colon, Sigmoid ; surgery ; Colostomy ; Humans ; Laparoscopy ; Perineum ; Peritoneum ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Surgical Stomas

Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Sigmoid Neoplasms ; diagnosis ; pathology ; surgery ; Solitary Fibrous Tumors ; diagnosis ; pathology ; surgery

Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.
Adult ; Carcinoma/*diagnosis ; Diagnosis, Differential ; Endometriosis/*diagnosis/pathology/surgery ; Female ; Humans ; Middle Aged ; Rectal Neoplasms/*diagnosis ; Sigmoid Neoplasms/*diagnosis

Tumor spreading through the lymphatic drainage is an important metastatic pathway for rectum and sigmoid colon carcinoma. Regional lymph node dissection, as an important part of radical resection of colorectal cancer, is the main way for patients with colorectal cancer to achieve radical resection and acquire tumor-free survival. The regional lymph nodes of sigmoid cancer include paracolic lymph nodes, intermediate lymph nodes, and central lymph nodes locating at the root of blood vessel, and radical surgery should include lymph node dissection at the above three stations. The lymphatic pathways of metastasis for rectal cancer include longitudinal metastasis within the mesorectum and lateral metastasis beyond the mesorectum. The standard surgical method of rectal cancer is total mesorectal excision (TME) at present, and the resection range includes the metastatic lymph nodes within the mesorectum through the longitudinal pathway. However, there are many different opinions about lateral lymph node dissection(LLND) aiming at the metastatic lymph nodes locating at the lateral space of rectum. The range of lymph node dissection for rectum and sigmoid cancer is a vital factor that determines the prognosis of patients. Insufficient range of dissection can lead to residual metastatic lymph nodes and have serious impacts on the prognosis of patients. Excessive range of dissection can result in greater surgical trauma, prolonged operation time, more blood loss, and higher rate of complication without oncological benefits. Individualizating the appropriate resection range of rectum and sigmoid colon cancer on the basis of standardization and according to the clinical stage and invasion range of tumor demonstrates great significance of ensuring the radical operation, reducing trauma, promoting rehabilitation, protecting the function and improving the prognosis.
Humans ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Rectal Neoplasms/pathology* ; Rectum/pathology* ; Reference Standards ; Sigmoid Neoplasms/surgery*