HighlightsPneumatosis cystoides intestinalis (PCI) may be asymptomatic and discovered incidentally.PCI can be divided into primary and idiopathic (15%) or secondary (85%).CT is the most sensitive tool for diagnosis, in addition to showing the presence of air in the bowel wall.The appropriate therapy is related to the underlying cause of PCI.
IntroductionDiverticular disease of the colon is a frequent pathology; however, perforated diverticulitis with a spontaneous sigmoidocutaneous fistula revealed by a perianal abscess is an uncommon presentation. We present this extremely rare case of a perforated sigmoid diverticulum in the perianal area, which is the first case that we have encountered in our practice and in the literature, along with the accompanying diagnostic and therapeutic issues and a review of the literature.Presentation of caseWe report the case of a 47-year-old man who was admitted to the emergency room due to a perianal abscess. The patient was taken to the operating room on an emergency basis. In the lithotomy position, the abscess was located at the 4 o’clock position. Incision and drainage was performed. Intraoperatively, the abscess was found to be deep, and considered an ischiorectal abscess. No fistulous tract was identified. An MRI of the pelvis was performed one month postoperatively which revealed a perforated diverticulitis of the sigmoid colon causing a perianal fistula. After the abscess was successfully treated, a sigmoidectomy was performed. Fifteen centimeters of the colon were resected. No postoperative complications occurred.DiscussionPerianal fistula is an obvious physical sign but its etiology is complex to determine. The pathophysiological mechanism involved is the emergence of a pressure gradient between the peritoneum and surrounding structures, causing rupture of the perianal tissue, allowing gas from a perforation to diffuse along tissue planes.ConclusionGeneral surgeons should bear in mind this rare presentation of a sigmoid diverticulitis.
A foreign body in the rectum is not a very common surgical emergency case. In the treatment of rectal foreign bodies, the aim is to use the simplest possible method while protecting the integrity of the intestine. Many removal techniques have been described in the literature. Here we report a case in which a transanal technique using a single incision laparoscopic surgery port was successfully used.
After the failure of sleeve gastrectomy (SG), three options are available as a second intervention: the conversion into a biliopancreatic diversion with duodenal switch, the Roux-en-Y gastric bypass (RYGBP), and more recently, a re-SG consisting in the refashioning of a dilated gastric tube. We describe two different approaches for the conversion. The conversion to RYGBP remains a technically challenging operation but feasible and effective, and it should be reserved to specialized centers.
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