Despite infection due to leech therapy being a well known and relatively common complication, many units are not using appropriate antibiotic prophylaxis.
Background Metastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma. Case presentation A 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB. Conclusion This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.
We report a case of a 58-y-old male with a metachronous abdominal wall metastasis secondary to colorectal cancer. The patient initially presented 2 y ago at an outside facility with stage IV (T4, N0, M1) sigmoid colon cancer with liver metastasis. Fine needle aspiration (FNA) was performed of the liver masses, located in segment 5, inferior segment 4B, and segment 2 and ranging between 1 and 3 cm in size. The patient subsequently underwent laparoscopic sigmoid colon resection with end colostomy creation. Following this, adjuvant chemotherapy was administered with five cycles of FOLFOX. Interval computed tomography (CT) scan following chemotherapy demonstrated a decrease in size of the larger liver masses. At our institution, an open total left hepatic lobectomy (hepatic segments 2, 3, and 4) and a partial right hepatectomy of hepatic segment 5 were performed. Twelve further cycles of adjuvant chemotherapy were then performed. One year after the sigmoid resection, robot-assisted colostomy closure with end-to-end, double-stapled coloproctostomy was then performed. A subsequent CT identified a small right liver lesion consistent with metastasis, and as such the patient underwent further cycles of chemotherapy. Following these cycles of chemotherapy, positron emission tomography/CT demonstrated a resolution of the liver recurrence; however, a hypermetabolic lesion at the former site of colostomy within left anterior rectus musculature was evident. This was confirmed on core needle biopsy to be adenocarcinoma of colon primary. Robotic-assisted resection of the abdominal wall metastasis was successfully performed.
We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), abdominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundoplication had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient’s presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with subsequent resolution of the patient’s symptoms.
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