Dear Editor, Colocutaneous fistulas are very rare, account for 1%-4% of the total number of fistulas complicating diverticular diseases, and may be caused by percutaneous drainage of diverticular abscesses without subsequent resection (1). They are more likely to occur in a patient who has undergone resection and primary anastomosis. In this letter, we report a case of a patient with a fistula connecting the sigmoid colon with left iliac fossa skin as a complication of sigmoid diverticulitis.A 45-year-old male was admitted to our department for cutaneous fistula formation and seropurulent secretion in the fistulous opening. Initially, the patient with complicated colon diverticular disease had been admitted to another hospital 3 months previously with an abscess in the left iliac fossa, and its drainage was performed. Postoperative evolution was unfavorable with fistula formation in the scar (Figure 1). Physical examination indicated the presence of a postoperative scar with signs of inflammation and at the lower pole of the postoperative scar, a fistulous orifice with a diameter of 0.2-0.3 cm discharging the seropurulent fluid.Fistulography of the left iliac fossa emphasized opacification of the sigmoid loop with inflammatory changes and incomplete lumen stenosis over a distance of approximately 10 cm.Abdomen and pelvis computed tomography (CT) revealed infiltration with inflammatory aspect of subcutaneous fat in the anterior and left abdominal wall. At the lower pole of the postoperative scar, inflammatory process spread in the intrapelvic region without extending to the left iliac muscle, but with no cleavage plane toward the ileal loops. It also revealed the presence of fluid and air bubbles in the abdominal wall muscles (Figure 2).During surgical intervention, we found inflammatory process in the left iliac fossa involving the side of the sigmoid colon, anterior abdominal wall, and greater omentum. Releasing the sigmoid loop was difficult. A fistulous orifice with a diameter of 0.4 0.5 cm, thickened wall, and irregular edges was identified. Sigmoidectomy with end-to-end colorectal anastomosis was performed as a one-step procedure.Postoperative specimen consisted of a 25-cm sigmoid segment, which contained three perforated diverticula (when it 248
Oncogenesis is an extremely complex phenomenon. The mechanisms by which cancer is induced is only partially known. Consequently, therapeutic targets may be uncertain and results are often unsatisfactory. The purpose of this paper is to develop a trans-level and multiple transdisciplinary perspective describing the kaleidoscopic reality of oncogenesis. This manner of understanding oncogenesis as a complex process characterized by a non-linear dynamic, far from equilibrium and with unpredictable evolution, transcends the classical perspective and requires a paradigm shift. This approach is also facilitated by recent studies that focus on group phenomena, with emerging behaviors in a continuous phase transition. Biological systems, and obviously the human organism, express this type of behavior with critical self-organizing valences in the context of a genome-mesotope (environment)-phenotype interaction. For example, nature has transposed in the ecosystem, among other things, the performance pattern of its mineral history represented by the dynamic energy-matter-information unit (the principle of invariance). And multi-cell biological systems in the phylogenetic tree crown have multiple directed aerobic metabolisms in accordance with specific functions. Cancers, in turn, have a hybrid (anaerobic and aerobic) and unidirectional metabolism whose only and ultimate reason is the survival of the malignant cell. Understanding the transdisciplinary reality of oncogenesis offers novel development paths for new therapeutic strategies compared to current ones which have relatively limited efficiency.
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