Common causes of lower gastrointestinal bleeding include diverticular disease, vascular disease, inflammatory bowel disease, neoplasms, and hemorrhoids. Lower gastrointestinal bleeding of appendiceal origin is extremely rare. We report a case of lower gastrointestinal bleeding due to angiodysplasia of the appendix. A 72-year-old man presented with hematochezia. Colonoscopy showed active bleeding from the orifice of the appendix. We performed a laparoscopic appendectomy. Microscopically, dilated veins were found at the submucosal layer of the appendix. The patient was discharged uneventfully. Although lower gastrointestinal bleeding of appendiceal origin is very rare, clinicians should consider it during differential diagnosis.
A 24-year-old, right-handed male patient presented with a 1-month history of continuous tingling paresthesia involving left medial hand and fingers accompanied by clumsiness of left hand and fingers. Thepain onset was sudden and marked by a severe aching pain in the medial elbow and medial scapular areas, without any prior cause. Two weeks of excruciating pain led to clumsiness of the left hand and fingers gradually occurred. Magnetic resonance imaging (MRI) of the left elbow revealed a swollen ulnar nerve with perineural enhancement involving anconeus epitrochlearis (AE) muscle within the cubital tunnel. The operation revealed adhesion of the AE muscle to the left ulnar nerve. Open in-situ decompression of the ulnar nerve without transposition eventually alleviated the pain and weakness associated with ulnar neuropathy. The patient slowly recovered 6 months after surgery. The AE muscle is a common anatomic variation, with a prevalence of up to 34%. However, the prevalence of ulnar neuropathy associated with the AE muscle is unknown. It is a congenital accessory muscle between the medial humeral epicondyle and the olecranon covering the posterior aspect of the cubital tunnel. It is usually diagnosed intraoperatively and not preoperatively in the absence of no imaging studies. The clinical presentation of ulnar neuropathy caused by the AE usually differs from idiopathic disease, including younger age at onset, rapid progression with a short duration of symptoms, and edema of the AE muscle on the MRI.
Purpose: Laparoscopic surgery has been accepted as a standard procedure for colorectal cancer.Preoperative chemoradiation for rectal cancer has some advantages, such as decreased tumor size and lower stage, and lower local recurrence. However, preoperative chemoradiation has the disadvantage of increasing postoperative complication risks. The aim of this study was to evaluate the safety of laparoscopic surgery for rectal cancer after preoperative chemoradiation in elderly patients.Methods: 46 patients underwent laparoscopic surgery for rectal cancer after preoperative chemoradiation. Patients were divided into younger (<70 years, n=35) and older groups (≥70 years, n=11).
Results:In the younger group, men were more predominant (80% vs. 54.5%, p=0.124). In the older group, more patients had high American Society of Anesthesiologists scores (score 3 was 2.9% vs. 36.4%, p=0.005) than in the younger group. Sphincter-preserving surgery was performed more frequently in the younger group (77.2% vs. 45.5%, p=0.065). Operation time (195.8 min. vs. 212.5 min, p=0.553) and intraoperative blood loss (200.6 cc vs. 209.1 cc, p=0.952) were not significantly different. Significant anastomotic leakage was absent in both groups. Postoperative hospital stay was 9.7 and 10.9 days (p=0.669). Complete remission rates were similar in the both groups (8.8% vs. 18.2%, p=0.824).
Conclusion:Postoperative outcomes are comparable between older group and younger group.Laparoscopic surgery could be considered as safe, feasible therapeutic options in elderly patients after preoperative chemoradiation for rectal cancer. However, large randomized trials with comparative methodologies are needed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.