HighlightsWe present a unique case of gallstone ileus with inguinal hernia.A one-stage operation can be considered for patients with gallstone ileus associated with cholecystocolonic fistula.A review of the literature pertaining to colonic gallstone ileus is presented.
HighlightsWe present a unique case of strangulated paracecal hernia with bowel resection.Laparoscopic surgery is feasible and a valid approach for the diagnosis and treatment of internal hernias.A review of the literature regarding paracecal hernias is presented and discussed.
The optimal surgical indications for small rectal neuroendocrine tumors (NETs) are controversial. Generally, treatment guidelines for rectal NETs >2 cm or with potential lymph node (LN) metastasis recommend formal oncologic low anterior resection (LAR) with total mesorectal excision (TME). However, rectal NETs have the potential to metastasize to the lateral lymph nodes (LLNs). To the best of our knowledge, there are no detailed reports in English on LLN metastasis from rectal NETs. A 47-year-old man diagnosed with a rectal NET underwent endoscopic submucosal dissection (ESD). The pathological diagnosis was NET G1. The tumor was 10 mm in diameter, and the tumor depth reached the submucosal layer. A period of 3 years after ESD, the patient was diagnosed with LN metastasis in the mesorectum and LLN metastasis on the left side from the NET. Robotic TME and bilateral LN dissection were performed. The pathological findings indicated that two of the 18 LNs in the mesorectum were metastatic, and all the LLNs on the left side were negative. In contrast, 1 of the 6 LLNs on the right side was metastatic. Early-stage rectal NETs can metastasize to the LLNs, and it is very difficult to detect LLN metastasis based on size alone. TME alone may be insufficient to treat rectal NETs, and additional LLN dissection may be an important treatment strategy. However, it is increasingly difficult to determine the surgical indications for optimally timed LLN dissection.
Even in the unstable group, NOM with TAE performed under careful general management facilitated avoidance of open surgery and provided high survival rates.
BackgroundSecondary small bowel volvulus is a rare condition caused by adhesions after laparotomy or tumors. There are no clear guidelines for indication of laparoscopic surgery.Case presentationA 69-year-old male visited our hospital complaining of epigastric pain. He had a history of hypopharyngeal carcinoma treated via pharyngolaryngoesophagectomy with restoration of esophageal continuity by harvesting a free jejunal autograft 6 years ago.Enhanced computed tomography revealed the whirl sign. An emergency laparoscopic operation was performed following a diagnosis of small bowel volvulus. This revealed rotation of the whole small bowel, involving the superior mesenteric artery as the center, and originating at the adhesion of the proximal and distal small bowel. Laparoscopic manipulation of volvulus and lysis of the adhesion were performed. The patient’s postoperative course was uneventful, and he was discharged on hospital day 5.ConclusionsLaparoscopic surgery may be useful for treating small bowel volvulus; however, the patient’s treatment indications should be judged carefully.
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