In experienced hands, laparoscopic colorectal resection can be performed safely for "high-risk" surgical patients. The better than expected outcomes in this patient population reinforce the benefits of minimally invasive surgery for this patient group and argues against using parameters of increased age, morbid obesity, high ASA class, or preoperative radiation alone as contraindications to even complex laparoscopic colorectal procedures.

Epiploic appendagitis is a rare and uncommon diagnosis that is frequently unknown to clinicians. Inflammation is usually acute and causes abrupt symptoms, but once the diagnosis is accurately made, most patients respond to pain control and conservative management. We report the case of a young woman presenting with acute primary epiploic appendagitis of the right colon. The inflammatory mass was unusually large and occurred a few months after surgery for gastric bypass. This case will give us the opportunity to discuss the clinical presentation of this disease, as well as the potential associations and risk factors and the means for adequate diagnosis and treatment.

Capsaicin-sensitive primary afferent fibers (CSPA) in the small intestine regulate many functions through the release of peptides and neurotransmitters. This study was undertaken to assess the role of CSPA in the regulation of jejunal alanine absorption in the rat. In a series of in vivo experiments, the effects of the sensory neurotoxin capsaicin on small intestinal alanine absorption were evaluated. In vitro experiments were also done to study its effects on alanine uptake by isolated jejunal strips and mucosal scrapings. Jejunal alanine absorption was reduced by 27% when capsaicin (160 and 800 microM) was perfused intraluminally and by 21% when it was applied topically to the cervical vagi. On the other hand, bilateral cervical vagotomy and reversible block of vagal CSPA increased alanine absorption by 29 and 41%, respectively. In vitro, capsaicin reduced alanine uptake by intestinal strips in a dose-dependent manner. Maximal inhibition (36.5%) occurred at 400 microM with the mean ineffective concentration at 87 microM. Alanine uptake by jejunal mucosal scrapings, however, was decreased only by 6.7% when incubated with 1,600 microM capsaicin. These data suggest that vagal CSPA exerts a tonic inhibitory effect on alanine absorption and that capsaicin's inhibitory effect on alanine absorption is mediated largely by the capsaicin-sensitive afferent fibers.

Highlights2 cases of intestinal obstruction secondary to ectopic pancreas.Ectopic pancreas causing intestinal occlusion is a very rare entity.In the first case, the ectopic tissue caused mechanical luminal occlusion in the distal ileal part, whereas the 2nd case presented intussusception sign, 20 cm distal to the Treitz ligament.Ectopic pancreas can serve as a lead point for ileo-ileal intussusception.

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