A case of atraumatic rupture of the spleen originally presenting as ruptured sigmoid diverticulitis is described. The underlying disease was found to be myelofibrosis. Although progressive splenomegaly is always associated with this disease, spontaneous rupture of this organ is not reported in the literature. We also reviewed the literature in regard to unusual presentation of splenic rupture and we could not find any case simulating acute sigmoid diverticulitis. It is suggested that awareness and familiarity with this disease may enable the surgeon to suspect this diagnosis when dealing with an unusual acute abdominal emergency.
Since 1872, 168 rectal leiomyomas have been reported in the world literature. Their incidence, therefore, is very low. It is estimated that one leiomyoma may be seen for every 2,000 or more rectal tumors. Those leiomyomas located in the anal canal and sphincter are the rarest. A case is reported here that appears to be the eleventh in such a location. The incidence of these lesions is highest between the ages of 40 and 59 years. Most patients have a combination of symptoms rather than a single one, the most frequent of these being the presence of a mass, bleeding, and constipation. Almost always, the chain of events that leads to the diagnosis starts when the tumor is discovered by digital examination of the rectum. The lack of reliable criteria of malignancy and the marked tendency to recur shown by these tumors are the two main problems the surgeon faces when selecting the operative procedure to be used. We believe that those tumors with an original size of 5 cm or more in largest diameter are the ones that have shown the highest tendency to recur, mostly as sarcomas. Therefore it is thought that these lesions should be treated radically from the beginning, especially when they recur. More adequate follow-up studies are needed.
During a 12-year period, 185 patients with papillary adenomas of the colon and rectum were treated. The average age was 63 years and there was a 10 per cent female preponderance. Seventy-one per cent of the lesions occurred in the rectum and rectosigmoid, and 40 per cent of the patients had rectal bleeding. Fifty-two per cent of the lesions were malignant: however, only 9 per cent of the patients died with metastatic carcinoma. The five-year survival rate in patients with papillary adenocarcinoma was 75 per cent. The results of this review indicate that a conservative approach to the surgical management of papillary adenoma of the colon and rectum should be encouraged, unless the tumor contains or is suspected to contain invasive carcinoma.
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