We report a unique case of intramucosal carcinoma in a tubulovillous adenoma arising from a single diverticulum. Endoscopic mucosal resection (EMR) was carried out successfully and completely with the assistance of laparoscopy. A 71-year-old man was admitted to our hospital because of melena and anemia. Emergent colonoscopy showed diverticulosis in the right-sided colon. However, endoscopy could not exactly detect the bleeding site. A flat elevated polyp was found within a single diverticulum located in the descending colon and diagnosed as an intramucosal carcinoma, as magnifying chromoendoscopy revealed a type IV pit pattern. As his diverticular bleeding repeated, a right-sided hemicolectomy was decided for treatment, the polyp within the diverticulum was also completely removed by EMR with the assistance of laparoscopy. Although a colonic perforation was detected immediately after EMR, the perforation was closed with endoclips intraluminally and also repaired laparoscopically from the serosal side. Histologically, the resected lesion was an intramucosal well-differentiated adenocarcinoma and the surgical margin was free of tumor.

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A 70-year-old female underwent follow-up colonoscopy after colonic polypectomy. The colonoscopy revealed the presence of a 7-mm submucosal tumor in the sigmoid colon. The tumor surface was smooth and covered with normal mucosa. It was diagnosed as a submucosal tumor, and polypectomy was performed. Histopathological examination of the resected specimen revealed moderately to poorly differentiated adenocarcinoma measuring 2 × 5 × 3 mm with marked peritumoral lymphocytic infiltration and lymphoid follicle formation. It was diagnosed as carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma), SM (1,800 μm), ly2, v0, budding; grade 1. We confirmed the indication for noncurative additional surgical resection and performed laparoscopic sigmoid colectomy. No metastases were observed in the dissected lymph nodes.

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Aim: This study was designed to compare preoperative and postoperative bowel functions in patients with rectocele repair. Methods: Patients who underwent surgery for rectocele between October 1988 and October 2004 were enrolled. Prior to surgery, the patients were asked to complete a questionnaire regarding evacuation difficulty, itching, fecal incontinence, and the need for digitation. Surgery was performed either transanally (group I) or transvaginally (group II). At follow-up after 12 months, the same questionnaire was obtained in the outpatient clinic or by mail to evaluate preoperative and postoperative changes in bowel function. Results: There were 71 patients in group I and 40 patients in group II. The median age was 56 years in group I and 67 years in group II. The evacuation difficulty was significantly improved in both group I (p < 0.001) and group II (p < 0.001). Incontinence to flatus was slightly increased in group I (p = 0.33) and group II (p = 0.6). Incontinence to solid stool was not statistically different in either group. The need for digitation was markedly improved in group I (p < 0.001) and group II (p = 0.0017). Conclusion: Although surgery for rectocele potentially increases the risk of fecal incontinence, it may be indicated if presented with evacuation difficulty necessitating digitation.