The diagnostic and therapeutic management of a peculiar case of rectal submucosal adenocarcinoma

Abstract

Introduction

A proposed therapeutic algorithm for colorectal cancer prevention, based on endoscopic polypectomies in patients with multiple colonic polyps

“…Distribution of polyps in relation to existing form and degree of dysplasia.DiscussionsConsidering that the reviewed literature (4, 5) did not contain specific guidelines for practicing repeated polypectomies in patients with multiple polyps, and given the results of our observations, we developed an algorithm that can be applied to cases of serial polypectomies in patients with multiple polyps. The goal is to implement uniform practice in gastroenterology and surgery that can provide meaningful and systematized results for future studies in this field and to resolve as many polyps with high dysplasia at the first examinations.Thus, review of our findings revealed a direct correlation between the larger size of the polyps and the higher degree of high dysplasia, highlighting that the most frequent presence of high dysplasia polyps are rectal, followed by a gradual decrease with ascension toward the rest of the colon segments(6)(7)(8).Consequently, we have chosen the following characteristics of the polyps as key-points for the algorithm: size, shape, location, and histological type, thus determining which polyps will be resected first and in the precise order of conducting the following procedures(9,10).As such the decisional algorithm is based on several layers, starting from: o Dimension (in mm): polypectomies will start with the largest polyps first. The basis for this decision relies on data depicted in Figure 12; o Morphology: if several polyps are present and they all are roughly the same size, polypectomies should start from the sessile ones and then to the pediculate (based on data from Figure 13); o Location: polypectomies should start from the left colon and proceed to the right, respectively from the rectum (based on data available inFigure 14); Histological type: if previous histological results are available, the villous polyps should be resected first and then the other forms would be considered (as laid out inFigure 15).…”

Abdominal cocoon syndrome. A rare cause of mechanical intestinal obstruction: A case report

“…Several surgical procedures are available for individuals who show indications of intestinal blockage or who have been identified intraoperatively with ACS. The membrane is partially removed, adhesions are removed, and the anastomosis and resection anastomosis with a covering ileostomy are performed [15] .…”