RESUMEN
BACKGROUND Reversed intestinal malrotation is an extremely rare disease, with an incidence of 1 in 250 000. In Japan, application of robotic-assisted colorectal cancer surgery is expected to increase. There are no reports of robot-assisted surgery for cecal cancer with reversed intestinal malrotation. CASE REPORT An 84-year-old Japanese man with epigastric pain and abdominal distention was referred to our hospital's Department of Gastroenterology for thorough examination. Colonoscopy revealed a semicircumferential type 2 tumor in the cecum and ascending colon. Gastrografin contrast study showed that the large intestine was entirely on the patient's right side and the small intestine was shifted to the left side. Contrast-enhanced computed tomography revealed enlarged lymph nodes near the tumor, and masses were observed at the liver, which were believed to be metastases. Following examination, reversed intestinal malrotation and concurrent cecal cancer was diagnosed. The patient was referred to our department for surgery and underwent robot-assisted ileocecal resection with D3 lymphadenectomy. The postoperative course was favorable, and patient was discharged on the sixth postoperative day, without complications. According to the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th edition, the pathological diagnosis was pT4b (ileum), pN1b, cM1a (H1 [grade A]), and pStage IVa cancer. After considering tumor stage and patient's overall condition in consultation with his family, we decided against palliative systemic therapy. The patient was provided with best supportive care. CONCLUSIONS Robot-assisted surgery might be useful in manipulation of the dissection of adhesions, owing to its capacity for high-resolution 3-dimensional imaging and forceps manipulation, using articulated functions.
Asunto(s)
Neoplasias del Ciego , Procedimientos Quirúrgicos Robotizados , Humanos , Masculino , Neoplasias del Ciego/cirugía , Neoplasias del Ciego/complicaciones , Anciano de 80 o más Años , Vólvulo Intestinal/cirugía , Anomalías del Sistema Digestivo/cirugía , Anomalías del Sistema Digestivo/complicaciones , Adenocarcinoma/cirugía , Adenocarcinoma/complicacionesRESUMEN
The patient was a 71-year-old woman diagnosed with mesenteric phlebosclerosis(MP)2 years earlier. CT performed to investigate her abdominal pain revealed an ascending colon obstruction. Colonoscopy(CS)revealed MP extending to the ascending colon hepatic flexure with stenosis and a cecal tumor(biopsy tub1). Although the cancerous lesion itself was potentially curable by endoscopic treatment, it was surgically resected because of the ascending colon stenosis caused by the MP that had also caused intestinal obstruction. Intraoperative findings revealed wall thickening and stiffening from the cecum to the ascending colon hepatic flexure. Postoperative pathological examination revealed cecal carcinoma pTis, N0, M0, pStage 0. The background mucosal tissue was consistent with MP, but no findings suggested a relationship between the MP and tumor. Although the relationship between MP and carcinogenesis is unknown, and no such relationship was identified in this case, we report this case because a further accumulation of cases of MP and carcinoma is necessary, considering the rarity of MP itself and the non-negligible number of cases with carcinoma.
Asunto(s)
Carcinoma , Neoplasias del Ciego , Obstrucción Intestinal , Laparoscopía , Humanos , Femenino , Anciano , Constricción Patológica , Ciego , Colonoscopía , Colon Ascendente , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/cirugía , ColectomíaRESUMEN
A 66-year-old man underwent laparoscopic ileocecal resection for cecal cancer with liver metastasis(cT3N1M1a, cStage â £a). One month later, combination chemotherapy with capecitabine, oxaliplatin, and bevacizumab was administered for liver metastasis. However, during the treatment, peritoneal dissemination and abundant diuretic-resistant ascites was revealed, resulting in poor dietary intake. One year and 11 months after the surgery, the chemotherapy was interrupted and cell-free and concentrated ascites reinfusion therapy(CART)was undergone as palliative care. The initial volume of retrieved ascites was 6,500 mL, and the volume was increased gradually to a maximum of 14,020 mL without hemodynamic instability. Totally CART was administered 10 times during 7 months without any complications: mean volume of retrieved ascites; 9,780 mL/unit, the interval between therapies; 2-3 weeks. Serum albumin level did not decrease since CART administration. His oral intake and daily activities were improved by CART. These clinical outcomes contributed to the readministration of chemotherapy. We present a recent case of safe and periodical CART for abundant refractory ascites in cecal cancer with peritoneal dissemination, resulting in the improvement of QOL and the readministration of chemotherapy.
Asunto(s)
Neoplasias del Ciego , Neoplasias Hepáticas , Masculino , Humanos , Anciano , Ascitis/etiología , Ascitis/terapia , Calidad de Vida , Peritoneo , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/tratamiento farmacológico , Neoplasias del Ciego/cirugía , Neoplasias Hepáticas/tratamiento farmacológicoRESUMEN
Intestinal malrotation is a congenital anomaly, treated mostly during childhood. A small number of cases are incidentally found in adulthood, during operation for other abdominal diseases, such as colon cancer.Here, we present a case of caecal cancer with isolated duodenal malrotation, a subtype of intestinal malrotation, discovered incidentally during the operation for the cancer. Although the anatomical abnormality made the operation more complicated, laparoscopic resection was safely performed with oncologically adequate lymphadenectomy, owing to intraoperative confirmation of anatomy and careful dissection.
Asunto(s)
Neoplasias del Ciego , Neoplasias del Colon , Laparoscopía , Humanos , Adulto , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/cirugía , Duodeno , Neoplasias del Colon/cirugíaRESUMEN
We report a case of ileocecal intussusception due to Burkitt's lymphoma(BL). A 14-year-old boy was admitted to our hospital for abdominal pain and diarrhea. He was diagnosed an intussusception by the ultrasonography and the CT scan. Laparoscopic ileocecal resection was performed. A diagnosis of BL was made on basis of pathological examination. He was transferred for the chemotherapy on postoperative day 8. We conclude that, if the intussusception associated with malignant lymphoma is assumed from the preoperative findings, we have to keep minimal surgical invasion and start postoperative chemotherapy immediately.
Asunto(s)
Linfoma de Burkitt , Enfermedades del Ciego , Neoplasias del Ciego , Intususcepción , Adolescente , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/cirugía , Enfermedades del Ciego/complicaciones , Enfermedades del Ciego/cirugía , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/tratamiento farmacológico , Neoplasias del Ciego/cirugía , Humanos , Intususcepción/etiología , Intususcepción/cirugía , Masculino , UltrasonografíaRESUMEN
A 26-year-old lactating mother presented with a 3-week history of abdominal pain, constipation, and vomiting. She denied any history of alcohol abuse or other gastrointestinal problems. Contrast-enhanced CT identified a small-bowel obstruction caused by a cecum cancer (Fig. 1A). Therefore, she underwent right hemicolectomy and ileocolic anastomosis. Post-operatively, she gradually developed drowsiness, fainting, and a rapid heart rate at 130 bpm. However, blood tests were all normal.
Asunto(s)
Neoplasias del Ciego , Obstrucción Intestinal , Encefalopatía de Wernicke , Adulto , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/diagnóstico por imagen , Neoplasias del Ciego/cirugía , Ciego , Femenino , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Lactancia , Encefalopatía de Wernicke/complicaciones , Encefalopatía de Wernicke/etiologíaAsunto(s)
Carcinoma/diagnóstico , Neoplasias del Ciego/diagnóstico , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Intestino Delgado , Enfermedad Aguda , Carcinoma/complicaciones , Carcinoma/terapia , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/terapia , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Obstrucción Intestinal/terapia , Persona de Mediana EdadRESUMEN
CASE SUMMARY: A 37-year-old woman with no relevant past medical history presented to the emergency department after a 2-day-long period of crampy abdominal pain with an inability for oral intake because of persistent vomiting. The physical examination was unremarkable. Abdominal CT scan with water-soluble oral contrast revealed an ileocecal intussusception (Fig. 1). Because the patient was hemodynamically stable and no abdominal tenderness was found, a delayed surgical intervention was planned with laparoscopic approach. During intervention, the intestinal invagination was reduced, a cecal neoplasm suspected, and a right hemicolectomy with complete mesocolic excision was performed (Fig. 2). Postoperative recovery was uneventful, with discharge on postoperative day 5. The definite pathological report showed well-differentiated colon adenocarcinoma pT2N1aMx, with 1 of 49 positive lymph nodes.
Asunto(s)
Enfermedades del Íleon/diagnóstico , Intususcepción/diagnóstico , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/diagnóstico , Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Manejo de la Enfermedad , Femenino , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Laparoscopía , Estadificación de Neoplasias , Tomografía Computarizada por Rayos XRESUMEN
A 37-year-old male presented with acute lower right abdominal pain. A CT-scan showed a cecal mass. During laparoscopic right colectomy, multiple liver lesions and peritoneal deposits were seen. Histology confirmed pT4aN0 cecum carcinoma, but the liver lesions were consistent with sarcoidosis, and the peritoneal deposits were suggestive of benign mesothelioma.
Asunto(s)
Carcinoma/secundario , Neoplasias del Ciego/patología , Neoplasias Hepáticas/secundario , Neoplasias Peritoneales/secundario , Dolor Abdominal/etiología , Adulto , Neoplasias del Ciego/complicaciones , Ciego/patología , Colectomía , Humanos , Hígado/patología , Masculino , Peritoneo/patología , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias del Ciego/cirugía , Intususcepción/diagnóstico , Intususcepción/cirugía , Dolor Abdominal/etiología , Neoplasias del Ciego/complicaciones , Humanos , Intususcepción/diagnóstico por imagen , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 74-year-old man presented with acute small bowel obstruction secondary to recurrence of a caecal tumour. The patient underwent laparotomy and formation of loop ileostomy and had a nasogastric tube (NGT) inserted in the theatre. A decision was made to remove the patient's NGT postoperatively, which was found to be stuck. High-quality imaging demonstrated a knot in the tube within the nasopharynx; so, subsequent removal via the oral route necessitated sedation. This case highlights the importance of considering rare or unusual complications of NGT insertion when a patient describes more pain or discomfort than would otherwise be expected. The clarity of imaging highlights clearly the underlying findings when compared with the few other documented cases. We offer a number of learning points specific to this complication.
Asunto(s)
Anestesia General/métodos , Anestésicos Generales/farmacología , Remoción de Dispositivos/métodos , Obstrucción Intestinal/terapia , Intubación Gastrointestinal/efectos adversos , Anciano , Neoplasias del Ciego/complicaciones , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Intubación Gastrointestinal/instrumentación , Masculino , Periodo Posoperatorio , RadiografíaAsunto(s)
Pared Abdominal/cirugía , Adenocarcinoma/cirugía , Neoplasias del Ciego/cirugía , Fascitis Necrotizante/etiología , Perforación Intestinal/cirugía , Pared Abdominal/patología , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/diagnóstico , Fascitis Necrotizante/diagnóstico , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Persona de Mediana EdadRESUMEN
We present a case of an unusually large, circumferential tubulovillous adenoma involving the terminal ileum and the caecum with ileocaecal valve consumption, presenting as intussusception in an otherwise healthy 90-year-old woman. The patient presented with several months of chronic symptoms of weight loss and diarrhoea. Clinical examination revealed a right-sided mass. Investigations revealed a large right-sided lesion suspicious of intussusception. The patient underwent a right-sided hemicolectomy where the intussusception was resected. Histology of the resected mass revealed a tubulovillous adenoma with focal invasive adenocarcinoma.
Asunto(s)
Adenoma/complicaciones , Neoplasias del Ciego/complicaciones , Válvula Ileocecal , Intususcepción/etiología , Adenoma/patología , Anciano de 80 o más Años , Neoplasias del Ciego/patología , Femenino , Humanos , Carga TumoralRESUMEN
BACKGROUND: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. CASE PRESENTATION: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. CONCLUSIONS: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.
Asunto(s)
Neoplasias del Ciego , Enfermedad Relacionada con Inmunoglobulina G4 , Laparoscopía , Fibrosis Retroperitoneal , Neoplasias del Ciego/complicaciones , Humanos , Inmunoglobulina G , Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
A 73-year-old man with an 8-week history of angina underwent an exercise tolerance test at the rapid access clinic, which indicated inducible ischaemia and he was subsequently referred for angiogram. His angiogram demonstrated no coronary pathology. It was later discovered that bloods taken on the day of the procedure showed a haemoglobin of 54 g/L (130-180 g/L). His haemoglobin used to book the angiogram 3 months before was 143 g/L. Following angiogram, a mass was identified in the right iliac fossa and CT scan confirmed a caecal tumour. The patient ultimately underwent a curative right hemicolectomy as an outpatient. The case is a reminder of the importance of basic preangiogram investigations, in particularly a full blood count, to rule-out angina secondary to anaemia through a low haemoglobin. Most importantly, it also questions when the appropriate time is for these investigations to be carried out, prior to coronary angiography.
Asunto(s)
Anemia Ferropénica/diagnóstico , Angina de Pecho/diagnóstico , Neoplasias del Ciego/diagnóstico , Anciano , Anemia Ferropénica/etiología , Angina de Pecho/etiología , Neoplasias del Ciego/complicaciones , Diagnóstico Diferencial , Humanos , MasculinoAsunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomía , Colestasis , Obstrucción Duodenal , Endosonografía/métodos , Cuidados Paliativos/métodos , Stents , Tomografía Computarizada por Rayos X/métodos , Adenocarcinoma/complicaciones , Adenocarcinoma/patología , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/patología , Coledocostomía/instrumentación , Coledocostomía/métodos , Colestasis/etiología , Colestasis/fisiopatología , Colestasis/cirugía , Obstrucción Duodenal/diagnóstico , Obstrucción Duodenal/etiología , Obstrucción Duodenal/fisiopatología , Obstrucción Duodenal/cirugía , Diseño de Equipo , Obstrucción de la Salida Gástrica/etiología , Obstrucción de la Salida Gástrica/cirugía , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Resultado del TratamientoAsunto(s)
Adenocarcinoma/secundario , Neoplasias del Colon/patología , Neoplasias Hepáticas/secundario , Neoplasias Primarias Múltiples/patología , Tumores Neuroendocrinos/secundario , Adenocarcinoma/cirugía , Anciano , Anemia/etiología , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Colectomía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Femenino , Hemorragia Gastrointestinal/etiología , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/cirugía , Neoplasias Primarias Múltiples/cirugía , Tumores Neuroendocrinos/cirugíaRESUMEN
A 67-year-old woman who had been treated for cardiac sarcoidosis was diagnosed with cecal cancer by detailed examination. Although an anatomical abnormality was present, we determined that a curative operation with single-port laparoscopic surgery(SILS)was feasible. We safely performed ileocecal resection with D3 lymph node dissection(operative time of 91 min with almost no intraoperative blood loss), and the patient developed no operation-related complications during the postoperative course. Although cecal cancer with situs inversus is very rare, SILS is thought to be safe and feasible when performed by surgeons, who are familiar with the SILS technique and the spatial-cognitive features of situs inversus.