Ruptured abdominal aneurysm disguised as an incarcerated inguinal hernia.

An incarcerated inguinal hernia is a textbook example of a basic and straightforward diagnosis. In rare cases, an incarcerated hernia may be a symptom of more complex underlying pathology. In this case report a patient with a ruptured abdominal aortic aneurysm presented with an incarcerated left inguinal hernia. Only two other cases have been reported with a stable patient at initial presentation. The diagnosis was suspected when blood seeping next to the internal inguinal ring was detected, and an urgent ultrasound in the operating room confirmed the diagnosis. Whether or not patients with an inguinal hernia are more at risk for an AAA remains unclear.

Preliminary results after Single-Incision Laparoscopic Colorectal Surgery.

OBJECTIVE: Single-incision laparoscopic surgery (SILS) represents the recent advance in laparoscopic surgery claiming to be less invasive than conventional laparoscopic surgery. This study investigates the feasibility and safety of the procedure in colorectal surgery and reports the experiences in our center. METHODS: We retrospectively evaluated 41 consecutive patients surgically treated in our institution (February 2011-April 2013). The patient characteristics were evaluated for: gender, age, body mass index and ASA-score. Data included: indication, procedure, intraoperative complications, operation time, number of lymph nodes, postoperative complications, length of stay (LOS), morbidity and cosmesis. RESULTS: SILS was performed in 41 patients including 9 patients with colorectal cancer resection. We performed 3 ileocaecal resections, 11 right hemicolectomies, 7 sigmoidectomies and 20 rectosigmoidectomies. The operation time ranged from 45-210 min (median 123 min). Number of lymph nodes identified, ranged from 1-37 (median n=8). Six post-operative complications (14%) occurred: 1 gastroparesis, 1 subobstruction, 1 anastomotic leak and 3 patients needed a blood transfusion postoperatively. Median LOS was 6 days (range 4-21 days). One delayed complication (2,4%) occurred (eventration). None of the patients died. All patients had satisfactory cosmetic results. CONCLUSIONS: With the proviso that the study population was limited in size, SILS is feasible and is a save procedure in colorectal surgery and the procedure has an obvious cosmetic benefit. The results are comparable to other international reports. Still the procedure should be restricted to selected patients and performed by experienced surgeons. Additional prospective studies are essential to define the further benefit.

Recurrence of gallstone ileus with Crohn's disease.

Gallstone ileus is an uncommon form of bowel obstruction. It can occur whenever a stone passes through the common bile duct or a cholecystoenteric fistula. When a stone is in the intestinal track it can either traverse the entire colon to be voided spontaneously or obstruct the small or more rarely the large intestine. We report a case of recurrence of gallstone ileus in a young patient with Crohn's disease. Clinical findings, diagnosis and treatment are presented.

Laparoscopic colorectal surgery. Analysis of the first 237 cases.

This study was made to prospectively assess the results of our first 237 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal procedures. Between May 1995 and July 1999, two hundred thirty seven laparoscopic (assisted) colorectal procedures were performed: 97 sigmoidectomies, 31 right hemicolectomies, 26 rectosigmoidectomies, 23 abdominoperineal rectum amputations and 60 other procedures. The following parameters were recorded and analysed: patients gender, age, diagnosis, procedure, conversion to open surgery, peroperative and postoperative complications, duration of procedure, mortality and length of hospitalization. There were 104 men (44%) and 133 women (56%) with a mean age of 62 years. Hundred and fifty-one operations were performed for benign indications (diverticular disease (51.6%), benign colonic polyps (17.5%) and others (30.9%)) and 86 for cancer (palliative and curative). The conversion rate was 4%. Postoperative complications occurred in 65 patients (27%). In 20% of these cases re-operation was necessary. The most common cause was bowel obstruction. Surgery lasted an average of 110 minutes. Mean overall hospital stay was 11 days. Sixty per cent left the hospital within eight days after operation. The 60-day mortality rate was 2.9%. The feasibility and safety of laparoscopic colorectal surgery has been established in a variety of procedures for different indications. Care must be taken in the case of acute diverticulitis which in our series is associated with higher minor and major complication rate and conversion rate. Although our results for malign cases are good, the definitive incidence of neither port-site metastasis nor local recurrence is known and no long-term results after laparoscopic surgery for carcinoma are available, we believe that curative procedures for cancer should continue to be carried out only within the framework of prospective studies unless the patient is more than 75-year old, is in bad general condition or when a palliative procedure has to be performed.

Second primary malignancies in patients with a gastrointestinal neuroendocrine tumour: a case report and review of the literature.

A second primary malignancy (SPM) is frequently reported in patients with a gastrointestinal neuroendocrine tumour (NET). The majority of SPM are located in the gastrointestinal tract, but malignancies at other sites are described as well. This phenomenon might just be coincidental due to high incidence rates of asymptomatic NET lesions in patients who are operated or who undergo autopsy for another primary malignancy. However, other theories have been developed since the observed incidences rates seem to be double as high as expected. Some authors suggest a common genetic predisposition, while others report tumourigenic properties of various neuroendocrine peptides, including secretin, gastrin and cholecystokinin. This review is illustrated by a case report of a patient in whom the radiological diagnosis of a diffuse liver metastasized adenocarcinoma of the rectum changed dramatically after positron emission tomography and explorative laparoscopy to a curable adenocarcinoma of the rectum with a simultaneous well-differentiated neuroendocrine carcinoma.