Cellular Angiofibroma Presenting as a Subepithelial Rectal Mass.

A very rare case of cellular angiofibroma arising from the rectum in a 62-year-old man with a normal colonoscopy 2 years earlier is reported. To our knowledge, this is the first such case reported in the literature. The tumor was transanally excised with clear margins, and the patient had no postoperative complications. It is key to accurately differentiate this lesion from other subepithelial rectal tumors and more aggressive genital soft tissue tumors because clinical management varies. We performed a review of clinical records and pathology as well as an extensive literature review.

Robotic cholecystectomy and cholecystoenteric fistula closure in a female with remote cholangitis.

Cholecystocolic fistula (CCF), a connection between the gallbladder and neighboring colon, is a rare entity with little consensus as to the optimal surgical management. Existing case reports have described both open and laparoscopic repairs. We describe the first reported case of a successful robotic repair of a CCF in a 50-year-old woman diagnosed with cholangitis 5 years prior to surgery. The patient had a longitudinal follow-up by a single surgeon, allowing for early diagnosis and repair. This case also includes radiographic imaging over 5 years during the index hospitalization and preoperative workup. This allows for a glimpse into the natural pathogenesis of this disease. After robotic surgery, the patient made a complete recovery with no postoperative complications.

Giant lipoma causing a colo-colonic intussusception.

Intussusception is much more common in children than in adults. Unlike in children, intussusception in adults is associated with an identifiable etiology in 90 per cent of cases. Lipomas are the second most common benign tumors of the colon. Small lipomas are usually asymptomatic and are found incidentally during colonoscopy. Giant lipomas are uncommon causes for colonic intussusception. This usually presents as abdominal pain and vomiting and less commonly as diarrhea. Computed tomography is an excellent method to diagnose giant colonic lipomas, by showing a well demarcated, round, low-attenuated lesion in the lumen of the colon. The definitive treatment for symptomatic lipomas is surgical resection. Both laparoscopic and open resections have been described. Endoscopic resection of colonic lipomas is associated with a high complication rate. In this report, we present a patient with a giant colonic lipoma causing colocolonic intussusception.

Migrating mesh mimicking colonic malignancy.

The use of prosthetic mesh is the current acceptable standard for the repair of hernias. Recurrence rate has been greatly reduced since Lichtensen in 1986 first described mesh repair of inguinal hernias. The most common complication arising from inguinal hernia repair even with mesh is recurrence. There are isolated reports of migrated mesh in the three decades of mesh use in hernia repair. We present a case report of a migrated mesh plug presenting with features highly suggestive of an intra-abdominal neoplasm in a 63-year-old man who presented with weight loss, anorexia, fatigue, and a palpable right lower quadrant mass. Work up had revealed a large inflammatory mass involving the cecum and not amenable to percutaneous or colonoscopic biopsy, thus requiring diagnostic laparoscopy. He had a right inguinal hernia repair with mesh 8 years earlier. At diagnostic laparoscopy, an extensive right lower quadrant mass involving the cecum, bladder, and transverse colon and extending to the midline was found, necessitating conversion to open laparotomy and a right hemicolectomy. A mesh plug was found intimately involved with the specimen. Plugs used in inguinal hernia repair rarely migrate. It is rarer still for them to present as a possible colonic mass. This is the first known case report of mesh plug migration presenting as a suspected colonic malignancy.