Laparoscopic hemicolectomy for cutaneous malignant melanoma metastasis to the ileocaecal valve.

Colonic tumours are most frequently primary and lesions secondary to metastasis are uncommon. Malignant melanoma is an aggressive cancer, with a tendency to metastasize and recur. This report describes the case of a 66-year-old man who underwent wide local excision and adjuvant therapy for malignant melanoma three years prior to presentation with loose stools, abdominal cramps and iron deficiency anaemia. CT colonography showed a 6cm ileocaecal mass, and following a laparoscopic right hemicolectomy, histological examination revealed a metastatic melanoma to the ileocaecal valve. Subsequent positron emission tomography showed no residual metastatic disease. Malignant melanoma metastasis to the colon is a rare clinical entity. Metastectomy via laparoscopic right hemicolectomy is an appropriate and effective treatment.

Single port laparoscopic right hemicolectomy for ileocolic intussusception.

A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

[Laparoscopic coincidental finding in a case of incomplete ileus: adenocarcinoma of the small intestine as first manifestation of Crohn's disease]. / Laparoskopischer Zufallsbefund bei inkomplettem Ileus: Adenokarzinom des Dünndarms als Erstmanifestation eines Morbus Crohn.

The case-study reminds of adenocarcinoma of the small intestine as a rare complication of Crohn's disease. A few more than 100 of these cases have been published. Epidemiological studies concerning small bowel carcinoma showed consumption of sugar and carbohydrates as pathogenetic factors, other conditions like ileostoma, ileumconduit, Crohn's disease and coeliac disease have been identified to some extent. An adenoma-carcinoma sequence as in large intestine carcinoma has been discussed. Immunohistochemical and oncogenetic findings failed to demonstrate any result of practical clinical value. Diagnosis of early stages of adenocarcinoma of the small intestine is very difficult and thus might be impossible to differentiate from exacerbation or progressive stenosis of preexisting Crohn's disease. If non-invasive diagnostic measures (ultrasound, small bowel enema, CT-scan, intestinoscopy, radiography, NMR-Sellink, capsule-endoscopy) fail to clear the situation a diagnostic laparoscopy or even laparotomy should not be delayed. This constitutes the only chance to discover early stages which can possibly be cured in accordance with oncosurgical principles. Otherwise the prognosis remains poor with a high percentage of late stages and a 5-year-survival-rate between 20 and 50 percent.

Lipomatosis of the ileocecal valve treated with right hemicolectomy as the consequence of an incomplete diagnostic procedure.

Lipomatosis is an excessive local or general accumulation of fat in the body. It is usually asymptomatic, but depending on localization and size it can cause the patient to experience various difficulties. It can occur within digestive system as a benign mass. We report a case of a 50 year old female presented with mild intestinal symptoms and anemia. She had a lipomatous change of ileocecal valve and due to positive fecal occult blood test, barium enema and incompletely performed colonoscopy was misdiagnosed as a malignant tumor and was treated accordingly.

Ileocecal valve: spectrum of normal findings at double-contrast barium enema examination.

PURPOSE: To characterize the spectrum of normal findings of the ileocecal valve at double-contrast barium enema examination to allow differentiation between a normal valve and one infiltrated by tumor. MATERIALS AND METHODS: A search of radiology and endoscopy files showed 106 patients who underwent double-contrast barium enema examination and colonoscopy. The radiographic images were reviewed by two authors to determine the morphology of the ileocecal valve and to evaluate whether it appeared normal or abnormal. The radiographic data were then correlated with endoscopic and pathologic findings. RESULTS: The ileocecal valve was visible in 91 (86%) of 106 patients. It was round or ovoid in 71 patients (78%) and triangular in 20 (22%). In the 88 patients with a normal valve at colonoscopy, mean valve height was 1.7 cm, and mean width was 2.8 cm. The valve was smooth in 75 patients (85%) and smoothly lobulated in 13 (15%). The lips of the valve were symmetric in 77 patients (88%) and asymmetric in 11 (12%). All 87 patients with a normal valve at double-contrast barium enema examination had a normal valve at colonoscopy, whereas the two patients with a valve suspicious for tumor at barium enema examination had neoplasms (one carcinoma and one villous adenoma) at colonoscopy. CONCLUSION: The ileocecal valve may show a spectrum of normal findings at double-contrast barium enema examination and may appear as a round, ovoid, or triangular structure with a maximal height of nearly 4 cm. The valve may be large, asymmetric, or smoothly lobulated, even in the absence of tumor.

Oxyuriasis-induced intestinal obstruction in a child--case report.

PURPOSE: The presentation of an unusual case of the tumor of ileum wall induced by pinworm infection in a 5-years-old child. MATERIAL AND METHODS: The record of a 4-years-old boy treated in the department of pediatric surgery was analyzed concerning the diagnostic difficulties. After 6 month from an episode of ileo-cecal intusussception successfully treated with a barium colon enema, the diagnosis of lymphoma was made and the resection of distant segment of small intestine was performed. RESULTS: No clinical and laboratory features of oxyuriasis could be stated before the onset of disease, during hospitalization and in the follow-up period. The hypertrophied and activated lymphatic tissue with a non-specific inflammatory reaction to the pinworms were seen in the wall of ileum, appendix and mesenteric lymph nodes. No neoplastic cells were found in the microscopic study of ileum, appendix, mesenteric lymph nodes and peritoneal lavage fluid. CONCLUSIONS: The proper diagnosis of oxyuriasis may be difficult when the course is atypical. The enterobius vermicularis infestation as an etiologic factor should be taken into account in any case of abdominal pathology. However, the methods routinely used in "acute abdomen" including examinations of blood, urine and stool, repeated ultrasound and CT, are not reliable. As the infestation may mimic neoplasm, the surgical treatment and microscopic examination can be necessary for the final diagnosis in some cases.

Adult intussusception due to a malignant polyp: a case report.

Intussusception is primarily a disease of childhood; only about 5 to 10 per cent of cases occur in adults. In contrast to childhood intussusception 90 per cent of adults have an associated pathologic process, usually a malignant lesion. Adult cases do not have the classical symptoms and diagnosis may be difficult. CT scan and barium studies are the most useful diagnostic methods. We report a very rare case of adult ileocecocolic intussusception caused by a pedunculated malignant polyp of the cecum and review the clinical features of intussusception.

Gastrointestinal smooth muscle tumors and iron deficiency anemia in children.

Smooth muscle tumors are rarely seen in the pediatric population. We present a child with smooth muscle tumor of low malignant potential in the ileocecal valve region in whom iron deficiency anemia was the only presenting sign. Abdominal computed tomographic (CT) scan, barium enema, and colonoscopy revealed the mass. Following resection of the tumor the anemia was corrected and the child feels well.

[Optimizing pelvic MR diagnosis with a new gastrointestinal contrast medium]. / Optimierung pelviner MR-Diagnostik durch eine neues gastrointestinales Kontrastmittel.

AIM: Optimization of pelvic MRI by a new concept of water-equivalent bowel contrast agent. METHODS: We performed contrast enhancement of the bowel by oral application of 1000 ml of an aqueous mannitol solution one hour before pelvic MRI. In addition we performed an enema by 250 ml of water in one patient. RESULTS: Oral and rectal contrast enhancement of the bowel was tolerated without complications by our patients. Pelvic MRI was improved by a better delineation of the bowel. CONCLUSION: The concept of water-equivalent bowel enhancement is promising. It must be assessed by further studies; in particular, it must be compared with the available concepts of positive and negative bowel contrast enhancement.

[Digestive hemorrhage caused by jejunoileal tumors]. / Hemorragia digestiva por tumoraciones yeyunoileales.

Between January-73 and February-92 twelve patients with digestive hemorrhage due to primary jejunoileal tumors were treated. Eight cases had rectal bleeding and four chronic gastrointestinal hemorrhage as first clinical manifestation. Patients underwent upper endoscopy, colonoscopy and barium enema. Three out of nine barium meals (33%), two out of four ultrasonographies (50%) and eight out of nine arteriographies (89%) were abnormal. The barium meals showed submucosal lesions on two occasions and a jejunal luminal mass. The ultrasonography detected two intrabdominal masses. All arteriographies, except one with extravased intestinal contrast and other which showed a hypovascular zone, depicted homogeneous hypervascular images. All patients were operated on. Seven segmental enterectomies, four limited resections and a polipectomy were performed. Seven tumours were found in the jejunum, three in the jejunoleum and two in the ileum. There were four leiomyosarcomas, three leiomyomas, two polyps, one leiomyoblastoma, one adenocarcinoma and one lymphoma. Rebleeding and mortality were absent.

Abscessed leiomyosarcoma of the ileum.

A-49-year-old man was admitted because of a lower abdominal mass. During the five days prior to admission, he had noted fever and lower abdominal pain. Palpation of the abdomen revealed a tender mass, 10 cm in diameter, in the suprapubic region. An x-ray revealed an irregular collection of gas, 9 cm in diameter, in the pelvic cavity, which appeared as a mirror image when the patient was upright. Based on the physical finding and the results of a barium enema, abdominal CT, MRI, and small intestine imaging, a diagnosis of leiomyosarcoma of the ileum was made. Excision of the tumor and part of the small intestine was performed. A saccular tumor, 11 x 6 x 5 cm, was found 1.0 m from the cecum and growing out of the wall of the ileum. A large amount of pus was found inside the cavity. The pathological diagnosis was leiomyosarcoma.

[Primary lymphoma of the small intestine: clinico-radiological correlations]. / Linfomi primitivi dell'intestino tenue: integrazione clinico-radiologica.

From 1987 to 1989, 7 patients were diagnosed as having a primary lymphoma of the small bowel. The patients, 5 men and 2 women aged 14-66 years (average: 45), were studied by means of small bowel enema and CT. Using small bowel enema, our findings were: masses related to a loop, stenosis, mucosal patterns with thick, irregular, and nodular folds, and bowel walls thickening. In nearly all cases CT showed not only small bowel lesions but also mesenteric lymphadenopathy. Five of seven patients had lymphomas, 1 had IP-SID lymphoma (immunoproliferative small intestinal disease related lymphoma), and 1 had IPSID associated with a late prelymphomatous stage. The diagnosis of IPSID is very important in patients with malabsorption syndrome, which may or may not be related to alpha heavy chain disease, because IPSID may evolve into lymphoma but its prelymphomatous stage can be treated and cured. We have therefore reported the different features seen with enteroclysis and CT, comparing the results obtained in the various forms of lymphoma of the small bowel. The importance is stressed of an accurate diagnosis of IPSID forms, however uncommon in our Country.

[Lipoma of the small intestine. A clinical case]. / Lipoma del tenue. Caso clinico.

The paper reports a case of a 45-year-old female with long-standing anemia, recurrent abdominal pain and subocclusive crises. Following a negative endoscopy of the upper tract of the large intestine, barium enema and angiography, the patient underwent total colonoscopy. Massive bleeding from the ileal valve suggested an ileal pathology: a small intestine enema confirmed a polypoid proliferation 60 cm above the Bahuino valve with related ileal invagination 25 cm long. The patient underwent surgery and pathological findings revealed a 7 cm-wide ileal lipoma near a small angiodysplasia. The latter seemed to be the cause of bleeding. The diagnosis of small intestine tumours is made difficult by the fact that the only important signs are abdominal pain, intestinal bleeding and subocclusive crises, which are common symptoms in many pathologies. The authors stress the importance of a thorough endoscopic examination and selective angiography.

Radiological findings in small-bowel tumours.

Radiological findings were evaluated in a series of 25 cases with malignant and three with benign small bowel tumours with surgical or autopsy confirmation of diagnosis. 27 patients were operated, two of them without any radiography due to 'acute abdomen'. 23 patients were examined with ultrasound, 14 with barium examination, seven with CT, four with plain films and two with angiography. Ultrasound revealed 16 (70%) out of 23 tumours, in two cases result was abnormal but the tumour was not found and in five cases no abnormality was identified. Eleven barium examinations (78%) showed signs of tumour, one showed signs of occlusion but not the tumour and in two cases no abnormality was found. The tumour was seen in six of seven cases examined with CT. Our results proved that US is useful as screening study. Barium studies are needed for exact location of the tumour and in US negative cases.

Intussusception of invaginated Meckel's diverticulum.

Two middle-aged patients are reported who came to laparotomy with a presumptive diagnosis of small bowel tumour. There was no overt evidence of small bowel obstruction in either case. They were found at laparotomy to have intussusception of an invaginated Meckel's diverticulum. This condition should be considered in the differential diagnosis of ileal tumours.

Inflammatory polyposis in an ileal blind loop.

A case of inflammatory polyposis of the ileum after ileosigmoid anastomosis is reported. Two features are noteworthy. First, the polyps were localized in a blind ileal loop. Second, while rare ileal inflammatory polyps related to enteroenteric anastomosis have been reported, to our knowledge this is the first instance of approximately 50 polyps to be described at such a site. The etiology of these lesions is unknown but may be related to fecal irritation, stasis, bacterial overgrowth, or bacterial toxin. These polyps may ulcerate and bleed, causing iron deficiency anemia, and they must be distinguished from neoplastic polyps. Since side-to-side and end-to-side anastomoses have become more common with use of the surgical stapler, inflammatory polyps may be encountered more frequently.

Small bowel tumors: a continuing challenge.

Small bowel tumors are difficult to diagnose and are frequently not identified at initial evaluation. We retrospectively reviewed 25 consecutive cases to assess the efficacy of procedures currently used in diagnosis. Barium contrast studies were diagnostic in 14 (56%) of the cases. Enteroclysis provided one diagnosis after the initial barium study was negative. Of the 11 patients for whom barium studies were negative, angiography provided the diagnosis in six (three benign, three malignant). Endoscopy was never helpful. Laparotomy was required in five cases (three benign, two malignant) after repeated negative work-ups. An evaluation protocol which calls for each method as needed seems to provide the most reliable means of diagnosing small bowel tumors.