Laparoscopic adjustable gastric banding connecting tube causing small bowel obstruction and perforation.

Background. Laparoscopic adjustable gastric banding (LAGB) is an effective method of reducing excess weight in obese patients. We report a patient who developed a bowel obstruction caused by the connecting tube between the gastric band and the injection port. Case Presentation. The patient was a 42-year-old Caucasian female who had undergone LAGB 19 months earlier. She presented with dehydration, low-grade fever, tachycardia, and mild abdominal tenderness. Laparotomy revealed that the connecting tube was looped around the mesentery, and a loop of small bowel was incarcerated between the tube and the mesentery. The incarcerated small bowel loop was perforated in two places. Conclusion. Surgeons should be aware of the possibility of obstruction caused by the connecting tube in patients who have undergone LAGB.

Anal sphincter injuries during hemorrhoidectomy: a multi center study.

Hemorrhoidectomy is the treatment of choice for patients with third or fourth-degree hemorrhoids. Although the majority of surgeons believe that surgical hemorrhoidectomy is the most effective approach with excellent results in the management of hemorrhoid disease, but hemorrhoidectomy is not a simple procedure. One of the complications of this surgery is an injury to anal sphincters that can lead to incontinency in some patients. In this study, we aimed to reveal the percentage of external and internal anal sphincter injuries in surgical hemorrhoidectomy. We prospectively enrolled 128 patients from April 2006 to February 2007. They underwent hemorrhoidectomy in three general hospitals in Tehran. All patients were in grade III or IV and underwent open hemorrhoidectomy (Milligan-Morgan). After surgery, all resected material was histopathologically examined by two expert pathologists and the results confirmed by other one if there is any discrepancy. From all specimens which sent to the pathology department 15.8% (21 Pts.) had muscle fibers that Smooth muscle fibers were seen in 80.5% (17 Pts.) of them and striated muscle fibers were found in 19.5% (4 Pts.). Although hemorrhoidectomy is a safe and effective method for treatment of hemorrhoid, but the inadvertent removal of smooth and striated muscle during open hemorrhoidectomy had raised concerns about its effects on postoperative anorectal function.

A cross-sectional survey of quality of life in colostomates: a report from Iran.

BACKGROUND: Considering the complications that colostomies may cause, patient self-assessments of their social, emotional, physical, sexual and functional conditions may help their surgeons to evaluate the impact of their interventions or use supplementary methods to maintain patient functional status or decrease its loss to the minimum level. The aim of this study was to evaluate the Quality of Life in Iranian patients with colostomies and to compare the age and gender differences among them. METHOD: This cross-sectional study was conducted from 2009 to 2010 to evaluate the quality of life of 96 patients who had undergone surgery for rectal cancer and had permanent colostomies. The European Organization for Research and Treatment of Cancers Quality of Life Questionnaire (EORTC QLQ)-C30 and the EORTC QLQ-CR38 were used to assess patient Quality of Life. RESULTS: The mean scores for the functional subscales were as follows: Physical Function, 70.9 (±2.2); Role Function, 68.4 (±2.6); Emotional Function, 56.9 (±2.7); Cognitive Function, 68.7 (± 2.6); and Social Function, 64.2 (±3.3). The EORTC questionnaires showed significant differences between males and females. Males had better body image scores. Sexual Function and Sexual Enjoyment were impaired in both males and females, but males had significantly higher scores and better roles in Physical and Sexual Functions. More sexual enjoyment problems in older ages were observed in both males and females. CONCLUSION: Having a colostomy was associated with a high level of emotional and sexual function impairment. The differing challenges between males and females should encourage us to design sex-specific interventions that improve the quality of life in this group of patients.

A submucosal fecal mass as the complication of stapled hemorrhoidopexy: A case report.

Despite the early encouraging results and safety profile of hemorrhoidopexy, several serious complications have been reported including rectal perforation, retroperitoneal sepsis, pelvic sepsis and rectovaginal fistulas. The recent article is the report of the case of a 30 year old woman, with a submucosal mass which was palpable in the anterior rectum. She had undergone a stapled hemorrhoidopexy due to a 2nd degree internal prolapsed hemorrhoid three years previously. Operation was planned to identify the nature of the mass and a cylindrical impacted 4 cm × 2 cm fecal mass was excised. The recent finding seems to be the first one being reported in this issue.

Malignant fibrous histiocytoma of rectum: Report of a case.

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of adults, mostly distributed in the thigh, buttock and groin (46%) and presents rarely in the gastrointestinal tract, classified as gastrointestinal stromal tumors (GIST). MFH is regarded as a diagnosis of exclusion, essentially synonymous with an undifferentiated pleomorphic sarcoma. The recent report presents an 80-year-old man with clinical manifestations of rectal bleeding and final diagnosis of MFH of rectum. It seems that radical resection and adjuvant radiation is important in the management strategy of a patient with such a rare rectal tumor.

Age of puberty in Iranian girls living in Tehran.

The aim of this study was to determine the age of appearance of secondary sexual characteristics in Iranian girls living in Tehran. A cross-sectional study was conducted between 2003 and 2004 on 1420 6-17-year-old females in different parts of Tehran. Data were collected on the basis of a multistage probability sampling. Secondary sexual characteristics were evaluated by inspection and palpation, and were recorded according to Tanner staging. The subjects were asked about the occurrence of menarche and the age of its onset. Generalized additive logistic modelling was used for the analysis of data. The median age (percentile 10-percentile 90) of Tanner 2 of breast development (B2) and Tanner 2 of pubic hair growth (P2) among 1136 girls was 9.74 years (8.23-11.94) and 10.49 years (8.86-12.17), respectively. The ages of the 2.5 percentile for B2 and P2 were 7.42 and 7.03 years, respectively, so the onset of puberty at < 7 years and 5 months is considered precocious in this population. The median age of menarche in 399 girls was 12.68 years (11.27-15.96).