Ball-Valve Syndrome Secondary to Large Fundic Adenoma.

Gastroduodenal intussusception is a rare presentation in adults. A mass lesion in the stomach typically acts as a lead point that invaginates into the pylorus and duodenum causing intussusception. In a subset of these cases, episodic symptoms of obstruction occur because of intermittent prolapse of the lesion, termed "ball-valve syndrome." We present a 73-year-old woman with intermittent abdominal pain and nausea who was discovered to have gastroduodenal intussusception secondary to a large prolapsing fundic adenoma through the pylorus and into the duodenum. The case highlights this rare complication from gastric lesions along with the importance of surgical intervention for definitive management.

Sarcopenia in Elderly Surgery.

Sarcopenia is a condition in which patients have an abnormally low muscle mass with poor muscle function. It is prevalent in older patients and is often associated with frailty. It has gained increasing recognition as a significant indicator of poor surgical outcomes. In this review, we examine the concept of sarcopenia and its impact on surgical outcomes and current research on its management. We also discuss the diagnosis of sarcopenia in terms of muscle mass and muscle function and common definitions of both terms. An overview of the impact of sarcopenia on different surgical specialties is reviewed. Lastly, a survey of current treatments available for sarcopenia and their limited impact are discussed with a view to encouraging possible future studies.

The role of lateral lymph node dissection in the management of lower rectal cancer.

INTRODUCTION: Lateral lymph node involvement is a problem encountered in patients with low rectal cancers. This has been documented in both anatomical and pathological studies. Currently, the vast majority of centers have concentrated on the use of chemoradiation to obtain better local control and manage these nodes indirectly. In Japan, extended nodal dissection for the control of pelvic nodal disease has seen further advancement. This paper discusses the key issues involved in the management of pelvic lateral nodes in low rectal cancers. METHODS: A review of available literature and critical appraisal of the entity of lateral nodes in low rectal cancers, the treatment options, and oncological and functional results were performed. RESULTS: There are good data showing that the entity of pelvic lateral nodes in low rectal cancers should not be ignored. Recent data have emerged showing that radiotherapy is associated with significant long-term functional side effects. Refinement of the technique, lateral node dissection, has led to good local control as well as good functional outcomes. CONCLUSION: In this context, there needs to be a reevaluation of the role of chemoradiation as the sole treatment for lateral nodal disease in centers outside of Japan. Individualization of the treatment of rectal cancer may require all centers to be able to offer both modalities.