Ileotransverse Anastomosis Research Articles

Rare Abdominal Desmoid Tumor: Case Report and Review of Literature

A desmoid tumor is a clonal fibroblast proliferation, occurring in deep soft tissues with a significant recurrence tendency. Aggressive fibromatosis is a rare disease. The prevalence in the population ranges from 2 to 4 cases per million. Mentioned neoplasms are highly unpredictable in terms of development. Typically, in the course of desmoid tumors, metastases do not occur, but they often infiltrate the surrounding tissues, which may be associated with numerous complications. There are currently no randomized standards of therapy designated, which is undoubtedly a challenge when referring to treatment. To a 37 year old patient, due to a pathological mass in the abdomen, the MR examination was performed. It showed the presence of an irregular, heterogeneous structure on the right side of the abdominal cavity. A laparotomy was performed. During the procedure adhesions were released and the giant abdominal tumor was removed in one block with part of the duodenum, caecum, ascending colon and part of ileum. End-to-end duodenal anastomosis and stapled, side-to-side ileo-transverse anastomosis were used. The surgical field was being drained. The postoperative course was uneventful. Tissue material was collected for a routine, histopathological examination in which the intra-abdominal form of fibromatosis was diagnosed. The macroscopic image describes a tumor with dimensions of 25.0 cm x 25.0 cm x 20.0 cm.

Intracorporeal ileotransverse anastomosis in laparoscopic right colectomy. Results of randomized clinical trial

AIM: to assess the postoperative complications rate in the groups with intra- and extracorporeal ileotransverse anastomosis in laparoscopic right colectomy.PATIENTS AND METHODS: a single-center, randomized, non-inferiority trial was conducted with intention-to-treat data analysis. There were two groups of patients in whom performed laparoscopic right colectomy using a standardized technique. In the main group (n = 39) intracorporeal ileotransverse anastomosis (IA) was formed, in the comparison group — extracorporeal anastomosis (EA) (n = 40).RESULTS: the operation time in the IA group was 192.4 ± 62.3, and in the EA group — 144.1 ± 41.3 minutes (p = 0.0002). The time of anastomosis formation was also significantly different: 53 (35; 71) minutes in intracorporeal and 30 (26; 35) minutes inn extracorporeal methods (p < 0.0001). The morbidity rate was not significantly different (25.6% vs 27.5%; p = 0.95). In the main group it was 25.6%, and in the control group 27.5% (p = 0.95). Postoperative hospital stay in the main group was significantly less — 5 vs 7.3 days in the comparison group (p < 0.001).CONCLUSION: the randomized trial demonstrated that IA is safe and comparable to EA in terms of the morbidity rate, despite its longer operation time. At the same time, in the IA group, patients achieved discharge criteria earlier, which reduced postoperative hospital stay.

Intestinal Obstruction Due to Ileotransverse Anastomosis Stenosis Secondary to Crohn's Disease: A Case Report

Introduction: Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. This report explores a case of intestinal obstruction resulting from stenosis of ileotransverse anastomosis, secondary to Crohn's disease. Epidemiology: The macroscopic features of Crohn's disease vary, including patchy inflammation, ulcers, and stenosis. Stenosis is a common occurrence, particularly in the terminal ileum, affecting 30-40% of individuals with Crohn's disease. OBJECTIVE: To describe a clinical case of intestinal obstruction due to ileotransverse anastomosis stenosis secondary to Crohn's disease, aiming to recognize its behavior and determine surgical management in patients with a high suspicion of this condition. Patient and Method: A 35-year-old female diagnosed with ankylosing spondylitis, recent Crohn's disease, and intestinal obstruction. Surgical history includes exploratory laparotomy, right hemicolectomy, and ileotransverse anastomosis due to acute appendicitis. Current symptoms led to surgical exploration, revealing extensive adhesions and stenosis at the anastomosis. Results: The patient underwent resection of the affected intestinal segment and the creation of a terminal ileostomy, successfully resolving the obstruction. Comprehensive preoperative evaluation, diagnostic confirmation through imaging, and appropriate surgical intervention played critical roles in achieving a positive outcome. Discussion: The discussion emphasizes the complexities associated with Crohn's disease surgery, highlighting common complications such as infection, fistulas, and anastomotic stenosis. The case underscores the need for a cautious surgical approach and the importance of early consideration of Crohn's disease in patients with intestinal obstruction. Conclusions: This case report underscores the significance of recognizing Crohn's disease in patients presenting with intestinal obstruction. Appropriate surgical management, though challenging due to the heightened risk of complications, is essential for improving treatment outcomes. A comprehensive approach, from timely diagnosis to surgical intervention, is crucial for effectively addressing Crohn's disease manifestations and enhancing patient quality of life.

An Unusual Case of a Strangulated Right Inguinal Hernia Containing the Caecum Managed with Desarda’s Repair

Groin hernias are most common hernias in abdominal wall hernias (75%). 95% of groin hernias, are from inguinal canal and remaining area femoral hernias. Two-thirds of the inguinal hernias are indirect and remaining are direct inguinal hernia. An indirect inguinal hernia is the most common, regardless of gender and in men, indirect hernias predominate over direct hernias at a ratio of 2:1. Direct hernias are uncommon. Strangulated external hernia is a relatively common serious surgical emergency. In these approximately 50% of cases involves small bowel obstruction and accounts for most of the deaths from this condition. Presenting a case of 64-year gentleman diagnosed with strangulated right inguinal hernia, managed with urgent surgery and underwent right hemicolectomy with Desarda’s repair in view of gangrenous caecum. This case report underscores the clinical presentation and prompt surgical management of an unusual case of a strangulated right inguinal hernia containing the cecum, entailing both hernia repair and right hemicolectomy. The Desarda’s technique was chosen as the hernia repair method which focuses on autologous tissue repair. Keywords: Strangulated hernia, Desarda’s repair, right hemicolectomy, ileo-transverse anastomosis, small bowel obstruction.

Intestinal Intussusception Secondary to Appendiceal Mucocele, Report of a Case in A 53-Year-Old Female

Appendiceal intussusception is defined as the invagination of a portion of the appendix into its own lumen or into that of the cecum. In adults, the most common etiology is endometriosis (33%), followed by appendiceal mucocele (19%) and appendiceal inflammation (19%) [4]. Symptoms may be absent or mild. Lower abdominal pain or mass may be confused with appendicitis or tuboovarian mass in women. The diagnosis of appendiceal mucocele is often difficult preoperatively, even with the use of imaging. The definitive diagnosis is by histopathology. Treatment is surgical resection with care. Do not spill the contents, to prevent peritoneal pseudomyxoma with a poor prognosis [2]. In the present work, a 53-year-old female is reported with a 72-hour evolution of abdominal pain in the mesogastrium, accompanied by nausea and vomiting, normal vital signs on physical examination, without acute abdominal symptoms, with laboratories within normal parameters. , a computed tomography of the abdomen is taken which reports extensive intussusception at the ileocecal level which extends to the transverse colon, adjacent neoplastic etiology must be ruled out. An exploratory laparotomy was performed, finding intussusception of the ileum in the transverse colon with a 5 x 5 cm blind sentence, for which it was decided to perform a right hemicolectomy + mechanical lateral ileotransverse anastomosis. Patient with favorable evolution, hospitalized for 6 days.

Metastatic Clear-Cell Renal Carcinoma: An Exceptional Cause of Ileocolonic Intussusception in Adults

Abstract Introduction Intussusceptions in adults are rare, representing 1% to 5% of intestinal obstructions in this age group. This condition can be caused by benign and malignant lesions acting as lead points, the latter being the most frequent. Furthermore, the diagnosis is challenging due to the non-specific symptoms with variable duration. Case Presentation A 43-year-old man, with a history of localized clear-cell renal carcinoma (ccRCC) treated 9 years earlier with a right radical nephrectomy, presented with bowel obstruction symptoms. An abdominal computed tomography scan showed an ileocolonic intussusception. Hence, the patient required a right hemicolectomy with ileotransverse anastomosis. The histopathological analysis showed a metastatic ccRC to the terminal ileum causing the intussusception. Discussion Adult intussusceptions are rare. However, they should be considered in the differential diagnosis of patients with abdominal pain and symptoms of bowel obstruction. Metastases of renal cancer to the small bowel are uncommon and even more so in the form of intussusception. Definitive treatment must be tailored to the patient's condition and underlying cause.

Laparoscopic right hemicolectomy with intracorporeal ileo-transverse anastomosis (review)

Colon cancer is one of the most common malignant tumors worldwide. The main treatment for localized colon cancer is surgery. Nowadays laparoscopic colectomies for colon cancer have advantages over open ones, as they provide better short-term results. There has been a continuous improvement in the technique of the operation, and due to the widespread use of laparoscopic stapling and cutting devices, intracorporeal anastomosis is becoming more and more accessible. This article discusses the advantages and disadvantages of various methods for the formation of ileo-transverse anastomosis in laparoscopic right hemicolectomy.

Ascending colon malignancy presenting as large bowel obstruction: a rare case report

Colorectal cancer is the third most common cancer in both men and women and the fourth most common cause of cancer related deaths. It can be classified as sporadic (70%), inherited (5%) and familial (25%), various genetic pathways are involved. Carcinomas of right colon are known to be relatively silent lesion producing non-specific symptoms like fatigue, weakness, and vague lower abdominal pain. Whereas, left colon carcinomas are frequently more dramatic presenting as altered bowel habits, bloody mucoid stools, and obstruction. Most importantly almost 50% of left sided cancers present as a palpable growth of lower rectum. Emergency right hemicolectomy is the treatment of choice for an obstructing right colon malignancy, options varies from open/lap right hemicolectomy with a primary ileo-transverse anastomosis in a stable patient with or without diverting ileostomy or placement of endoluminal self-expanding metallic stent (SEMS). Here we present a case 47 year old female who presented with abdominal pain and vomiting for 2 days and was diagnosed with mid ascending colon growth with distended caecum and proceeded with emergency laporotomy. Intraoperatively circumferential constrictive growth seen in ascending colon with impending perforation in caecum and was subjected to a right hemicolectomy with end-to-end ileo-transverse anastomosis with an uneventful post-operative period.

Does the type of anastomosis affect the risk of recurrence in Crohn disease?

AIM: to evaluate the effect of intestinal anastomosis type on risk of Crohn’s disease (CD) recurrence.PATIENTS AND METHODS: the retrospective cohort study included 130 patients with CD who underwent surgery for a complicated CD in 2012–2017. Ileocecal resection with anastomosis was performed in 112/130 (86.2%) patients. Resection of the terminal ileum with resection of the right side of the colon with the formation of an ileo-transverse anastomosis. In 18/130 (13.2%) cases. Stapled “side-to-side” anastomosis was formed in 57/130 (43.8%) patients, while hand sewn “end-to-end” — in 73/130 (56.2%) patients. Post-op complications occurred in 21/130 (16.2%) cases. After surgery, most patients were treated by azathioprine as an anti-recurrence therapy — 112/130 (86.2%) patients, while in 31/112 (23.8%) cases, additional biological therapy was done. In 14/130 (10.7%) patients, anti-recurrence therapy was carried out in mono mode with a biological drug.RESULTS: mean follow-up was 28.5 (1.9–95.4) months. Recurrence occurred in 54/130 (41.5%) patients on average 18 ± 5 (12–41) months after surgery. Thus, the operative time exceeding 200 minutes was significantly associated with an increase in the recurrence rate (p = 0.03). It was found that the type of anastomosis does not affect the recurrence risk. Moreover, among the significant factors was the operative time. It increases the chance of recurrence by 2.9 times in the univariate model (p < 0.05), and in the multivariate model — by 6.3 times, when exceeding 155 minutes.CONCLUSION: the type of anastomosis does not affect the recurrence risk. The operation time exceeding 155 minutes increases the chance of recurrence by 6 times (p < 0.01).

Successful treatment of advanced purulent peritonitis. Clinical case

The advanced purulent peritonitis is one of the urgent problems in urgent surgery . The improvement of surgical research methods is one of important problem of nowadays surgery . The article presents a clinical case of effective treatment of peritonitis , abdominal sepsis in the context of ileotransverse anastomosis failure . Female patient with generalized fibrinous purulent peritonitis underwent surgical interventions using VAC system , damage control tactics .

Importance of intraoperative indocyanine green imaging in the management of non-occlusive mesenteric ischemia: a case report

BackgroundNon-obstructive intestinal ischemia (NOMI) is caused by intestinal vascular spasm and has a poor prognosis if not diagnosed and treated early. Indocyanine green (ICG) fluorescence imaging has been reported to be useful for the intraoperative assessment of the extent of intestinal resection required for NOMI. Few reports have described massive intestinal bleeding after conservative management of NOMI. We report a case of NOMI with massive postoperative bleeding from the site of an ICG contrast defect found before the initial surgery.Case presentationA 47-year-old woman with hemodialysis-dependent chronic kidney disease presented complaining of severe abdominal pain. A computed tomography scan showed portal gas and dilation of the small intestine, leading to a diagnosis of NOMI and subsequent emergency surgery. At the time of initial surgery, the contrast effect of ICG was slightly reduced, showing a granular distribution in the ascending colon to cecum (fine grain pattern) and significantly reduced in parts of the terminal ileum except around blood vessels (perivascular pattern). However, there was no obvious gross necrosis of the serosal surface, and the intestinal tract was not resected. The acute postoperative course was uneventful; however, the patient went into shock on the 24th postoperative day due to massive, small intestinal bleeding, and emergency surgery was performed. The bleeding originated from the section of the ileum that had complete loss of ICG contrast effect before the initial surgery. A right hemicolectomy with the terminal ileum resection was performed, and an ileo-transverse anastomosis was performed. The second post-operative course was uneventful.ConclusionsWe report a case of delayed hemorrhage of the ileum shown to have poor blood flow on ICG imaging at the initial surgery. Intraoperative ICG fluorescence imaging is useful in assessing the degree of intestinal ischemia for NOMI. When patients with NOMI are followed up without surgery, complications such as bleeding should be noted.

Value of ileo-ascending colic end to side anastomosis after ileocaecal resection.

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material & Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.

“COMPARATIVE STUDY OF CONSERVATIVE VERSUS OPERATIVE MANAGEMENT IN CASES OF ABDOMINAL KOCH'S”

Background: Abdominal tuberculosis is sixth most common type of extra- pulmonary tuberculosis. It can affect any intra-abdominal organ and any part of the intestinal tract. Patients are managed conservatively and Surgery in patients with Abdominal Tuberculosis is reserved for those with acute surgical complications including intestinal obstruction, perforation, abscess, colocutaneous stula, excessive bleeding and patients who are not responding to medical management. Our study was conducted on 65 Patients of abdom Methods: inal tuberculosis admitted in department of general surgery RD Gardi Medical College, Ujjain between December 2019 to July 2021. Out of 65 patients, 66.2% were managed Results: surgically and 33.8% managed conservatively. Exploratory laparotomy With Segmental Bowel Resection due to multiple ileal strictures with ileostomy with ileostomy closure after 3 months of ATT is done in 30.23% patient in our study. Exploratory laparotomy with loop ileostomy for ileocaecal mass and abdominal abscess 2ndstage surgery after 3 months of ATT right hemicolectomy with ileotransverse anstomosis done in 20.93 % patients. Exploratory laparotomy With Resection Of ileocaecal Mass with ileoascending anastomosis is done in 20.93% of patients in our study In our study, exploratory laparotomy with adhesiolysis with release of bands with loop ileostomy. 2ndstage surgery done after 3 months of ATT, reexploration with right hemicolectomy with ileotransverse anastomosis done in 11.62 % patients.Exploratory laparotomy with right hemicolectomy with ileotransverse anastomosis is done in 10.76 % patients.In our study, slight seroma discharge from wound site is the most common complication seen post operatively (35%). In our study, fecal stula is seen only in 5% of patients. In our study, there are complications developed during and after ATT in which 6 patients required surgery Abdominal tuberculos Conclusions is is an increasingly common disease that poses diagnostic challenge despite advances in diagnostic modalities, as the symptoms and signs of the disease are nonspecic, which may lead to diagnostic delays and eventually lead to development of complications. Therefore, a high index of suspicion is an important factor in early diagnosis. Patients are managed conservatively and Surgery in patients with Abdominal Tuberculosis is reserved for those with acute surgical complications.

Urgent Right Hemicolectomy

Right hemicolectomy with the formation of primary ileotransverse anastomosis is the method of choice in emergency surgery as well. Aim of the study Comparative evaluation of the results of urgent right hemicolectomy with the formation of a primary anastomosis and without the formation of a primary anastomosis at the first stage of surgical intervention. Material and methods A retrospective cohort study included patients who underwent emergency right hemicolectomy. The database includes: demographic indicators, comorbidity, data on the general condition of the patient, the time of the surgical intervention, the time from the onset of the disease to hospitalization, laboratory parameters. The patients were divided into two groups. Group 1 included patients in whom the operation was performed with the formation of a primary anastomosis, which was applied manually; group 2 consisted of patients who underwent surgery with the formation of a separate double-barrel stoma and the 2nd stage of surgical intervention was planned. The Clavien–Dindo classification was used to assess postoperative complications. Results The results of 112 right hemicolectomies performed according to emergency indications were analyzed. Group 1 (operations with the formation of a primary anastomosis) included 87 patients (77.7%); group 2 (n=25) included 18 patients (16.1%) who underwent two-stage operations: stage 1 — right hemicolectomy without primary anastomosis formation, stage 2 — restorative intervention, anastomosis formation; and 7 patients (6.2%), in whom the operation ended with the formation of a separate double-barreled intestinal stoma. In the 1st group, the patients were younger: the average age was 61 years versus 73 years in the 2nd group (p=0.021). Patients of the 2nd group were in a more serious condition upon admission (ASA III–IV) and had a higher comorbidity. The average duration of surgical intervention was 162±10.2 minutes in group 1 and 110±9.5 minutes in group 2 (p=0.038). Group 2 had more serious complications (IIIB–IVB according to Clavien–Dindo) compared to group 1 (p=0.001). The main factors that had a statistically significant impact on the risk of postoperative complications were: severe degree of comorbidity (odds ratio — OR 3.1; 95% confidence interval — CI 1.4–6.3; p=0.002), severe general condition upon admission — ASA III–IV (OR 2.7; 95% CI 1.2–7.4; p=0.01), anemia — Hb<90 g/l (OR 1.7; 95% CI 1.5– 6.1; Odd=0.004), time between the onset of the disease and admission more than 12 hours (OR 2.1; 95% CI 0.9–6.8; p=0.03), time to perform the operation (OR 2 .05, 95% CI 1.38–8.1, p=0.033). Conclusion The presence of chronic diseases characterized by systemic lesions and comorbidity determines the choice of a primary treatment strategy for perforation, bleeding, acute mesenteric ischemia, where it is advisable to perform a right hemicolectomy without primary anastomosis, followed by recovery stage.

CASE REPORT ON RARE OUTCOME OF A RETROPERITONEAL MASS: MANAGEMENT CHALLENGES AND LESSONS LEARNT

Background. Gastrointestinal stromal tumours (GIST) are non-epithelial mesenchymal solid neoplasm with varied presentation. The study reports the case of a retroperitoneal GIST in a 21‑year‑old male presented with an abdominal lump for six months. The lesion was initially thought to be a retroperitoneal sarcoma. Exploratory laparotomy revealed an abdominopelvic mass covering the entire right side of abdomen and pelvis. The tumour was adherent to the terminal ileum and ascending colon. There were dense adhesions between the retroperitoneum with involvement of the middle third of the right ureter. The tumour was resected with right hemicolectomy with ileotransverse anastomosis. Post-operative histopathology revealed it as high-grade spindle cell type GIST. The patient is presently on post-operative chemotherapy with Imatinib mesylate. Objective. Atypical presentations of GIST are seldom discussed but frequently encountered in clinical practice. This article depicts different challenges the surgeon has to face while diagnosing such atypical entity. Methods. Case report of atypical GIST presenting as retroperitoneal lump. Results. The patient underwent surgical resection and is presently on post-operative chemotherapy with good overall outcome for a one year follow up. Conclusions. GISTs presenting as retroperitoneal lumps are very rare, they should be considered in their differential diagnosis of an atypical retroperitoneal mass.

197 Non-Traumatic Spontaneous Ileal Perforation: Experience With 125 Cases

Abstract Background Non-traumatic ileal perforation is a common cause of obscure peritonitis in developing and underdeveloped world. The perforation of the ileum is one of the causes of peritonitis that is difficult to diagnose preoperatively. The objective of the study was to determine the increasing frequency of cases of non-traumatic ileal perforations and their subsequent management Method This descriptive case-series included 125 cases presenting in surgical emergency of Lahore General Hospital from 1st January 2014 to 1st December 2014. All patients were resuscitated and underwent emergency exploratory laparotomy. Results The causes for perforation were enteric fever in 82 cases (65.6%), tuberculosis in 38 cases (30.4%), adhesions and other causes in 5 cases (4%). The main presenting symptom in all patients were severe abdominal pain associated with fever and abdominal distension. Perforations were surgically treated depending upon the number of perforations, general health status of patient and degree of fecal contamination. In total out of 125 cases, primary repair was done in 9 cases, resection, and end to end anastomosis in 19 cases and in 13 patients’ resection and ileotransverse anastomosis was done. In the case of 78 patients loop ileostomy was done and in 6 patients double barrelled ileostomy was performed. Conclusions The incidence of terminal ileal perforations due to typhoid and the tuberculosis is high and carries high mortality and morbidity rates in delayed presentations. Therefore, it is high time now that general public health awareness should be created regarding food handling, sanitation, and personal hygiene.

Intussusception in Older Children: A Single Center Experience

Background: Intussusception in older children may be less common than intussusception in infants. However, it is a significant cause of bowel obstruction across all age groups. The aim of this study was to evaluate our experience with regards to older children (5 years and above) who were managed for intussusception in a single tertiary center in a developing country. Materials and Methods: This was a retrospective study of children, aged 5 year and above, who presented with intussusception (ultrasound confirmed) over a 5-year period at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The information analyzed included the patients’ age (in years), gender, time interval between onset of symptoms and presentation to the hospital, presenting symptoms, operative procedure performed, complications of treatment and outcome of treatment. Results: A total of 378 cases of childhood intussusception were seen during the study period. Out of this number, 18 (4.8%) patients were older than 5 years of age. There was male predominance. Abdominal pain was the most common and consistent symptom in all the patients and majority of the patients had bowel resection (right hemicolectomy with ileotransverse anastomosis). One-fifth of the patient had pathologic lead point (PLP) Wound infection was the most common post-operative complication and one patient expired due to overwhelming sepsis. Conclusion: Although intussusception is more common in infants; it’s occurrence in older children is not uncommon and may be associated with PLP. Non-operative treatment is often ineffective and operative treatment is always required.

Synchronous Manec (Mixedadeno-Neuroendocrine Carcinoma) of the Colon and Renal Cell Carcinoma - Case Report

Abstract Synchronous multiple carcinomas represent two or more primary carcinoma that occur sumultaneously in the same patient. In order to fulfill the condition that tumors are synchronous, each tumor must be primary and not a metastasis of another tumor. The occurrence of renal carcinoma synchronously with colonic carcinoma is not so common. On the other hand, the pathohistological image in rare cases shows a mixed glandular and neuroendocrine component described in earlier works. In this paper, we present a patient who made a colonoscopy, a biopsy from a tumor change in the cecum due to malady, fainting, loss of appetite, and a positive test for faecal occult bleeding, and confirmed that it is an adenocarcinoma of the cecum. Multi slise computerized tomography of the abdomen also described a tumor change in the uretero-pelocalrix system of the left kidney region. The patient had no urinary tract disorders. The diagnosis of the synchronous tumor of the cecum and left kidney was set. A right hemicolectomy with latero-lateral ileo-transverse anastomosis, as well as left nephroureterectomy, was performed. What is particularly interesting in this case is that the pathohistological picture of the cecum carcinoma shows a rare form of tumor tone, mixed adenoneuroendocrine carcinoma. In patients with diagnosed colorectal cancer, routine as well as additional preoperative diagnostic procedures should be performed to exclude the existence of kidney cancer, since, when synchronous with colorectal carcinoma occurs, renal carcinoma is mainly asymptomatic. In rare cases, the pathohistological picture may also show the neuroendocrine component of the tumor, which directs further therapy to the other direction.

Cecal volvulus in malrotation at 41 years

Cecal volvulus is rare, and its preoperative diagnosis poses a challenge. Because of its variable clinical features, the ultimate diagnosis of cecal volvulus is determined during surgery. We aim to demonstrate the rarity of cecal volvulus, the challenge in preoperative diagnosis of cecal volvulus, and the use of surgery in both diagnosis and treatment. We herein present a case of ischemic cecal volvulus in a 41-year-old man who presented within 5 hours of onset of symptoms ofabdominal pain, vomiting, and lower abdominal distension. He had not passed flatus or opened bowels for a day. The available abdominal radiographs did not reveal preoperative cecal volvulus. An emergency laparotomy was performed, and it showed ischemic anticlockwise cecal volvulus that was managed by right hemicolectomy plus ileo-transverse primary anastomosis and transverse colopexy. The postoperative recovery and follow-up were uneventful.

COLORECTAL CANCER IN YOUNG ADULTS: A CASE SERIES

Introduction & Background: Colorectal cancer (CRC) is a frequent tumor in adults, it rarely occurs before the age of 25 years, with an annual incidence of only 1-2 cases per 10,00,000 people, accounting for only about 80 cases per year worldwide. Overall incidence of CRC involving hepatic exure is 2%, ascending colon is 5%, sigmoid colon is 21% which is very rare in young age group. Herein we report a 3 rare cases of CRC in young adults less than 25 years of age involving hepatic exure, ascending colon and sigmoid colon respectively. Case Description: Case 1: A 20 year-old male presented with complaints of abdominal distension and constipation for 1 week and loss of weight for 1 month. Patient had no comorbities and no family history of malignancy. CECT done showed an asymmetric wall thickening involving proximal transverse colon with signicant luminal narrowing. He underwent emergency laparotomy and intra operatively patient had a growth at hepatic exure of colon with dilated ascending colon, caecum and distal ileum and multiple enlarged mesenteric lymph nodes. He was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving hepatic exure. Case 2: A 25 year-old female was hospitalized due to com plaint s of abdominal pain for 3 months, lower abdomen mass for 1 month and melena for the past 15 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a suspicious wall thickening involving ascending colon. The patient was taken up for laparotomy and per operative ndings showed a ulceroproliferative growth involving ascending colon. Patient was proceeded with right hemicolectomy with ileo transverse anastomosis. Post operative histopathology revealed mucinous adenocarcinoma involving ascending colon.Case 3: A 22 year-old male was admitted for comp laint s of lower abdominal pain for 4 months, bleeding per rectum on and off for 1 month and abdomen distension and constipation for 5 days and loss of weight and appetite. Patient had no comorbities and no family history of malignancy. CECT done showed a circumferential wall thickening involving sigmoid colon. Hence the patient was proceeded for emergency laparotomy and per operative ndings showed a stenosing growth involving sigmoid colon. Patient was proceeded with Hartmann's procedure. Post operative histopathology revealed adenocarcinoma involving sigmoid colon. Conclusion: Within a young group, CRC is usually diagnosed later andpotentially associated with worst prognosis. Detecting CRC at an early, more treatable stage is important for cure and survival. This report suggest a greater suspicion rate and early screening that necessary when evaluating young patients with common symptoms.