Resection Of Transverse Colon Research Articles

The efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy

Objectives: To explore the efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy in patients with gastric cancer. Methods: A retrospective analysis of clinical and pathological data of 20 patients with locally advanced gastric cancer (clinical TNM stage T3-4aN+M0) admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from July 2021 to July 2023. All patients received 3 cycles of SOX (Oxaliplatin+S-1) regimen combined with immunotherapy (Trastuzumab) and targeted therapy (Apatinib) as neoadjuvant treatment followed by laparoscopic radical gastrectomy for gastric cancer. Surgical outcomes, postoperative pathological response, and postoperative recovery were observed. Quantitative data, except for age and operation time, were expressed using Median (range). Results: Among the 20 patients, there were 18 males and 2 females, aged 41 to 73 years [(60.6±9.7) years]. All 20 patients underwent laparoscopic surgical treatment after neoadjuvant therapy, with one patient undergoing laparoscopic conversion to open total gastrectomy with partial transverse colon resection due to tumor invasion into the transverse mesocolon. Eight patients underwent totally laparoscopic radical gastrectomy, all with Billroth Ⅱ+Braun anastomosis at the distal stomach. Eleven patients underwent laparoscopic-assisted radical gastrectomy, among which total gastrectomy with Roux-en-Y anastomosis was performed in ten cases, and proximal gastrectomy with esophagogastrostomy overlap anastomosis was performed in one case. The mean operation time for the 20 patients was (165.0±34.1) minutes; intraoperative blood loss was 80 (20-100) ml; and the number of lymph nodes retrieved was 68 (21-89). Postoperative pathological TNM staging revealed stage T0N0M0 in six cases, stage Ⅰ in two cases, stage Ⅱ in three cases, and stage Ⅲ in nine cases. Six patients (30.0%) achieved pathological complete response, and nine patients (45.0%) achieved significant pathological response. The median postoperative time to flatus was 4 (1-5) days; oral intake resumed after 3 (2-5) days; and the median length of hospital stay was 13 (6-19) days. One patient developed colonic anastomotic leakage with intra-abdominal infection, and one patient developed duodenal stump leakage with intra-abdominal infection, both classified as Clavien-Dindo grade 3A complications, and improved after treatment and discharged. One patient developed gastric paresis, and two patients developed pleural effusion, classified as Clavien-Dindo grade 2 complications, and improved after treatment and discharged. There were no deaths within 30 days after discharge. Conclusions: Laparoscopic radical gastrectomy for gastric cancer after neoadjuvant treatment with the SOX regimen combined with immunotherapy and targeted therapy is safe and feasible, with satisfactory short-term efficacy. However, there is an increase in overall surgical risk and difficulty, and it is recommended to be performed in experienced gastric cancer centers.

Solid pseudopapillary epithelial neoplasm of pancreas presenting as an abdominal lump: a case report

Solid pseudopapillary epithelial neoplasm (SPEN) of the pancreas is a rare cystic exocrine tumour of the pancreas that predominantly affects women between 30 and 40 years of age. This case report aims to describe clinical presentation and management of SPEN. We report a case of 20 years old female who presented with palpable lump in upper abdomen and continuous dull aching pain. Preoperative contrast enhanced computed tomography (CECT) abdomen was suggestive of large solid mass of size 11×10×10 cm with liquified content in relation to tail of pancreas with a possibility of retroperitoneal tumour or gastrointestinal tumour (GIST). Spleen sparing distal pancreatectomy with segmental resection of transverse colon with colo-colic anastomosis was performed and the diagnosis of SPEN was subsequently confirmed on histopathology examination. SPEN is a slow-growing tumour with a low-grade malignant potential found incidentally in asymptomatic patients. The average tumour size is about 4 to 6 cm in diameter at presentation. Distal pancreatectomy with splenectomy is the procedure of choice as described in literature. SPEN should be kept as a differential diagnosis in a young female patient presenting with vague abdominal pain and retroperitoneal lump in relation to the pancreas. Complete surgical resection is the definite treatment with a 5-year survival rate of 95%.

Outcomes of emergency surgical interventions in right-sided colonic cancer: nationwide population-based study based on Danish Colorectal Cancer Group register.

The aim of this study was to investigate the trends in morbidity and mortality of patients with right-sided colonic cancer who had an emergency surgical procedure in Denmark after the introduction of quality index parameters. This was a retrospective nationwide study based on a prospectively maintained Danish Colorectal Cancer Group database focused on right-sided colonic cancer in the interval from 1 May 2001 to 30 April 2018, who underwent emergency surgical intervention (within 48 h of hospital admission). The primary objective was to investigate the trends in morbidity and mortality throughout the study years. Multivariable estimates were adjusted for age, sex, smoking status, alcohol consumption, ASA score classification, tumour localization, type of access to abdominal cavity, surgeon's grade of specialization, and metastatic disease. Out of 2839 patients, a total of 2740 patients fulfilled the inclusion criteria, of whom 2464 underwent right or transverse colon resection (89.9 per cent). The 30-day and 90-day postoperative mortality rates were significantly reduced over the time of the study (OR 0.943, 95 per cent c.i. 0.922 to 0.965, P < 0.001 and OR 0.953, 95 per cent c.i. 0.934 to 0.972, P < 0.001 respectively); however, the complication rates did not follow this trend. Older patients (OR 1.032, 95 per cent c.i. 1.009 to 1.055, P = 0.005) and patients with high ASA scores (OR 1.61, 95 per cent c.i. 1.422 to 1.830, P < 0.001) had higher rates of severe grade 3b postoperative complications. A stoma was constructed in 276 patients (10 per cent), whereas a stent was used in only eight patients. Defunctioning procedures, including stoma construction or colonic stenting (without oncological resection), did not reduce the risk of complications compared with that of definitive surgery. The 30-day and 90-day postoperative mortality rates were significantly reduced over the time of the study. Age and ASA score were risk factors for severe postoperative complications.

A case of retrograde intussusception due to transverse colon cancer detected by abdominal ultrasonography

A 78-year-old female patient presented to our hospital with abdominal pain and melena. Abdominal ultrasonography detected a multiple concentric ring sign and retrograde invagination mass near the hepatic flexure. Colonoscopy revealed a 40-mm diameter type 1 tumor in the transverse colon near the splenic flexure, and the biopsy specimen demonstrated a well-differentiated adenocarcinoma. Retrograde intussusception due to transverse colon cancer was diagnosed, and laparoscopic transverse colon resection with lymph node dissection was performed. The resected specimen revealed a 48×40mm diameter type 1 tumor in the transverse colon and was diagnosed as pT2N0M0 pStage I. Contrast-enhanced computed tomography was unavailable, but real-time assessment of the invaginated mass and bowel blood flow was possible by abdominal ultrasonography, which was useful in determining the diagnosis and treatment strategy.

Surgical tactics in peritonitis, caused by complicated course of colorectal cancer

Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer.&#x0D; Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV.&#x0D; Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome.&#x0D; Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.

The prevalence, risk factors, and complications of Clostridium difficile infection in a tertiary care center, western region, Saudi Arabia

BackgroundClostridium difficile is an anaerobic gram-positive spore-forming bacillus that is most commonly associated with nosocomial diarrhea. This study aimed to analyze the prevalence and risk factors of Clostridium difficile infection (CDI) at a tertiary health care center, Western region, Saudi Arabia. We also aimed to examine the duration of exposure to each risk factor prior CDI development, and to categorize CDI as severe and non-severe depending on the white blood cell (WBC) count. Various complications of the infection were also analyzed. MethodsWe performed a retrospective chart review of all patients who had a positive nucleic acid amplification test (NAAT) for Clostridium difficile toxin genes between October 2018 and October 2020. ResultsThe prevalence of CDI among the included patients was 9.1% (237 of 2611 patients). The mean age (standard deviation) was 56.86 (21) years, and the infection was more prevalent among men (52.74%) than among women (47.26%). The most common risk factor associated with CDI was recent antibiotic use (74.68%), followed by recent acid suppressant use (67.50%), malignancy (46%), and previous gastrointestinal surgery (6.30%). The CDI recurrence rate was 13.90%. Piperacillin-tazobactam was the most frequently used broad-spectrum antibiotic, and was used in 38.8% of the patients, followed by meropenem. The most common malignancy type was lymphoma (22.94%, n = 25), followed by leukemia (n = 23). The most common type of surgery was subtotal colectomy (n = 6). Three patients underwent transverse colon resection, and two underwent ileocecal resection. Hypotension was the most frequently recorded complication (28.40%) in the study population. ConclusionThe prevalence rate of CDI among the study patients during the two-year study from October 2018 to October 2020 was 9.1%. Appropriate use of antibiotic and acid suppressants, and contact isolation measures can help in decreasing the number of CDI cases.

Rapidly Growing Acinar Cell Carcinoma of the Pancreatic Head: A Case Report and Literature Review

Pancreatic acinar cell carcinoma (ACC) is a rare neoplasm accounting less than 1% of malignant pancreatic tumors. A 47-year-old male patient visited the emergency room with epigastric pain. Computed tomography or magnetic resonance imaging revealed a 4.7-cm heterogeneously enhanced solid and cystic mass with internal necrosis located in the head of the pancreas. Radiological diagnosis was borderline malignancy such as neuroendocrine tumor or solid pseudopapillary neoplasm. Two months later, the necrotic mass in the pancreas head had grown up to 11 cm, compressing the duodenum, superior mesenteric vein, and proximal transverse colon. Pylorus preserving pancreatoduodenectomy with segmental resection of transverse colon was performed. Histopathological examination revealed that the tumor was pancreatic ACC. The patient recovered without any complication and was doing well without recurrence for 12 months after surgery.

Rare but Real Presentation of Pancreatic Cystic Tumor

Cystic tumors of the pancreas are rare neoplasms. These tumors are frequently detected incidentally and a definitive preoperative diagnosis remains challenging. Because of widespread use of high quality cross-sectional imaging, pancreatic cystic neoplasms are being diagnosed with increasing frequency. This heterogeneous group of tumors is important because of their high cure rate as well as frequent confusion with the commoner pancreatic pseudocyst. We present a 69-year-old man with vague abdominal pain and loose motion for 3 months. Firstly, this case was misdiagnosed radiologically as pancreatitis with infected pseudocyst. From endoscopic diagnosis, pancreatico-gastrostomy fistula was found and biopsy taken from cyst wall. Histology report showed mucinous adenocarcinoma of pancreas. This was managed by excision of tumor and partial gastrectomy and local resection of transverse colon. It is rare but real presentation of pancreatic cystic tumor.

Advanced gastric cancer with abdominal wall invasion treated with curative resection after chemotherapy: a case report

IntroductionIn patients with gastric cancer, 6–27% of patients are diagnosed with T4b disease that invades adjacent organs, and curative resection can improve the prognosis of these patients.Case presentationA 70-year-old Japanese man presented with an abdominal tumor and was diagnosed with advanced gastric cancer (L-Circ type 3 T4b N2 M0 H0 stage IVA, based on the 15th edition of the Japanese Classification of Gastric Carcinoma) with extensive abdominal wall invasion. We performed open gastrojejunal bypass for gastric obstruction and initiated a chemotherapeutic regimen comprising S-1 (120 mg/day) and oxaliplatin (100 mg/m2). Upper gastrointestinal endoscopy performed after the administration of six courses of the S-1 and oxaliplatin regimen revealed a persistent primary lower gastric wall lesion; however, the diameter of the abdominal wall invasion and metastatic lymph nodes was significantly reduced, in addition to decreased serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels. Subsequently, the patient underwent distal gastrectomy with D2 lymphadenectomy combined with transverse colon and abdominal wall resection. We performed radical en bloc resection and achieved a tumor-free resection margin. Simple abdominal wall closure was performed without mesh or musculocutaneous flap placement. Histopathological examination of the resected tumor specimen showed direct invasion of the mesocolon and rectus abdominis muscle. The patient was postoperatively diagnosed with L Gre-Ant type5 T4b (SI: rectus abdominis muscle) N2 PM0 DM0 Stage IIIA R0 Grade 2a gastric cancer based on histopathological findings and received S-1 as adjuvant chemotherapy, 2 months postoperatively. No recurrence was detected 6 months postoperatively.ConclusionsWe report a case of advanced gastric cancer with extensive abdominal wall invasion that was successfully treated with gastrectomy combined with resection of adjacent organs showing tumor invasion after effective systemic chemotherapy. A therapeutic approach comprising curative surgery combined with perioperative chemotherapy is useful in patients with T4b gastric cancer.

Case report; A diagnostic dilemma caused by the presence of ORISE gel, when not removed with initial endoscopic en‐bloc resection

The submucosal cushion product ORISE gel enhances the visibility and resectability of small lesions at endoscopic mucosal resection. However, the presence of this product in tissue, when not resected with initial polypectomy, sometimes presents a diagnostic dilemma to the clinician as well as the pathologist. We present a case report of residual submucosal gel underlying a tubular adenoma in a segmental transverse colon resection. The granuloma formation beneath the underlying tubular adenoma along with residual ORISE gel, appeared a a mass to the clinician, and presented a diagnostic challenge to the pathologist in the frozen section evaluation without clinical history.

The first single-incision plus one-port transverse colon resection using Senhance Digital Laparoscopy System: a case report

BackgroundWe have introduced the Senhance Digital Laparoscopy System and actively use for colorectal cancer surgery. Recently, we also try to perform surgery by reduce port as less invasive method. For the first time, we report a case of single-incision plus one-port transverse colectomy using Senhance system.Case presentationThe case was a 57-year-old woman, diagnosed with transverse colon cancer referred to our department. The preoperative diagnosis was cT1bN0M0, Stage I. We performed single-incision plus one-port transverse colon resection using Senhance system without any problems. The operative time was 203 min and the blood loss was 35 ml.ConclusionWe report the first case of single-incision plus one-port transverse colectomy using Senhance system. We trust this approach will find increasing use, enabling a safer means of minimally invasive robotic surgery.

Transverse Colonic Perforation in Renal Transplant Recipients During the Early Postoperative Period: A Case Series

There are very few cases of nondiverticulitis episodes of colonic perforation in the acute postoperative period following kidney transplantation described in the literature. Various nondiverticular causes of colonic perforations include ischemia, malignancy, cytomegalovirus (CMV) enterocolitis, and nonobstructive colonic dilatation. Immunosuppressive medication can contribute to colonic perforation, placing kidney recipients at risk for these complications. Since 2011, there have been 2 cases of transverse colonic perforation in the early postoperative period following renal transplantation at our institution. Both patients underwent urgent exploratory laparotomy with resection of perforated transverse colon and creation of a proximal colostomy. The aim of this study is to review the cases of colonic perforation following renal transplantation to gain a greater understanding of this rare occurrence. Despite the lack of a clear cause of perforation, it is imperative to have a high index of suspicion for colonic perforations in these immunocompromised patients to provide prompt surgical management and improved outcomes.

Aggressive Clinical Behavior of Pure Squamous Cell Carcinoma (SCC) of the Liver

Introduction: Primary SCC of the liver is extremely rare. According to a few sporadic reports, surgical resections seem to be selected as an initial treatment, if it resectable; however, the prognosis is universally unfavorable. Methods: We presented one case of pure SCC of the liver. A total of 41 cases of primary SCC of the liver previously reported in the English literatures were reviewed. Results: A 57-year-old man with history of right flank pain presented with 1 week of high grade fever. On physical examination, his abdomen was tender, with the most severe pain in the right upper quadrant. Contrast-enhanced computed tomography revealed that there was 14x10cm irregular mass with central necrosis at S4+5 of the liver and swollen nodes, which were compatible with his symptoms. The patient underwent S4+5 segmentectomy with extended resection of gall bladder, transverse colon, and diaphragm. Histological examination revealed pure squamous cell carcinoma of the intrahepatic biliary tract. On the POD 44 prior to discharge, relapse was found around the common bile duct and liver resection edge. Although chemotherapy was proposed, his severe fatigue refused it. He was died of multiple metastasis including bones on the 52nd day after discharge. We made Kaplan-Meier survival curves of the patients divided by with and without surgery from the review of previous reports. One year survival rate with surgery is better than without surgery (63.4% vs 15.4%, p=0.0024). Conclusion: Radical resection should be firstly recommended; however, case collections and data analysis may be needed to establish better treatments.

SURGICAL TREATMENT OF ANOMALIES OF FIXATION OF THE COLON IN CHILDREN

Pyrrhic disease is a congenital anomaly that occurs during embryogenesis due to the fixation of the splenic angle of the colon by a short and highly located left transverse-diaphragmatic ligament, creating a sharp bend and forming a "wellbore". In this case the passage of feces on a cross colon becomes difficult, there is also its sagging to a small pelvis. This pathology is characterized by paroxysmal pain (aggravated by exercise and after eating) and prolonged constipation, which progresses over time. Hilaiditis syndrome is a rather rare pathology in which there is an interposition of the hepatic angle of the colon between the liver and the diaphragm. There are permanent and intermittent localizations. The work generalizes the experience of evaluation of clinical manifestations and remote results of treatment of children with chronic colostasis caused by fixation abnormalities of the colon. 58 children were detected to have Payre’s disease, with Cyilaiditi’s syndrome – 3 children. 24 patients with Payre’s disease and 2 Cyilaiditi’s syndrome were operated on. To assess the effectiveness of surgery, children were divided into two groups: I group – comparative and II group - experienced. In I group (n=12 children) – the analysis of surgical treatment was performed traditionally. In II group (n=14 children) – the analysis of surgical treatment was conducted by means of the methods proposed. Traditional surgical treatment of Payre’s disease in children was followed by relapse of chronic constipation in 45,45%, pain in 50%, flatulence in 33,33% and failure of the ileocoecal closing apparatus in 100% of children. Unsatisfactory outcomes of surgical treatment of Cyilaiditi’s syndrome was observed in a child from the comparative group. Relapse of clinical symptoms to a lesser degree than before the surgery was found in 1 child from the experienced group. To treat Payre’s disease the following operation is proposed: intersection of the left diaphragm-colon ligament, resection of transverse colon and colofixation of the left bending of the colon. To treat Cyilaiditi’s syndrome (in case of dolichoascendocolon) the following operation is suggested: hepatopexy, resection of the right bending of the colon with ascending transversal anastomosis “end to end”, fixing of right bending of the colon. Their reasonability is being proved.

GB perforation- A surgical emergency

Background: Gallbaldder perforation is rare but life threatening complication following acute cholecystitis. Series of events occur that leads to gallbladder perforation. Hence; the present study was undertaken for assessing the surgical management of gallbladder perforation patients. Materials & methods: The present study was conducted in the department of general surgery with the aim of assessing the surgical management of gallbladder perforation patients. Complete demographic data of all the patients was obtained. Records of all patients diagnosed to have gall bladder perforation were analysed. Ultrasonography and Abdominal computerized tomography findings of all the patients were obtained. Details of surgical treatment followed was recorded and analysed. Results: Out of 10 patients with gallbladder perforation, four patients had type I perforation, four patients had type II perforation and remaining two patients had type III perforation. Diagnosis was acute cholecystitis in 7 patients while 3 patients had peritonitis. There were 3 females while 7 males. Biliary sphincterotomy with Open cholecystectomy was carried out in 1 patient. Open cholecystectomy was done in 1 patient with type I perforation. In one patient with diagnosis of peritonitis, laparoscopic cholecystectomy was done. ERCP, Biliary sphincterotomy and Open cholecystectomy was carried out in one patient. Open cholecystectomy along with segmental resection of transverse colon was carried in two patients (type III perforation). Laparoscopic cholecystectomy, Common bile duct exploration and Choledochoduodenstomy were done in another patient. Laparoscopic cholecystectomy converted to open cholecystectomy in two patients. Conclusion: Gall bladder perforation is life threatening condition. Early diagnosis and emergency surgical treatment of gallbladder perforation is of crucial importance. If the patient is stable, then intervention after optimizing has better outcome.

Hartmann’s operation: 100 years in surgery

The first idea of stage operations for colon cancer was introduced in 1898 by G. F. Ceidler. The first stage of treatment, he recommended the formation of colostoma above the tumor. At the 30th Congress of French Surgeons in 1921 in Strasbourg, H. Hartmann, a surgeon from Paris, reported on the successful treatment of two patients with cancer of the left half of the colon. In the domestic literature, there were different names of Hartmann’s operation. The first report of its performance in our country belongs to N. N. Petrov, who called this intervention operation Coffey – Hartmann (1929) or the single-step intraperitoneal operation by Hartmann (1939). For many decades, the term «obstructive colon resection» has been widely used in foreign and domestic literature. A two-stage operation under this name was developed and practiced by the American surgeon F.W. Rankin in 1928. At the same time, obstructive resection of the colon by Rankin can be performed only in a planned order, unlike Hartmann’s operation, which is carried out also in case of acute colon obstruction. Thus, the following names of surgical interventions using H. Hartmann’s name are valid and terminologically correct: Hartmann’s sigmoid resection (with formation of a flat sigmostoma and suturing of the sigmoid stump); Hartmann’s resection of the sigmoid and rectum (with formation of a flat sigmostoma and suturing of the stump of the supra-ampular or ampular parts of the rectum); left-sided hemicolectomy of Hartmann type (with formation of flat transversostoma and suturing of sigmoid stump); transverse colon resection of Hartmann type (with formation of flat transversostoma and suturing of transverse colon stump).

Transverse colon perforation in the mediastinum after esophagectomy: a case report

BackgroundWhile anastomotic leakage, recurrent laryngeal nerve paralysis, and pneumonia are well-known complications of esophagectomy, the incidence of hiatal hernia after esophagectomy for carcinoma has been reported to only be between 0.6 and 10%. We report a very rare case of hiatal hernia with transverse colon rupture in the mediastinum after esophagectomy in a 65-year-old woman.Case presentationThe patient underwent definitive chemoradiotherapy for clinical stage IIA esophageal squamous cell carcinoma and salvage esophagectomy with gastric tube reconstruction through a posterior mediastinum route for residual carcinoma. Three years after the initial surgery, two metastatic nodules in the lateral and posterior segments of the liver were detected on follow-up CT and were treated with oral anticancer drugs. After 6 months, the patient was readmitted for anorexia. Upon admission, computed tomography revealed an ileus caused by a hiatal hernia. Emergent operative repair was performed; an incarcerated herniation of the transverse colon was perforated in the mediastinum, and partial transverse colon resection and colostomy were performed. Intensive care was required to control septic shock after surgery, and the patient was discharged on the 53rd postoperative day.ConclusionsCases of hiatal hernia with digestive tract prolapsing into the mediastinum after esophagectomy with reconstruction through posterior mediastinum are rare but potentially life-threatening complications.

Mesenteric venous thrombosis as a rare complication of decompression sickness

BackgroundDecompression sickness (DCS) induced by extravascular and intravascular gas bubbles during decompression can present with varying manifestations, such as joint pain, numbness, cutaneous symptoms, and cardiopulmonary dysfunction. However, mesenteric venous thrombosis (MVT) is a rare complication of DCS. To the best of our knowledge, only a few cases have been reported, and surgical cases of MVT secondary to DCS have not yet been reported.Case presentationA 59-year-old man who was a fisherman and recreational diver dived to a depth of 100 feet. After diving, he noted abdominal and postcervical pain and visited a community hospital. Computed tomography (CT) revealed a large amount of intravenous gas, so he was diagnosed with DCS. He was then transferred to a previous hospital, where hyperbaric oxygen therapy (HBOT) was performed. HBOT reduced the amount of venous gas, but his abdominal pain worsened, so he was transferred to our hospital. CT showed pneumatosis cystoides intestinalis. Because of the possibility of intestinal necrosis, a laparoscopic examination was performed, which revealed necrosis of the transverse colon. We therefore performed a transverse colon resection. He was discharged 36 days after the surgery and followed an uneventful postoperative course.ConclusionsDCS is likely to cause MVT. If intestinal necrosis is suspected, a laparoscopic examination may be useful for determining the diagnosis and treatment. MVT should be included as a differential diagnosis of abdominal pain that persists after HBOT.

A case of portal venous gas after obstructive transverse colon cancer surgery

BackgroundPortal venous gas has traditionally been considered an inevitable harbinger of death due to its association with bowel necrosis. Recently, an increasing number of cases of portal venous gas have been reported in patients with various clinical conditions and without bowel necrosis. We herein report the case of a patient in whom portal venous gas developed after transverse colon cancer surgery.Case presentationA 69-year-old man who had transverse colon cancer underwent insertion of a transanal ileus tube for decompression. Transverse colon resection was performed on the 11th day after the insertion of the transanal ileus tube. The patient had a high fever on the 6th day after the operation. Computed tomography showed portal venous gas over the entire area of the liver and pneumatosis intestinalis in the wall of the ascending colon. There were no signs of anastomotic leakage or bowel necrosis, so we decided to use conservative therapy with fasting and antibiotics. The portal venous gas disappeared on the 19th day after the operation. The patient was discharged in good condition on the 29th day after the operation.ConclusionsConservative treatment for portal venous gas is reasonable for patients without signs of anastomotic leakage or bowel necrosis. However, it is important to carefully observe patients with portal venous gas during conservative treatment because portal venous gas may be life-threatening.

The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report

BackgroundIntestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus.Case presentationA 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far.ConclusionsSurgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.