Spontaneous enterocutaneous fistula in a patient with femoral hernia: a case report

Background Enterocutaneous fistula commonly occurs in the post-operative setting. However, a handful of cases have been reported to occur secondary to strangulation of hernia, mostly femoral due to the narrow femoral ring through which this type of hernia passes through. Case presentation We encountered a case of spontaneous fecal fistula, which occurred in the setting of an incarcerated femoral hernia. The patient did not develop peritonism, or obstruction, throughout the course of the disease. The hernia ruptured on day 7 of incarceration. Exploratory laparotomy under epidural anesthesia revealed a femoral hernia with ileum as content, arising approximately 20 cm from the ileocecal junction. Reduction of the contents was done, and a resection performed along with repair of the hernia. Conclusion As very few literature describe the formation of spontaneous fecal fistula, we discuss the presentation in this report.

Caecal desmoid tumour – A rare tumour at uncommon location and review of literature

A 49-year female presented to surgery outpatient clinic with the awareness of a right lower abdomen asymptomatic lump for one week. Contrast enhanced computed tomography of the abdomen demonstrated a 10x11x15cm heterogeneous lesion anterior to the ileocecal junction with the possibility of leiomyosarcoma. Patient was prepared for laparotomy and intraoperative there was a large tumour arising from the medial wall of cecum. Right hemicolectomy was performed, and histopathology came as a desmoid tumour of the cecum. The patient had an uneventful postoperative course and is well on one year follow up.

Segmental dilatation of ileum in a child with juvenile idiopathic arthritis, localized myopathy with focal stasis induced immunogenic injury as a possible etiology: a case report

Background Segmental dilatation of the intestine (SDI) though uncommon is a well-known entity and more than 150 cases of SDI are reported in the literature. The presentation and association of SDI are well described; however, the association of SDI with juvenile idiopathic arthritis (JIA) has not been reported earlier. We described a case of SDI with JIA, who presented with malnutrition and chronic abdominal distension. Case presentation A 5-year-old female child was getting treated for JIA and referred to us for evaluation of chronic abdominal distension. On laparotomy, a huge SDI was found approximately 40 cm from the ileocecal junction and resection of the dilated part with approximately 2–3 cm of healthy ileum on each side and anastomosis was performed. The child recovered well and the features of arthritis also resolute 6 weeks later. From histologic analysis, we have suggested role of localized myopathy in development of segmental dilatation. We have further emphasized the link between the SDI with development of arthritis. Conclusion Etiology of SDI is multifactorial with architectural malformation of the smooth muscle due to localized myopathy is the key. Focal stasis in SDI affecting permeability and increased exposure to macromolecules, and antigens may give rise to immune-mediated arthritis. Surgical management can reduce and cure the symptoms of such patients.

Caecal desmoid tumour: a rare tumour at uncommon location and review of literature

A 49-year-old woman presented to surgery outpatient clinic with the awareness of a right lower abdomen asymptomatic lump for one week. Contrast-enhanced CT of the abdomen demonstrated a 10×11×15 cm heterogeneous lesion anterior to the ileocecal junction with the possibility of leiomyosarcoma. The patient was prepared for laparotomy and intraoperative there was a large tumour arising from the medial wall of cecum. Right haemicolectomy was performed, and histopathology came as a desmoid tumour of the cecum. The patient had an uneventful postoperative course and is well on 1-year follow-up.

Gastrointestinal Syndrome in a Rabbit (Oryctolagus cuniculus)

Background: The term “rabbit gastrointestinal syndrome” (RGIS) refers to a decrease in peristaltic movements, which in some cases can progress to absolute inactivity of the digestive apparatus. This condition is mostly secondary to others that promote changes in gastrointestinal motility, such as dehydration, fiber deficiency, excess carbohydrates in diets, stress, and acute or chronic painful processes. Clinical manifestations are mostly nonspecific. Thus, a case of RGIS resulting from environmental change in a domestic rabbit (Oryctolagus cuniculus) is reported.Case: A 4-month-old male domestic rabbit weighing 0.962 kg was referred to a university veterinary hospital. The patient had a history of absence of defecation and anorexia for the past two days. The owner reported that the patient was apathetic but became aggressive when manipulated. The changes started after a move of residence. On physical evaluation, an increase in abdominal volume and a painful response to touch on the abdomen were observed. Complementary examinations were performed, such as a blood count and an ultrasound study. The blood tests showed no alterations, but the ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic structure associated with acoustic shading in the small intestine, all findings suggestive of obstruction. Given the failure of clinical management, the patient was referred for an exploratory laparotomy procedure followed by enterotomy. The obstruction point was located near the ileocecal junction. After surgery, analgesics, antibiotics, fluid therapy, anti-inflammatory drugs, intestinal motility inducers, and probiotics were prescribed. One week after the surgical procedure, the patient showed improvement in the clinical condition, with normal appetite, defecation, and docility.Discussion: RGIS is diagnosed based on the clinical history, clinical manifestations, and complementary examinations. In the reported case, the patient presented apathy, anorexia, absence of defecation, and aggressiveness on manipulation, which were associated with abdominal pain. In cases of RGIS, hematological changes may or may not be present, which matches the findings in this report. Imaging exams provide important information, such as the patient’s condition and evolution. Ultrasound evaluation showed the presence of free abdominal fluid, dilated intestinal loops due to fluid content, reduced gastrointestinal motility, and a hyperechoic, immobile acoustic shading structure in the small intestine. Ultrasound findings were compatible with those found in cases of foreign-body obstructions, a common complication in RGIS. Initially, a clinical approach was taken, but in view of the unfavorable evolution of the case, with worsening motility and alterations in the imaging examination, a surgical approach was instituted. Intestinal obstructions in rabbits are usually found either in the proximal duodenum or near the ileocecal junction. In the presently reported patient, an obstruction was identified in the ileocecal junction region and the content found was composed of hair and dehydrated food. There are several conditions that can alter intestinal peristalsis in rabbits; in the present case, it was considered that the distress caused by moving to a new household led to a condition of RGIS. Despite the reserved prognosis associated with surgical interventions in the gastrointestinal system of rabbits, as described in the literature, in the present case this approach made it possible to preserve the patient’s life, which returned to its normal activities and behavior.

A Rare Case of Diffuse Intestinal Ganglioneuromatosis in a Child Presenting with Intussusception

Ganglioneuromas are benign neurogenic neoplasms commonly seen in children which are originating from neural crest cells of sympathetic ganglia or adrenal medulla. Rarely, they may arise from the visceral organs like intestine. Diffuse intestinal ganglioneuromatosis is a rare disease, caused due to abnormal proliferation of ganglion cells, nerve fibres and schwann cells in the wall of intestine. Author hereby present a case of diffuse intestinal ganglioneuromatosis in an 18-month-old male child who presented with symptoms of small bowel obstruction. Resected segment of ileocecal junction revealed ulcero-nodular areas which on microscopy showed diffuse hyperplasia of nerve bundles and ganglion cells with immunohistochemistry confirmation. Intestinal ganglioneuromatosis is a rare condition having syndromic association with MEN-2B, Neurofibromatosis-1 and Cowden syndrome. As this disease has a low clinical suspicion, very nonspecific symptoms and radiological findings, histopathological examination becomes mainstay in diagnosis. Further workup is essential to rule out presence of associated syndromes.Surgical excision is the ultimate treatment with screening for genetic abnormalities.

Congenital short bowel syndrome: a rare cause of neonatal intestinal obstruction

Congenital short bowel syndrome (CSBS) is an uncommon gastrointestinal disorder in which an unclear aetiology causes considerable intrauterine reduction in small bowel length. As a result of reduced absorptive intestinal length, chronic diarrhoea, vomiting, and consequently, failure to thrive are likely. We report a case of CSBS in a 26-day-old girl who had malrotation and a short bowel with a length of bowel from the pylorus to the ileocecal junction of approximately 40 cm. The patient underwent Ladd’s procedure, but she is still dependent on parenteral nutrition.

Extended Colectomy Followed by Cecorectal Anastomosis as a Surgical Treatment Modality in Synchronous Colorectal Cancer

Subtotal and extended left colectomies with ileocecal junction preservation represent preferable alternatives in cases of massive involvement of the colon in the pathological process. However, these approaches might be challenging in terms of reconstructive steps. Antiperistaltic cecorectal anastomosis is one of the possible techniques. Still, this type of pouch formation is described mostly in slow-transit constipation surgical management. We report on a patient with synchronous colorectal cancer who underwent extended left colectomy. In the case of compromised vessel anatomy, it was decided to perform antiperistaltic cecorectal anastomosis. We present all clinical and intraoperative patient’s data, determining the surgical tactics, and short-term postoperative results. An antiperistaltic cecorectal anastomosis can be considered in nonstandard clinical cases and variable anatomy of the patient.

The feasibility and safety of complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction in right-transverse colon cancer

Background: To evaluate the feasibility and safety of a new surgical method, complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction in right-transverse colon cancer.Methods: We retrospectively analyzed and compared the data of consecutive patients with right-transverse colon cancer who underwent complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction (n=23) and conventional complete laparoscopic extended right hemicolectomy (n=34) in our hospital between October 2017 to May 2019, respectively.Results: The overall operation time of the ileocecal junction-preserved group was significantly shorter than that of the control group (p=0.024). There was no difference in the number of harvested lymph nodes, metastatic lymph nodes and rate of metastatic lymph nodes (p＞0.05). The ileocecal junction-preserved group showed shorter time of first flatus, lower frequency of postoperative diarrhea and shorter duration of postoperative hospitalization. Furthermore, it also showed that the defecation frequency was lower in the ileocecal junction-preserved group than control group on the 1st, 3rd and 6th month (p＜0.05), and the number of patients who defecated at night or defecated four times or more a day were less in the ileocecal junction-preserved group than control group on the 1st month (p＜0.05).Conclusion: The complete laparoscopic extended right hemicolectomy with preserving the ileocecal junction promises as a safe and feasible surgical procedure for right-transverse colon cancer, associated with earlier recovery of bowel function, shorter operation time and similar pathological outcomes when compared to the conventional laparoscopic procedure.