Delayed Ureteral Fistula After Laparoscopic Lateral Lymph Node Dissection for Rectal Cancer: A Case Report and Literature Review

Background: Ureteral injury is the most common urological complication of pelvic surgery. Lateral lymph node dissection (LLND) is a technically demanding procedure by laparoscopy after neoadjuvant chemoradiotherapy (nCRT), which may increase the risk of ureteral injury because the ureter and hypogastric fascia must be dissected from the vesicohypogastric fascia to preserve them. Case presentation: Here, we present a case of delayed ureteral leakage occurring in a 63-year-old male patient who underwent laparoscopic abdominoperineal resection (APR) with right LLND after nCRT. Ureteral reimplantation (vesicoureteric anastomosis) was performed in this patient due to the failure of the placement of the double J stent. Conclusions: Our case shows that ureteral leakage may occur in the pelvic segment of the ureter in the patient who underwent laparoscopic LLND, especially received preoperative radiotherapy or chemoradiotherapy.

Rectal Granular Cell Carcinoma Requiring Abdominoperineal Resection

Background Granular cell tumors, derived from neural crest cells, are rare tumors infrequently located in the colon or rectum. We will discuss a patient with a rectal granular cell tumor invading the anal sphincters requiring an abdominoperineal resection. Methods A 56-year-old male, with anal pain, was found to have a perirectal mass. Pathology from ultrasound-guided transrectal biopsy demonstrated low grade granular cell tumor. The patient underwent a laparoscopic abdominoperineal resection with perineum reconstruction. Results Pathology demonstrated a granular cell tumor of 4.5 centimeters with tumor invasion of the anal sphincters. Surgical margins were free of neoplasm. Discussion This is the only documented case of a colorectal granular cell tumor that has required an abdominoperineal resection. On histology, it was considered low grade but its behavior was more consistent with a malignant process. Additional research on malignant granular cell tumors is necessary to help improve treatment options, prevent recurrence, and improve overall survival. His medical course will be followed for disease progression or metastasis.

Internal hernia of the stomach through the lateral space of the colostomy: a case report

An 81-year-old woman had undergone laparoscopic abdominoperineal resection for rectal cancer. A permanent colostomy was created through an intraperitoneal route. Three months after the surgery, the patient presented with lower abdominal pain and vomiting. Computed tomography showed gastric incarceration through the lateral space of the lifted sigmoid colostomy. Although the herniated stomach was reduced by nasogastric tube decompression, the patient experienced a recurrence of gastric hernia shortly thereafter. A laparoscopic operation was performed, and a new colostomy was constructed through an extraperitoneal route. The patient had no hernia recurrence during the 20 months of follow-up after the operation. Gastric internal hernia associated with colostomy can occur as a rare complication. Although reduction of the incarcerated stomach is possible by nasogastric tube decompression, surgical repair of the hernia may be the optimal management to prevent recurrence.