Resección transanal de un adenoma velloso rectal a través de un trocar monopuerto / Excision of a rectal villous adenoma using a transanal single port trocar

Single port access for minimally invasive surgery is feasible nowadays. We report a 55 years old female presenting with hematochezia. During a colonoscopy, a villous adenoma of 2 cm in diameter located 5 cm above the anal margin, was found. This lesion was excised through the anus, using a single port trocar. The procedure lasted 45 minutes, the postoperative evolution was uneventful and the patient was discharged 24 hours after the procedure.

Posterior al advenimiento de la cirugía laparoscópica colorrectal, desde comienzos de la década de los 90, se han desarrollado diversos tipos de accesos minimamente invasivos, siendo hoy en día el acceso por un puerto único una alternativa factible. Se presenta el caso clínico de una paciente de 55 años, a la cual por sintomatología se le diagnóstica una lesión rectal, la que luego de ser estudiada endoscópica y endosonográficamente, es resecada por monopuerto via anal. La cirugía duró 45 minutos y no presentó eventos adversos intraoperatorios. Su evolución quirúrgica fue satisfactoria con alta hospitalaria al día siguiente de la cirugía.

Korean Guidelines for Post-polypectomy Colonoscopic Surveillance / 대한소화기학회지

Post-polypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. However, because the medical resource is limited, and the first screening colonoscopy produces the greatest effect on reducing the incidence and mortality of colorectal cancer, there is a need to increase the efficiency of postpolypectomy surveillance. In the present report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy. Based on the results of review of the evidences, we elucidated the high risk findings of the index colonoscopy as follows: 1) 3 or more adenomas, 2) any adenoma larger than 10 mm, 3) any tubulovillous or villous adenoma, 4) any adenoma with high-grade dysplasia, and 5) any serrated polyps larger than 10 mm. In patients without any high-risk findings at the index colonoscopy, surveillance colonoscopy should be performed five years after index colonoscopy. In patients with one or more high risk findings, surveillance colonoscopy should be performed three years after polypectomy. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polyp removal, the patient's general condition, and family and medical history. This practical guideline cannot totally take the place of clinical judgments made by practitioners and should be revised and supplemented in the future as new evidence becomes available.

A Case of Synchronous Colonic Laterally Spreading Tumors Treated by Sequential Endoscopic Submucosal Dissection Performed on Two Consecutive Days / 대한소화기학회지

Endoscopic submucosal dissection (ESD) is an useful therapeutic technique for large gastrointestinal epithelial tumors that it provides an en bloc resection. Although there is some controversy about the role of ESD for colorectal lesions, for large lesions in the distal rectum, ESD has the advantage of preserving anal function. However, the large amount of insufflating gas used during the procedure can cause severe abdominal pain and discomfort. Moreover, high intra-luminal pressure caused by a by large amount of gas can cause a micro-perforation. There is no consensus as to whether ESD is the optimal treatment for synchronous large colorectal laterally spreading tumors (LSTs) that cannot be removed en-bloc by conventional endoscopic mucosal resection. Here, a case with two neighboring synchronous large LSTs, one located in the rectum and the other in the distal sigmoid colon, were sequentially removed by separate ESD procedures performed on two consecutive days in a patient who could not tolerate a long procedure.

A Case of Early Bile Duct Cancer Arising from Villous Adenoma in Choledochal Cyst / 대한소화기학회지

Choledochal cyst is an uncommon premalignant anomaly. The morphology and pathogenesis of the premalignant lesion of cholangiocarcinoma arising from the choledochal cyst has not been well described. Herein, we report a rare case of bile duct adenoma arising from choledochal cyst with anomalous union of pancreaticobiliary duct (AUPBD). 50-year-old woman was admitted to our hospital with the complaint of epigastric pain. She had received common bile duct (CBD) exploration and choledocholithotomy and cholecystectomy 3 months earlier under the diagnosis of multiple CBD stones. Intraoperalive cholangiogram was not remarkable except CBD dilatation at that time. Endoscopic retrograde cholangiopancreatography revealed choledochal cyst with AUPBD and round filling defect which disappeared easily on the balloon cholaniogram. On magnetic resonance cholangiopancreatography, the filling defect was confirmed as 2 cm polypoid mass attached to the distal bile duct wall. At laparotomy, a soft whitish mass was palpable on the lower CBD. On histological examination, adenoma with focal carcinoma change arising from choledochal cyst was diagnosed.

Villous adenoma: a rare tumor of vaginal vault.

Villous adenomas are extremely rare tumors in the vagina and are indistinguishable from their colonic counterparts. These are considered as enteric type neoplasms of lower female genital tract arising from cloacal remnants. The significance of this lesion lies in the fact that it has to be distinguished from metastatic adenocarcinoma from other sites. We present a case of villous adenoma of vaginal vault, a rare site of presentation in a 30-year-old female.

Adenoma velloso hipersecretante del colon sigmoides / Hypersecretive villous adenoma of the sigmoid colon

Se presenta el caso de una paciente de 41 años portadora de un adenoma velloso (AV) hipersecretante del colon sigmoides que es hospitalizada de urgencia por deshidratación y shock hipovolémico secundaria a una diarrea mucosa de un año de evolución, con falla prerrenal y acidosis metabólica, marcada hipokalemia y baja de peso de 6 kg. Luego de una vigorosa reposición hidroelectrolítica, el estudio de la diarrea reveló la presencia de un tumor velloso de 10 cm en el colon sigmoides, logrando identificarse el AV tanto al enema baritado como a la colonoscopia. Fue sometida en forma electiva a una resección anterior con buena evolución postoperatoria, cesando la diarrea en forma abrupta. El estudio histopatológico de la pieza demostró un adenoma velloso gigante sin displasia

El abordaje retrorrectal en el tratamiento de las lesiones polipoideas sésiles del tercio medio y superior de recto / Retrorectal approach of sessile polypoid lesions of middle and proximal rectum

Antecedentes: Las lesiones polipoideas sésiles del tercio medio y superior del recto, cuando reúnen ciertas características, pueden ser extirpados utilizando un abordaje retrorrectal, del cual se han descripto múltiples variantes a la técnica original. Objetivos: Evaluar los resultados obtenidos con el uso de la modificación a la técnica de Bevan que utiliza la vía retrorrectal sin resección del coxis, ni sección del aparato esfinteriano, y remarcar los criterios de selección. Diseño: Trabajo retrospectivo. Población: Pacientes portadores de formaciones polipoideas sésiles del tercio medio y superior del recto, de ambos sexos, que presentaban los criterios de selección para la realización de esta técnica. Método: Se realizó la técnica de abordaje retrorrectal en el tratamiento de lesiones polipoideas según la técnica de Bevan modificada. Conclusiones: El abordaje retrorrectal para la resección quirúrgica de lesiones polipoedeas del recto medio y superior según esta técnica, es la vía de elección cuando dichas lesiones cumplen los criterios de selección. Su morbilidad es baja y no registramos mortalidad.

Duodenal villous adenoma.

Duodenal villous adenomas are extremely rare (1/5th of small bowel tumors). In view of their strategic position and risk of malignancy, they require definitive management in specialized care units. We report a case of a 35 year old female patient with a large duodenal (5 cm) villous adenoma causing intussusception of duodenum (a phenomenon rare because of its anatomic location & fixation).

Villous adenoma of the bile ducts: a case report and a review of the reported cases in Korea

Villous adenomas are benign epithelial lesions with malignant potential which can occur at any site in the gastrointestinal tract. They are usually encountered in the rectum and colon, less frequently in the small bowel and very rarely in the biliary trees. Nine cases of bile duct villous adenomas have been reported in the literature. However, 4 cases of bile duct villous adenomas have been reported in the Korean literature. Recently, we experienced a case of villous adenoma in the common hepatic duct in a 77-year-old man presenting with obstructive jaundice in which preoperative histologic diagnosis of villous adenoma played a critical role in managing this patient. Herein, we present a case report of bile duct villous adenoma and a review of the reported cases in Korea to help define and manage this rare disease entity in the bile ducts. In addition, confusing nomenclature of bile duct adenomas is discussed.

Adenomas vilosos e tubulo-vilosos do colon e reto: resultados observados em 30 casos / Villous and tubulovillous adenomas of the colon and rectum: results in 30 patients

Os polipos vilosos do colon e reto apresentam-se como entidades de vital importancia em coloproctologia devido a sua frequencia e, fundamentalmente, devido ao seu alto potencial de degeneracao maligna, que aumenta sobremaneira conforme seu tamanho e a presenca proporcional do componente viloso, orientando a sua resseccao como a conduta terapeutica exigida. Justamente devido a incapacidade da resseccao de todos os polipos atraves da colonoscopia, como opcoes cirurgicas, incluem-se as resseccoes locais (transanais) bem como as resseccoes colorretais segmentares, com morbidade e taxas de recorrencia diversas. Neste trabalho os autores realizaram um estudo retrospectivo de 30 doentes com esta afeccao, internados no Servico de Cirurgia do Colon e do Reto do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo no periodo de 1980 a 1997...

Preservación del esfinter anal en lesiones rectales bajas / Preservation of the anal sphincter in low rectal lesions

We have discussed the surgical options to save the anorectal sphincter in lesions within the lower 2/3 of the rectum. We presented four clinical cases: two villous adenomas, one adenocarcinoma and one benign tumor, probably of embryonic origin. We discussed the surgical options in order to avoid a permanent colostomy. There is not a single surgical procedure that we can count on to preserve the anal sphincter, either in benign or malignant lesions. The surgeons treating this pathology should consider all options and be able to select the most adequate, the less complicated and yet be able to preserve continence. The surgeons should remember that in treating malignant lesions [quot]a curative resection is worth a colostomy[quot]

Adenomas colónicos: factores de riesgo para su malignización / Colonic adenomas: risk factors for its malignization

Antecedentes: La mayoría de los cánceres colorrectales se desarrollan en pólipos adenomatosos; su detección y extirpación previene el cáncer colorrectal. Varias características de los adenomas, como: número, tamaño, morfología, variedad histológica y grado de displasia, se han considerado como factores de riesgo para su malignización. Objetivo: Conocer la frecuencia de los adenomas colorrectales los principales factores de riesgo para su malignización. Métodos: Se analizaron retrospectivamente los hallazgos endoscópicos de 846 colonoscopias realizadas en nuestro servicio entre 1989 y 1994, regisrándose los pacientes con pólipos colorrectales, así como las características de los adenomas, para determinar los factores de riesgo para su malignización. Resultados: Se encontraron 183 821.6 por ciento) pacientes con 322 pólipos colorrectales; sólo se estudiaron 214 extirpados por polipectomía transcolonoscópica; 120 (57 por ciento) fueron pólipos neoplásicos, y 94 (43 por ciento) no neoplasicos; entre los neoplásicos, 100 (83.4 por ciento) fueron adenomas tubulares, 11 (9.1 por ciento) adenomas tubulovellosos y 9 (7.5 por ciento) adenomas vellosos. Se encontraron. 16 (7.4 por ciento) adenomas con carcinoma, 14 (87.5 por ciento) de ellos en pacientes mayores de 50 años y en pólipos mayores de 1 cm (p 0.040); 11 (68.7 por ciento) fueron sésiles, con una p 0.001. Conclusiones: Los adenomas tubulares son los pólipos neoplásicos más frecuentes. La edad del paciente, el tamaño y morfología del pólipo, son los factores de riesgo significativamente estadístico para la malignización de los adenomas.

Large villous adenoma of the duodenum.

A 27-year-old man, who had symptoms of gastric outlet obstruction, was found on endoscopy to have a large duodenal polyp which on histology was diagnosed as villous adenoma. The tumor was resected surgically and the patient remained asymptomatic until two years later.

Malacoplaquia en colon y retroperitoneo: informe de dos casos / Colonic and retroperitoneal malakoplakia: a report of two cases

Se informan dos pacientes con malacoplaquia extravesical. El primero corresponde a un caso de autopsia de malacoplaquia colónica asociada a un adenoma velloso que se manifestó por dolor lumbar, rectorragia y fiebre en un hombre de 34 años con neurofibromatosis. El segundo a una mujer de 43 años con manifestaciones clínicas vagas e imagen tomográfica de tumor retroperitoneal que fue sometida una lumbotomía. El diagnóstico histopatológico inicial fue de sarcoma de bajo grado. La información obtenida de la revisión de la literatura nos permitió identificar 58 casos de malacoplaquia colónica, unicamente uno asociado a un adenoma velloso y cuatro de localización retroperitoneal. No existe un cuadro clínico característico de la malacoplaquia intestinal o retroperitoneal. Con frecuencia las imágenes radiográficas muestran lesiones de bordes irregulares, por lo que ocasionalmente la impresión clínica es de neoplasia maligna. Esto complica la interpretación morfológica. Por ello, es necesario informar los casos de esta entidad con el objeto de crear experiencia en su diagnóstico