Risk factor leading to complicated appendicitis: pelvic position of the appendix

Objective@#Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. @*Methods@#The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. @*Results@#Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. @*Conclusion@#The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Risk factor leading to complicated appendicitis: pelvic position of the appendix

Objective@#Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. @*Methods@#The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. @*Results@#Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. @*Conclusion@#The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Laparoscopic Treatment of Colonic Intussusception Caused by Sigmoid Colon Cancer

Reports on the laparoscopic treatment for colonic intussusception are exceedingly rare. We report a case of colonic intussusception caused by sigmoid colon cancer which was treated with a laparoscopic approach. A 76-year-old man visited an emergency room with the chief complaint of lower abdominal pain. He was diagnosed with colonic intussusception probably due to sigmoid colon cancer on a CT scan. Upon laparoscopic exploration, sigmoid colon intussusception was noted. Manual reduction was impossible because the colonic walls were friable and due to the possibility of a cancerous leading point. Therefore, the bowel was resected with en bloc Hartmann procedure. Pathology of the resected specimen revealed a tumor measuring 4.5 cm in size and comprising moderately differentiated adenocarcinoma (pT3N0M0, pStage II). The patient's postoperative course was uneventful and was discharged on the 8th day after surgery.

Factors Affecting the Length of Hospitalization after Laparoscopic Resection of Gastric Subepithelial Tumor

A subepithelial tumor (SET) is a common disease of the stomach. A gastrointestinal stromal tumor (GIST), which has malignant potential, is the most common tumor among SETs. The definite treatment of SETs of the stomach should be a complete resection; thus, a laparoscopic wedge resection has been the standard treatment for SET of the stomach. The surgical and oncologic outcomes of laparoscopic wedge resections for gastric GIST have shown it to be safe and feasible compared to open surgery. The authors reported that small sized SET and tumor located in areas other than the posterior wall can be a candidate for shorter hospitalization. The critical pathway (CP) and new therapeutic options can be helpful for reducing the hospital stay. On the other hand, it is important not to overlook the fatal complications after discharge.

Laparoscopic Treatment of Hepatic Abscess Caused by an Ingested Foreign Body

Pyogenic hepatic abscess caused by an ingested foreign body is extremely uncommon, and reports on the laparoscopic treatment for it are very rare. We report here on a case of hepatic abscess caused by an ingested chicken bone which was treated with a laparoscopic approach. A 61-year-old man visited an emergency room with the chief complaints of high fever. He was diagnosed with pyogenic liver abscess that contained a sharp calcified foreign body seen on a CT-scan. At first, percutaneous transhepatic drainage of the abscess was performed to achieve recovery of the patient's condition. Subsequent laparoscopic exploration found and removed the foreign body in the lesser sac. The foreign body turned out to be an ingested chicken bone. The patient was discharged on the 10th day after surgery.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Comparison of partially-absorbable lightweight mesh with heavyweight mesh for inguinal hernia repair: multicenter randomized study

PURPOSE: Prosthetic mesh is widely used for inguinal hernia repair; however, pain and stiffness can develop. This study was a prospective, multicenter, single-blind, randomized trial to assess postoperative pain and quality of life according to mesh type after inguinal hernia repair. METHODS: Forty-seven patients who underwent Lichtenstein repair for unilateral inguinal hernia with prosthetic mesh were enrolled and randomly allocated to the partially-absorbable lightweight mesh (LW group, n = 24) or heavyweight mesh group (HW group, n = 23). Data were collected using a visual analogue scale (VAS), Carolinas Comfort Scale (CCS), and Activities Assessment Scale (AAS) at screening and postoperative day 1, 7, 90, and 120; foreign body sensation, sense of stiffness, and sense of pull during activity were also evaluated. RESULTS: There were no significant differences in patients' demographics and clinical characteristics between groups. The VAS at day 90 was significantly lower in the LW group (0.46 ± 0.78 vs. 0.96 ± 0.82, P = 0.027). The CCS and AAS were significantly lower in the LW group at day 1 (51.33 ± 20.29 vs. 64.65 ± 22.64, P = 0.047 and 39.83 ± 9.88 vs. 46.43 ± 7.82, P = 0.015, respectively). Foreign body sensation was significantly lower in the LW group at day 120 (4.2% vs. 30.4 %, P = 0.023), as was sense of stiffness (P = 0.023). The sense of pull during activity was lower in the LW group at day 90 and 120 (P = 0.012 and P = 0.022, respectively). There was no recurrence or serious complication during follow-up. CONCLUSION: Partially-absorbable lightweight prosthetic mesh can be used for inguinal hernia repair safely and improve functional outcomes and quality of life after surgery.

Primary Squamous Cell Carcinoma of the Remnant Stomach after Subtotal Gastrectomy

Primary squamous cell carcinoma (SCC) of the stomach is a very rare disease. However, the pathogenesis, clinical characteristics, and prognosis of gastric SCC are controversial and remain to be elucidated. Herein, we report a case of primary gastric SCC of the remnant stomach after subtotal gastrectomy. A 65-year-old man was admitted to our hospital due to epigastric discomfort and dizziness. He had undergone subtotal gastrectomy 40 years previously for gastric ulcer perforation. Endoscopy revealed a normal esophagus and a large mass in the remnant stomach. Abdominal computed tomography revealed enhanced wall thickening of the anastomotic site and suspected metachronous gastric cancer. Endoscopic biopsy revealed SCC. Total gastrectomy was performed with Roux-en-Y esophagojejunostomy. A 10-cm tumor was located at the remnant stomach just proximal to the previous area of anastomosis. Pathologic examination showed well-differentiated SCC extended into the subserosa without lymph node involvement (T3N0M0). The patient received adjuvant systemic chemotherapy with 6 cycles of 5-FU and cisplatin regimen, and he is still alive at the 54-month follow-up. According to the treatment principles of gastric cancer, early detection and radical surgical resection can improve the prognosis.

Editorial: Additional Gastrectomy after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

No abstract available.

Clinical characteristics of acute appendiceal diverticulitis / 대한외과학회지

PURPOSE: Diverticulitis of vermiform appendix is known as a rare cause of acute appendicitis, most of which are diagnosed after surgery. We compared appendiceal diverticulitis with acute appendicitis to study the clinical characteristics of appendiceal diverticulitis. METHODS: Among 1,029 patients who received appendectomy from January 2009 to May 2011, 38 patients with appendiceal diverticulitis (diverticulitis group) were compared with 98 randomly collected patients with acute appendicitis (appendicitis group) during the same period. Patients' characteristics, clinical features, laboratory findings, operative findings, and postoperative course were compared between the two groups. RESULTS: Thirty-eight patients (3.7%) were pathologically diagnosed with acute appendiceal diverticulitis among 1,029 cases of appendectomy. The mean age of patients in the diverticulitis group was significantly older than that of the appendicitis group (49.0 +/- 15.2 years vs. 25.4 +/- 14.2 years, P < 0.05). Mean duration of preoperative symptoms was longer in the diverticulitis group (3.6 +/- 3.8 days vs. 1.8 +/- 3.2 days, P < 0.05). The site of abdominal pain, fever, signs of localized peritonitis, accompanying gastrointestinal symptoms, and white blood cell count showed no differences between the two groups. Twenty-five patients (65.8%) of the diverticulitis group and 10 patients (10.2%) of the appendicitis group showed perforation of appendix (P < 0.05). Mean operating time and postoperative hospital stay were longer in the diverticulitis group (55.3 +/- 28.8 minutes vs. 41.4 +/- 17.8 minutes, 6.8 +/- 3.4 days vs. 4.9 +/- 1.5 days, P < 0.05). CONCLUSION: Acute diverticulitis of the appendix can be classified into quite different disease entities compared with acute appendicitis. Regarding high rates of perforation, immediate surgical treatment is needed for patients with a high index of suspicion of acute diverticulitis of the appendix.

A Case of Idiopathic Sclerosing Mesenteritis with Retroperitoneal Fibrosis / 대한소화기학회지

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery. It produces tumor-like masses of the mesentery composed of varying degrees of fibrosis, chronic inflammation, and fat necrosis. It has been described variously as fibrosing mesenteritis, retractile mesenteritis, mesenteric Weber Christian disease, and systemic nodular panniculitis. The etiology and pathogenesis of the disease are as yet unknown, but autoimmune disorder, previous abdominal surgery, trauma, and ischemia could play a role. The clinical features include abdominal pain, vomiting, diarrhea, and constipation. Occasionally, patients with this condition may present with bowel obstruction. Rarely, It can be associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, and orbital pseudotumors. We report a case of idiopathic sclerosing mesenteritis with retroperitoneal fibrosis in a 58-year-old man.

Comparison of Single Port and Conventional Laparoscopic Surgery in Acute Appendicitis / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic surgery is widely applied for treating acute appendicitis, and even the complicated cases. Single port laparoscopic surgery has recently been introduced and it is being increasingly accepted for treating acute appendicitis. The aim of this study is to evaluate the effectiveness of single port laparoscopic appendectomy as compared with that of conventional laparoscopic surgery. METHODS: Eighty-seven patients who underwent laparoscopic appendectomy were enrolled. The clinicopathologic characteristics, the perioperative courses and postoperative pain using the VAS (visual analog scale) were compared between the conventional (n=61) and single port (n=26) groups. RESULTS: There were no significant differences in age (28.2 Vs. 32.4, respectively), gender (29:32 Vs. 13:13, respectively) and BMI (22.3 Vs. 22.0, respectively) between the two groups. An extraperitoneal location of the appendix was found in 10 cases (16.4%) of the conventional group and in 4 cases (15.4%) of the single port group. Statistically, no significant difference was shown in terms of the degree of inflammation of the appendicitis. The average length of the operation was significantly shorter in the single port group compared to that of the conventional group (52.4 Vs. 41.3 minutes, respectively, p<0.05). The VAS at 6 hours after surgery (5.2 Vs. 6.0, respectively) and at the time of discharge (1.9 Vs. 1.9, respectively) showed no differences between the two groups. There was no difference for the postoperative hospital stay (3.8 Vs. 3.1 days, respectively) and the rate of postoperative complications (16.4% Vs. 7.7%, respectively) between the two groups. Wound infection was the most common complication. CONCLUSION: When regarding the minimal scar and invasiveness, single port laparoscopic appendectomy is feasible option for treating acute appendicitis. With accumulation of experiences and the development of instruments, additional studies are needed for the indications and advantages of single port surgery.

Radical Reresection for T2 Gallbladder Cancer Patients Diagnosed following Laparoscopic Cholecystectomy

PURPOSE: Despite advances in imaging techniques, laparoscopic cholecystectomy (LC) gives many advantages to some patients with suspected gallbladder cancer. The aim of this study was to investigate clinicopathological features and to analyze the risk factors of recurrence after radical reresection for T2 gallbladder cancer patients diagnosed following LC. METHODS: From January 2002 to December 2009, the data of 21 consecutive patients for radical reresection for T2 gallbladder cancer were reviewed, retrospectively. The significance of the variables for recurrence was examined by the Kaplan-Meier method and log-rank test followed by multivariate analyses using Cox's proportional hazard model. RESULTS: Of the 21 patients studied, 11 were men and 10 were women. Lymph node metastasis was present in 7 patients (33.4%). The 5-year survival rate and disease-free survival rate in those patients were 75.3% and 67.9%, respectively. In the univariate analysis, the male gender (P=0.0047), poorly differentiated tumor (P=0.0169), presence of lymph node metastasis (P=0.0012), presence of lymphovascular invasion (P=0.0259) and presence of perineural invasion (P=0.0096) were significant factors related to recurrence after radical reresection. In the multivariate analysis, the presence of lymph node metastasis was an independently significant factor (5-year disease free survival rate, 20.9% vs. 83.8% in the absence of lymph node metastasis; P=0.015). CONCLUSION: For patients with T2 gallbladder carcinoma diagnosed following LC, radical reresection is highly recommended and the presence of lymph node metastasis is an unfavorable prognostic factor that calls for additional treatment after radical surgery.

Short-term Oncologic Outcome of Curative Resection for Obstructive Colorectal Cancer Followed by Stent Insertion: Comparative Study with Non-abstructive Colorectal Cancer

PURPOSE: Recently, a self-expandable metallic stent has allowed an elective single-stage resection avoiding the risk of emergency operation and stoma formation in patients with obstructive colorectal cancer (CRC). But, forceful expansion of stent may increase the possibility of tumor cell exfoliation and dissemination through bowel lumen, lymphatic and blood vessels. Aim of study is to evaluate the short-term outcome of curative resection for obstructive colorectal cancer followed by stent in terms of oncologic safety. METHODS: Twenty-seven patients who underwent curative resection for obstructive CRC followed by stent insertion were included in 'stent group' and control group included 87 patients who underwent surgery for non-obstructive CRC. The clinicopathologic characteristics and prognosis were compared between two groups. RESULTS: There was no significant difference in clinicopathologic characteristics between two groups. No difference was found in postoperative complications between two groups. Overall survival rate of two groups showed no statistically significant differences (P=0.1254). Stage-matched survival rates (stage II & III) were also showed no differences between two groups. CONCLUSION: Stent insertion itself does not compromise the survival of patients with obstructive CRC. Oncologic safety of stent insertion for obstructive CRC is acceptable. A further large-scaled prospective study and long-term follow-up is necessary to evaluate the oncologic safety of stent insertion in obstructive CRC.

Initial Experience with Laparoscopic Surgery for Treating Upper Gastrointestinal Disease / 대한내시경복강경외과학회지

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.

Ileal Perforation Caused by Ingestion of Multiple Magnets

Ingestion of foreign bodies is a common clinical problem encountered in early childhood. But ingestion of multiple magnets can cause serious lethal complications. Magnets located within another bowel loop may attract each other across the intestinal walls, resulting pressure necrosis, bowel perforation, fistula formation, intestinal obstruction, and death. Clinicians who care for children should be aware of this unexpected risk of magnetic ingestion. We report a case of ileal perforation caused by ingestion of multiple magnets in a child.

The Prognostic Significance of the Preoperative Serum CEA, CA19-9 and AFP Levels in Gastric Cancer Patients

PURPOSE: No tumor-specific markers for gastric cancer are currently known, although various tumor markers have been utilized. CEA, CA19-9 and AFP are the most commonly used tumor markers for gastric cancer. The aim of this study is to evaluate the prognostic significance of the preoperative CEA, CA19-9 and AFP levels in patients with gastric cancer. METHODS: A total of 366 patients who underwent curative surgery for gastric cancer were analyzed. The clinicopathologic characteristics and disease-free survival rate of the patients were compared between the positive and negative CEA, CA19-9 and AFP groups of patients, respectively. Also, the prognostic significance of each tumor marker was assessed by multivariate analysis. RESULTS: The CEA, CA19-9 and AFP levels were elevated in 14.2%, 7.9% and 19.1% of the patients, respectively. Serosal invasion and advanced cancer were more frequently found in the groups of patients who were positive for CEA and CA19-9 (P<0.05). More lymph node metastasis and an advanced tumor stage were found in the group of patients who were positive for CA19-9 (P<0.05). On univariate analysis, the disease-free survival rate was significantly lower in the CA19-9 positive group (P<0.05). Serosal invasion and lymph node metastasis were the only significant prognostic factors on multivariate analysis. CONCLUSION: CEA, CA19-9 and AFP have proved unhelpful for the early detection of gastric cancer due to the low positive rate. CEA and AFP have no prognostic significance and only CA19-9 can be useful for estimating the severity of gastric cancer and as a limited prognostic factor for gastric cancer patients.

Development and Implementation of a Critical Pathway for Pediatric Inguinal Hernias

PURPOSE: Critical pathway (CP) refers to the standardized care process that predefines the treatment sequence and timing for a specific group of diseases and patients. The recent interest in CPs has increased as a quality improvement tool and a cost-effective delivery system for medical services. The authors applied a CP for pediatric inguinal hernias, and we investigated the cost effectiveness and also the satisfaction of the patients and the medical staff. METHODS: The CP was applied to 24 patients (the CP group) and the characteristics of the patients, the length of the hospital stay, the postoperative course, the medical costs and the results of the survey were compared with 26 other patients (the non-CP group). RESULTS: There was no difference in the patients' characteristics, the length of the hospital stay, the postoperative complications and the course of between the two groups. The cost for the medications, injections, treatments and examinations for the CP group were significantly lower than those for the non-CP group (P<0.05). The satisfaction of patients was significantly improved after the application of the CP (P<0.05), and the satisfaction of the medical staff was high. CONCLUSION: The application of a CP for pediatric inguinal hernia can save treatment-related medical costs. Moreover, the CP is an effective, excellent care process that improves the satisfaction of both the patients and the medical staff.

Clinicopathological Features and Prognostic Factors of T2 Gastric Cancer

PURPOSE: T2 gastric cancer is classified as advanced cancer, and defined as tumors invading into the muscularis propria or subserosa, but is limited within the gastric wall. The aim of this study was to evaluate the clinicopathological features and prognostic factors of T2 gastric cancer. METHODS: Out of 384 gastric cancer patients, 44 (11.5%), who underwent a gastrectomy for T2 gastric cancer, between January 2001 and December 2004 were analyzed. The clinicopathological features and prognostic factors were evaluated retrospectively. RESULTS: The male to female ratio was 3.4 to 1, with a mean age of 57 years. The most common lesion location was the lower one third of the stomach (63.6%). The median lesion size was 3.7 cm. Borrmann type II was the most common lesion gross type (52.3%) and a moderately differentiated carcinoma the most common histological type (36.4%). Lymph node metastasis was found in 19 patients (43.2%). According to the disease stage, the disease free survival rates were 92.9, 91.7, 66.7 and 0.0% in stages I, II, III and IV, respectively. From a univariate analysis, the tumor size and TNM stage were found to be significant prognostic factors for T2 gastric cancer. A further examination by multivariate analysis demonstrated that the TNM stage was the only significant prognostic factor. CONCLUSION: The TNM stage according to lymph node metastasis was the only significant prognostic factor for T2 gastric cancer. Extensive lymph node dissection should be performed to improve the disease free survival from T2 gastric cancer.

Chronic Colonic Pseudo-obstruction by Sporadic Degenerative Visceral Neuropathy

Chronic intestinal pseudo-obstruction is characterized by severe alteration to the intestinal motility, with clinical features that mimic those of a mechanical obstruction in the absence of any organic obstacle to the intestinal transit. The syndrome is induced by a disease of the muscle layer or intrinsic nerves. However, the sporadic degenerative non-inflammatory type of visceral neuropathy is rare. A 65-year-old woman was admitted to our institution due to chronic constipation and abdominal distention. She had a past history of admission due to repeated chronic constipation. An abdomen-pelvic CT revealed no evidence of an organic cause of the obstruction. Her colonic transit time was delayed. An anorectal manometry showed a normal rectoanal inhibitory reflex, but a decreased maximal pressure. A colon study revealed a pseudo-obstruction at the splenic flexure level. Her symptoms were not improved with conservative management; therefore, a subtotal colectomy was subsequently performed. The pathological diagnosis was that of sporadic degenerative non-inflammatory visceral neuropathy. The patient recovered uneventfully, and showed normal bowel movement during the follow-up period.