A rare case of medullary carcinoma of the colon presenting as intussusception in an adult with rectal bleeding.

Medullary carcinoma is a recently recognized rare subtype of colorectal cancer resembling both poorly differentiated adenocarcinoma and neuroendocrine tumors. Medullary carcinoma most commonly presents in the proximal colon and can be differentiated from other right-sided malignant lesions by histology and immunochemical markers. We present here a rare case of an adult patient with rectal bleeding who was found to have an intussusception due to underlying medullary carcinoma of the splenic flexure. A 72-year-old woman presented to our GI clinic with rectal bleeding. Colonoscopy revealed a necrotic mass of the sigmoid colon, later determined by CT to be a colo-colonic intussusception at the level of the splenic flexure. Patient underwent diagnostic laparoscopy with findings of a large splenic flexure mass, which was resected and found to be medullary carcinoma of the colon. The tumor was poorly differentiated and exhibited microsatellite instability but was discovered at an early stage and thus did not require any adjuvant chemotherapy. Unlike most previously reported cases of medullary carcinoma, our patient presented with a left sided tumor. To our knowledge, this is the first report of a medullary colon cancer presenting with intussusception.

Transgastric synthetic mesh migration, 9 years after liver resection.

Complications of synthetic mesh have been described in various hernia procedures including migration and erosion, but no previous report mentions this complication after liver resection. This case describes a patient who had undergone a left hepatic resection with mesh pledgets sutured along the cut edge of the liver. He remained complication-free until nine years later when he presented with weight loss and early satiety, and endoscopy revealed mesh within the lumen of the stomach. While still attached to the liver, the mesh had eroded into the lumen of the stomach and he ultimately required surgery to remove this. The use of synthetic mesh in hepatectomies and other abdominal procedures may require further consideration by surgeons regarding its relatively unknown tendency for migration and erosion.

Epidemiology of jellyfish stings presented to an American urban emergency department.

INTRODUCTION: Cnidarian, or jellyfish, stings are a common malady in tropical Emergency Departments. There are limited studies examining cnidarian stings in the United States. The team investigated the epidemiology and treatments for jellyfish stings presenting to an urban emergency department (ED) in Honolulu, Hawai'i. METHODS: The team performed a retrospective chart analysis of stings presented between 2000 and 2008. A total of 116 patients were identified. Charts were reviewed for patient demographics, incident characteristics, patient arrival condition, and treatments given in the emergency department. RESULTS: The median age was 24 years (range 9-85). Of patients 58% were men, 64% were Hawai'i non-residents, and 23 % arrived between the hours of 10pm and 2 am. Emergency Medical System transported 64%, and 65% arrived with normal vital signs. Twenty-four different types of IV/PO medications were administered and patients received up to 5 different medications per visit. Intravenous medications were given to 64%. All patients were eventually discharged home from the ED. DISCUSSION: Risk factors for cnidarian stings include being men, being a Hawai'i non-resident, and nighttime ocean activities. Stings were treated with various medications and routes suggesting that there is no current standard of care for stings. This study suggests that there is a need for public health interventions tailored to tourists. Prevention and education of home treatment could decrease the cost of health care by decreasing ambulance transports and total number of ED visits for a non-urgent disease.