ABSTRACT
We present a patient with perforated diverticulitis contained within an inguinal hernia sac-a diagnostic and treatment dilemma. A 61-year-old man presented to the emergency department with left testicular and groin pain, and loose stool. CT imaging showed a left inguinal hernia containing a perforated segment of sigmoid colon. A segmental sigmoidcolectomyy and end colostomy Hartmannn's procedure) was performed after reducing the incarcerated inguinal contents. The inguinal hernia was not repaired because of faecal contamination of the hernia sac and risk for recurrence. Pathological examination of theresectedd bowel specimen showed perforated sigmoid diverticulitis in an inguinal hernia sac. The patient had an uneventful recovery and is awaiting definitive inguinal hernia repair andtakedownn of his colostomy.
Subject(s)
Abdominal Pain/diagnostic imaging , Colon, Sigmoid/surgery , Colostomy , Diverticulitis/surgery , Hernia, Inguinal/surgery , Intestinal Perforation/surgery , Scrotum/pathology , Abdominal Pain/etiology , Colon, Sigmoid/diagnostic imaging , Diverticulitis/diagnostic imaging , Hernia, Inguinal/diagnostic imaging , Humans , Intestinal Perforation/diagnostic imaging , Male , Middle Aged , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: The management of high-grade esophageal dysplasia has included surveillance, endoscopic ablative techniques, and esophagectomy. Herein we describe an alternative treatment, laparoscopic transgastric esophageal mucosal resection. METHODS: Laparoscopic transgastric esophageal mucosal resection was accomplished through an anterior gastrotomy. The mucosa was stripped from the Z-line to the proximal extent of the abnormal epithelium. The gastrotomy then was closed with a linear stapler, and a Nissen fundoplication was performed. RESULTS: Six patients with high-grade dysplasia of the distal esophagus underwent mucosal resection. After 4 to 7 years of endoscopic surveillance, all patients have regenerated squamous epithelium. One patient developed nondysplastic Barrett's esophagus after 2 years and was treated medically. Two strictures were treated successfully with dilatation. CONCLUSIONS: Laparoscopic transgastric esophageal mucosal resection was a reasonable treatment for high-grade dysplasia in this small sample of patients. This technique is a potential alternative treatment for high-grade dysplasia of the esophagus.
