Removal of a Giant Rectosigmoid Phytobezoar without Laparotomy.

Bezoars are the uncommon result of ingestion of indigestible or poorly digestible substances. Phytobezoars are the most common bezoars in children. Small bowel obstruction, especially of the terminal ileum, is the most common complication. Colonic obstruction is rare. Most reviewed intestinal phytobezoars with obstruction necessitate laparotomy with enterotomy. Here, we report a rare case of giant rectosigmoid phytobezoar with near-total colonic obstruction. Successfully, removal of this bezoar by an alternative way of fragmentation with colonoscopy, not conventional enterotomy is needed. The patient recovered well and then discharged without any morbidity 2 days later.

The use of table fixation staples to control massive presacral hemorrhage: a successful alternative treatment. Report of a case.

Management of presacral hemorrhage has always been a challenge for surgeons because such bleeding can rapidly destabilize a patient during pelvic surgery. Conventional hemostatic measures are often effective for arresting this type of hemorrhage, however, sometimes conventional measures make the problem worse. A number of alternative hemostatic techniques have been proposed. This case report describes a successful tamponade of presacral hemorrhage with a titanium table fixation staple and a cancellous bone graft fixed to the sacrum. The bleeding was stopped immediately and the patient recovered uneventfully. We think this is an effective alternative method for controlling massive hemorrhage from a large hole in presacral fascia.

Steel bar penetrating injury of rectum and vertebral body without severe morbidities: report of a case.

Although traumatic injuries to the rectum are not uncommon, they pose significant challenges to surgeons. Challenges relate to timely diagnosis, control of pelvic hemorrhage, multiplicity of associated injuries, difficulties in operative exposure, and prevention of sepsis. We report an unusual case of combined rectal and vertebral body penetrating injuries by a long rusty steel bar as a result of a falling accident. Successful treatment of this condition entailed removal of the bar, perineal and retroperitoneal drainage, and fecal diversion. The patient was discharged without neurologic, hemorrhagic, or intestinal morbidities 20 days later. Closure of colostomy was performed three months later uneventfully.

A modified Ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids with skin tags.

PURPOSE: We describe a modification of the Ferguson hemorrhoidectomy for circumferential prolapsed hemorrhoids. This details the operative procedure and compares the results of other radical methods in patients with circumferential hemorrhoidal disease. METHODS: A total of 738 patients (mean age, 43 (range, 19-83) years) were treated with our modified Ferguson method under sedative analgesia between 1989 and 2004: 576 patients had Grade III and 162 patients had Grade IV hemorrhoids, and 131 patients also had a partial lateral internal sphincterotomy to correct anal hypertonia. RESULTS: Postoperative bleeding occurred in 16 patients, 3 of whom required surgical hemostasis. Fecal impaction occurred in 11 patients and wound complications in 6 patients. Thirty-two patients needed bladder catheterization because of acute urinary retention. The median follow-up was 13.2 months in our outpatient department. One patient developed mild gas incontinence, five developed anal stenosis, and three had an anal fissure. Only three patients had recurrent skin tags, which did not affect their quality of life. CONCLUSIONS: Our modified Ferguson method represents a good choice for radical treatment of circumferential prolapsed hemorrhoids because it is easy to perform, has few complications, and provides satisfying results.

Clinical entity and treatment strategies for adult intussusceptions: 20 years' experience.

PURPOSE: Intestinal intussusception in adults is rare and the optimal management of this problem remains controversial. The purpose of this study was to determine the causes of intussusceptions in adults and to assess their treatment. METHODS: A retrospective review of patients older than aged 18 years who were diagnosed with intestinal intussusception at Tri-Service General Hospital between July 1984 and July 2004 was conducted. RESULTS: During the 20-year period, there were 292 patients with intussusception, 24 (8.2 percent) of which were adults. Abdominal pain was the most common presenting complaint (79.2 percent). The diagnosis of adult intussusception was made preoperatively in 18 cases (75 percent) and intraoperatively in 6 cases (25 percent). Of the 24 patients, 20 (83.3 percent) had a defined lesion; 11 (55 percent) lesions were benign and 9 (45 percent) were malignant. In eight patients (33.3 percent), the intussusception was reduced; perforation occurred in one patient (12.5 percent). Segmental resections were performed on 14 patients (58.3 percent), right hemicolectomies on 6 patients (25 percent), laparoscopic low anterior resection on 1 patient (4.2 percent), appendectomy on 1 patient (4.2 percent), and diverticulectomy on 1 patient (4.2 percent). Intraoperative colonoscopy was performed on three patients (12.5 percent) before reduction (lipomas were noted in 2 of the patients (66.7 percent) with limited resection of the ileum and preservation of the antireflux ileocecal valve. There was one perioperative mortality (4.2 percent) and seven postoperative morbidities (29.2 percent). CONCLUSIONS: Adult intussusception is an unusual and challenging condition and is a preoperative diagnostic problem. We discuss our 20 years of experience in treatment strategies for dealing with such unusual problems.

Ureteral obstruction caused by a duplicated anomaly of inferior vena cava.

Developmental anomalies of inferior vena cava are a rare cause of ureteral obstruction. We report a case that presented with right upper ureteral obstruction that radiologically simulated a retrocaval ureter. An aberrant vessel, which caused obstruction of the right ureter was identified at operation and surgical relief of ureteral obstruction was performed. Inferior venocavography was performed postoperatively and disclosed an unusual incomplete duplication of inferior vena cava. Our findings suggested that ureteral obstruction by incompletely duplicated anomaly of the inferior vena cava should be included in the differential diagnosis of extrinsic ureteral obstruction.