Rectoseminal vesicle fistula after radical surgery for rectal cancer: Four case reports and a literature review.

BACKGROUND: A rectoseminal vesicle fistula (RSVF) is a rare complication after anterior or low anterior proctectomy for rectal cancer mainly due to anastomotic leakage (AL). Limited literature documenting this rare complication is available. We report four such cases and review the literature to investigate the etiology, clinical manifestations, and the diagnostic and treatment methods of RSVF in order to provide greater insight into this disorder. CASE SUMMARY: Four cases of RSVF were presented and summarized, and a further 12 cases selected from the literature were discussed. The main clinical symptoms in these patients were pneumaturia, fever, scrotal swelling and pain, anal pain, orchitis, diarrhea, dysuria, epididymitis and fecaluria. Imaging methods such as pelvic X-ray, computed tomography (CT), sinus radiography, barium enema and other techniques confirmed the diagnosis. CT was the imaging modality of choice. In cases presenting with reduced levels of AL, minimal surrounding inflammation, and controlled infection, the RSVF was conservatively treated by urethral catheterization, antibiotics administration and parenteral nutrition. In cases of severe RSVF, incision and drainage of the abscess or fistula and urinary or fecal diversion surgery successfully resolved the fistula. CONCLUSION: This study provides an extensive analysis of RSVF, and outlines, summarizes and examines the causes, clinical manifestations, diagnostic procedures and treatment options, in order to prevent misdiagnosis and treatment errors.

Laparoscopic Low Anterior Resection of the Rectum with Transanal Prolapsing Specimen Extraction: Early Experience with 23 Patients.

OBJECTIVE: For laparoscopic low anterior resection of the rectum, a small additional incision is needed to extract the specimen. We describe an adjustment technique, which inserted the anvil and extracted the specimen through transanal pathway. METHODS: Between July 2010 and July 2012, 23 patients underwent laparoscopic rectal surgery with transanal anvil insertion and transanal prolapsing specimen extraction. All perioperative data and short-term outcomes were recorded in a database. RESULTS: The mean patient age was 61.3 years (range 47-68 years). Of the 23 patients, 17 underwent resection for rectal carcinoma and 6 had tubulovillous adenomas. No intraoperative complications occurred. The mean operative time was 137 minutes (range 118-170 minutes). The distal margins, circumferential resection margins, and lymph node dissections were oncologically adequate for all malignancies. One patient experienced anastomotic leakage (4.3%), treated conservatively. One male patient with benign prostatic hyperplasia suffered from postoperative urinary retention. The average postoperative hospital stay was 11.3 days (range 7-21 days). No patients experienced anal dysfunction. At a median follow-up of 26 months, there were no tumor recurrences. CONCLUSION: The technique of transanal prolapsing specimen extraction for laparoscopic low anterior resection of the rectum is feasible and safe for selected patients.

[Expression and significance of RECK, metalloproteinase-9 and vascular endothelial growth factor-C in colorectal cancer].

OBJECTIVE: To investigate the expression of reversion-inducing cysteine-rich protein with Kazal motifs (RECK), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-C (VEGF-C) in colorectal cancer. METHODS: S-P immunohistochemistry was used to detect the expression of RECK, MMP-9 and VEGF-C in colorectal cancer specimen. Colorectal mucosal tissue at least 10 cm away from the tumor was used as control. RESULTS: The positive expression of RECK in colorectal cancer was significantly lower than that in the controls(53.3% vs. 100%, P<0.05). Both MMP-9 and VEGF-C were over expressed compared with the controls(86.7% vs. 23.3% and 71.7% vs. 13.3% respectively, P<0.01). The expression of RECK was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C. There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, and TNM staging (all P<0.05). CONCLUSIONS: RECK expression is low in colorectal cancer, while MMP-9 and VEGF-C expressions are high. Combined testing of these 3 markers is important in the evaluation of tumor metastasis and invasion, and is helpful in the prediction of the prognosis.

Ileum perforation due to delayed operation in obturator hernia: a case report and review of literatures.

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h. The pain localized over the periumbilical area with radiation along the medial side of the thigh. Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately, her family refused surgery because of her worsening condition. On the third evening after admission, the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy. Bowel resection and an end-ileostomy were performed. She recovered well despite of the complication of multiple organ dysfunction syndrome. Literature is reviewed, and the pathogenesis, clinical manifestation, imaging features and treatment are discussed.

Clinicopathological characteristics of advanced colorectal cancer 30 mm or smaller in diameter.

OBJECTIVE: To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter. METHODS: Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D. RESULTS: The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases. CONCLUSIONS: Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.

Submucous colon lipoma: a case report and review of the literature.

Colon lipoma is remarkably rare in clinical practice. We reported a case of ascending colon lipoma in an 83-year-old woman. She was asymptomatic with a lipoma of 35 mm x 30 mm x 24 mm in size which was found by routine colonoscopy. Right hemicolectomy was performed uneventfully. The diagnosis was made by histological examination. Reviewing the literature and combining with our experience, we discussed the clinical features, diagnosis and treatment of this uncommon disease.