Annals of Coloproctology

Benign bowel disease

Colonic duplication in an adult with chronic constipation: a case report and review of its surgical management: Muhammad Ash-Shafhawi Adznan, Hizami Amin Tai, Aras Emre Canda, Nevra Elmas, Mustafa Cem Terzi; Ann Coloproctol. 2024;40(Suppl 1):S6-S10. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01081.0154

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Abstract PDF: One of the possible causes of chronic constipation is colonic duplication. Although seldom asymptomatic, its diagnosis is important due to the risk of malignancy that it carries. We present a case of a young female patient with long-standing constipation who was referred to Kolorektal Cerrahi Clinic (Izmir, Turkey) after scans revealed tubular type of colonic duplication. We successfully performed a laparoscopic total colectomy, and she recovered well. Identifying the type of duplication is important to ensure adequate resection and treatment. A proper workup, including carcinoembryonic antigen levels, must be done as well. Multiple surgical techniques and procedures have been introduced for this condition, but resection of the duplicated colon with its native lumen should be the management of choice, especially in tubular type of duplications such as in our case. In centers where laparoscopic services are available, laparoscopy could be a better option, as it provides multiple benefits of minimally invasive surgery. Attention should also be paid to anatomical details during surgery to ensure better results and outcomes.

Anorectal benign disease

Chronic fistula in ano associated with adenocarcinoma: a case report with a review of the literature: Nalini Kanta Ghosh, Ashok Kumar; Ann Coloproctol. 2024;40(Suppl 1):S1-S5. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.00752.0107

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Abstract PDF: The malignant transformation of chronic fistula in ano is rare, accounting for 3% to 11% of all anal canal malignancies. It results from long-standing inflammation and chronic irritation. No guidelines are available for the management of these cases. We herein present a case report of a 55-year-old man who presented with a history of constipation, perianal pain, and discharging fistula in ano of 4-year duration and underwent fistula surgery with recurrence. Biopsy of the fistulous tract revealed adenocarcinoma. He received neoadjuvant chemoradiotherapy, followed by abdominoperineal excision including excision of the fistulous tract. After 18 months of follow-up, he is free of recurrence. We present this case with a review of the literature, highlighting the management strategies.

Benign bowel disease

Strangulated internal hernia through a defect of the broad ligament: a case report of laparoscopic surgery: Ji Hyeong Song, Jin Soo Kim; Ann Coloproctol. 2024;40(Suppl 1):S44-S47. Published online April 27, 2023; DOI: https://doi.org/10.3393/ac.2022.00906.0129

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An internal hernia is defined as the protrusion of an internal organ through a defect in the abdominal cavity. Broad ligament hernia (BLH) is an extremely rare type of internal hernia that is difficult to diagnose preoperatively because the symptoms are nonspecific. However, early diagnosis is crucial, and early surgery is required to reduce complications such as strangulation. Laparoscopy has the advantage of enabling simultaneous diagnosis and treatment of BLH. With the advancement of the laparoscopic techniques, several cases of laparoscopic treatment of BLH have been reported. Nevertheless, open surgery is primarily performed in patients requiring bowel resection. We present a case of laparoscopic surgery for a strangulated internal hernia through a broad ligament defect. We successfully resected the strangulated small intestine and closed the defect of the broad ligament laparoscopically with a minor incision.

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Inflamed Appendix Protruding Through a Right Broad Ligament Defect: A Case Report
Elissavet Symeonidou, Ioannis Gkoutziotis, Maria S SidiropouIou, Chrysoula Gouta , Kalliopi Gianna , Konstantinos Mpallas
Cureus.2024;[Epub] CrossRef

Colorectal cancer

Neuroendocrine carcinoma associated with chronic ulcerative colitis: a case report and review of the literature: Yumi Yokota, Hiroyuki Anzai, Yuzo Nagai, Hirofumi Sonoda, Takahide Shinagawa, Yuichiro Yoshioka, Shinya Abe, Yuichiro Yokoyama, Hiroyuki Matsuzaki, Shigenobu Emoto, Koji Murono, Kazuhito Sasaki, Hiroaki Nozawa, Tetsuo Ushiku, Soichiro Ishihara; Ann Coloproctol. 2024;40(Suppl 1):S32-S37. Published online April 19, 2023; DOI: https://doi.org/10.3393/ac.2022.00801.0114

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Abstract PDF: Adenocarcinoma is a common histological type of ulcerative colitis-associated cancer (UCAC), whereas neuroendocrine carcinoma (NEC) is extremely rare. UCAC is generally diagnosed at an advanced stage, even with regular surveillance colonoscopy. A 41-year-old man with a 17-year history of UC began receiving surveillance colonoscopy at the age of 37 years; 2 years later, dysplasia was detected in the sigmoid colon, and he underwent colonoscopy every 3 to 6 months. Approximately 1.5 years thereafter, a flat adenocarcinoma lesion occurred in the rectum. Flat lesions with high-grade dysplasia were found in the sigmoid colon and surrounding area. The patient underwent laparoscopic total proctocolectomy and ileal pouch-anal anastomosis with ileostomy. Adenocarcinoma was diagnosed in the sigmoid colon and NEC in the rectum. One year postoperation, recurrence or metastasis was not evident. Regular surveillance colonoscopy is important in patients with long-term UC. A histological examination of UCAC might demonstrate NEC.

Colorectal cancer

Treatment of side limb full-thickness prolapse of the side-to-end coloanal anastomosis following intersphincteric resection: a case report and review of literature: Guglielmo Niccolò Piozzi, Krunal Khobragade, Seon Hui Shin, Jeong Min Choo, Seon Hahn Kim; Ann Coloproctol. 2024;40(Suppl 1):S38-S43. Published online February 8, 2023; DOI: https://doi.org/10.3393/ac.2022.00829.0118

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Intersphincteric resection (ISR) with coloanal anastomosis is an oncologically safe anus-preserving technique for very low-lying rectal cancers. Most studies focused on oncological and functional outcomes of ISR with very few evaluating long-term postoperative anorectal complications. Full-thickness prolapse of the neorectum is a relatively rare complication. This report presents the case of a 70-year-old woman presenting with full-thickness prolapse of the side limb of the side-to-end coloanal anastomosis occurring 2 weeks after the stoma closure and 2 months after a robotic partial ISR performed with the Da Vinci single-port platform. The anastomosis was revised through resection of the side limb and conversion of the side-to-end anastomosis into an end-to-end handsewn anastomosis with interrupted stitches. This study describes the first case of full-thickness prolapse of the side limb of the side-to-end handsewn coloanal anastomosis following ISR. Moreover, a revision of all reported cases of post-ISR full-thickness and mucosal prolapse was performed.

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International standardization and optimization group for intersphincteric resection (ISOG‐ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome
Guglielmo Niccolò Piozzi, Krunal Khobragade, Vusal Aliyev, Oktar Asoglu, Paolo Pietro Bianchi, Vlad‐Olimpiu Butiurca, William Tzu‐Liang Chen, Ju Yong Cheong, Gyu‐Seog Choi, Andrea Coratti, Quentin Denost, Yosuke Fukunaga, Emre Gorgun, Francesco Guerra, Ma
Colorectal Disease.2023; 25(9): 1896. CrossRef

Colorectal cancer

Melanocytic nevus of the anal canal and granular cell tumor of the cecum: a case report and literature review of 2 coincidentally co-occurring neurocristopathies: Victoria Sandoval, Jorge Lara-Endara, Javier Rodríguez-Suárez, Williams Arias Garzón, Ligia Redrobán, Nelson Montalvo; Ann Coloproctol. 2024;40(Suppl 1):S23-S26. Published online January 12, 2023; DOI: https://doi.org/10.3393/ac.2022.00444.0063

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Abstract PDF: Granular cell tumors are predominantly benign soft tissue tumors originating from Schwann cells, whereas melanocytic nevi are benign proliferations of melanocytes. We present the case of a patient with the presence of both entities located in the cecum and anal canal, respectively, constituting an extremely rare coincidental finding. A 43-year-old woman was evaluated by colonoscopy for iron-deficiency microcytic anemia that had lasted for 1 year. Colonoscopy demonstrated a macular lesion of 0.3 cm with a melanocytic appearance in the anal canal; at the cecum level, a subepithelial, yellowish, and partially mobile firm nodular lesion measuring 1.3 cm was observed. A histopathological study showed a melanocytic nevus in the anal canal and a granular cell tumor in the cecum. This is the first reported case of a patient with the extremely rare coincidental-incidental finding of these 2 entities at the same time.

Benign bowel disease

A case report of a giant solitary juvenile polyp: from obstructed defecation syndrome to incontinence: Zhan Huai Teoh, Jien Yen Soh, Nasibah Mohamad, Norzaliana Zawawi, Andee Dzulkarnaen Zakaria, Zaidi Zakaria, Michael Pak-Kai Wong; Ann Coloproctol. 2024;40(Suppl 1):S27-S31. Published online November 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00549.0078

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Abstract PDF: Juvenile polyps (JPs) are the most common polyps in pediatric patients. We present the case of an 18-year-old male patient with a giant solitary JP resembling solitary rectal ulcer syndrome (SRUS). The presenting history was rectal bleeding and symptoms of obstructed defecation syndrome. Colonoscopy revealed a polypoidal mass at the anorectal junction, with biopsy-confirmed SRUS. The symptoms worsened, and a protruding mass from the anus caused fecal incontinence. Pelvic magnetic resonance imaging showed a huge pedunculated mass occupying the low rectum with local compression of the urinary bladder. Transanal excision of the anal tumor was performed due to bleeding. A histopathological examination showed a JP with high-grade dysplasia. A histological examination to differentiate JPs and SRUS could be challenging based on a superficial forceps biopsy. Therefore, an excision biopsy is usually warranted with the understanding that adenomatous or malignant transformation is found in 5.6% to 12% of all JPs.

Metastasis

Peritoneal metastatic mixed adenoneuroendocrine carcinoma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report: Sungchul Lee, Euitae Kim, Dong-Guk Park; Ann Coloproctol. 2024;40(Suppl 1):S18-S22. Published online November 21, 2022; DOI: https://doi.org/10.3393/ac.2022.00339.0048

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A 61-year-old man presented with abdominal distension without any symptoms. On colonoscopy and computed tomography findings, it was clinically diagnosed as peritoneal metastasis of sigmoid colon cancer, and diagnostic laparoscopy was performed. Only the peritoneum was partially resected, and the pathology was signet ring cell carcinoma with predominantly local mucinous carcinoma component. However, the patient complained of persistent symptoms and, despite the progress of chemotherapy, the peritoneal dissemination worsened, and additional cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) was performed. Mixed adenoneuroendocrine carcinomas (MANECs) were reported in the appendix with perforated visceral peritoneum. After additional chemotherapy, the patient was discharged. Patients with advanced MANEC with peritoneal spreading may benefit from aggressive treatment by cytoreduction surgery with HIPEC, followed by intravenous chemotherapy.

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Mixed neuroendocrine non-neuroendocrine neoplasms in gastroenteropancreatic tract
Sebastián Díaz-López, Jerónimo Jiménez-Castro, Carlos Enrique Robles-Barraza, Carlos Ayala-de Miguel, Manuel Chaves-Conde
World Journal of Gastrointestinal Oncology.2024; 16(4): 1166. CrossRef

Rare disease & stoma

A small, low-grade rectal neuroendocrine tumor with lateral pelvic lymph node metastasis: a case report: Seonhui Shin, Young-In Maeng, Seyun Jung, Chun-Seok Yang; Ann Coloproctol. 2022;38(4):327-331. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00899.0128

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Rectal neuroendocrine tumors (NETs) are typically small lesions that are confined to the submucosa and have favorable behavior at the time of diagnosis. Local endoscopic or surgical resection is recommended because lymph node metastasis is very rare. In this report, we present the case of a 36-year-old male presenting with an incidentally found rectal mass during screening colonoscopy. Pathologic examination of the primary tumor revealed a 9-mm grade 1 NET with submucosal invasion and no significant aggressive factors except for central ulceration. However, radiologic studies revealed a suspected 2.6-cm mesorectal lymph node metastasis and multiple left internal iliac lymph node metastases. We performed laparoscopic intersphincteric resection with left lateral pelvic lymph node dissection. The final pathologic report revealed a metastatic lymph node with low grade, low mitotic count, and low Ki-67 index. We describe an overview of lymph node metastasis of rectal NETs focusing on lateral pelvic lymph node metastasis.

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Successfully Resected Isolated Lateral Lymph Node Recurrence in a Patient with T1 Lower Rectal Cancer: Case Report and Literature Review
Kazuma Rifu, Koji Koinuma, Hisanaga Horie, Katsusuke Mori, Daishi Naoi, Mineyuki Tojo, Yuko Homma, Satoshi Murahashi, Atsushi Kihara, Toshiki Mimura, Joji Kitayama, Naohiro Sata
Journal of the Anus, Rectum and Colon.2024; 8(3): 259. CrossRef
Risk factors for and prognostic impact of lateral pelvic lymph node metastasis in patients with rectal neuroendocrine tumors: a single-center retrospective analysis of 214 cases with radical resection
Tsubasa Sakurai, Y. Hiyoshi, N. Daitoku, S. Matsui, T. Mukai, T. Nagasaki, T. Yamaguchi, T. Akiyoshi, H. Kawachi, Y. Fukunaga
Surgery Today.2024;[Epub] CrossRef
Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Multiple rectal neuroendocrine tumors: An analysis of 15 cases and literature review
Shu Pang, Ye Zong, Kun Zhang, Haiying Zhao, Yongjun Wang, Junxiong Wang, Chuntao Liu, Yongdong Wu, Peng Li
Frontiers in Oncology.2022;[Epub] CrossRef

Malignant disease,Rare disease & stoma

Outcomes of surgical management of buschke-lowenstein tumor in a Philippine tertiary hospital: Sofia Isabel T. Manlubatan, Mark Augustine S. Onglao, Mayou Martin T. Tampo, Marc Paul J. Lopez; Ann Coloproctol. 2022;38(1):82-87. Published online February 23, 2022; DOI: https://doi.org/10.3393/ac.2020.00731.0104

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Buschke-Lowenstein tumor (BLT) is a sexually transmitted infection (STI) caused by the human papillomavirus. This study investigated the profile, management, and outcomes of patients who underwent surgery for BLT from 2015 to 2019 at the Philippine General Hospital. Seven patients underwent surgery for BLT. All were male, with ages ranging from 21 to 41 years. Presenting symptoms were anal mass, foul-smelling discharge, pain, bleeding, and pruritus. All were positive for human immunodeficiency virus. All admitted to having engaged in both insertive and receptive anal intercourse, with multiple partners. All underwent excision with healing by secondary intention. Two had recurrence of warts. Four had an anal stricture. Of these, 3 underwent anal dilatation, while 1 had to undergo proximal bowel diversion. One had intraepithelial carcinoma without dermal invasion on histopathologic analysis. BLT is a rare STI characterized by local aggressiveness but with low malignant potential. Wide excision remains to be the mainstay of treatment.

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Sex Steroid Modulators and the Development of Buschke-Lowenstein Tumor: A Case Report of an Immunocompetent Patient
Paige Stratton , Vithal Vernenkar, Aeryn J Fulton, Varun Soti
Cureus.2023;[Epub] CrossRef

Benign bowel disease

Perioperative considerations for acute appendicitis in patients with COVID-19 infection: two case reports: In-Kyeong Kim, Seung-jin Kwag, Han-Gil Kim, Young-Tae Ju, Seung-Jun Lee, Tae-Jin Park, Sang-Ho Jeong, Eun-Jung Jung, Jin-Kwon Lee; Ann Coloproctol. 2023;39(6):521-525. Published online December 7, 2021; DOI: https://doi.org/10.3393/ac.2021.00647.0092

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Abstract PDF: We report considerations related with surgery through 2 cases of acute apendicitis with COVID-19 infection. In November and December 2020, two patients infected with COVID-19 developed acute apendicitis and underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with acute apendicitis on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was a 69-year-old male patient with pneumonia treated with antibiotics, steroids and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform appendectomy in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if acute apendicitis is suspected. If the patient has pneumonia before surgery, it can get worse after surgery, and complications such as wound infections can occur.

Benign bowel disease

Recurrent perianal abscess in a patient with Hermansky-Pudlak syndrome–associated granulomatous colitis: a case report: Ahmet Omak, Tevfik Kıvılcım Uprak, Wafi Attaallah; Ann Coloproctol. 2024;40(Suppl 1):S11-S14. Published online November 19, 2021; DOI: https://doi.org/10.3393/ac.2021.00437.0062

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Abstract PDF: Hermansky-Pudlak syndrome (HPS) is a rare genetic disease consisting of the triad of oculocutaneous albinism, bleeding diathesis, and pigmented reticuloendothelial cells. In HPS patients’ granulomatous colitis could be an additional feature and perianal abscess could be seen in such patients. We report a patient with HPS-associated granulomatous colitis, refractory to medical treatment, and perianal involvement. Patients with HPS-associated granulomatous colitis and perianal involvement may require multiple surgical interventions and there is no consensus yet for treatment in such patients.

Benign bowel disease

A case report of impacted fecalith within mucosal pouch: an unusual cause of colocolic intussusception: Douglas Greer, Adrian Fernandez; Ann Coloproctol. 2024;40(Suppl 1):S15-S17. Published online November 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00724.0103

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Abstract PDF: Intussusception involving the colon is unusual in adults and when present is managed with resection due to the risk of malignancy. We present an unusual case where the intussusceptum was impacted stool in a mucosal pouch in the transverse colon. The patient presented with bleeding per rectum and abdominal pain and was found to have a colocolic intussusception on computed tomography. Colonoscopy showed an ulcerated mass in the transverse colon. A laparoscopic right hemicolectomy was performed. Histopathology demonstrated known chronic lymphocytic leukemia, but not solid malignancy. A large fecalith impacted within a mucosal pouch had acted as the lead point. This represents a highly unusual but benign cause of intussusception.

A rare presentation of low-grade appendiceal mucinous neoplasm within an amyand’s hernia: a case report: Hani Atiqah Saim, Ian Chik, Fahrol Fahmy Jaafar, Zamri Zuhdi, Razman Jarmin, Azlanudin Azman; Ann Coloproctol. 2023;39(2):183-187. Published online October 18, 2021; DOI: https://doi.org/10.3393/ac.2021.00430.0061

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An Amyand’s hernia is characterised as the presence of the appendix in an inguinal hernial sac. During laparoscopic cholecystectomy for gallbladder polyps, an incidental Amyand’s hernia was discovered in a 75-year-old female patient. On examination, the hernia contained an appendiceal mucocele but no evidence of perforation. An open appendicectomy with tension-free mesh repair was performed for the hernia. The histopathological report of the appendix was a low-grade appendiceal mucinous neoplasm (LAMN), an entity that is just as rare as an Amyand’s hernia. The patient had the right inguinal swelling for over 10 years but it was thought to be an inguinal intramuscular cyst as reported on a previous abdominal ultrasound. Mucocele of the appendix may have a benign or malignant appendiceal progress, leading to individualised diagnosis and treatment. We review an Amyand’s hernia with LAMN and discuss the asymptomatic tendency yet malignant potential of appendiceal mucoceles along with treatment strategies.

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Complicated Appendicitis Associated With Appendiceal Mucinous Neoplasm Within Amyand’s Hernia in a Patient With Previous Hernia Repair: A Case Report and Literature Review
Carlos A Navarro-Castañeda, Luis A Pérez-Silva, Rubén A Sandoval-Barba, Nubia A Ramírez-Buensuceso-Conde, Jorge Farell-Rivas
Cureus.2024;[Epub] CrossRef

Benign bowel disease

A case report of a colouterine fistula treatment: when the patient chooses the steeplechase: Stefano Pontone, Pier Giorgio Nardis, Chiara Eberspacher, Domenico Mascagni; Ann Coloproctol. 2023;39(4):366-370. Published online August 9, 2021; DOI: https://doi.org/10.3393/ac.2021.00318.0045

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Abstract PDF: Colouterine fistula is a rare disease that is primarily treated using surgical approaches. Although invasive surgery is controversial in terms of techniques and results, minimally invasive endoscopic treatments have not been widely described. However, because it is rare for these fistulas to close spontaneously, surgical treatment is often mandatory. Appropriate management of colouterine fistula is complicated, especially when the patient refuses surgery. In this case study, we provide the first description of a minimally invasive endoscopic treatment of an iatrogenic colouterine fistula using a self-expandable metallic stent after an over-the-scope clip malposition.

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