BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagn...BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.展开更多
BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To c...BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.展开更多
BACKGROUND Peutz-Jeghers(PJ)syndrome(PJS)is a rare autosomal dominant genetic disease characterized by the association of intestinal polyposis,mucosal skin pigmen-tation,and cancer susceptibility.PJS patients have a s...BACKGROUND Peutz-Jeghers(PJ)syndrome(PJS)is a rare autosomal dominant genetic disease characterized by the association of intestinal polyposis,mucosal skin pigmen-tation,and cancer susceptibility.PJS patients have a significantly increased risk of malignant tumors in the gastrointestinal tract and extra-gastrointestinal tract,including various epithelial malignant tumors(colorectal cancer,gastric cancer,pancreatic cancer,breast cancer,and ovarian cancer,etc.).PJS is commonly seen in children and adolescents with multiple small intestinal polyps,often causing intussusception.CASE SUMMARY A 62-year-old male presented with intermittent left lower abdominal pain after drinking or consuming cold beverages that was accompanied by occasional hematochezia.Abdominal contrast-enhanced computed tomography indicated an isolated sigmoid colon grape-like lesion.Subsequently,the patient underwent la-paroscopic surgery,and the pathological diagnosis was PJ hamartomatous polyp.PJS was not considered at the initial visit,as the patient was older,and the facial pigmentation was not obvious.However,significant pigmentation was observed in the perineum during digital rectal examination.Interestingly,we observed that the patient exhibited nodular shadows in the adrenal glands computed tomo-graphy images that may be related to pigmentation.Therefore,we performed the determination of adrenal cortical hormones,but the results were not abnormal.Combined with skin and mucosal pigmentation and laboratory examinations,the patient was diagnosed with PJS.After laparoscopic sigmoid colon resection,the patient's symptoms improved,and no discomfort symptoms were reported in the later follow-up.CONCLUSION The age of onset and lesion location of this case are different from those of typical or isolated PJS patients.展开更多
This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initiall...This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.展开更多
BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcino...BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcinoma in a right-sided sigmoid colon revealed by a preoperative computed tomography(CT).CASE SUMMARY A 56-year-old Chinese man was admitted to the hospital with abdominal pain.CT revealed a redundant sigmoid colon with a mass on the right side of the cecum and ascending colon.Laparoscopy confirmed an abnormal course in the descending colon and sigmoid colon.Subsequently,hemicolectomy was performed in an open manner after laparoscopic exploration.Pathological examination revealed an infiltrative mucinous adenocarcinoma with two lymph node metastases.The patient was discharged without any complications after a week.There were no signs of recurrence or metastasis during the 3-month followup period.CONCLUSION We report a rare anomaly of a right-sided sigmoid colon with carcinoma,which should be differentiated from ascending colon cancer and pericecal hernia to prevent errors and other surgical complications.展开更多
文摘BACKGROUND Cecal and sigmoid volvulus during pregnancy are extremely rare.Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.AIM To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.METHODS A systematic review of human studies(PubMed,PubMedCentral,Google Scholar)up to October 2024 was conducted per PRISMA guidelines.Data on demographics,clinical features,diagnostics,treatment,and outcomes were analyzed.RESULTS Antepartum and postpartum volvulus occurred in 75.5%and 24.5%of cases,respectively,most commonly in the third trimester(70.3%).Nausea was less frequent and obstipation was more common in sigmoid volvulus(P=0.0004).Endoscopic detorsion was successful in 23.9%of sigmoid cases,with a mean gestational age of 33.5±3.5 weeks.Maternal mortality was 12.5%for cecal and 5.5%for sigmoid volvulus(P=0.103).While maternal mortality was unaffected by the timing of delivery relative to surgery,fetal mortality was significantly higher when the interval was<24 hours(52.9%vs 10.4%,P<0.001).Both maternal and fetal mortality declined over time.CONCLUSION Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus.Endoscopy was more often used in sigmoid cases.Gestational age and maternal age did not affect fetal outcomes.Earlier imaging and appropriate surgery were linked to lower mortality.Delay>24 hours between intervention and delivery increased fetal,but not maternal mortality.Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.
基金Supported by the Health Commission of Fuyang City,Anhui,China,No.FY2023-45Fuyang Municipal Science and Technology Bureau,Anhui,China,No.FK20245505+1 种基金Anhui Provincial Health Commission,No.AHWJ2023Baa20164Bengbu Medical University,No.2023byzd215.
文摘BACKGROUND Sigmoid colon cancer faces challenges due to anatomical diversity,including variable inferior mesenteric artery(IMA)branching and tumor localization complexities,which increase intraoperative risks.AIM To comprehensively evaluate the impact of three-dimensional(3D)visualization technology on enhancing surgical precision and safety,as well as optimizing perioperative outcomes in laparoscopic sigmoid cancer resection.METHODS A prospective cohort of 106 patients(January 2023 to December 2024)undergoing laparoscopic sigmoid cancer resection was divided into the 3D(n=55)group and the control(n=51)group.The 3D group underwent preoperative enhanced computed tomography reconstruction(3D Slicer 5.2.2&Mimics 19.0).3D reconstruction visualization navigation intraoperatively guided the following key steps:Tumor location,Toldt’s space dissection,IMA ligation level selection,regional lymph node dissection,and marginal artery preservation.Outcomes included operative parameters,lymph node yield,and recovery metrics.RESULTS The 3D group demonstrated a significantly shorter operative time(172.91±20.69 minutes vs 190.29±32.29 minutes;P=0.002),reduced blood loss(31.5±11.8 mL vs 44.1±23.4 mL,P=0.001),earlier postoperative flatus(2.23±0.54 days vs 2.53±0.61 days;P=0.013),shorter hospital length of stay(13.47±1.74 days vs 16.20±7.71 days;P=0.013),shorter postoperative length of stay(8.6±2.6 days vs 10.5±4.9 days;P=0.014),and earlier postoperative exhaust time(2.23±0.54 days vs 2.53±0.61 days;P=0.013).Furthermore,the 3D group exhibited a higher mean number of lymph nodes harvested(16.91±5.74 vs 14.45±5.66;P=0.030).CONCLUSION The 3D visualization technology effectively addresses sigmoid colon anatomical complexity through surgical navigation,improving procedural safety and efficiency.
基金Supported by Medical Science Research Program of Hebei Province,No.20250060.
文摘BACKGROUND Peutz-Jeghers(PJ)syndrome(PJS)is a rare autosomal dominant genetic disease characterized by the association of intestinal polyposis,mucosal skin pigmen-tation,and cancer susceptibility.PJS patients have a significantly increased risk of malignant tumors in the gastrointestinal tract and extra-gastrointestinal tract,including various epithelial malignant tumors(colorectal cancer,gastric cancer,pancreatic cancer,breast cancer,and ovarian cancer,etc.).PJS is commonly seen in children and adolescents with multiple small intestinal polyps,often causing intussusception.CASE SUMMARY A 62-year-old male presented with intermittent left lower abdominal pain after drinking or consuming cold beverages that was accompanied by occasional hematochezia.Abdominal contrast-enhanced computed tomography indicated an isolated sigmoid colon grape-like lesion.Subsequently,the patient underwent la-paroscopic surgery,and the pathological diagnosis was PJ hamartomatous polyp.PJS was not considered at the initial visit,as the patient was older,and the facial pigmentation was not obvious.However,significant pigmentation was observed in the perineum during digital rectal examination.Interestingly,we observed that the patient exhibited nodular shadows in the adrenal glands computed tomo-graphy images that may be related to pigmentation.Therefore,we performed the determination of adrenal cortical hormones,but the results were not abnormal.Combined with skin and mucosal pigmentation and laboratory examinations,the patient was diagnosed with PJS.After laparoscopic sigmoid colon resection,the patient's symptoms improved,and no discomfort symptoms were reported in the later follow-up.CONCLUSION The age of onset and lesion location of this case are different from those of typical or isolated PJS patients.
文摘This case reports a 63-year-old male patient who was admitted to the hospital due to the discovery of sigmoid colon protrusion during physical examination.EUS indicated submucosal lesions,and lymphangioma was initially considered.Colonoscopy revealed a 0-Is+Ⅱc type protrusion,with a smooth surface and visible dendritic vessels.The biopsy was tough.Auxiliary imaging showed no distant metastasis or obvious organ damage,and the laboratory test results were normal.The pathological confirmation after submucosal dissection was non-Hodgkin's small B-cell lymphoma(MALT lymphoma).Combining imaging,pathological and immunohistochemical analyses,this case emphasizes the precise sampling and classification strategy for submucosal masses in the digestive tract,suggesting that endoscopic biopsy is difficult to fully reflect submucosal infiltration and should be supplemented by EUS and large tissue sampling.In terms of treatment,based on the local lesion,pathological classification and the patient's overall condition,a strategy combining endoscopic dissection and subsequent chemotherapy is selected to achieve a balance between local control and systemic intervention.
文摘BACKGROUND A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery.Here,we report the first clinical case of a carcinoma in a right-sided sigmoid colon revealed by a preoperative computed tomography(CT).CASE SUMMARY A 56-year-old Chinese man was admitted to the hospital with abdominal pain.CT revealed a redundant sigmoid colon with a mass on the right side of the cecum and ascending colon.Laparoscopy confirmed an abnormal course in the descending colon and sigmoid colon.Subsequently,hemicolectomy was performed in an open manner after laparoscopic exploration.Pathological examination revealed an infiltrative mucinous adenocarcinoma with two lymph node metastases.The patient was discharged without any complications after a week.There were no signs of recurrence or metastasis during the 3-month followup period.CONCLUSION We report a rare anomaly of a right-sided sigmoid colon with carcinoma,which should be differentiated from ascending colon cancer and pericecal hernia to prevent errors and other surgical complications.
