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
相比燃油拖拉机,电动拖拉机具有节能高效、绿色清洁的优点。分布式驱动电动拖拉机结构简单、控制维度多,能进一步提高电动拖拉机的工作效率和作业精度。但是电机检测转速噪声导致轮毂电机速度波动严重,复杂路面及多种作业工况下进一步...相比燃油拖拉机,电动拖拉机具有节能高效、绿色清洁的优点。分布式驱动电动拖拉机结构简单、控制维度多,能进一步提高电动拖拉机的工作效率和作业精度。但是电机检测转速噪声导致轮毂电机速度波动严重,复杂路面及多种作业工况下进一步加剧了上述问题,严重降低了拖拉机的作业质量。针对上述问题,该研究提出一种基于sigmoid滤波器的线性自抗扰控制(linear active disturbance rejection control,LADRC)以提高轮毂电机的转速稳定性和抗扰动能力。该控制策略在传统LADRC的基础上引入sigmoid滤波器至扩张状态观测器(extended state observer,ESO),根据输入噪声信号误差变化改变滤波器带宽,以抑制观测误差中的中高频干扰信号,同时避免滤波器积分环节对轮毂电机速度跟踪快速性的影响,具有较快的收敛性。搭建试验平台对所提出控制策略进行试验验证,结果表明:与传统LADRC策略相比,本文所提控制策略在变速和变载工况下的转速脉动分别减小了32%和41.67%,iq电流脉动分别减小了6.25%和4.17%,可在快速、准确跟踪给定转速的同时,大幅提高轮毂电机驱动系统的噪声抑制性能,为复杂环境下电动拖拉机高精度作业提供技术参考。展开更多
Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is ...Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is this the same presentation observed in fetuses? Objective: To describe the sigmoido-jugular junction in fetuses. Materials and Methods: Over a period of seven months, a histochemical and immunohistochemical study was conducted on 30 sigmoido-jugular junctions taken from 15 fetuses aged at least 32 weeks of gestation. These fetuses were obtained following expulsion due to intrauterine death, after informed consent from the parents. Results: Three portions can be identified: sigmoid, junctional, and jugular. Histochemical preparations revealed the existence of two constant layers and a third layer present only at the jugular level. From the inside out, the layers are as follows: 1) Inner Layer (Endothelium): This layer is clearer from the junction and reveals the presence of smooth muscle cells at the sigmoid level in immunohistochemistry. 2) Outer Layer: At the sigmoid and junctional levels, this layer consists of collagen fibers and becomes median at the jugular level, where it is composed of elastic and muscular collagen fibers. 3) Third Layer: Present only at the jugular level, this layer corresponds to the adventitia. Conclusion: The architecture of the sigmoido-jugular junction in fetuses, which is identical to that in adults, excludes the metaplastic hypothesis regarding endothelial smooth muscle cells in the sigmoid portion. Instead, it favors their role in regulating encephalic venous drainage.展开更多
BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial ...BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.展开更多
BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve tr...BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve trunks,with rarity in the gastrointestinal tract.Among gastrointestinal locations,the stomach harbors the majority of nerve sheath tumors,while such occurrences in the sigmoid colon are exceptionally infrequent.CASE SUMMARY This study presented a clinical case involving a 60-year-old female patient who,during colonoscopy,was diagnosed with a submucosal lesion that was later identified as a nerve sheath tumor.The patient underwent surgical resection,and the diagnosis was confirmed through immunohistochemistry.This study highlighted an exceptionally uncommon occurrence of a nerve sheath tumor in the sigmoid colon,which was effectively managed within our department.Additionally,a comprehensive review of relevant studies was conducted.CONCLUSION The preoperative diagnosis of nerve sheath tumors poses challenges,as the definitive diagnosis still relies on pathology and immunohistochemistry.Although categorized as benign,these tumors have the potential to demonstrate malignant behavior.Consequently,the optimal treatment approach entails the complete surgical excision of the tumor,ensuring the absence of residual lesions at the margins.展开更多
BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggres...BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggressive and infiltrative and has a high recurrence rate after surgery.Common sites for intra-abdominal AF are the small bowel mesentery,retroperitoneum,and pelvis.AF in the colon is extremely rare.CASE SUMMARY Here,we report the first case of sigmoid colon AF,which was accidentally discovered in a 27-year-old woman during laparoscopic myomectomy.Computed tomography confirmed a slightly enhanced mass in the sigmoid colon.Subsequent colonoscopy did not reveal a mass in the colonic lumen,but a suspected external compress was found in the sigmoid colon.Surgical disease involving a gastrointestinal stromal tumor was suspected.The patient underwent laparoscopic exploration,and sigmoidectomy with a negative margin was performed to excise the mass.Postoperative immunohistochemistry revealed that the mass was an AF.The patient recovered well and was recurrence-free at the 30-month follow-up without adjuvant therapy.CONCLUSION AF should be considered in the differential diagnosis of subepithelial colon masses.Radical resection alone can achieve good outcomes.展开更多
BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon iden...BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.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.
文摘相比燃油拖拉机,电动拖拉机具有节能高效、绿色清洁的优点。分布式驱动电动拖拉机结构简单、控制维度多,能进一步提高电动拖拉机的工作效率和作业精度。但是电机检测转速噪声导致轮毂电机速度波动严重,复杂路面及多种作业工况下进一步加剧了上述问题,严重降低了拖拉机的作业质量。针对上述问题,该研究提出一种基于sigmoid滤波器的线性自抗扰控制(linear active disturbance rejection control,LADRC)以提高轮毂电机的转速稳定性和抗扰动能力。该控制策略在传统LADRC的基础上引入sigmoid滤波器至扩张状态观测器(extended state observer,ESO),根据输入噪声信号误差变化改变滤波器带宽,以抑制观测误差中的中高频干扰信号,同时避免滤波器积分环节对轮毂电机速度跟踪快速性的影响,具有较快的收敛性。搭建试验平台对所提出控制策略进行试验验证,结果表明:与传统LADRC策略相比,本文所提控制策略在变速和变载工况下的转速脉动分别减小了32%和41.67%,iq电流脉动分别减小了6.25%和4.17%,可在快速、准确跟踪给定转速的同时,大幅提高轮毂电机驱动系统的噪声抑制性能,为复杂环境下电动拖拉机高精度作业提供技术参考。
文摘Context and Justification: The sigmoido-jugular junction connects two structures of different compositions and has a complex organization. The sinusoidal portion of its endothelium contains muscle cells in adults. Is this the same presentation observed in fetuses? Objective: To describe the sigmoido-jugular junction in fetuses. Materials and Methods: Over a period of seven months, a histochemical and immunohistochemical study was conducted on 30 sigmoido-jugular junctions taken from 15 fetuses aged at least 32 weeks of gestation. These fetuses were obtained following expulsion due to intrauterine death, after informed consent from the parents. Results: Three portions can be identified: sigmoid, junctional, and jugular. Histochemical preparations revealed the existence of two constant layers and a third layer present only at the jugular level. From the inside out, the layers are as follows: 1) Inner Layer (Endothelium): This layer is clearer from the junction and reveals the presence of smooth muscle cells at the sigmoid level in immunohistochemistry. 2) Outer Layer: At the sigmoid and junctional levels, this layer consists of collagen fibers and becomes median at the jugular level, where it is composed of elastic and muscular collagen fibers. 3) Third Layer: Present only at the jugular level, this layer corresponds to the adventitia. Conclusion: The architecture of the sigmoido-jugular junction in fetuses, which is identical to that in adults, excludes the metaplastic hypothesis regarding endothelial smooth muscle cells in the sigmoid portion. Instead, it favors their role in regulating encephalic venous drainage.
文摘BACKGROUND Rectal prolapse arises from benign etiology.When symptoms of internal intussusception mirror those of rectal prolapse,a misdiagnosis is possible,especially under limited clinical presentation.It is crucial to recognize and differentiate rectal prolapse from internal intussusception because the two diagnoses have different prognoses.Here,we describe a case of adult sigmoid intussusception presenting as rectal prolapse.CASE SUMMARY A 64-year-old woman with no known medical history visited a gastrointestinal outpatient department due to hard bloody stool defecation for 1 wk followed by constipation for 3 d.Colonoscopy revealed a huge polypoid ulcerated tumor at the sigmoid colon with lumen stenosis.The patient was admitted due to postprocedural dull abdominal pain.Due to failed colonoscopy reduction and stent insertion,the patient underwent sigmoid colon resection with primary end-to-end anastomosis,with the transverse colostomy pathological report showing adenocarcinoma,pT3N0M0.She recovered well from the operation and was discharged with regular outpatient clinic follow-up.CONCLUSION Presentation and manifestation of sigmoid intussusception may resemble that of rectal prolapse,necessitating careful observation due to distinct prognostic implications.
文摘BACKGROUND Schwannomas are uncommon tumors originating from Schwann cells,forming the neural sheath.They account for approximately 2%-6%of all mesenchymal tumors and are most commonly identified in peripheral nerve trunks,with rarity in the gastrointestinal tract.Among gastrointestinal locations,the stomach harbors the majority of nerve sheath tumors,while such occurrences in the sigmoid colon are exceptionally infrequent.CASE SUMMARY This study presented a clinical case involving a 60-year-old female patient who,during colonoscopy,was diagnosed with a submucosal lesion that was later identified as a nerve sheath tumor.The patient underwent surgical resection,and the diagnosis was confirmed through immunohistochemistry.This study highlighted an exceptionally uncommon occurrence of a nerve sheath tumor in the sigmoid colon,which was effectively managed within our department.Additionally,a comprehensive review of relevant studies was conducted.CONCLUSION The preoperative diagnosis of nerve sheath tumors poses challenges,as the definitive diagnosis still relies on pathology and immunohistochemistry.Although categorized as benign,these tumors have the potential to demonstrate malignant behavior.Consequently,the optimal treatment approach entails the complete surgical excision of the tumor,ensuring the absence of residual lesions at the margins.
基金Supported by Hangzhou Health Science and Technology Program,No.A20210271.
文摘BACKGROUND Aggressive fibromatosis(AF),also known as desmoid tumor or desmoid-type fibromatosis,is a rare soft tissue neoplasm that can occur in almost any part of the body.Although it is a benign disease,AF is aggressive and infiltrative and has a high recurrence rate after surgery.Common sites for intra-abdominal AF are the small bowel mesentery,retroperitoneum,and pelvis.AF in the colon is extremely rare.CASE SUMMARY Here,we report the first case of sigmoid colon AF,which was accidentally discovered in a 27-year-old woman during laparoscopic myomectomy.Computed tomography confirmed a slightly enhanced mass in the sigmoid colon.Subsequent colonoscopy did not reveal a mass in the colonic lumen,but a suspected external compress was found in the sigmoid colon.Surgical disease involving a gastrointestinal stromal tumor was suspected.The patient underwent laparoscopic exploration,and sigmoidectomy with a negative margin was performed to excise the mass.Postoperative immunohistochemistry revealed that the mass was an AF.The patient recovered well and was recurrence-free at the 30-month follow-up without adjuvant therapy.CONCLUSION AF should be considered in the differential diagnosis of subepithelial colon masses.Radical resection alone can achieve good outcomes.
文摘BACKGROUND The presence of a right-sided sigmoid colon is a rare anatomical variation usually discovered incidentally during surgical interventions.This case report details an unexpected right-sided sigmoid colon identified during a laparoscopic appendectomy and examines the pertinent literature to explore its clinical importance.CASE SUMMARY A 71-year-old woman presented with acute appendicitis.A preoperative computed tomography(CT)scan showed peri-appendiceal inflammation but no significant anatomical abnormalities.During laparoscopic surgery,an unexpected finding was encountered:The sigmoid colon was situated on the right side and exhibited an abnormal relationship with the cecum and ascending colon.Postoperative pathological examination confirmed appendicitis with no additional pathological findings.The right-sided sigmoid colon anomaly was verified through intraoperative assessment and later re-evaluation with CT and colonographic imaging.The patient underwent a laparoscopic appendectomy and experienced a smooth postoperative recovery.CONCLUSION This case highlights the necessity of being attentive to anatomical variations during laparoscopic surgery,particularly when managing appendicitis.A review of the literature indicated that the occurrence of a right-sided sigmoid colon is infrequent and may be associated with anomalies in midgut rotation during embryonic development.Awareness of this variation can help prevent surgical complications and inform future clinical practice.
