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Emergency laparoscopic closure of rectosigmoid perforation, following a diagnostic colonoscopy
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a p o l l o m e d i c i n e 1 2 s ( 2 0 1 5 ) S10–S29
shorter learning curve, fewer complications with less cost and can be done as day care procedure in selected patients. http://dx.doi.org/10.1016/j.apme.2015.11.062 TAMIS – An alternative to TEMS Rauf A. Wani 1 , N.A. Chowdri 2 , Fazl Q. Parray 2 1
Department of Colorectal Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India 2 Professor, Department of Colorectal Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India Aims and objectives: Transanal endoscopic surgery is especially useful in villous adenoma and early T1 carcinoma of lower rectum. However, it requires special equipment which is not available everywhere. Material and methods: 9 patients of villous adenoma with dysplasia and early rectal carcinoma were subjected to Transanal Minimally Invasive Surgery using SILS port. Results: The tumor was excised in total in all 9 cases. The was no operative complication. 1 patient developed recurrence on follow-up which was again managed by TAMIS. Conclusion: TAMIS is a safe procedure in experienced hands and can be used in place of TEMS. http://dx.doi.org/10.1016/j.apme.2015.11.063 Rare case of intussusception in adult due to colonic lipoma Reshma Bhoir, Lisha Suraj, S. Pani, Prashant Sawarkar Department of General Surgery, MGM Hospital and University of Health Sciences, Kamothe, India Colonic lipomas are uncommon tumours of the gastrointestinal tract. Most of these tumours are asymptomatic and usually detected incidentally during colonoscopy or laparotomy. Gastro-intestinal lipomas are rare and pose a diagnostic challenge. Accurate preoperative diagnosis of colonic lipoma often becomes difficult, although new imaging techniques are available, these lesions are frequently diagnosed by laparotomy and definitive diagnosis is made on basis of histopathological exam. Large lipomas are usually symptomatic and may mimic clinic manifestations of colonic carcinoma. Here, we report two cases of colonic lipoma in adults presenting as intussusception. Patients were in their sixth decade of life presented with complaints of pain in abdomen and constipation and bleeding per rectum. On examination, there was a palpable lump. Investigations were showing intussusception and patient underwent laparotomy, intraoperative there was colo-colic intussusception with a mass being at the lead point, wide local resection with ileo-transverse anastomosis was done. Histopathology was suggestive of lipoma. http://dx.doi.org/10.1016/j.apme.2015.11.064
Emergency laparoscopic closure of rectosigmoid perforation, following a diagnostic colonoscopy Rohit Dama, Rabela Pradeep, G.V. Rao, D.N. Reddy Asian Institute of Gastroenterology, Hyderabad, India Aims and objectives: Perforation during colonoscopy although uncommon, is a difficult clinical scenario to manage. For an elective out patient procedure, the sudden need for exploratory laparotomy for perforation closure and potential chance of diversion stoma, is difficult pill to swallow for the patient and his relatives. A minimal invasive surgical option for perforation closure can be handy in such a clinical scenario. We present a video of laparoscopic closure of rectosigmoid perforation. Material and methods: A middle aged lady who had colonoscopic perforation, underwent emergency laparoscopic lavage and primary closure of the rectosigmoid perforation without the need of any diversion stoma. One 10 mm and three 5 mm ports used. Results: The operative time was about 40 min. The patient recovered uneventfully in the post operative period and was discharged on day 5 after oral feeds and drain removal. Conclusions: Immediate laparoscopic closure of colonoscopy induced perforation is feasible and safe surgical option. Diversion stoma in most of the cases is not required as the colon is already prepared for colonoscopy, and there is minimal contamination. This should be the gold standard in management of colonoscopy induced perforations. http://dx.doi.org/10.1016/j.apme.2015.11.065 A rare case of synchronous colorectal cancer in a patient of attenuated variant of familial adenomatous polyposis Rohit Kumar Gohil Familial adenomatous polyposis is an inherited disorder with numerous polyps in the epithelium of large intestine with high malignant potential. Its prevalence is of 2–3 per 100,000 population. 3 variants of FAP has been described in literature1 FAP 2 Attenuated variant of FAP 3 MYH associated FAP 1 in 25 cases of diagnosed colorectal cancer has a synchronous lesion. I am going to present a case of 53-year-old female presented to the emergency department with the feature of acute intestinal obstruction with prior history of intermittent episode of subacute intestinal obstruction and bleeding per rectum. Exploratory laparotomy revealed two tumours; one involving the caecum and the other at recto sigmoid region. Total colectomy done with end ileostomy. On gross examination of the
a p o l l o m e d i c i n e 1 2 s ( 2 0 1 5 ) S10–S29
shorter learning curve, fewer complications with less cost and can be done as day care procedure in selected patients. http://dx.doi.org/10.1016/j.apme.2015.11.062 TAMIS – An alternative to TEMS Rauf A. Wani 1 , N.A. Chowdri 2 , Fazl Q. Parray 2 1
Department of Colorectal Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India 2 Professor, Department of Colorectal Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India Aims and objectives: Transanal endoscopic surgery is especially useful in villous adenoma and early T1 carcinoma of lower rectum. However, it requires special equipment which is not available everywhere. Material and methods: 9 patients of villous adenoma with dysplasia and early rectal carcinoma were subjected to Transanal Minimally Invasive Surgery using SILS port. Results: The tumor was excised in total in all 9 cases. The was no operative complication. 1 patient developed recurrence on follow-up which was again managed by TAMIS. Conclusion: TAMIS is a safe procedure in experienced hands and can be used in place of TEMS. http://dx.doi.org/10.1016/j.apme.2015.11.063 Rare case of intussusception in adult due to colonic lipoma Reshma Bhoir, Lisha Suraj, S. Pani, Prashant Sawarkar Department of General Surgery, MGM Hospital and University of Health Sciences, Kamothe, India Colonic lipomas are uncommon tumours of the gastrointestinal tract. Most of these tumours are asymptomatic and usually detected incidentally during colonoscopy or laparotomy. Gastro-intestinal lipomas are rare and pose a diagnostic challenge. Accurate preoperative diagnosis of colonic lipoma often becomes difficult, although new imaging techniques are available, these lesions are frequently diagnosed by laparotomy and definitive diagnosis is made on basis of histopathological exam. Large lipomas are usually symptomatic and may mimic clinic manifestations of colonic carcinoma. Here, we report two cases of colonic lipoma in adults presenting as intussusception. Patients were in their sixth decade of life presented with complaints of pain in abdomen and constipation and bleeding per rectum. On examination, there was a palpable lump. Investigations were showing intussusception and patient underwent laparotomy, intraoperative there was colo-colic intussusception with a mass being at the lead point, wide local resection with ileo-transverse anastomosis was done. Histopathology was suggestive of lipoma. http://dx.doi.org/10.1016/j.apme.2015.11.064
Emergency laparoscopic closure of rectosigmoid perforation, following a diagnostic colonoscopy Rohit Dama, Rabela Pradeep, G.V. Rao, D.N. Reddy Asian Institute of Gastroenterology, Hyderabad, India Aims and objectives: Perforation during colonoscopy although uncommon, is a difficult clinical scenario to manage. For an elective out patient procedure, the sudden need for exploratory laparotomy for perforation closure and potential chance of diversion stoma, is difficult pill to swallow for the patient and his relatives. A minimal invasive surgical option for perforation closure can be handy in such a clinical scenario. We present a video of laparoscopic closure of rectosigmoid perforation. Material and methods: A middle aged lady who had colonoscopic perforation, underwent emergency laparoscopic lavage and primary closure of the rectosigmoid perforation without the need of any diversion stoma. One 10 mm and three 5 mm ports used. Results: The operative time was about 40 min. The patient recovered uneventfully in the post operative period and was discharged on day 5 after oral feeds and drain removal. Conclusions: Immediate laparoscopic closure of colonoscopy induced perforation is feasible and safe surgical option. Diversion stoma in most of the cases is not required as the colon is already prepared for colonoscopy, and there is minimal contamination. This should be the gold standard in management of colonoscopy induced perforations. http://dx.doi.org/10.1016/j.apme.2015.11.065 A rare case of synchronous colorectal cancer in a patient of attenuated variant of familial adenomatous polyposis Rohit Kumar Gohil Familial adenomatous polyposis is an inherited disorder with numerous polyps in the epithelium of large intestine with high malignant potential. Its prevalence is of 2–3 per 100,000 population. 3 variants of FAP has been described in literature1 FAP 2 Attenuated variant of FAP 3 MYH associated FAP 1 in 25 cases of diagnosed colorectal cancer has a synchronous lesion. I am going to present a case of 53-year-old female presented to the emergency department with the feature of acute intestinal obstruction with prior history of intermittent episode of subacute intestinal obstruction and bleeding per rectum. Exploratory laparotomy revealed two tumours; one involving the caecum and the other at recto sigmoid region. Total colectomy done with end ileostomy. On gross examination of the