secondary anastomosis after
sigmoid colon resection for perforated diverticulitis (Hinchey Stage III and IV).
Total Total number of patients 29 Age (years) 74 (46-85) Gender, n, (%) Male 14 (48%) Female 15 (52%) Tumor size (mm) 28 (11-89) Tumor location, n (%) Cecum 4 (14%) Transverse colon 2 (7%)
Sigmoid colon 6 (21%) Rectum 17 (59%) Macroscopic type, n, (%) Sessile 10 (34%) LST-G 12 (41%) LST-ng 7 (24%) Histology, n, (%) Low-grade adenoma 19 (66%) High-grade adenoma 5 (17%) Adenocarcinoma, sm1 3 (10%) Adenocarcinoma, >sm1 2 (7%) LGT-G: laterally spreading tumor-granular type; LST-NG: laterally spreading tumor-nongranular type; sm1: submucosal invasion <1000 [micro]m; >sm1: submucosal invasion >1000 [micro]m.
Volvulus of the
sigmoid colon. Ann Surg 1973;177:527-537.
When lesions involve the
sigmoid colon, we prefer utilizing shaving excision when possible to limit dissection of the retrorectal space and pelvic sidewall nerves.
Pronounced bands of peritoneum may also be found running from the proximal
sigmoid colon to the posterior abdominal wall thereby restricting its mobility.
Internal herniation of a loop of the ileum anteriorly along with Richter's hernia of the
sigmoid colon posteriorly through the same defect in the superior wall of the urinary bladder was found (Figure 2).
Emergency surgery is needed to treat gangrenous SV, and primary anastomosis or stoma is used together with the resection of the gangrenous
sigmoid colon.7,8
The total abdominal augmentation computed tomography and total colorectal sputum angiography showed that the upper and middle rectum, descending colon, transverse colon, and ascending colon were dilated, the maximum diameter of the intestine was 23 cm, and the intestine was filled with feces, suggesting that the lower rectum and
sigmoid colon were narrow [Figure 1]a and [Figure 1]b.
Separating the mass from the
sigmoid colon was challenging (Figure 2).
Failure to pull out IUD strings on gynecological examination made us suspicious of translocated IUD and its ectopic placement in
sigmoid colon was confirmed on colonoscopy and a CT abdomen with contrast.
Ileosigmoid knotting (ISK) is an uncommon cause of bowel obstruction where a loop of ileum and a loop of
sigmoid colon form a knot.
Surgical exploration revealed that the
sigmoid colon had been split at the distal end and had been primarily closed at both the proximal and distal ends.