Incarcerated hernia

The frequency, diagnosis, treatment and prognosis of incarcerated hernia are reviewed on the basis of a case series collected from two departments of general surgery. Various aspects of hernial incarceration are discussed and some conclusions concerning management are presented.     

Endometrioid carcinoma arising from endometriosis of the sigmoid colon during estrogenic treatment

A case of endometrioid carcinoma arising from endometriosis of the sigmoid colon is reported. The patient had been treated with unopposed continuous estrogen injection for twenty years after bilateral salpingo-oophorectomy because of severe endometriosis. The pathology, pertinent literature and implications of the present case are discussed.     

Laparoscopic colpopoiesis using sigmoid colon

Superficial siderosis of the central nervous system (CNS) is a rare disease resulting in the accumulation of haemosiderin in the meninges, the brain surface, the spinal cord and the cranial nerves. The pigment is deposited as a result of chronic bleeding in the subarachnoid space. This produces a clinical picture of deafness, ataxia, cranial nerve deficits and in the latest stages dementia. In some cases the source of bleeding can be identified, whilst in others it can not. Despite its rarity the disease should be considered in the differential diagnosis of sensorineural deafness, particularly as it is a progressive and in some cases curable disease which is easily diagnosed by magnetic resonance imaging (MRI). In this case report the haemosiderin was derived from an ependymoma of the fourth ventricle with extension into the cerebello-pontine angle. The first symptom was a worsening sensorineural hearing loss.     

Volvulus of the sigmoid colon

The clinical presentation and treatment of 31 consecutive patients with sigmoid volvulus are reviewed. Nearly half of these patients had a history of mental illness and one-third of all patients were chronically constipated. The main clinical features of abdominal pain and gross abdominal distension had been present for an average of 8 days before presentation of the patient to hospital. The clinical diagnosis of sigmoid volvulus was not difficult but the presence of non-viable bowel was more difficult to establish. A silent abdomen was the most valuable indication of the presence of gangrenous bowel. Conservative measures, including sigmoidoscopy and therapeutic barium enema, successfully reduced the volvulus in half of the cases so treated. In those patients undergoing surgery the procedure associated with the lowest mortality was sigmoid resection with end-to-end anastomosis. The overall mortality was 35%.     

Volvulus of the sigmoid colon: a ten-year study

A ten-year study of volvulus of the sigmoid colon is presented. Although the results of treatment of volvulus of the sigmoid colon are generally improving, the challenge for further improvement remains.     

Giant true diverticulum of sigmoid colon

A case of giant true diverticulum of the sigmoid colon, manifesting as pain and abdominal mass is presented. The patient is asymptomatic after resection of the diverticulum and end-to-end anastomosis of the colon.     

Double tracking in the sigmoid colon

Double tracking of barium in the sigmoid colon has been associated with granulomatous colitis by some; others consider it a sign of peridiverticulitis. Patients who showed no evidence of inflammatory disease elsewhere in the large intestine were analysed. The pathological diagnosis was diverticulitis in 29 of 35 cases, and granulomatous diverticulitis in only 1. In 5 the underlying process was perforated carcinoma of the sigmoid colon. In those with paracolonic sinus tracts due to peridiverticulitis, pathological study demonstrated tracts extrinsic to the muscularis and usually traceable to a perforated diverticulum. Long-term follow-up disclosed no evidence of subsequent inflammatory bowel disease.     

Metastasis of a sigmoid carcinoma to the breast

Breast metastases are usually a rare event. We present the case of a 42-year-old patient with a primary carcinoma of the sigmoid metastatic to the breast and metastasis in the liver as well. Although seldom, it is important that metastatic cancer to the breast be differentiated from primary breast carcinoma as both the treatment and the prognosis differ significantly.     

Perforation of the sigmoid colon following ingestion of a dental plate

The authors report on the perforation of the sigmoid colon in a 48-year-old male following the accidental ingestion of a partial dental plate. Sharp, pointed objects may perforate the bowel and surgery should be considered. A review of the literature revealed no previously reported cases.     

Retrorectal herniation of the sigmoid colon: report of a case

A rare retrorectal hernia of the sigmoid colon associated with diverticulitis and a presacral abscess is reported. The anatomy of the retrorectal space is reviewed. The value of routine lateral fluoroscopy and overhead films is emphasized.     

Genital fistulas caused by diverticular disease of the sigmoid colon

OBJECTIVE: Our purpose was to bring to the attention of gynecologists a subject not mentioned in a single textbook of gynecology, namely, genital fistulas resulting from diverticular disease of the sigmoid colon. STUDY DESIGN: We report our experience with 13 genital fistulas caused by sigmoid diverticulitis. RESULTS: Ten fistulas involved the vagina, one the vagina and bladder, one the tube, and one the uterus. Average age of the patients was 68.6 years (range 54 to 89 years). Presenting symptom in 12 patients was a malodorous vaginal discharge. All with vaginal lesions had previously undergone total hysterectomy. A barium enema failed to demonstrate a fistula in 8 of 11 patients. Colonoscopy failed in 8 of 8 patients. All fistulas were demonstrated by retrograde dye studies. Ten patients operated on were cured. Three patients refused surgery; of these, 1 had intestinal obstruction, 1 may have had spontaneous closure of the fistula, and 1 is being observed. Surgery involved staged procedures in 2 patients, fistulectomy in 4, and bowel resection and anastomosis in 4. CONCLUSIONS: Sigmoidovaginal fistulas are the most prevalent variety of cologenital fistula caused by sigmoid diverticulitis. The diagnosis should be considered in a patient > 50 years old who complains of a foul vaginal discharge and has a history of total hysterectomy. Its presence is best demonstrated by vaginogram. Surgical therapy is advised, the extent of which will rest on the surgeon's judgment of the severity of the inflammatory process found at exploration.     

Measurement of the sigmoid colon and its relationship with volvulus

Sigmoid volulus occurs more frequently in Turkish people than the European. The anatomy of the sigmoid colon plays an important role in the etiology. In our study various measurements of the sigmoid colon of 25 preserved cadavers were taken and the results were interpreted according to the frequency of sigmoid volvulus in this country.     

Early cancer of the sigmoid colon with multiple atypical polypoid lesions

Three types of morphologic abnormalities of megaloblasts in the bone marrows of eight patients with severe untreated pernicious anemia and two patients with folate deficiency are described. A fourth type of abnormality, probably indicating disturbances in hemoglobin synthesis, was also observed in megaloblasts from patients with these conditons. In addition to the phenomenon of erythrophagocytosis in these disorders, the degenerating megaloblasts and those showing disturbances of hemoglobinization may constitute additional cytologic evidence for intramedullary destruction of erythroid precursors contributing to ineffective erythropoiesis in these disorders.