Project description:Colonic lipomas are rare and can sometimes cause intussusception. The aim of this review was to define the presentation and possible management for colocolic intussusception caused by colonic lipomas. A systematic search for patients with colocolic intussusception caused by colonic lipoma, including all available reports up to 2021. Epidemiological, clinical, laboratory, and instrumental data and details about the treatments performed were gathered. Colocolic intussusception caused by lipoma is more frequent in women (57%), occurring between 40 and 70 years of age. Up to 83% of patients report abdominal pain, followed by constipation (18%), rectal bleeding (16%), and diarrhea (12%), with abdominal tenderness (37%), and distension in 16%, whereas 24% have a negative exploration. CT (72%) and colonoscopy (62%) are more commonly able to diagnose the entity. The most common location of intussusception is the transverse colon (28%). The surgical operation varies according to the site. The average dimensions of the lipoma are 59.81 × 47.84 × 38.9 mm3. A correct preoperative diagnosis of colonic lipoma causing intussusception might not be easy. Despite nonspecific clinical and laboratory presentation, cross-sectional imaging can help differential diagnosis. Surgical treatment depends on the localization.
Project description:Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during endoscopic debridement in patients with jumper's knee or the tibial insertion during endoscopic debridement in patients with Osgood-Schlatter disease.
Project description:Precancerous or cancerous lesions of the gastrointestinal tract often require surgical resection via endomucosal resection. Although excision of the colonic mucosa is an effective cancer treatment, removal of large lesions is associated with high morbidity and complications including bleeding, perforation, fistula formation, and/or stricture, contributing to high clinical and economic costs and negatively impacting patient quality of life. The present study investigates the use of a biologic scaffold derived from extracellular matrix (ECM) to promote restoration of the colonic mucosa following short segment mucosal resection. Six healthy dogs were assigned to ECM-treated (tubular ECM scaffold) and mucosectomy only control groups following transanal full circumferential mucosal resection (4 cm in length). The temporal remodeling response was monitored using colonoscopy and biopsy collection. Animals were sacrificed at 6 and 10 wk, and explants were stained with hematoxylin and eosin (H&E), Alcian blue, and proliferating cell nuclear antigen (PCNA) to determine the temporal remodeling response. Both control animals developed stricture and bowel obstruction with no signs of neomucosal coverage after resection. ECM-treated animals showed an early mononuclear cell infiltrate (2 weeks post-surgery) which progressed to columnar epithelium and complex crypt structures nearly indistinguishable from normal colonic architecture by 6 weeks after surgery. ECM scaffold treatment restored colonic mucosa with appropriately located PCNA+ cells and goblet cells. The study shows that ECM scaffolds may represent a viable clinical option to prevent complications associated with endomucosal resection of cancerous lesions in the colon.
Project description:BackgroundEndoscopic mucosal resection (EMR) is a procedure commonly used for large sessile and flat polyps. However, it may cause bleeding, perforation, and complications related to anesthesia. There are limited data on the safety and efficacy of EMR in the elderly. Therefore, we conducted a comprehensive review and meta-analysis to assess EMR safety in elderly patients.MethodsWe searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection for studies evaluating EMR for large colorectal lesions (>20 mm) in older patients (75+ years). Our primary result was post-polypectomy bleeding and perforation, while our secondary outcome was recurrence or residual polyp.ResultsThe meta-analysis included 6 studies with 2903 patients. The rate of post-polypectomy bleeding was 5.3% (95% confidence interval [CI] 2.3-11.7%), I 2=73.7%; and perforation was 1.9% (95%CI 0.9-3.8%), I 2=0%, in patients over 75 years old. The pooled risk of post-polypectomy bleeding was 2.4%, 95%CI 1.2-4.8%, I 2=0%; and perforation was 2.1%, 95%CI 0.7-5.8%, I 2=8.6%, in patients over 80 years old. The risk of post-polypectomy bleeding (odds ratio [OR] 0.922, 95%CI 0.359-2.367, I 2=0%); and perforation (OR 1.066, 95%CI 0.188-6.031, I 2=0%) did not differ significantly between patients aged over 80 and younger patients. The pooled rate of residual or recurrence of polyps in patients aged over 80 was significantly higher (25%, 95%CI 17-35.3%, I 2=59.5%) vs. younger patients (OR 2.234, 95%CI 1.549-3.223, I 2=0%).ConclusionEMR is as safe for the elderly as it is for younger patients, and is not associated with a greater risk of bleeding or perforation.