Rectal mucocoele following subtotal colectomy for colitis

Blind loop mucocele of a side-to-end colorectal anastomosis as a rare cause of large bowel obstruction

Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. To our knowledge, LBO due to blind colonic limb mucocele of a side-to-end colorectal anastomosis has not yet been described. We report a man in his late 50s presenting with pain, abdominal distension and constipation. He had extensive surgical history; notably, a side-to-end colorectal anastomosis was fashioned following Hartmann-type colostomy reversal. CT and MRI suggested a mucus-filled short blind colonic segment compressing the anastomotic site and causing LBO. Flexible sigmoidoscopy under general anaesthesia showed external rectal compression and lumen narrowing. Transrectal needle aspiration of the blind segment yielded 145 mL of mucoid fluid. The patient's symptoms improved and he was discharged with outpatient Gastrografin enema and flexible sigmoidoscopy which confirmed successful blind segment emptying. This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction, and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.

The Use of a Hartmann's Pouch for Bowel Vaginoplasty: A Case Report

Bowel vaginoplasty is a well-described procedure utilizing a pedicled segment of large or small bowel. It has most commonly been used for vaginal agenesis, male-to-female gender affirmation surgery when the phallus skin is not sufficient, or a revision after failure of the primary reconstruction. Our case report describes the usage of a pedicled segment of large bowel to reconstruct the vagina after severe stricture of the original reconstruction. We were able to provide relief of the symptomatic Hartmann's pouch mucocele, urethral stricture, and provide a functional introitus and vaginal canal. This technique can provide a framework that can be used as a salvage plan in patients with previously irritated and inhospitable defects.

Rectal stump mucocele after a Hartmann's procedure causing mechanical ileus

Two years after a Hartmann's procedure, an 85-year-old woman was admitted at our emergency department with abdominal bloating and severe constipation for 5 days. Abdominal CT showed a large rectal stump mucocele associated with compression of surrounding structures, causing a mechanical ileus and a bilateral pyelocaliceal dilatation. Successful transanal drainage with a rectal catheter allowed rapid recovery.

Not Your Typical Mucocele: A Case Report of a Benign Sigmoidal Diverticular Mucocele

In recent literature, mucoceles have been discovered to be in the appendix vermiformis or in the nasal sinuses. Although rare, colonic mucoceles, as well as rectal mucoceles, have also been encountered. Furthermore, colonic mucoceles arising from a diverticulum is an even more unusual occurrence, and to date, there has been only one reported case. We present a 48-year-old male with a past medical history of multiple episodes of diverticulitis who presented to the emergency department complaining of bilateral lower quadrant abdominal pain for three days. Upon arrival to the emergency department, the patient had a CT scan of the abdomen and pelvis, which showed an annular constricting 65 mm mass in the proximal sigmoid causing large bowel obstruction. The patient underwent unsuccessful endoscopies and inevitably underwent a hand-assisted laparoscopic sigmoid resection. The following days, the biopsy returned and resulted to be a mucocele arising from a sigmoid diverticulum. We encountered the very first benign colonic mucocele arising from a sigmoid diverticulum.

Rectal mucocele in the anterior wall of the rectum

An 84-year-old man presented in 2009 with a sensation of discomfort in his anus, combined with difficulty in urination. He had previously undergone a haemorrhoidectomy in 1964. After examination, he was diagnosed with a rectal mucosal cyst and followed up for observation. In 2015, he presented to our hospital complaining that the cyst was prolapsing from his anus. CT revealed a 48×41 mm cystic mass in the anterior wall of the rectum. Tumour extirpation, via a transanal route, was performed. The postoperative pathological diagnosis confirmed a rectal mucocele. Rectal mucoceles are extremely rare, with no prior report of a mucocele in the anterior wall of the rectum. In this case, we believe the mucocele developed from an invagination of the mucous membrane or obstruction of the anal gland during suturing during the previous haemorrhoid surgery.

Giant Symptomatic Rectal Mucocele following Subtotal Colectomy

Introduction

Rectal mucoceles rarely occur and only a few cases are described in the literature. They usually appear after subtotal colectomy or Hartmann procedure originating from persisting rectal mucus production and simultaneous stenosis of the anal canal.

Case Presentation

A 74-year-old female patient presented with the feeling of an abdominal growing mass. Complex medical history included a subtotal colectomy with an end ileostomy and a mucous fistula at the descending colon due to Crohn disease at the age of 16 years. MRI showed a massive dilatation of the remaining colon and the rectum. Endoscopy failed due to complete anal stenosis and stenosis of the descending colon at the stoma site. A total proctocolectomy was performed. The pathology report showed a dilated rectum and sigma with large amounts of partly calcified mucus. There was no evidence of dysplasia, malignancy, or Crohn manifestation in the completely obliterated proximal colon and the anus.

Conclusion

Our case report underlines the importance of active endoscopic surveillance of the remaining colon and rectum in patients with diverting stomas and inflammatory bowel disease in order to detect stenosis. If endoscopic control is not possible due to obliteration, surgical therapy must be discussed due to the risk of developing cancer.

Intersphincteric proctectomy for rectal mucocele in a Crohn's patient with anal stenosis. A case report and review of literature

In patients who have undergone a colonic resection with creation of an end colostomy, drainage of mucus secreted by the mucosa of the rectal stump may not be possible if there is an outlet obstruction. With an outlet obstruction, formation of a rectal mucocele occurs. A rectal mucocele is a rare condition which has only been reported sporadically in case reports. We present here the utility of an intersphincteric proctectomy for treatment of a rectal mucocele in a 47 year old male Crohn's patient resulting in negligible post-operative or long-term morbidities.