{"paper_id":"a0309bfb-82f9-454f-bafd-b3dddd986c3a","body_text":"arteries. The cervical oesophagus was mobilized \nthrough a neck incision. The mobilized stomach \nand thoracic oesophagus were pulled into the \nneck. The stomach was divided 3 cm distal to the \ntumour. The cervical oesophagus was divided \nand gastro-oesophageal anastomosis performed \nin the neck. A feeding jejunostomy was placed \nassisted by laparoscope. The operating time was \n5 hours and blood loss was 250 ml. There were \nno major incisions in the abdomen and chest. An \nintercostal tube was placed which drained 50ml \nduring the first 24 hours. Operative time was 6 \nhrs and patient had an uneventful recovery.\nReferences\n1. Darzi A. Minimal Access Surgery. In: Kirk RM, \nMansfield AO, Cochrane JP Seds. Clinical Surgery in \nGeneral. Churchill Livingstone, 1999; 240-244.\n2. Cushieri A, Houston G. Minimal access therapy. In: \nCushieri A, Steele RJC, Moossa A  Reds. Essential \nSurgical Practice. London: Arnold, 2001; 493-520. \n3. Palanivelu C. CIGES Atlas of Laparoscopic Surgery. \nJaypee Brothers 2003; 3-32.\nBowel endometriosis: case report                                       \n1 2 3\nAjith Lamahewage , JPM Kumarasinghe , NG Ranawaka1 2 3\nSenior Lecturer, Department of Pathology, Senior Lecturer, Department of Surgery,  Lecturer, \nDepartment of Pathology, Faculty of Medicine, University of Ruhuna, Galle. \nIntroduction\nEndometriosis is defined as the presence of \nendometrial glands and/or stroma in extra uterine \nsites. It is principally a disease of women in \nactive reproductive life. This disorder often \ncauses infertility, dysmenorrhoea, pelvic pain, \nand symptoms related to the affected organs. It \noccurs in the following sites in descending order \nof frequency: ovaries, uterine ligam ents, \nrectovaginal septum , pelvic peritoneum , \nlaparotomy scars and rarely in umbilicus, vagina, \nbladder and bowel. Three potential explanations \nof the origin of endom etriosis are; the \nregurgitation-im plantation theory, the \nmetaplastic theory and the vascular or lymphatic \ndissemination theory. In addition hormonal and \nimmune genetic factors may play a role for the \nsusceptibility to develop endometriosis [1]. \nCase Report\nA  37 year-old female was referred to the surgical \ncasualty ward with a vague pain in the right side \nof the abdomen. The clinical diagnosis was an \nacute appendicitis. Conventional appendectomy \nwas attempted but a mass lesion involving the \nwall of the ileo-caecal junction was found. \nT herefore, an exploratory laparatom y w as \ncarried out. \nPart of the ascending colon, caecum along with \nthe appendix and a part of ileum was removed \nand end to end anastamosis was made. \nPathological specimen consisted of a segment of \nthe ascending colon, caecum along with the \nappendix and a segment of ileum. A  white, \nconstricting lesion was seen involving the wall of \nthe bowel at the ileocael junction which appeared \nto involve the serosa, too. The lesion measured \n4×2×2 cm. Appendix looked macroscopically \nnormal. Eleven enlarged mesenteric lymph \nnodes were recovered.\nHistological sections from the constricting lesion \nin the ileo-cecal junction showed several foci of \nendometrial glandular structures accompanied \nby endometrial stroma embedded in muscularis \npropria (Figure 1). They were lined by a single \nlayer of columnar epithelium with basally \nlocated nuclei.  No atypical features were noted. \nGalle Medical Journal, Vol. 12: No.1, September 200760\nCase Reports\n\nOccasional mitoses were seen in the stroma. \nIntestinal mucosa of the ileum and caecum \nshowed a moderate chronic inflammatory cell \ninfiltration. Ascending colon and appendix were \nmicroscopically normal. All the eleven lymph \nnodes showed features of reactive hyperplasia.  \nFigure 1 - Histological section of the lesion in \nthe ileo - caecal junction\nDiscussion\nBowel endometriosis is very rare. It is usually an \nincidental finding in the gut, but some examples \npresent themselves as an obstructing tumefactive \nm ass that closely sim ulates an intestinal \nneoplasm [2]. Although some women with bowel \nendom etriosis m ay be asym ptom atic, the \nm ajority of them  develop a variety of \ngastrointestinal complaints. Except for rectal \nnodules bow el endom etriosis cannot be \ndiagnosed by physical examination. Therefore, \nimaging techniques such as double contrast \nbarium enema, transvaginal ultrasonography; \nrectal endoscopic ultrasonography, magnetic \nresonance imaging (M RI) and mu lti slice \ncomputed tomography enterolysis should be \nused [3].\nMedical management of bowel endometriosis is \ncurrently speculative. S everal studies \ndemonstrated an improvement in quality of life \nafter surgical excision of the lesion. \nBowel endometriotic nodules can be removed by \nvarious techniques; m ucosal skinning, \nnodulectomy, full thickness disc-resection and \nsegmental resection of the bowel [2].\nReferences\n1. H C  A n d erso n , E n d o m etrio sis. In : W .S t. \nrd\nSymmer's. Systemic Pathology, 3  Edition, Vol. 6, \nChurchill Livingstone, 1990; 241-62.  \n2. Patrick L, Fitzgibbons. Pseudoneoplastic lesion \nof alimentary treat. In: Mark R W ick, Peter A  \nH u m p h rey, Jo n  H  R itter. P ath o lo g y  o f \nst\nPseudoneoplastic Lesions, 1  Edition, Lippincott, \nRaven: 1997: 149-150.\n3. Juan Rosai. Female genital trent. In: Juan Rosai. \nth\nAckerman's Surgical Pathology, 9  Edition, Vol 2: \nMosby , 2004; 1569-635.   \n \nLow rectal carcinoma with liver metastasis\n1 2 3\nHCM Hettiarachchi,  KB Galketiya,  SS Edirimuni1 2  3\nRegistrar in Surgery, Consultant Surgeon,Senior Registrar in Surgery, Teaching Hospital, Karapitiya, \nGalle. \nIntroduction\n35-45% of patients with colorectal carcinoma \ndevelop hepatic metastases and if left untreated, \nsurvival beyond five years is extremely rare. In \nappropriately selected patients liver resection is \nassociated with a 30-40% 5-year survival and a \n20 % longterm disease free survival.\nCase history\nA  sixty year-old female, presented with bleeding \nper rectum and alteration of bowel habits of nine \nCase Reports\nGalle Medical Journal, Vol. 12: No.1, September 2007 61","source_license":"CC0","license_restricted":false}