Stenosing colon neoplasia causing colonic perforation in a patient with morgagni-larrey’s hernia

Congenital diaphragmatic hernia, is a congenital abnormality, rare in adults with a frequency of 0.17-6%. We present the case of an 88-year-old female patient with a history of arterial hypertension, obesity and bronchial asthma. She attended the emergency department of our center with diffuse abdominal pain associated with vomiting, absence of intestinal transit for 4 days and respiratory distress. Laboratory tests showed 11750 leukocytes/μl and PCR 127 mg/L. On suspicion of acute abdomen, a Computerized Tomography (CT) scan was performed (Figure 1), showing a left Morgagni-Larrey Hernia (MH) with gastric chamber and colon inside, with abundant pneumoperitoneum. At surgery we found there was a diffuse purulent peritonitis due to perforation of the transverse colon, which, like the gastric chamber and spleen, was located within a large left diaphragmatic hernia. An extended right hemicolectomy until the tumor in the splenic angle of the colon was surpassed was performed.

Relationship between gastric intestinal metaplasia and colorectal neoplasms.

Background and aims : Colorectal cancers are one of the most common types of cancer. Gastric intestinal metaplasia is considered a precancerous lesion that can progress into gastric cancer. Even though there are previous publications stating that Helicobacter pylori and intestinal metaplasia are related to colorectal adenomas, there are also studies stating the opposite. This study aims to determine the relationship between gastric intestinal metaplasia and colorectal neoplasia. Methods: A total of 214 patients between the ages of 19 and 92 who underwent combined gastroscopy and colonoscopy between August 2016 and April 2020 were included in this retrospective study. Medical records including demographic data, gastroscopy and colonoscopy findings and histopathology results of the patients were reviewed and analyzed. The association of intestinal metaplasia and Helicobacter pylori infection with colorectal neoplasia was evaluated in these patients. Results: The mean age of the patients included in the study was 49.07±15.80, and 125 (58.4%) of the patients were male. A statistically significant correlation was found between intestinal metaplasia and colon neoplasm prevalence (p= 0.03). However, such a correlation was not seen between Helicobacter pylori and colon neoplasia. Conclusion: A positive correlation was found between gastric intestinal metaplasia, which is a precancerous lesion, and colon neoplasia. Even though this correlation indicates higher prevalence rates of colon neoplasia in patients with gastric intestinal metaplasia, how to evaluate these patients in terms of colon neoplasia remains a controversial issue.