Idiopathic chronic megacolon syndrome is a condition in which the large intestine is pathologically dilated despite the absence of a mechanical obstruction of the large intestine and the absence of an underlying disease or evidence that this condition may have been caused by the patient's medication history. Medical treatment is preferred for this condition, but if it is inadequate, surgical treatment may be required. Subtotal colectomy with ileorectostomy is the surgical treatment generally performed, but only removing the dilated intestine frequently results in dilation of the residual colon and some patients experience defecation disorder due to postoperative pelvic perineal dysfunctions.

For surgical treatment, it is important to understand the pathology and to diagnose the scope of the lesion. Our hospital uses a colonic transit study with radiopaque markers to determine the range of resection. We also examine the results of defecography and anorectal manometry, and look at the patient's background to determine the optimal reconstruction method.

The short-term and long-term results of the seven surgical cases we experienced at our hospital were good, and both the bowel movements and abdominal symptoms improved after surgery.

2,738 patients receiving follow-up colonoscopies were divided into five groups according to initial findings as follows: 736 with negative colonoscopy (group A), 708 with diminutive adenomas (group B), 560 with low-risk adenomas (group C), 388 with high-risk adenomas (group D), and 346 with intramucosal cancers, submucosal invasive cancers, and lesions more than 20 mm in size (group E). The cumulative incidences of patients with metachronous high-grade adenomas and cancers (advanced lesions) significantly increased from group A to B, group C to D, and group C to E, (p<0.0001, p<0.05, p<0.005), although there were no differences between group B and C and between group D and E by the log-rank test. The mean intervals from the initial to next colonoscopy were 52.1, 34.3, 32.5, 31.4, and 27.1 months in group A, B, C, D, and E, respectively, and were thus less than 3 years in all groups except group A. Adherence to surveillance recommendations in guidelines by the JSGE, US Task Force, and ESGE were evaluated: 96.2% in group A, 65.8-99.4% in group B, 67.0-98.0% in group C, 15.7-66.4% in group D, and 28.5-77.2% in group E received follow-up earlier than the guideline recommendations. Colonoscopies were overused especially among patients with a normal colorectum and low-risk adenomas.

The patient was a 52-year-old man. On abdominal CT, PET, and lower gastrointestinal endoscopy a submucosal tumor measuring 50 mm in diameter was seen on the right colon, which was suspected as a differential diagnosis of GIST, schwannoma, NET, etc. Laparoscopic ileocecal resection was performed, and although the tumor had invaded the abdominal wall, complete resection was possible. Histopathologically, the tumor was negative for c-kit, S-100, Desmin, and CD34, and was positive for β-catenin, and a diagnosis of desmoid tumor was made. In this case, there was no familial adenomatous polyposis and β-catenin was positive, suggesting a solitary intra-abdominal desmoid tumor. This type of tumor is known to be triggered by mechanical stimuli, but this was not observed in this case and the cause was unknown. A definitive diagnosis is often difficult to make preoperatively, and the patient is often resected without a diagnosis being made preoperatively, but desmoid tumor should also be considered. Intra-abdominal desmoid may be difficult to resect due to severe multi-organ involvement. Although there are few reports of laparoscopic resection of intra-abdominal desmoid, we report such a case here.

The patient was a 45-year-old woman who visited another hospital because of abdominal pain and bloody stool. Colonoscopy showed a mass at the sigmoid colon, but a diagnosis was not confirmed by biopsy. She was referred to our hospital for further examination and treatment. Surgery was performed for diagnosis and treatment. The mass was adhered to the left gonadal vessels and the left lateral femoral cutaneous nerve. Laparoscopic-assisted sigmoidectomy (D2 dissection) with resection of these vessels and nerve was performed considering the possibility of malignant invasion. The histopathological diagnosis was intestinal endometriosis with no malignancy. Postoperatively, the patient is undergoing hormone therapy to prevent recurrence as an outpatient. The preoperative diagnosis rate of intestinal endometriosis by biopsy is low because the main lesion is often located under the submucosa. We describe this case of intestinal endometriosis with a review of the literature.

A 29-year-old woman, who underwent primary repair of the anal sphincter for perineal laceration 4 days after delivering her first child, developed fecal incontinence. A physical examination revealed a gross anorectal and vaginal deformity, which led to a diagnosis of anal sphincter failure associated with wound dehiscence. Early secondary sphincteroplasty was performed on the 8th day after delivery. Postoperatively, there was marked improvement in her fecal incontinence score, and she was discharged from the hospital without wound infection or complications. Early sphincter repair for anal sphincter injury during childbirth can restore anal function without temporary stoma, and may be useful in improving the patient's quality of life.