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The patient was investigated for iron deficiency anemia. Colonoscopy revealed a large rectal polyp and a carcinoma of the transverse colon. The ascending colon was not viewed due to the malignant stenosis. The patient’s comorbidity included diabetes, asthma, chronic obstructive airways disease, and coronary artery disease. He was declared unsuitable for surgical treatment of his coronary disease.

Investigation of lower abdominal pain and rectal bleeding revealed a carcinoma of the sigmoid colon at 30cm. Apart from well controlled hypertension, the patient was in reasonable health.

The patient had noticed dark red rectal bleeding for 5 months accompanied by frequent urge to defecate. Her previous health included mastectomy 51 years previously and stable congestive cardiac failure associated with aortic incompetence. She had borne 12 children and now had 54 grandchildren! She was sprightly physically, but early signs of dementia were present. Examination revealed a carcinoma on the posterior wall of the rectum 6 cm from the anal verge occupying 40% of the lumen. Above the lesion, no pathology was detected on colonoscopy. A computerized tomography (CT) examination showed no evidence of perirectal extension or metastatic disease. A sphincter-saving resection was planned, and the patient was treated with preoperative radiotherapy (37.5 Gy in 15 fractions over 3 weeks).

The patient suffered from asthma, an enormous goiter, obesity (weight, 252 lb), and severe kyphosis of the thoracic spine. In March 1993, a barium enema demonstrated an “apple core” deformity that could not be reached by colonoscopy examination.

In November 1971, this patient suffered a sigmoid colon perforation due to diverticulitis. His general health was very poor due to respiratory insufficiency (heavy smoker), poor nutrition, and homelessness. At laparotomy, fecal peritonitis was present, managed by abdominal irrigation, drainage of the perforation site, and a proximal colostomy. The postoperative course was stormy. A colocutaneous fistula appeared, and radiological investigations diagnosed a colovesical fistula. The patient was referred.

The patient presented with a 5-month history of rectal bleeding and diarrhea. Colonoscopy revealed a carcinoma at 13 cm and no other significant abnormality to the cecum. The patient’s psychological background included depression, aggression, and a tendency towards litigation.

The patient had noticed diarrhea, urgency, and minimal rectal bleeding for 8 months. Until this time, the patient had been in excellent health. Examination revealed a mobile carcinoma of the rectum at 7cm. It occupied one-third of the lumen circumference in the right lateral quadrant. Colonoscopy revealed no other pathology.

In 1975, cholecystectomy was performed for gallstones. In 1982, appendectomy for gangrenous appendicitis was followed by several operations for a pelvic abscess. During 1996, episodes of acute small bowel obstruction necessitated 3 admissions to the hospital. Laparotomy (9.19.96) revealed small bowel obstruction due to extensive adhesions. Complete adhesiolysis of small bowel was performed with repair to several sites of the bowel wall. The obstruction failed to settle over the subsequent 17 days and reoperation was necessary. Laparotomy (10.6.96), revealed a “mass of matted bowel with adhesions rock solid, like concrete.” Extensive dissection resulted in ischemia to segments of small bowel and the left colon. A “massive” resection of ileum was performed (leaving 100cm of small bowel), and the left colon was resected as a Hartmann operation. Subsequent to this operation, a small bowel fistula presented in the lower part of the abdominal wound. It failed to heal with conservative treatment. The patient was referred for further management.

In April 1996, the patient was urgently admitted to the hospital, with severe abdominal pain. Clinical examination revealed evidence of peritonitis, indicating the need for immediate operation.

In 1974, the patient, aged 28 years, was diagnosed with chorionic carcinoma. Local spread had formed a large pelvic mass and lung metastases were present. The latter disappeared after treatment with methotrexate. Laparotomy was performed in August 1974 when extensive pelvic spread was found beyond surgical excision. This pelvic disease was successfully treated with external beam radiotherapy (58.6 Gy) and actinomycin D. Eighteen months after completing this treatment, the patient was referred for the surgical management of a stricture (6 mm in diameter) of the rectum and a rectovaginal fistula discharging into the posterior fornix. Investigations revealed no evidence of recurrent tumor. The skin of the perineum showed evidence of tissue reaction to radiotherapy (Figure 100.1).