Introduction: Colorectal villous adenoma (VA) is the least common of all histological types of colorectal polyps, but it has the highest malignant potential. Adenoma–carcinoma sequence follows a clinically predictable indolent course, and hence, there is scope for targeted clinical intervention. This study aimed to determine the incidence of malignant transformation of colorectal VA and correlate it with clinicopathological features. Materials and Methods: Ninety-eight cases of VA lesions retrieved from files of the Department of Surgical Gastroenterology at Amrita Institute of Medical Sciences, India, covering a 14-year period, were submitted to statistical analysis through the Chi-square test. Results: The mean age at presentation of VA with associated invasive malignancy was 59.5 ± 12.21 years, whereas of VA without malignant transformation, it was 66 ± 11.21 years. Males were more commonly affected than females (1.5:1). Rectum was most commonly involved. 56.1% of VAs were associated with invasive malignancy. There were 45.5% of VAs with low-grade dysplasia and 54.5% of VAs with high-grade dysplasia. Malignancy could not be ascertained in 43.1% of colonoscopic biopsies but established on surgical resection specimens. Conclusion: We infer that colorectal VA in Indian population has a higher risk of malignant transformation compared to the West. Colonoscopic biopsy grading of dysplasia may be limited on superficial biopsies, and therefore, pathological diagnosis with clinical and radiological correlation is important in taking management decisions. Ulcerated colorectal VA at index colonoscopy is a strong predictor of invasive malignancy. The authors recommend that there should be a high degree of suspicion for invasive malignancy in management of VAs.

Colostomies are commonly performed operation in colorectal surgery. These are not free of complications which vary from acute retraction, and malfunction to delayed stoma prolapse. Prolapse is an annoying complication that may lead to excoriation, obstruction, and gangrene. There are various ways of treating stoma prolapse. Here, we discuss and report one simple technique of stoma revision, called transcolostomy colectomy.

Intussusception is relatively common in children in comparison to adult. Only 1% of adult shows symptoms of bowel obstruction, in which most of the cases, malignancy is responsible. Herein, I present an extremely unusual case of intussusception that occurred in a young female who had gangrenous ileum inside the ascending colon with multiple enlarged lymph nodes around the terminal ileum. A 32-year-old female patient was diagnosed with the 13 cm ileo ascending intussusception with the complaint of not passing flatus and motion, severe pain abdomen, and vomiting for 3 days. Abdomen was distended. She had mild pain abdomen for 3 months. Computed tomography scan revealed 13 cm intussusception of ileo ascending. Laparoscopic right hemicolectomy was performed and revealed dense adhesion at the ileum and ascending region with gross dilatation of the ileum. No neoplastic lesions were observed in the resected tissue of the lead part of intussusception. The postoperative clinical course was favorable and the patient was discharged on day 6 after surgery. There are no reports of 13 cm intussusception as observed in the present case. Intussusception should thus be considered as one of the causes due to multiple lymph nodes in adults also.

Rectal foreign body is not an uncommon encounter these days in the current medical practice. It usually occurs due to sexual eroticism, sexual abuse, assault, or rarely accidental involuntary insertion. This condition possesses a significant challenge among general surgeons on handling these cases. Diagnosis is usually made by history taking, physical and radiological examination. Here, we present a case of a 22-year-old young male college student with retained rectal foreign body of 3 h duration who presented with impacted foreign body per rectum, nonspecific abdominal pain, abdominal mass, and nonpassage of stool and flatus. Successful removal of rectal foreign body was done manually under local anesthesia in lithotomy position in the operation theater.