Patients with breast carcinoma metastatic to the colon generally present with multiple symptoms, usually pain, vomiting, nausea, and ascites. We describe a patient who presented only with persistent diarrhea, underwent surgery for colon cancer, and, on pathological evaluation of the surgical specimen, was found to have metastatic breast cancer affecting the colon. Metastatic breast cancer should therefore be suspected in patients with a history of breast cancer and diarrhea of unknown cause that is not accompanied by other symptoms. Evaluating such patients by colonoscopy and biopsy would provide important information relevant to choosing between colon surgery and systemic therapy.

Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.In general, authors of case reports should use the Brief Report format. Economic Impact of Laparoscopic Appendectomy in a Rural HospitalOpen appendectomy (OA) may have been one of the first minimally invasive operations fulfilling some of the criteria for that category; that is small incisions, less pain, and short recovery time. 1 Laparoscopic appendectomy (LA) has similar attributes, but little attention has been focused on the cost and length of stay that occurs in a rural hospital and the economic impact of the additional use of technology. The specific place of LA treatment option remains unclear as studies show conflicting results. This study attempts to identify the place for LA in a community setting as well as the associated cost and length of stay.