Gastrointestinal lipomas are benign subepithelial tumors arising from adipose tissue. Most colonic lipomas are clinically silent and do not require intervention. However, if the lipomas are large or symptomatic, removal can be considered. Of the endoscopic techniques available, endoscopic ligation, also known as “loop-and-let-go,” provides a safe and easy alternative to other endoscopic therapies and does not require any specialized equipment or advanced training. We describe a case of a patient found to have large colonic lipoma that recurred after endoscopic unroofing but was successfully treated with “loop-and-let-go.”

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INTRODUCTION: Crohn’s disease is an inflammatory condition that can present with fistulous communications with extraluminal structures. The presence of urachal remnants that do not communicate with the skin account for 50% of urachal malformations and are generally asymptomatic and benign. CASE DESCRIPTION/METHODS: We present a case of an active duty soldier, with no previous medical history, found to have Crohn’s disease presenting as an enterourachocutaneous fistula. The patient presented to primary care with persistent umbilical drainage that did not resolve with antibiotics given. Computed tomography showed a mass on the dome of the bladder with surrounding inflammation but no extravasation of contrast outside of the bladder during cystography. Ileocolonoscopy revealed a narrowed ileocecal valve with biopsies consistent with active Crohn’s disease. Magnetic resonance enterography showed a fistulous communication from the terminal ileum to a urachal cyst which drained to the skin via the umbilicus. After multi-disciplinary discussion with urology and colorectal surgery, patient will undergo planned cyst, fistula, and terminal ileal resection. DISCUSSION: This case represents a rare presentation of Crohn’s disease. The true prevalence of urachal malformations is unclear; a large number remain undiagnosed until noted on imaging when asymptomatic. Enterourachal fistulas are rare, with only 13 cases reported; cutaneous communication has occurred in only 4 of the 13 reported cases. Cutaneous fistulas are more commonly seen in penetrating Crohn’s Disease given proximity of the bowel to the abdominal wall. In our case, the involved segment of bowel created a cutaneous fistula by way of a patent urachal remnant. This case highlights the ability of Crohn’s disease to mimic more benign conditions. A diagnosis of Crohn’s disease should be considered in patients with umbilical drainage that fails to resolve with antibiotics.

In vitro fertilization has served as a great tool in the human and bovine field in its ability to treat infertility in females. The purpose of this study was to compare hormone injection treatments in goats using the laparoscopic ovum pickup technique. A crossover trial was conducted to evaluate 2 superovulation injection protocols [a multiple-injection FSH (F) and a one-injection FSH-eCG (F+E)] for their ability to increase recovery of oocytes using laparoscopic ovum pickup (LOPU) technique in 10 prepubertal Kiko does. Does were randomly assigned to 2 sequence groups (n=5). Period 1 initiated on 28 July 2017 and Period 2 on 12 August 2017. A CIDR device was inserted on Day 0 and removed after LOPU. On Day 6 of each period, 3mL of prostaglandin F2α was given IM to each doe. F-treated does received (IM) twice daily injections of 15, 12.5, 10, and 7.5mg of FSH, whereas F+E-treated does received (IM) 80mg of FSH and 300 international units (IU) of eCG. Thirty-six hours after injection, follicles were aspirated using LOPU. Treatment response measurements included total follicles observed, oocyte recovery rate, and blastocyst rate. Total follicles observed were higher (P=0.004) in F+E-treated does (305 follicles) than F-treated does (236 follicles). Neither oocyte recovery rates (F+E=41.5% and F=38.1%) nor blastocysts rates (F+E=18% and F=32%) were affected (P>0.05) by injection protocol. In conclusion, we summarise that multiple injections of FSH can results in a higher number of follicles produced; however, this does not have a subsequent effect on IVF and development rates.

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