In this account, addition of alvimopan to a standard perioperative recovery pathway decreased length of stay and incidence of postoperative ileus for elective laparoscopic colectomy.

No abstract

Sacrococcygeal teratomas rarely present in adulthood. Due to its rarity, accurate diagnosis is a clinical dilemma in adults. The patient was a 41-year-old female who presented with pelvic pain, low back pain radiating to the legs and chronic constipation.  The patient underwent a CT scan which demonstrated a 6 cm presacral multiloculated mass compressing rectum. Prior to presentation at our clinic, she had an EUS and biopsy by gastroenterology, followed by diagnostic laparoscopy due to her past medical history of endometriosis.  Her workup was negative for gynaecologic pathology which led to a surgical referral. We evaluated the images and took her to the operating room for posterior paracoccygeal retrorectal mass resection with coccygectomy and intraoperative flexible sigmoidoscopy. She had complete excision for pathologically proven mature 9 cm teratoma. Sacrococcygeal teratoma is rare in adults. A high index of suspicion is required for diagnosis. It should be in the differential diagnosis when dealing with presacral masses in adults. Complete excision is the treatment of choice.