Schwannoma is a benign tumor arising from Schwann cells that form the neural sheath. Primary schwannoma of the colon is rare and a few cases have been reported. We report a case of schwannoma of the colon and present the differential diagnosis that must be considered in the evaluation of colonic subepithelial lesions.

Background: Chronic anal fissure is a frequent and disabling disease, often affecting young adults. Botulinum toxin and lateral internal sphincterotomy are the main therapeutic options for refractory cases. Botulinum toxin is minimally invasive and safer compared with surgery, which carries a difficult post-operative recovery and fecal incontinence risk. The long-term efficacy of Botulinum toxin is not well known. Objective: The aim of this study was to evaluate the long-term efficacy and safety of Botulinum toxin in the treatment of chronic anal fissure. Methods: This was a retrospective study at a single center, including patients treated with Botulinum toxin from 2005 to 2010, followed over at least a period of 5 years. All patients were treated with injection of 25U of Botulinum toxin in the intersphincteric groove. The response was registered as complete, partial, refractory and relapse. Results: Botulinum toxin was administered to 126 patients, 69.8% (n ¼ 88) were followed over a period of 5 years. After 3 months, 46.6% (n ¼ 41) had complete response, 23.9% (n ¼ 21) had partial response and 29.5% (n ¼ 26) were refractory. Relapse was observed in 1.2% (n ¼ 1) at 6 months, 11.4% (n ¼ 10) at 1 year, 2.3% (n ¼ 2) at 3 years; no relapse at 5 years. The overall success rate was 64.8% at 5 years of follow-up. Botulinum toxin was well tolerated by all patients and there were no complications. Conclusion: The use of Botulinum toxin to treat patients with chronic anal fissure was safe and effective in long-term follow-up.

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A 72 year-old male with previous history of coronary heart disease, diabetes and gallbladder lithiasis, regularly medicated with low dose aspirin and oral anti-diabetics drugs, was admitted at the emergency room complaining of severe right upper abdominal quadrant pain and hematemesis. Physical examination: pallor, BP 110/70 mmHg, HR 90 bpm; tender and distended abdomen and normal cardiac-pulmonary auscultation; normal rectal examination. Laboratory data: haemoglobin 7.5 g/dL, platelet count 230.000/µL, INR 1.05, blood-urea nitrogen 12.3 mg/dL, ALT 130 U/L, AST 130 U/L, ALP 424 U/L.

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