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PubMed1983

[Extracolonic-infiltrative process of the sigmoid colon and the rectosigmoid junction].

The problems of extracolic-infiltrative lesions of the sigmoid colon and recto-sigmoid junction are discussed, based on representative case studies. Because of the localisation of these bowel segments in the lower peritoneal cavity, they can be reached by direct infiltration of contiguous tumors--especially carcinoma of the ovary--or by seeding into the pouch of Douglas and the sigmoid mesocolon. In many cases characteristic roentgen-morphologic features indicate a secondary infiltration, but inflammatory and malignant lesions have to be differentiated. The differential-diagnosis must consider also diverticulitis, endometriosis and extracolic growth of colonic carcinoma. Additional ultrasonography and computed tomography may help to clear topographical relations and to detect direct and indirect signs of peritoneal carcinomatosis and abscess.

Adenocarcinoma↗
PubMedDate not supplied

Psammoma bodies found in cervicovaginal and/or endometrial smears.

Eight cases of the unusual occurrence of psammoma bodies associated with adenocarcinoma cells in cervicovaginal and/or endometrial smears are presented. Three of the eight cases were advanced ovarian cancers, four were primary endometrial adenocarcinomas, and one was a metastasis of breast cancer to the pouch of Douglas. From our histologic and histochemical observations, psammoma bodies seem to be secretory rather than degenerative in origin.

Adult↗
PubMed1982

[Cancer of the ovary: the usefulness of Cul-de-sac aspiration and the level of carcino-embryonic antigen in the peritoneal fluid].

While it is useful to carry out aspiration from the Pouch of Douglas for screening for cancer of the ovary, the technique is irreplaceable for the follow-up of tumours that have been operated on or irradiated or treated with chemotherapy. We have carried out 1,353 aspirations: 189 of these which were done routinely have been equivocal. 380 aspirations that were carried out because of abnormal symptoms led to the discovery of 26 cancers of which 2 were very early ones. 784 aspirations were carried out for follow-up. There were in all 4.8% blank aspirations, 0.5% false positives and 1.6% false negatives, which is an indication of the reliability of the method so long as certain points in the technique are carefully followed. These figures, which are quoted as a percentage of the total number of aspirations, however, become more important when considered as a percentage of the number of cancers that were diagnosed (5.5% false positive and 18% false negatives). Furthermore, the level of C.E.A. in peritoneal fluid is a method which can be added to cytology in following up the progress of the disease which is not to be dismissed.

Adolescent↗
PubMed1981

[Recent studies into conductivity of oviduct (author's transl)].

A modern functional test of tubal activity is based on the fundamental activity of the oviduct. A glass pessary is applied to the portio, before iodine-containing contrast medium is injected into the Douglas pouch. The blue colour of genital secretion which accumulates in the pessary during iodine-starch reaction will indicate not only tubal patency but also conform tubal function. The functional test is easy to perform and does not imply any risk to the patient. It can thus be carried out in any hospital, but iodine allergy of the patient concerned should be ruled out beforehand.

Adolescent↗
PubMed1994

[An experimental study on liver hyperthermia using intraperitoneal hyperthermic perfusion (IPHP)].

We evaluated the efficacy of intraperitoneal hyperthermic perfusion (IPHP) in regional hyperthermia of the liver. In white rabbits, an infusion catheter and a drainage catheter were placed in the Douglas pouch and upper abdominal cavity, respectively. Warm saline (46-48 degrees C) was infused into the abdominal cavity at a flow rate of 30-60 ml/min. The temperature was continuously monitored at seven measuring points including water bath, peritoneal inflow line, abdominal cavity, liver parenchyma, portal vein, rectum and esophagus. Temperature of the inflow line was maintained at 46-48 degrees C throughout the course. Temperature of the abdominal cavity reached 42.0-42.6 degrees C 30 minutes after the start of IPHP. The temperature of the portal vein reached 40.9 degrees C and 41.8 degrees C at 30 and 60 minutes, respectively. Liver parenchymal temperature increased to 41.5 degrees C and 42.1 degrees C at 30 and 60 minutes, respectively, indicating effective heating of the liver. On the other hand, the temperatures of the rectum and esophagus remained less than 39.2 degrees C and 40.4 degrees C throughout the course. Therefore, we consider that IPHP will be a simple and effective method for the performance of liver hyperthermia.

Animals↗
PubMed1994

[Dual arterial infusion chemotherapy, continuous hyperthermic peritoneal perfusion, and total parietal peritonectomy for peritoneal dissemination in gastric cancer--a case report].

A 36-year-old man developed massive ascites, of which cytology proved Class V, and upper gastrointestinal endoscopy disclosed Borrmann type 4 gastric cancer. We performed dual arterial infusion chemotherapy (DAIC) through the celiac axis and superior mesenteric artery, followed by the operation including continuous hyperthermic peritoneal perfusion, total gastrectomy, subtotal colectomy, massive intestinal resection, splenectomy, cholecystectomy, appendectomy, and total parietal peritonectomy (TPP). Ascites disappeared and the CA125 level was normalized by DAIC. This operation was well tolerated. Though the histopathological study revealed multiple peritoneal disseminations on the visceral peritoneum of stomach, small intestine, colon, and parietal peritoneum such as Douglas' pouch, there were denatured cancer cells in the visceral peritoneum to which blood supply under DAIC was distributed. These results suggested the effect of neoadjuvant DAIC and the significance of TPP.

Adult↗
PubMed1994

Long-term disease-free survival after isolated peritoneal metastasis from colonic cancer.

We present the case of a 29-year-old female patient with an isolated peritoneal metastatic mass in the Douglas pouch, following ileocecal resection for a Dukes C2 colon cancer of the caecum. As initial treatment, four courses of continuous infusion with epiadriamycin were administered. The effect on the tumour size was marginal. Palliative radiotherapy (33 Gy) resulted in a reduction of the tumour size and subsequently a wide posterior exenteration could be performed. Five years after the initial diagnosis the patient is still in good health with no evidence of tumour recurrence. We sincerely believe that a maximum effort aiming for cure is warranted in selected patients with localized residual or metastatic peritoneal colon cancer, even if the initial prospects seem less favourable.

Adenocarcinoma↗
PubMed1995

[Evaluation of peritoneal fluid in women with endometriosis].

An analysis of the peritoneal fluid in women with endometriosis was undertaken. Peritoneal fluid was collected during laparoscopy from the Douglas pouch. The quantity, color of the fluid as well as macrophages number, concentration and activity were assessed. Conclusion is that no one of the listed parameters of peritoneal fluid could be considered as an endometriosis marker.

Adult↗
PubMed1996

[Arterial infusion chemotherapy for advanced gastric cancer by sequential MTX/5-FU].

Intra-aortic infusion chemotherapy by low-dose sequential MTX/5-FU was performed in 46 advanced or recurrent gastric cancer patients. Partial response was found in 13 cases (28%). The major lesion of 13 responders was inoperable Borrmann Type 4 gastric cancer in 4 cases, peritoneal recurrence with an abdominal wall in 6 cases, recurrence in the abdominal mass in 2 cases and Douglas pouch in one. The mean duration of effectiveness in the responders was 6.7 months and the median survival time was 19 months after the treatment. The side effects were mainly related to the digestive organs, but the symptoms were mild. Leucopenia of grade 3 and 4 was found in 6 (13%) and thrombocytopenia of grade 2 in one patient. Arterial infusion chemotherapy by sequential MTX/5-FU proved to be effective in poorly differentiated and signet ring cell carcinoma, such as Borrmann type 4 gastric cancer.

Adenocarcinoma↗
PubMed1997

Laparoscopic diagnosis of blunt abdominal trauma in children

This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominal pain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar was inserted through the umbilical fossa and the intra-abdominal organs were observed for 10 - 60 min under an insufflation pressure of 10 - 12 mmHg. The patients remained hemodynamically stable without pneumothorax development. Three patients underwent laparatomies: one, who had blood in the omental sac, had a duodenal injury with hemorrhagic necrosis and underwent a resection; one with ascites and high amylase levels had an injury of the main pancreatic duct and underwent resection of the pancreatic tail; and one who had fresh blood in the upper abdomen and Douglas' pouch had a splenic hemorrhage and underwent hemostasis. The other two had serous or serosanguinous ascites and recovered without surgery. In patient 1, the same amount of information might have been obtained from a barium study. In patient 2, the pancreatic transection might have been diagnosed from ascites shown on serial computed tomograms. Patient 3 might also have been treated successfully non-surgically. It hus appears that laparoscopy may be a safe diagnostic method for blunt abdominal trauma in children, however, this small series has yielded insufficient information to assess its usefulness in making the diagnosis and the decision for laparotomy. Further studies are required to ascertain whether it will make any significant difference in the form of management.

Journal Article↗
PubMed1997

Laparoscopic diagnosis of blunt abdominal trauma in children.

This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominal pain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar was inserted through the umbilical fossa and the intra-abdominal organs were observed for 10 - 60 min under an insufflation pressure of 10 - 12 mmHg. The patients remained hemodynamically stable without pneumothorax development. Three patients underwent laparatomies: one, who had blood in the omental sac, had a duodenal injury with hemorrhagic necrosis and underwent a resection; one with ascites and high amylase levels had an injury of the main pancreatic duct and underwent resection of the pancreatic tail; and one who had fresh blood in the upper abdomen and Douglas' pouch had a splenic hemorrhage and underwent hemostasis. The other two had serous or serosanguinous ascites and recovered without surgery. In patient 1, the same amount of information might have been obtained from a barium study. In patient 2, the pancreatic transection might have been diagnosed from ascites shown on serial computed tomograms. Patient 3 might also have been treated successfully non-surgically. It hus appears that laparoscopy may be a safe diagnostic method for blunt abdominal trauma in children, however, this small series has yielded insufficient information to assess its usefulness in making the diagnosis and the decision for laparotomy. Further studies are required to ascertain whether it will make any significant difference in the form of management.

Abdominal Injuries↗
PubMed1977

[Single ruptured pelvic hydatid cyst as an unusual manifestation of secondary peritoneal echinococcosis].

The authors report the case of a large pelvic tumour compressing the bladder, the ureters and the recto-sigmoid junction. Its sudden rupture into the peritoneum led to an emergency operation and the discovery of a hydatid cyst ruptured into the pouch of Douglas and a hepatic cyst. The most frequent presentation of peritoneal echinococcosis, peritoneal cysts are metastases from a hepatic or splenic cyst which has ruptured into the peritoneum. They are usually multiple. Single pelvic lesions are rare, their hydatid nature is in the absence of a past history of hydatid disease difficult to suspect before operation. The object of the latter is to treat in one stage the primary cyst and its peritoneal metastases. The narrow vascular connections of the pelvic cysts render cystectomy dangerous and make one prefer removal of the germinal membrane followed by marsupialisation or drainage of the remaining cavity. In the long term, the frequency of peritoneal recurrences makes prolonged supervision necessary.

Douglas' Pouch↗
PubMed1998

Peritoneocele. A radiological study with defaeco-peritoneography.

REPORT STUDY: Defaecography reports from 2816 patients were evaluated. Twenty-three percent of the investigations were considered normal, 31% showed rectal intussusception, 13% rectal prolapse, 27% rectocele, and 19% enterocele. A standardised protocol is suggested to ensure a complete evaluation of defaecography. One hundred and ten reports were unclear and reviewed. The unclear reports usually concerned an unexplained widening of the rectovaginal space, and gave incitement to further studies. TECHNIQUE STUDY: Twelve patients with an unexplained widening of the rectovaginal space at defaecography were investigated using defaecography and peritoneography simultaneously, by us named defaeco-peritoneography. All investigations were carried out without complications. Defaeco-peritoneography proved the unexplained widening to be an extension of the pouch of Douglas, a peritoneocele. UNEXPLAINED WIDENING STUDY: Twenty-two patients with unexplained widening of the rectovaginal space noted at defaecography were studied using defaeco-peritoneography. The outline and movements of the peritoneum in the pelvic cavity could be visualised during the dynamic act of defaecation. The unexplained widening of the rectovaginal space was caused completely by a peritoneocele in 14 patients, partially in 6 patients and 2 remained unexplained. However, only 9 out of 22 widenings were peritoneoceles with an enterocele. Just 11 peritoneoceles only contained fluid. Three types of peritoneocele were demonstrated: vaginal, septal, and rectal, with or without enterocele. Combinations of these were also found. RECTAL INTUSSUSCEPTION STUDY: Fifty-seven patients with defaecation disorders were examined using defaeco-peritoneography. Twenty-three patients had rectal intussusception and 7 patients had a rectal prolapse. All these patients had a rectal peritoneocele in the serosal ring-pocket of the rectal intussusception or in the rectal prolapse. Twenty-seven patients had neither rectal intussusception nor rectal prolapse and none of these patients had a rectal peritoneocele. DAILY LIFE STUDY: Twenty-six female patients showing peritoneocele without a contrast-filled rectum at start at defaeco-peritoneography were investigated; 13 of them had enteroceles. Spot radiographs before and after filling the rectum with contrast medium were compared. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7, and the enterocele disappeared completely when the rectum was distended. Defaeco-peritoneography should therefore include a radiograph before the rectum is filled, as it shows the habitual (daily life) anatomy and can disclose pathology as peritoneocele and enterocele. TRANSFORMATION STUDY: Forty-six patients with peritoneocele at defaeco-peritoneography were studied at three different stages during rectal evacuation. At start with contrast-filled rectum, 14 patients had a peritoneocele, and 32 were regarded as normal. At maximum straining, all patients had a peritoneocele and 20 of these were still present after rectal evacuation. The peritoneoceles were largest at straining and rectal types were most common. No enterocele was seen at start. At maximum straining, 21 patients developed an enterocele.

Adolescent↗
PubMed1989

[Laparoscopic studies of pelvic endometriosis in relation to sterility].

Six hundred and eighteen endometriosis patients out of 2,966 cases diagnosed with laparoscopy were statistically analyzed. The incidence of pelvic endometriosis was 28.3% of infertile cases, 47.2% of infertile cases of etiology unknown sterility, and 53.6% of cases of dysmenorrhea. Initial onset was most common in the sacrouterine ligament and the pouch of Douglas, followed by the ovaries. It was also seen in the vesicouterine pouch. The progress after the initial onset was considered to be due mainly to ovarian lesions, and the progressive rate appeared to be 0.3 point per month according to the R-AFS point system. Cases with stage 3 ovarian lesions were seen up to 7 years after menarche, and there were almost no cases of endometriosis 10 years after menopause. No differences in the average age were seen by stage of clinical progress or R-AFS, and the average age was around 31. The period of infertility showed no definite relation with the stage of the disease in cases of primary sterility, but stage 1 cases were common in patients with secondary sterility. The incidence of dysmenorrhea did not differ depending on the stage of the disease, but severe menstrual pain was common in stage 4 cases. The frequency associated with sterility did not differ in accordance with the stage. Severe pain at the time of endoscopy and induration of Douglas' pouch were common in stage 4 cases, but 31.9% of stage 4 cases showed no abnormal findings in pelvic examination. There was no significant difference between R-AFS points and the incidence of abnormal findings in HSG.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Fine needle aspiration cytology of rectal masses.

This paper describes the results of transproctoscopic fine needle aspiration cytology in the diagnosis of rectal lesions. Fifty one consecutive patients referred with a presumptive diagnosis of rectal mass were subjected to proctoscopic examination when fine needle aspiration cytology, brush cytology and biopsy samples were taken. Of the 30 patients of malignancy of rectum in whom all the three sampling techniques were applied, the biopsy was positive in 27 (90%), brush cytology in 25 (83.3%) and fine needle aspiration cytology in 29 (96.6%). A combination of fine needle aspiration cytology with brush cytology gave a positive yield in 96.6% while that fine needle aspiration cytology with brush cytology gave a yield of 100%. Fine needle aspiration cytology was most helpful in infiltrative tumours. All 10 patients with secondaries in the pouch of Douglas or rectovesical pouch, and the single patient with submucosal rectal carcinoma were correctly diagnosed at fine needle aspiration cytology. There were no false positive results with fine needle aspiration cytology and no complications were encountered with the procedure.

Adenocarcinoma↗