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The Authors report about a case of colonic atresia localized on the transverse colon a few cms after the right flexure curd by one time resection and end-to-end anastomosis. The pathology of the lesion is atypical since features of Bland-Sutton and Louw's classification types II and III were mixed together at the atresia site while the radiological features were those typical of type II.
Three cases of perforated diverticulitis of the transverse colon are added to 19 case reports in the English literature. This unusual disease entity is usually confused with acute appendicitis prior to operation and with carcinoma of the colon during the procedure. The cause of these diverticula is unclear, and their clinical presentation resembles that of right-sided diverticula. Segmental resection of the transverse colon together with end-to-end anastomosis is the treatment of choice, except in the occasional instance of a large intra-abdominal abscess, when anastomosis may be deferred.
A 4-year-old boy with a volvulus of the transverse colon is presented. The mildness of the obstruction made direct visualization of the twisted loop with barium enema possible. At laparotomy a congenital band between the transverse colon and the small intestine was found to have been the predisposing factor of the volvulus.
Primary extranodal non-Hodgkin's lymphoma of the transverse colon is a rare presentation of non-Hodgkin's lymphoma or colonic neoplasm. Dermatomyositis is an autoimmune condition of the skin, muscle, and blood vessels that when associated with malignancy is a true paraneoplastic syndrome but is rarely associated with non-Hodgkin's lymphoma. We present a case of primary non-Hodgkin's lymphoma of the transverse colon diagnosed after the presentation of dermatomyositis and review the literature on dermatomyositis and hematologic neoplasm.
A rare case of a newborn infant with leiomyosarcoma of the transverse colon is reported. The condition was associated with meconium peritonitis due to a perforation proximal to a portion of the transverse colon that was completely surrounded by the tumor. The 12 previously published cases of leiomyosarcoma of the colorectum in childhood are reviewed, and the pathogenesis of meconium peritonitis is discussed.
Diagnosis of perforation of a solitary diverticulum of transverse colon followed the discovery at operation of an abdominal mass, ultrasound and CT scan imaging demonstrating a heterogeneous mass of enhanced density provoking apparent extrinsic compression of colon. A literature review showed the rarity of this complication, only 22 cases being reported but associated almost constantly with a pseudo-tumoral abscess centered on the diverticulum. This was the case in the patient reported but current imaging methods (ultrasound and particularly CT scanning) allowed correct evaluation of the nature and relations of the mass preoperatively, eliminating, its neoplastic nature by precise morphologic criteria. Despite its rarity, the diagnosis of perforation of an isolated transverse colon diverticulum should be evoked systematically by an extrinsic mass developed in contact with its wall, the nature of which is now simple to define preoperatively by CT scan imaging.
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A 52-year-old man suffering neither from allergies or asthma, with necrotizing granulomatous vasculitis (allergic granulomatosis) of the transverse colon and gallbladder is presented. During an emergency laparotomy, segmental necrosis of the mesenteric side of the mid-transverse colon, and a bulky enlarged gallbladder were found. The affected colon was resected and cholecystectomy was performed. Histological findings included necrotizing granulomatous vasculitis of the small- and medium-sized muscular arteries and adjacent veins with tissue infiltration by eosinophils and extravascular eosinophilic granulomas. These histological features were compatible with allergic granulomatous angitis described by Churg and Strauss (CSS). The patient had neither asthma nor involvement of two or more extra-pulmonary organs which is a key clinical criteria of CSS and fulfilled the criteria of eosinophilia alone. Although pulmonary vasculitis was not confirmed in this patient, the histological diagnosis of this patient was definitive CSS. Localised PAN with allergic granulomatosis or an isolated or limited form of CSS based on these clinical features may be an alternative entity.
A 32-year-old Chinese man with cystic lymphangioma of the transverse colon is described. He presented with a 1-year history of altered bowel habits. Double-contrast barium enema study demonstrated a submucosal lesion in the midportion of the transverse colon with intact mucosa. Computed tomography (CT) showed a round 3.0-cm submucosal cystic mass lesion. Colonoscopy revealed a smooth, soft polypoid mass on a broad base. He underwent segmental resection of the colon. Histologically, the lesion was characterized by cystic lymphangioma originating from the submucosa. The clinical features, radiology, appropriate treatment, and possible pathogenesis of colonic lymphangioma are discussed.
Twenty-two patients with extensive pelvic irradiation underwent supravesical urinary diversion using a transverse colon conduit. Primary diseases were most often carcinoma of the cervix and urinary bladder. Indications for diversion included original treatment planning, radiation cystitis, vesicovaginal fistula, and ureteral obstruction. Operative mortality was low (4 per cent), and most complications were managed by further surgery. Normal upper urinary tracts usually remained normal after diversion; relief of existing hydroureteronephrosis was seen in a majority of patients. Stomal problems have been minimal, and renal function has remained normal or stable. The method affords the use of nonirradiated transverse colon as well as the ureter high above the field of pelvic irradiation and is the preferred diversion in such patients.
A case report of leiomyosarcoma of the transverse colon was presented in view of its rarity of the occurrence. An extra-colonic, mobile abdominal mass showing a rapid growth with mild tenderness was the principal preoperative findings in the patient. The occurrence of malignant tumors in smooth muscles of the colon, not including the rectum, is extremely rare. In review of the references, about thirty cases have been previously reported.
Although considered rare, transverse colon volvulus (TCV) may actually comprise as many as 10% of all cases of colon volvulus. Correct identification clinically is necessary in order to reduce the high mortality. Unlike the treatment of sigmoid volvulus, conservative treatment of TCV is thought to be inadequate. Furthermore, simple proximal colostomy may lead to bowel necrosis. Bowel resection, rather than detorsion procedures, is advocated. The barium or diatrizoate enema examination can readily differentiate TCV from sigmoid and cecal volvulus if one pays careful attention to detail.
Volvulus of the transverse colon is a very rare entity, representing 1 to 3.4% of all volvuli of the colon. We report three cases illustrating the problems of this pathology. The presentation is usually acute, leading to prompt surgery. Multiple etiologies may be combined: congenital malrotations of the gut, chronic constipation in the elderly enhanced by psychiatric medications, and mechanical by adhesion bands which help to create anomalous rotation axes for the volvulus. The best treatment must be surgical, and we recommend an aggressive approach: an extended right colectomy, which gave good results in our patients.
An 81-year-old man who had been aware of a right anterior abdominal mass for 1 week was admitted to our hospital on July 3, 1999, after the mass had perforated and was secreting mucinous purulent material. Computed tomography clearly showed an anterior abdominal wall abscess and a large intraabdominal tumor that contained a fistula-like structure. Barium enema revealed an apple-core sign at the transverse colon, with a fistula that connected the colon to the abscess cavity. Transverse colonic cancer complicated by an anterior abdominal wall abscess was diagnosed, and an extended right hemicolectomy was performed. We did not perform en bloc excision of the full thickness of the anterior abdominal wall, including the abscess, because the defect was determined to be too large to repair. Thus, when curative resection is not feasible, as in our patient, resection of the primary tumor with en bloc partial resection of the adherent parietal wall should be performed if possible, as this procedure has the potential to improve the postoperative quality of life of the patient.
Postoperative urinary tract complications were evaluated in 75 women who underwent urinary diversion with formation of a transverse colon conduit after radiation for gynecologic cancer. Urinary stents were placed at the ureterocolonic junction in 37 women, while no stents were used in 38 women. Leaks or fistulae developed in 18% of the nonstented group but in only 3% of the stented group (P less than 0.05). Ureteral strictures developed in 18% of the nonstented but in only 8% of the stented group. Pyelonephritis developed in 13% of the nonstented and in 8% of the stented patients. Overall, urinary tract complications developed in 50% of the nonstented and in 16% of the stented group (P less than 0.01). Leaks or strictures developed in 11% of the 75 renal units in the nonstented group but in only 1% of the 72 renal units in the stented group (P less than 0.02). Postoperative leaks or fistulae were associated with further serious complications. Results indicate a significant advantage in employing stents at the ureterocolonic junction in the formation of a transverse colon conduit.
We report a case of primitive neuroectodermal tumor (PNET) arising in the transverse colonic mesentery. A 24-year-old Japanese woman was admitted to Kagoshima City Hospital with complaints of abdominal pain and sensations of abdominal fullness of 5 months' duration. On palpation, a mass the size of an infant's head was noted in the right flank. Abdominal computed tomography (CT) and ultrasonography showed a huge mass that consisted of multiple cystic components. On arteriography, a slight tumor stain appeared, with stretched and displaced tributaries of the right colic and middle colic arteries. Barium swallow examination demonstrated that the ascending colon was shifted to the right and small intestine to the left. We performed an en-bloc resection of the tumor in the transverse colonic mesentery, including the ascending colon, proximal jejunum (20 cm in length), and greater omentum. The resected tumor was 12 x 10 x 7 cm in size, 590g in weight, elastic soft in consistency, and multicystic. Histologically, the specimens showed a sheet-like proliferation of spindle-to-polygonal cells, and focally, the tumor formed rosette structures. Immunohistochemically, the tumor cells were positive for neuron-specific enolase (NSE) and mic-2. EWS-FLI1 chimeric mRNA was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Based on the above findings, we finally diagnosed the tumor as PNET of the colonic mesentery. There has been no recurrence for 20 months after operation. PNET arising in the mesentery is very rare, and we distinguished PNET from other tumors by immunohistochemical examination and by demonstration of the presence of EWS-FLI1 chimeric mRNA in the tumor.
Two monozygotic female twins with chronic idiopathic intestinal pseudo-obstruction associated with transverse colon volvulus are described. Quite similar clinical events and temporal coincidences characterized the symptoms which has preceded and followed right colectomy undergone by both of them due to intestinal volvulus. The esophageal, gastroduodenal, colonic and anorectal manometric investigation revealed very similar alterations in both girls. Increased amplitude of distal contractions of the esophagus, a depressed fasting antro-duodenal motility, with absence into antrum and oro-aboral non-propagation in the duodenum of the phase III activity of the interdigestive motor complex were the main findings along with a state of pronounced colonic hypomotility and an hypoesthesia of the rectal ampulla to the volumetric stimulus. This report indicates the association between chronic intestinal pseudo-obstruction and transverse colon volvulus in monozygotic female twins, and it points out the rarity both of the specific symptomatic coincidences and the similar clinical events and of the almost absolute identity of the intestinal motor patterns.
BACKGROUND: Gastrocolic fistula is a rare presentation of both benign and malignant diseases of the gastrointestinal tract. Malignant gastrocolic fistula is most commonly associated with adenocarcinoma of the transverse colon in the Western World. Despite radical approaches to treatment, long-term survival is rarely documented. CASE PRESENTATION: We report a case of a 24-year-old woman who presented with the classic triad of symptoms associated with gastrocolic fistula. Radical en-bloc surgery and adjuvant chemotherapy were performed. She is still alive ten years after treatment. CONCLUSIONS: Gastrocolic fistula is an uncommon presentation of adenocarcinoma of the transverse colon. Radical en-bloc surgery with adjuvant chemotherapy may occasionally produce long-term survival.