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A case of volvulus of the transverse colon in an elderly female Australian Aboriginal is reported. The rarity of the condition is stressed and the radiological features are discussed. Reference is also made to the geographical distribution of all types of volulus of the colon, and to the apparently high incidence of the condition in Aboriginal patients admitted to the Darwin Hospital.
Volvulus of the transverse colon is rare. Sixty-six cases have been reported in the English medical literature, and three new cases are presented herein. The causative factors, classical clinical presentation, radiologic findings, and management have been addressed. It is believed that colonoscopy will have an increasing role in the diagnosis and treatment of this condition in the future.
A case of transverse colon volvulus is reported, bringing the total number of collected cases in the English language medical literature to 45. Although this type of volvulus is rare, a definite pattern can be appreciated. Patients tend to be young, female, and give a history of chronic or recurrent difficulty in having bowel movements. A triad of underlying factors predisposes to the development of the volvulus: a distal impediment (either organic or functional) to the evacuation of the bowel, a redundant bowel and mesocolon and a fixed point around which the bowel can twist. The best treatment is resection with either anastomosis or exteriorization, depending on bowel viability.
An unusual case of volvulus of the transverse colon associated with scleroderma is presented. The morphologic changes in the large bowel due to progressive systemic sclerosis, resulting in pseudo-obstruction, are considered in the etiology and pathogenesis of colonic torsion.
Intestinal obstruction secondary to transverse colon volvulus in a 7-year-old girl with previously diagnosed pathologic aerophagia is presented. This unusual combination is not previously described.
The hepatodiaphragmatic interposition of the colon (Chilaiditi's Syndrome) and associated volvulus of the transverse colon is a rare cause of mechanical intestinal obstruction. The preoperative diagnosis is extremely difficult. We report a 26-year-old- male case, symptomatic since childhood, whose diagnosis by barium enema was confirmed surgically in Hospital Universitário de Taubaté. He underwent a transversectomy, and presented an intestinal obstruction in the post-operative period. Two reoperations were required. He has remained well, with outpatient supervision.
A personal series of 83 cases of carcinoma of transverse colon has been analysed, as the recent works of international literature. The low percentage of success of these cancers is justified by the anatomical conditions and the pathological findings. Particularly, this prognosis is made worse by the high percentage of multivisceral cancers, hepatic metastases and emergency cases. The operative technics are very different. Beside the typical resections (right or left hemicolectomy), there remains one more important place for segmental colectomy. At least the subtotal colectomy gets some more indications, especially in the high risk patients. Only 28% of the resected cases shows a 5 years survival rate. This percentage is nearly the same as most of the recents statistics.
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The authors report two cases of primitive tuberculosis of the transverse colon. Its rare occurrence and the importance of endoscopy are pointed out. A therapeutic test is often justified. Surgery is needed in case of acute complications or stenosis, and when a malignant lesion cannot be ruled out.
Segmental atresia of the transverse colon was observed at necropsy in a neonatal foal. The dorsal and ventral components of the large colon were fused, and ended blindly. The small colon was collapsed and completely closed at its cranial end. The right and left dorsal and ventral colons were fused into one blind-ended tube. Histologically, eosinophilic intranuclear inclusion bodies demonstrative of Equine Rhinopneumonitis were present in the thymus.
A case of replacement of a damaged ureter with ileum, in a previously constructed transverse colon conduits, is reported. This is an attractive surgical alternative that deserves a place as a reconstructive procedure in the management of ureteral complications following urinary diversion.
We report a case of anastomotic recurrence after curative surgery for transverse colon cancer in a 53-year-old man. The recurrence was first detected as a submucosal tumor 1.3 cm in diameter, located on the suture line, during an annual follow-up barium enema and colonoscopy. A repeat examination 3 months later showed the lesion to be a typical colon cancer, 2.5 cm in size, with a large ulcerated area. Right hemicolectomy was performed with curative intent. Anastomotic recurrence is much rarer after colonic resection than after anterior resection. This was the first time that we had detected a recurrent lesion as a submucosal tumor during annual follow-up examination.
The authors discuss the optimal surgical attitude in the cases of 44 patients with cancers of the transverse colon (excluding the angular localizations), representing 5.4% of the total number of colic cancers operated in the Clinic over the last 20 years. All the patients were in stages C and D (according to the Turnbull and Dukes classification), and the general index of resectibility of 79%. Segmental transverse colectomy should be reserved for patients of advanced age, as well as for those with organic disturbances, altered general condition, of when there is extensive loco-regional involvement, or metastases at distance. Fifteen patients were included in these categories. Extended transverse colectomy, with radical intent from the oncological standpoint, appears to be the optimal attitude in the cases of patients which do not have any of the contraindications mentioned above. Twenty patients were in this group. The postoperative death rate was 11.4% for the entire group of patients in whom resections were performed. Five patients (25%) have survived according to our data between 5 and 11 years after extensive radical colectomy.
A 68-year-old woman presented with transverse colon cancer invading the liver, duodenum, and pancreas. The patient underwent a curative resection including a right hemicolectomy, partial hepatectomy, and pancreaticoduodenectomy (PD). The pathological examination showed adenocarcinoma of the colon with a direct extension into the duodenum, liver, and pancreas. Several lymph nodes were also involved. The patient is still alive and disease-free 2 years and 6 months after the operation. This case illustrates that even in patients with locally advanced colon cancer, a favorable prognosis can be obtained by aggressive surgery incorporating the resection of the adjacent involved organs.
The authors report a series of 75 cases of carcinoma of the transverse colon, involving equally the right and left halves. They rarely arose from the middle segment (10% of the series). Usually the tumour was very large affecting the serous layer with lymph node invasion. Liver metastases were frequent. 50% of patients were aged over 70 years. Theoretically, wide removal attempting to cure the disease means removing both colonic angles and the areas supplied by both the superior and inferior mesenteric arteries. But fairly often the existence of vascular variations in the transverse mesocolon permits one to restrict the extent of the resection whilst saving the basic principles of radical removal. Furthermore, in 20% the treatment was purely palliative. The operative mortality was high (25%). The five year survival, in the whole series was about 50%.
Patients with pelvic malignancies often require irradiation as part of the treatment protocol or as definitive treatment for the malignancy. Subsequent urinary diversion with the low lying small bowel or the descending colon often results in increased morbidity. Therefore, a method of urinary diversion using the transverse colon conduit in an end-to-end ureterocolic anastomosis as described by Wallace was used. Several advantages with this method are identifiable easily and are described. The satisfactory results in the last 30 patients who underwent this procedure after pelvic irradiation are presented. The ureterocolic anastomosis with reflux is of particular importance since it allows retrograde conduitograms to be performed at later dates to evaluate the urothelium for possible recurrent disease.
An analysis is presented of late results in 144 reconstructions of oesophagus with transplants (137 isoperistaltic, 7 anisoperistaltic) from transverse colon for correction of stricture, mainly after corrosive trauma. The grafts were interposed retrosternally in 126 cases and intrathoracically in 18. Delayed passage due to excessive size of the colon segment was managed in four cases by plication of the intra-abdominal part of the graft or by jejunal by-pass. 'Pseudo-diverticulum' at the proximal anastomosis occurred in five cases as a complication of the standard by-pass procedure. Correction was made by closure of the pouching oesophagus below the cervical anastomosis. Transformation to end-to-end anastomosis is also recommended. The incidence of gastrocolic reflux was low. In two of the four observed cases the cause was late pyloric stenosis. There was no case of peptic ulceration. For good late results of colo-oesophageal reconstruction, appropriate length and type of colon segment, suitable site of gastric implantation and isoperistalsis are of primary importance.
Extranodal Hodgkin disease presenting as a primary localized neoplasm is uncommon, with rare case reports describing primary sites other than lymph nodes. The gastrointestinal tract is the most frequent site of involvement by extranodal Hodgkin disease, typically involving the stomach or small bowel. To date, we have been able to find only one fully documented case of Hodgkin disease of the sigmoid colon confirmed by immunohistochemical studies. We report a case of extranodal Hodgkin disease involving the transverse colon, presenting as inflammatory bowel disease and documented by light microscopic, immunohistochemical, cytogenetic, and molecular studies.