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Percutaneous transgastric intestinal decompression: the management of malignant bowel obstruction without nasal intubation.

We inserted a long intestinal tube via the percutaneous transgastric route in three patients with an inoperable malignant bowel obstruction. The percutaneous endoscopic gastrostomy technique facilitated this method. The main purpose of our procedure is to achieve direct intestinal decompression without nasal intubation, which is not always possible by venting gastrostomy alone. Palliative intestinal decompression proved to be effective in all patients. This alternative therapeutic strategy for managing bowel obstruction in terminal cancer patients is herein presented.

Cecal Neoplasms↗

Non-Hodgkin's lymphomas presenting with gastrointestinal involvement.

Between 1978 and 1983 a total of 33 patients with non-Hodgkin's lymphoma (NHL) involving the gastrointestinal tract were seen in our institution. Pathological classification was performed according to Kiel. Low grade NHL was diagnosed in 17, high grade NHL in 16 patients. The most frequent histological entity was lymphoplasmocytoid immunocytoma (11 patients). The most common sites of origin were the stomach (23 patients) and the ileocecal region (6 patients). The majority of patients presented with stage I and II disease (20 of 33 patients). As a rule primary therapy consisted of surgery with curative intent. Most of the patients received additional chemotherapy or radiotherapy. Patients with limited disease and complete tumour resection showed long-term survival from 12+ to 57+ months (mean 32.9+ months). Patients with advanced disease (stage III and IV) and only palliative surgery or with lymphoblastic lymphoma had a probability of survival of less than 12 months.

Adolescent↗

Multiple concentric ring sign in the ultrasonographic diagnosis of intussusception.

Gray scale ultrasound examination of two patients with abdominal space-occupying lesions demonstrated characteristic ring shadows on longitudinal scans. In one case a multiple concentric ring shadow resulted from an ileocolic intussusception, and in the other a "bull's eye" image was due to an infiltrating carcinoma of the pyloric antrum. A study of these patients confirms the suspicion [1] that there is a characteristic ultrasonic appearance of intussusception in bowel loops.

Adenocarcinoma↗

Staging cecal and ascending colon carcinoma with computed tomography.

Operable subserosal and transserosal and inoperable cecal and ascending colon carcinomas can be differentiated by computed tomography (CT). Invasion of the posterior peritoneal reflection produces recognizable changes on CT, which, with or without adjacent muscle invasion, are indicative of tumor nonoperability.

Adult↗

Computed tomographic evaluation and staging of cecal carcinoma.

The preoperative computed tomographic (CT) scans of 14 patients with biopsy-proven primary adenocarcinoma of the cecum were reviewed to assess clinical presentation, CT findings, and value of staging by CT. The correlation of CT evidence for tumor invasion beyond the bowel wall with histopathology had predictive value of negative examination of 33% with sensitivity of 78%. More importantly, the correlation of metastatic nodal involvement by CT had predictive value of negative examination of 22% with sensitivity of only 12%. Of chief concern was the involvement of pericolic and mesenteric nodal chains that were not discernible by CT. Computed tomographic tumor staging was accurate in 57% of cases and upgraded in 43%. This study concludes that, although predictive values of positive CT examination are high, CT tends to underestimate disease extent.

Adenocarcinoma↗

Ultrasonography of the cecum.

Ultrasound can define masses in the cecum and the cecal bed. In the patient with a prior resection of adenocarcinoma of the cecum, the sonogram fulfills a primary role in the detection of large and ill-defined recurrences not amenable to detection by barium enema because of a right colectomy. Discrete lesions within the cecum whether secondary to inflammatory or neoplastic processes could not be differentiated.

Adenocarcinoma↗

Crohn's disease and adenocarcinoma of the intestinal tract. Report of four cases.

Four patients with intestinal adenocarcinoma complicating Crohn's disease are reported. The youngest of the four patients was a 21-year-old female with a 9-year history of Crohn's disease of the terminal ileum as well as of the entire colon. She developed mucus-producing moderately differentiated adenocarcinoma in the cecum. Of the remaining three patients with Crohn's disease, one presented an adenocarcinoma in the ascending colon, one in the rectum and the remaining one in the duodenum. All three colorectal adenocarcinomas originated in areas of high-grade dysplasia and all four in areas with chronic transmural inflammation. The review of the literature indicates that a total of 174 small and large bowel cancers occurring in Crohn's disease have been recorded (including the four reported herein). The vast majority of the reported cases have been found in the North American subcontinent. Only in a few instances were bowel adenocarcinoma and Crohn's disease observed in the European continent. It is therefore remarkable that three of our four cases were seen within a period of 12 months. Interestingly, six patients having colorectal adenocarcinoma in association with Crohn's disease were recently reported from a single hospital in England. The question therefore arises whether our cases and those reported recently from England are unrelated and merely coincidental or whether carcinomas are now also affecting European CD patients. If the latter is the case, the surveillance policy for patients with CD should be reconsidered at this hospital.

Adenocarcinoma↗

Pitfall of laparoscopic colectomy. An unrecognized synchronous cancer.

This case report describes near-obstructing sigmoid colon cancer resected using the laparoscopic-assisted technique. An unrecognized, synchronous cecal cancer caused an early postoperative bowel obstruction. The authors review the incidence of synchronous colon lesions and the need for preoperative and intraoperative evaluation of the entire colon, especially with the use of the laparoscopic technique.

Aged↗

Neuronal intestinal dysplasia presenting as an abdominal mass: report of a case.

An unusual clinical presentation of a patient with neuronal intestinal dysplasia is presented. A 46-year-old male noted a palpable mass in the right lower quadrant of his abdomen for two months. A computed axial tomographic scan showed a thickened wall of the cecum with a tumor-like appearance. The excised specimen consisted of a mass caused by the thickened, edematous wall of the dilated cecum and appendix. The wall of the cecum and appendix measured up to 2.5 and 0.8 cm, respectively, in thickness. Microscopic studies showed extensive hyperplasia and hypertrophy of the ganglia and nerve plexuses and hypertrophy of the muscularis propria, consistent with neuronal intestinal dysplasia.

Appendix↗