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PubMed1995

Retrograde contrast radiography of the distal portions of the intestinal tract in foals.

A technique for retrograde contrast radiography of the distal portions of the intestinal tract of foals was developed and then performed in 25 foals (1 to 30 days old) with colic. Retrograde contrast radiography was shown to be sensitive (100%) and specific (100%) for evaluating obstruction of the small colon or transverse colon. It was slightly less sensitive (86%) and specific (83%) for evaluation of the entire large colon, particularly in older foals. Retrograde contrast radiography provided increased diagnostic capability, compared with that for noncontrast radiography. Retrograde contrast radiography can provide valuable information when evaluating foals with colic and should be part of the diagnostic evaluation.

Animals↗

PubMed1993

Distributional pattern of diverticular disease of the colon in Taiwan.

From May 1981 to October 1991, 66 patients with diverticular disease of the colon were analyzed retrospectively. Data were obtained from medical records. There were 29 men and 37 women, ranging in age from 32 to 85 years, with a mean age of 58.7 years. Forty-nine patients had a singular site of distribution in the diverticulum, and 17 patients had more than two sites of distribution in the diverticula. The locations of the diverticular disease were sigmoid colon (45.4%), ascending colon (36.4%), cecum (33.3%), descending colon (18.2%), transverse colon (12.1%) and rectum (1.5%). The left-sided lesions (46.9%) were approximately equal to the right-sided lesions (43.9%).

Adult↗

PubMed1998

[The yield of endoscopic follow-up after removal of adenomatous polyps from the colon].

OBJECTIVE: To determine the results of follow-up endoscopy after resection of adenomatous polyps from the colon. DESIGN: Retrospective. SETTING: De Heel Hospital, department of Internal Medicine, Zaandam, the Netherlands. PATIENTS AND METHOD: The 124 patients, 66 males and 58 females, with a mean age of 53 years (range: 23-74), in whom a colonpolyp had been removed endoscopically, who had no colonic carcinoma and no positive family history, were registered for follow-up after one year and after 3 or 5 years. In 1997, data were collected on the polyps found and removed at follow-up. RESULTS: At the original coloscopy, 68 patients (55%) had one polyp, 46 (37%) had two to four polyps and 10 (8%) > or = five polyps. The localizations of the polyps were: rectum 17%, sigmoid 66%, descending colon 12%, transverse colon 3%, ascending colon 1% and caecum 1%. Over one-third of the polyps were larger than 1.5 cm. Ninety-eight patients underwent a first follow-up endoscopy after an average of 12 months (range: 0.4-57); one or more polyps were found and removed in 37 of them (38%). At a second follow-up endoscopy after an average of 28 months (range: 5.4-68 months), polyps were again found and removed in 26 of the 57 patients (46%). If two or more polyps had been removed at an earlier coloscopy, the risk of polyps being found again at the next coloscopy was larger (p < 0.001).

Adenomatous Polyposis Coli↗

PubMed1998

[Drug-associated hemorrhagic enteritis].

Drug-associated hemorrhagic colitis are divided into antibiotic associated hemorrhagic colitis (AAHC) and other drug associated hemorrhagic colitis. AAHC are mainly caused by oral usage of Ampicillin and its derivatives (85%). Initially AAHC are believed to be caused by Klebsiella oxytoca overgrowth. However, these organisum has no exotoxin like Clostridium difficile and pathogenesis of AAHC are still unresolved. Typical AAHC are diagnosed by colonoscopy with diffuse hemorrhage and edema mainly found in descending colon and transverse colon. NSAIDs are also the cause of hemorrhagic colitis like AAHC. Mephenamic acid are famous for this complication. Diarrhea is one of the main complication of oral 5-fluorouracil administration and even causes hemorrhagic colitis. Its histology are characteristic in gland atrophy. Gold colitis are reported 36 cases in rheumatoid arthritis patients. Exact mechanism of bleeding are not understood. NSAIDs may cause collagenous colitis and or lymphocytic colitis in RA patients. Other rare hemorrhagic colitis are associated with azathioprine, methyl dopa, interferon alfa etc. NSAIDs and anticoagulants are well known drugs for complication of GI bleeding making hemorrhagic enteritis.

Ampicillin↗

PubMed1998

[Nonrotation of the midgut with abnormality of the superior mesenteric artery].

This report describes an anomalous case of nonrotation of the midgut with two superior mesenteric arteries in a 74 year-old Japanese female cadaver at the anatomical laboratory of Kanazawa Medical University. The characteristics of this nonrotation case were as follows: all the small bowel shifted to the right side and all the large bowel to the left side of the abdomen; cecum and appendix vermiform were situated to the left lower abdomen; and ligament of Treiz was absent. There were three arteries originating from the abdominal aorta for blood supply of abdominal organs: 1) the celiacomesenteric trunk with the first superior mesenteric artery, 2) the second superior mesenteric artery, 3) the inferior mesenteric artery. This case had two superior mesenteric arteries. The first one arose from the celiacomesenteric trunk. The second one arose from the left wall of the abdominal aorta about 95.0 mm below the origin of the celiacomesenteric trunk and 23.0 mm above the origin of the inferior mesenteric artery. The first superior mesenteric artery with five branches supplied the inferior portion of the duodenum and the superior portion of the small bowel. The second superior mesenteric artery had five small intestinal arteries supplying the inferior portion of the small bowel, and five large intestinal arteries supplying the cecum, the ascending colon, the transverse colon and the superior portion of the descending colon. The authors believe that the existence of the two superior mesenteric arteries caused the malformation in the nonrotation of the intestinal tracts in this cadaver.

Abdomen↗

PubMed2000

Free colon transfer for pharyngo-oesophageal reconstruction.

This report describes free transfer of transverse colon for reconstruction of the hypopharynx and cervical oesophagus. The transverse colon based on the middle colic vessels was used in three patients following laryngo-pharyngo-oesophagectomy for hypopharyngeal squamous carcinoma. There were no flap failures or intra-abdominal complications. Solid diet was well tolerated. Transverse colon is easy to harvest, has a long vascular pedicle, wide diameter and good ischaemic tolerance. Contrast studies showed it to be a wide bore passive conduit. Compared with currently available options these features may allow better outcome in pharyngo-oesophageal reconstruction and warrant further evaluation.

Adult↗

PubMed1991

Scintigraphic measurement of regional gut transit in idiopathic constipation.

In this study, total gut transit and regional colonic transit in patients with idiopathic constipation were measured scintigraphically. Eight patients with severe constipation were studied, none of whom had evidence of abnormal function of the pelvic floor. 99mTc-radiolabeled Amberlite resin particles (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO) with a mixed meal were used to assess gastric emptying and small bowel transit; similar particles labeled with 111In were ingested in a coated capsule that dispersed in the ileocecal region. These were used to quantify colonic transit. Five healthy volunteers were also studied. Two patients showed delayed gastric emptying and two had slow small bowel transit. Seven of the eight patients had slow colonic transit. In five, delay affected the whole colon ("pancolonic inertia"); in two, transit in the ascending and transverse colon was normal, but solids moved through the left colon slowly. Mean colonic transit was also measured using radiopaque markers; this technique identified the patients with slow transit, as shown by measurements of overall colonic transit by simultaneous scintigraphy. However, estimated transit through the ascending and transverse colons was considerably shorter by the radiopaque marker technique. In conclusion, idiopathic constipation is characterized by either exaggerated reservoir functions of the ascending and transverse colons and/or impairment of propulsive function in the descending colon. Particle size may influence the result of regional colonic transit tests. Transit delays in other parts of the gut suggest that, in some patients, the condition may be a more generalized motor dysfunction.

Adult↗

PubMed1994

Abdominal radiography for diagnosis of enterolithiasis in horses: 141 cases (1990-1992).

Medical records of 245 horses that had been evaluated by use of abdominal radiography between January 1990 and December 1992 were reviewed. One hundred forty-one horses subsequently had a postmortem examination or surgical exploration performed for definitive lesion diagnosis. The signalment, diagnosis, site, and number of enteroliths were obtained from the medical records. Radiographs were evaluated individually by 3 reviewers for the presence of enteroliths, preferred diagnostic view, evidence of large colon tympany, and film quality. Of the 141 cases reviewed, 66.7% (94/141) had confirmed enterolithiasis. Enteroliths were identified in the right dorsal colon of 59 horses, in the transverse colon of 28, in the small colon of 24, and in the ventral colon of 1 (enteroliths were detected in multiple sites in 12 horses). For the 3 reviewers, mean sensitivity was 76.9% and specificity was 94.4%. Mean positive-predictive value was 96.4%, and negative-predictive value was 67.5%. Cases involving only large colon enteroliths were correctly diagnosed 83.2% of the time, compared with 41.6% of the time for cases involving small colon enteroliths. Enteroliths were evident in 54.8% of the horses with radiographic signs of large colon distention. Fifteen horses had enteroliths in the small colon, 4 in the transverse colon, and 4 in the dorsal colon. Radiographic quality was evaluated and scored as adequate (0), underexposed (-1), overexposed (1), or incomplete. Mean score was -0.5, and there were 21 (14.9%) incomplete studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1998

Autogenic allotopic small-bowel mucosa transplantation in beagles. A new perspective for treatment of small-bowel syndrome?

There is no standard treatment for the short-bowel syndrome. The aims of surgical therapy are based on: slowing the intestinal transit, increasing the absorbing intestinal area and small-bowel transplantation. Searching for a new surgical treatment we developed an alternative for increasing the absorbing small-bowel area by means of autogenic allotopic small-bowel mucosa transplantation in beagle dogs. In young animals we isolated the transverse colon leaving the blood supply intact. Colonic continuity was reestablished and two abdominal stomata were performed at the ends of the isolated transverse colon. A week thereafter the colonic mucosa of the isolated transverse colon was surgically removed and autologous small-bowel mucosa was transplanted in the demucosed colon. The animals were then sacrificed 2, 4 and 6 weeks after transplantation and the colon-coat-ileal-mucosa complex (CIC) was histologically examined. The ileal mucosa could be transplanted in the demucosed colon showing histological characteristics of ileal mucosa. The circular muscle of the colon coat developed a hypertrophy which was present even 6 weeks after transplantation. In this study we could show that autogenic allotopic small-bowel mucosa transplantation is feasible in beagle dogs and may prove a novel method of small bowel expansion in cases of small-bowel syndrome.

Animals↗

PubMed1982

Carcinoma of the colon and rectum: the natural history reviewed in 1704 patients.

For 1704 patients with large bowel cancer compiled by the Armed Forces Central Medical Registry, selected prognostic factors were related to five-year or longer survival. The majority of late deaths (those occurring after five years) resulted from cancer in the descending colon, sigmoid colon or rectum rather than from cancer in the right or transverse colon. For example, among all patients with cancer of the rectum, 15.4% of those with Dukes' B tumors and 10.9% of those with Dukes' C tumors died of rectal cancer between five and ten years after diagnosis. When late survival rates were compared, patients with right and transverse colon cancer (8 deaths/93 at risk) fared significantly better than those with left colon and rectal cancer (33 deaths/171 at risk; P = 0.01). Among patients with left-sided colon and rectal carcinoma, a further significant difference in late survival was found when stage of disease was considered: patients with Dukes' A cancers (3 deaths/47 at risk after five years) fared better than those with Dukes' C cancers (21 deaths/74 at risk) (P = 0.002). For Dukes' B and C stages of disease, patients with left colon and rectal cancer fared worse than those with right and transverse colon lesions after 60 months. Of all patients who died of large bowel cancer after five years, 69% had a recurrence of cancer by 60 months, and most late recurrences were located in the descending and sigmoid colon and in the rectum. These results show differences in survival after five years with respect to both site of cancer in the colon and stage of initial disease. Our findings indicate that many left-sided large bowel cancers have a slowly progressive natural history.

Adenocarcinoma↗

PubMed1989

Continent urinary diversion in gynecologic oncology.

Pelvic exenteration is a salvage procedure used primarily for recurrent gynecologic carcinoma. Up to the present time, an ileal or colon conduit has been used for urinary diversion and the patient remains incontinent of urine. This is a preliminary report of nine patients with gynecologic carcinoma in whom a continent urinary diversion procedure was performed. A segment of distal ileum, the ascending colon, and part of the transverse colon are used to create the colonic reservoir. The segment of colon is opened along the tenia and folded onto itself. The walls of the ascending and transverse colon are anastomosed to detubularize this segment of bowel and eliminate the transient high pressure of the colon. Surgical staples are used for the anastomosis. The segment of ileum is tapered and three purse-string sutures (2-O silk) are placed at the level of the ileocecal valve to achieve continence. The short segment of ileum is then exteriorized as a stoma through which the patient catheterizes. Antirefluxing, non-tunneled ureterocolonic anastomoses are performed. The anterior wall of the reservoir is closed with absorbable staples. Postoperative urodynamic studies have shown maximum capacity of 750 ml and the area of continence to be at the ileocecal valve where the purse-string sutures are placed. All patients are continent and postoperative radiographs were negative for reflux. Follow-up was 6 to 12 months. The colonic reservoir is a capacious low-pressure system and warrants further clinical trials in patients with gynecologic cancer.

Colon↗

PubMed1987

Ultrasound assessment of fetal intestinal development in the evaluation of gestational age.

A prospective ultrasound study was conducted in 289 uncomplicated pregnancies with gestational ages ranging from 16-40 weeks. Biometric measurements obtained included biparietal diameter (BPD), head and abdominal circumferences, measurements of long bones, and maximal transverse colon diameter. The pattern of small intestinal peristalsis, presence of colonic haustra, and progressive changes in the colon's intraluminal echogenicity were also evaluated. A high degree of correlation was found between gestational age and transverse colon diameter (in millimeters) (R2 = 0.859; P less than .0001), increasing colonic intraluminal echogenicity (R2 = 0.741; P less than .0001), and the appearance and progressive increase in small intestinal peristalsis (R2 = 0.726; P less than .0001). Colonic haustra were visualized in 87.5% after 30 weeks (specificity 100%, sensitivity 77.4%). A high degree of correlation with gestational age was also found if echogenicity and peristalsis were combined (R2 = 0.873; P less than .0001), and proved superior to that found with measurement of BPD (R2 = 0.655; P less than .0001) or femur length (R2 = 0.805; P less than .0001) after 28 weeks. Observations of progressive changes in small intestinal peristalsis and colonic intraluminal echogenicity, together with the development of colonic haustra and progressive increase in transverse colon diameter, allow one to estimate gestational age independent of standard biometry. This approach has particular utility in the third trimester, when sonographic estimation of gestational age is least accurate.

Colon↗

PubMed2000

Metastasis to the forearm skeletal muscle from an adenocarcinoma of the colon: report of a case.

While the liver and lung are primary targets for distant metastasis from colorectal carcinoma, metastasis in other distant sites is rarely found. We report herein an unusual case of metastasis to the skeletal muscle of the right forearm from an adenocarcinoma of the transverse colon. A 60-year-old man was originally admitted to our hospital for surgical treatment of an intestinal obstruction caused by a transverse colon carcinoma. Transverse colon resection along with lymph node dissection was performed and no evidence of distant metastatic foci was found. Angiography-enhanced computed tomography scanning done 14 months after the first operation revealed multiple hepatic metastases which were resected. A metastasis was subsequently detected in the right extensor carpi ulnaris muscle 2 years after the primary resection, and a major part of the right extensor carpi ulnaris and the extensor digiti minimi muscle were resected, warranting a sufficient margin of 5 cm of normal tissue from the tumor. Reattachment of the residual muscles into the ulna was performed. Metastases to bone and/or soft tissues from colorectal carcinomas are extremely rare and to our knowledge, only eight other cases have been reported in the world literature. This low incidence may be related to the anatomical characteristics and/or the biochemical environment of the skeletal muscle, but it is also possible that the true incidence is underestimated. Recent improvements in interventional radiological procedures may facilitate a diagnosis of skeletal muscle metastasis being made more frequently.

Adenocarcinoma↗

PubMed1991

Early clinical experience with the transverse colon-gastric tube continent urinary reservoir.

The clinical results of the first 4 patients undergoing reconstruction with the transverse colon-gastric tube urinary reservoir are presented. All patients had a minimum 1-year follow-up. All 4 patients are continent with stable or improved renal function. Two patients required reoperation. Indications as well as possible modifications of this procedure are discussed.

Adult↗

PubMed2006

Transthoracic repair of Morgagni's hernia: a 20-year experience from open to video-assisted approach.

BACKGROUND: Foramen of Morgagni's hernia is an uncommon congenital diaphragmatic hernia. Repair is mostly performed through laparotomy. We prefer the transthoracic approach, which allows better and safer control during thoracic dissection, although it is considered more painful and related to greater morbidity. In recent years we introduced the transxiphoid hand-assisted videothoracoscopic approach, which combines the advantages of the thoracic route with a mini-invasive procedure facilitated by one hand inside the chest. METHODS: A retrospective review was performed over a 20-year period (1985-2005). Twenty-two patients who had a foramen of Morgagni's hernia repaired were identified and relevant data were collected. Average age was 57 +/- 10 years and one half of the patients were asymptomatic. Chest roentgenograms, chest computerized tomography, and barium enema were used as diagnostic utilities. Posterolateral thoracotomy was performed in 17 (15 right-sided) patients, whereas in 5 (all right-sided) the defect was repaired by transxiphoid hand-assisted videothoracoscopy. Operative time, pain scored by visual analog scale, hospital stay, and cosmetic results by acceptance score were reviewed for every patient. RESULTS: Hernial sac was present in all cases and contained only omentum (n = 13), omentum plus transverse colon (n = 7), omentum plus transverse colon and small bowel (n = 2). In 6 patients (2 videothoracoscopy) we repaired the large defects with polypropylene mesh. Videothoracoscopy achieved significant good results compared to thoracotomy in operative time (85 +/- 7.9 versus 110 +/- 11.3 min, p < 0.01), 24-h visual analog scale (3.5 +/- 1.1 versus 6.7 +/- 3.9, p < 0.01), hospital stay (2.6 +/- 0.5 versus 6.4 +/- 1.2 days, p < 0.01), and acceptance score (4.3 +/- 0.5 versus 3.1 +/- 0.8, p < 0.05). Postoperative course was always uneventful. Patients were followed for an average period of 58.6 +/- 14.7 and 109.7 +/- 43.5 months, respectively: no recurrences were found in any group. CONCLUSIONS: We believe that the transthoracic approach is a safe and effective method for repairing Morgagni's hernia. The videothoracoscopic approach is a promising alternative and it may be facilitated by introducing a hand inside the chest.

Adult↗

PubMed2006

A monotonous population of elongated cells (MPECs) in colorectal adenoma indicates a high risk of metachronous cancer.

Accurate predictors for metachronous colorectal cancer (CRC) development after polypectomy are lacking. We evaluated the prognostic value of classical clinicopathologic features and a monotonous population of elongated cells (MPECs) in colorectal adenomas from 171 consecutively selected population-based patients with long-term follow-up. Quantitative image analysis, and univariate and multivariate regression analysis were applied. Ten of 171 adenomas (5.8%) developed metachronous CRC (defined as >24 mo interval and >5 cm from the index adenoma to the cancer). Median follow-up of adenomas with metachronous CRC was 68.4 and without cancer 149.7 months (range: 25 to 192 and 25 to 256, respectively). The most prognostic classical features were the localization of the marker adenoma as proximal (ie, in the cecum through transverse colon) versus distal from the transverse colon [P=0.0003, hazard ratio (HR)=8] and the number of polyps found during colonoscopy ( 2, P=0.002, HR=6). Quantitative features of the MPECs included the longest nuclear axis and variance of the number of nuclei with 2 neighbors (higher and lower in cancer cases, respectively). Of the 171 adenomas, 50 (29%) had MPECs, of which 9 (18%) patients developed metachronous CRC at follow-up, contrasting 1/121 (0.8%) without MPECs (P=0.0003, HR=23). MPECs occurred in both low-grade and high-grade dysplasia, and in tubular and (tubulo) villous adenomas. MPECs had the strongest predictive value for metachronous CRC development. Adenomas proximally located had additional value but only if they were MPEC positive (which only occurred in 5 adenomas, 3 of which (60%) developed cancer). Having more than 2 polyps also had additional prognostic value but only in MPEC-negative adenomas [10 cases; 1 (10%) developed cancer]. Dysplasia grade and histologic growth pattern had no additional value. Thus, colorectal adenomas with subsequent metachronous cancer development can be identified more accurately with MPECs than with classical prognostic factors.

Adenoma↗

PubMedDate not supplied

Computed tomography of gastrocolic ligament: involvement in malignant tumors of the stomach.

BACKGROUND: This study investigated computed tomographic (CT) features and anatomic bases of gastrocolic ligament involvement in malignant neoplasms of the stomach. METHODS: We retrospectively reviewed CT scans of 34 patients known to have gastric malignant neoplasm and gastrocolic ligament involvement. Emphasis was placed on direct invasion, lymph node metastasis, and omental seeding. RESULTS: CT manifestations of gastrocolic ligament involvement included direct invasion (38.2%, 13 of 34), enlargement of lymph nodes (50%, 17 of 34), "smudged" appearance (26.5%, nine of 34), "omental caking" (5.9%, two of 34), cystic mass (2.9%, one of 34), and varices of the omentum (2.9%, one of 34). We also found that gastric carcinoma and gastrointestinal stromal tumor invaded the transverse colon through the gastrocolic ligament in six patients (17.6%, six of 34). CONCLUSION: CT scan is useful for detecting gastrocolic ligament involvement in gastric malignant neoplasm. The imaging features consist of a mass sign, enlargement of lymph nodes, smudged appearance, omental caking, and so on. Gastric malignant neoplasm also may involve the transverse colon through the gastrocolic ligament.

Adenocarcinoma↗

PubMed2000

Gastric carcinoma presenting with extensive extraluminal growth: report of a case.

We report a 48-year-old-man with gastric carcinoma presenting with an unusual extraluminal growth. The patient underwent a barium meal examination and gastrofiberscopy because of progressive anemia over 6 months. These examinations revealed a Borrmann type 3 advanced gastric carcinoma of the greater curvature of the antrum. Biopsies showed moderately differentiated tubular adenocarcinoma. The intraoperative findings showed gastric carcinoma associated with extensive extraluminal invasion into the adjacent organs, i.e., the transverse colon and mesocolon. A palliative distal gastrectomy with a partial resection of the transverse colon was performed because of peritoneal dissemination found in the mesocolon and rectovesical pouch. A histological examination of the specimen confirmed adenocarcinoma which had massively infiltrated the transverse colon and mesocolon. His postoperative course was uneventful. However, he died of peritonitis carcinomatosa 9 months later.

Adenocarcinoma↗