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PubMed1989

[A case of chemotherapy by the transarterial catheter with reservoir against malignant lymphoma of the colon].

We had a case of malignant lymphoma of the colon with two lesions, one in the transverse colon and the other in the ascending colon. The tumor of the transverse colon was resected, but that of the ascending colon was unresectable. Chemotherapy was performed through the catheter with reservoir via the iliac artery into the right colic artery. Three months later, the tumor disappeared completely, and the ascending colon was resected. On histopathological examination, there was no lymphoma cell in the ascending colon. Chemotherapy by a transarterial catheter with reservoir is a new method of treatment against malignant lymphoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1978

Left-sided colectomy with retroileal colorectal anastomosis.

Following resection of the sigmoid and descending colon for cancer or extensive diverticular disease, it may be impossible to make a colorectal anastomosis due to inadequate length of the residual transverse colon. To correct this problem, the remaining transverse colon may be pulled into the pelvis by making a "window" in the terminal part of the ileal mesentery. From January 1966 to January 1975, 302 resections of the descending colon with colorectal anastomoses were performed by one of the authors (R.B.T.) for upper sigmoid cancer and extensive diverticulitis at the Cleveland Clinic. Eleven patients (4%) had retroileal colorectal anastomoses. The retroileal apprach is a technical aid when performing an extensive left-sided colectomy and/or when there is insufficient length of residual transverse colon to make a tension-free colorectal anastomosis.

Adult↗

PubMed2006

A singular pancreatico-colic artery: anatomical report and clinical implications.

After dissection of the abdominal cavity of a 59-year-old male, a long artery, extending from the hepatic artery to the transverse colon, and comprised proximally within the neck of the pancreas and distally within the transverse mesocolon, has been detected. This "pancreato-colic" artery (P-C A) was 13 cm in length and 4 mm in diameter at the origin. Its mesocolic part (2.5 mm in diameter) contributed to the formation of the marginal arcade. No middle colic artery from the superior mesenteric was observed. Thus, the transverse colon was supplied by the distal part of the P-C A. Considering both the P-C A caliber and topography, attention should be paid during pancreatic resections and in the interposition of the transverse colon for esophageal replacement in order to avoid serious bleeding and necrosis. Embryologically, the proximal part of the P-C A might be regarded as an intrapancreatic variant of the tract of the longitudinal anastomosis between the ventral segmental arteries, persisting in the adult as dorsal pancreatic artery. Different from its usual retropancreatic location, this part might be entrapped inside the gland by the developing primitive pancreatic anlages. The distal, mesocolic, part of the P-C A might be regarded as a replacing middle colic artery into the dorsal mesentery during midgut rotation.

Arteries↗

PubMed1995

Strangulation of the colon complicating acute pancreatitis.

We report a patient with alcohol-induced necrotizing pancreatitis who developed a severe ileus followed by incarceration of a portion of the transverse colon within a ventral hernia. Laparotomy 9 days after the onset of symptoms revealed infarction of the transverse colon and infection of the pancreas. This is the first report of a case of acute pancreatitis that led to a strangulated ventral hernia of the colon. We believe that the enteric organisms that infected the pancreas originated in the incarcerated transverse colon.

Acute Disease↗

PubMedDate not supplied

[Tubular duplication of the colon: a case report and review of the literature].

Among Gastrointestinal Duplications, colonic duplications are the less common. The case presented here consist of a duplication of the transverse colon, difficult to diagnose, which had abdominal distension as the main symptom. A 4-year-old child was referred to the Unity of Pediatric Surgery, Hospital de Base, Brasilia, DF with a history of progressive abdominal distension. Plain X-Rays of the abdomen demonstrated a large fecaloma, which demanded removal. A Barium Enema was done suggesting Congenital Megacolon. A rectal biopsy was performed under general anesthesia, demonstrating normal ganglion cells. Medical treatment was instituted for chronic constipation in the Pediatric Gastroenterology clinic. The patient returned three months later with the same complaints. A new rectal biopsy was done; normal ganglion cells were described, ruling out Hirschsprung's disease. The parents were told to insist on the medical treatment diets. Four years later the patient was seen in the Emergency Room with signs and symptoms of low intestinal obstruction. Exploratory Laparotomy was undertaken as an emergency and the findings were complete volvulus of the large bowel involving the transverse colon up to the splenic flexure, demonstrating a large duplication of the transverse colon. A resection of the duplication and end-to-end colonic anastomosis was performed with an uneventful postoperative care. Discharged on excellent conditions.

English Abstract↗

PubMedDate not supplied

[Lipoma of the colon].

Two cases of submucosal lipoma of the transverse colon are described with their anatomoclinic characteristics and the different aspects of their treatment. These lesions occur with the maximum frequency in the fifth or sixth decades of life and are mostly found in women. 18 per cent of them are located on the transverse colon. In 10 per cent of the cases, the lipomas are multiple. Their clinical symptoms are directly related to their size. Abdominal pains, rectal bleedings and signs of obstruction are the most common symptoms. Thanks to barium enema and endoscopic examination, they are usually diagnosed preoparatively and may be excised through a colotomy in the majority of cases, or by endoscopic removal.

Aged↗

PubMed1994

[Efficacy of extramucosal myotomy in an experimental model of intramural colonic obstruction. An experimental study in rats].

An experimental study over the efficacy of myotomy in the treatment of intramural colon obstruction is presented. Forty Wistar rats were used. Four groups were made with ten animals each: Group I: control; Group II: myenteric denervation of four cm segment of transverse colon; Group III: myenteric denervation of 4 cm segment of transverse colon and myotomy; Group IV: myotomy of segment of transverse colon. Myenteric denervation was produced by serosal application of 0.1% benzalkonium chloride during 30 minutes. Animals were evaluated by clinical parameters (survival, weight change, food intake, nutritional state), radiological (barium enema) and Histomorphometry. The myotomy is an effective technique for the treatment of the experimental model of colon obstruction used.

Animals↗

PubMed1993

Retrogastric colon: CT demonstration of anatomic variations.

In a series of 9,400 body computed tomographic (CT) scans of adult patients, a retrogastric course of the transverse colon with interposition of colon between the pancreatic body-tail and stomach was identified in 18 patients (0.2%). Three other patients (0.03%) had retrosplenic, retrogastric colon with transverse colon interposed between the spleen and posterior diaphragm. Three of the 18 patients with pancreaticogastric interposition also had small bowel malrotation. Clinically, no symptoms attributable to retrogastric colon were found. Retrogastric colons probably result from mild embryologic abnormalities of bowel rotation and fixation. Radiologically, colon in the area of the lesser sac must be differentiated from the normal duodenojejunal flexure, a perforated viscus, and abscess.

Adult↗

PubMed1982

Fecal blood loss in patients with colonic polyps: a comparison of measurements with 51chromium-labeled erythrocytes and with the Haemoccult test.

The quantitative determinations of fecal daily blood loss after intravenous administration of 51Cr-labeled erythrocytes in 44 patients with colonic polyps and in 11 controls were compared with the results of the daily performed Haemoccult test without dietary restrictions. A total of 642 stool specimens was analyzed for 51Cr loss and the Haemoccult test. The mean fecal daily blood loss in the 34 patients with adenomatous polyps of the descending colon and rectosigmoid was 1.36 +/- 0.14 ml/day (mean +/- SEM), in the 10 patients with polyps of the ascending and transverse colon it was 1.28 +/- 0.31 ml/day, and in the 11 controls 0.62 +/- 0.07 ml/day. There was no positive Haemoccult test in the controls. In fecal specimens from patients with polyps in the descending colon and rectosigmoid containing 2.0-3.99 ml blood/day, the Haemoccult-test was positive in 86%. Fecal specimens from patients with polyps in the ascending colon and transverse colon containing equal blood loss yielded a positive Haemoccult test result in 26%. Thus, the positivity of the Haemoccult test is determined by the fecal daily blood loss and the anatomic location of colonic bleeding sites.

Chromium Radioisotopes↗

PubMed2000

Intestinal bypass of the oesophagus: 117 patients in 28 years.

This study includes 117 patients operated upon in the period from 1970 to 1999. Indications, surgical techniques, complications, and results are reviewed. Indications included: long-gap oesophageal atresia with or without fistula in 81 patients; peptic stenosis in 19; caustic stenosis in 12; oesophageal varices in 2; and 1 case each of oesophageal epidermolysis bullosa, total oesophageal leiomyomatosis, and a non-functioning antiperistaltic retrosternal colic graft operated upon in another hospital. A retrosternal bypass was performed 106 times: 98 first operations and 8 redos; the intrathoracic technique was used 19 times. The left transverse colon was used in 107 cases (85.6%), the right transverse colon in 8 (6.4%), and the ileocecum in 10 (8%). All the intestinal bypasses were placed in the isoperistaltic direction. There were 5 deaths in the first 11 years of our experience; no patient died from 1982 on. Ten complications were treated conservatively (8%): 2 wound infections healed with medical treatment, and 8 leaks of the cervical anastomosis closed spontaneously. The major surgical complications were 8 gangrenous bypasses (6.4%), removed and reoperated about 1 year later utilizing an ileocolic retrosternal graft. Three cases of peptic disease of the colic bypass (2.4%) were successfully treated with the author's technique. Nine patients had minor surgical complications (7.2%): 3 strictures of the oesophagocolic anastomosis in a retrosternal bypass (resected and reoperated) and 6 cases of adhesive occlusion. In our opinion, the best substitute of the oesophagus is the colon, particularly the left transverse segment, which may be placed behind the sternum or in the oesophageal bed, always in the isoperistaltic direction. The low mortality (4%), restricted to the early period of our experience, and few major surgical complications (6.4%) are acceptable considering the importance of the operation, and the long-term results may be considered very satisfactory.

Burns↗

PubMed1986

Gastric involvement by omental cakes: radiographic findings.

Six cases of malignancy (3 ovarian, 1 endometrial, 1 cecal, and 1 breast) were collected in which upper gastrointestinal (UGI) examinations revealed mass effect, nodularity, flattening, and/or spiculated mucosal folds on the greater curvature of the stomach due to contiguous spread of tumor from the greater omentum. Carcinoma of the transverse colon invading the stomach via the gastrocolic ligament may produce identical radiographic findings. In 3 cases, however, barium enema (BE) examinations revealed simultaneous involvement of the transverse colon by omental tumor as well as other evidence of intraperitoneal seeding. When a UGI examination suggests gastric involvement by omental metastases or so-called omental "cakes," a BE should be performed to demonstrate associated colonic involvement and to rule out a carcinoma of the transverse colon as the cause of these radiographic findings.

Adult↗

PubMedDate not supplied

[A case of strangulated congenital diaphragmatic hernia with necrosis and rupture of the colon and herniation into a left hemithorax in an adult (author's transl)].

This is a case report of a successful repair of congenital diaphragmatic hernia in a 48 years old male that contained the transverse colon which was strangulated and ruptured in the left thoracic cavity. It was approached in two stages. First through a laparotomy the proximal part of the transverse colon was divided. The side going to the hernial sac was sutured and the proximal stump was anastomosed to the descending colon. In a second stage, two days later, through a felt thoracotomy the strangulated and ruptured colon was resected and the distal stump of the transverse colon was sutured and the hernia repaired.

Colon↗

PubMed1990

[Adaptation of the esophagus, reconstructed using the colon, based on 135 cases of surgery in corrosive stenosis].

Late aspects of adaptation were studied on the basis of 135 esophagoplasty by means of isoperistaltic (except of 7 anisoperistaltic) transverse colon for corrosive strictures. Histochemically, the augmentation of neutral mucopolysaccharide, which increases mucosal resistance--was observed on the surface and in Lieberkühn glands of colonic mucosa. Mucosal absorption remains unmodified. Transit time is considerable longer, but without functional consequences. Radiokinematographically, characteristic, coordinated, multihaustral, propulsive movements of transverse colon were present, playing a secondary, but active role in the swallowing mechanism. In the authors opinion, the marked differences between the iso- and anisoperistaltic interposition modality, in point of view of gastro-colic reflux, is explained by these unmodified, more independent, motor activity of the bowel wall. Good long-term functional results were present in 92% of patients. In management of corrosive strictures, isoperistaltic transverse colon may be considered the graft of choice, both technically and functionally.

Burns, Chemical↗

PubMedDate not supplied

A case of primary mesenteric embryonal carcinoma.

We describe a case of primary mesenteric embryonal carcinoma. The patient was a 73-year-old man who presented with a huge mass palpable at the right upper side of the abdomen. Laboratory evaluations showed very high alpha-fetoprotein and PIVKA-II levels, and an abdominal computed tomographic scan demonstrated a mass contiguous with the liver. These findings suggested hepatic cell carcinoma extending beyond the liver. However, angiography showed the mass to be supplied mainly by the middle colic artery and greater omentum artery, suggesting a mesenteric tumor. Gastroscopy demonstrated a IIc lesion in the anterior wall of the antrum. This lesion was histologically diagnosed to be moderately differentiated adenocarcinoma. The large tumor adjacent to the liver was diagnosed to be a primary mesenteric tumor or a metastatic mesenteric tumor from arising gastric cancer. At laparotomy, a huge tumor was found in the gastrocolic ligament. The tumor adhered to the distal part of stomach, the transverse colon, and the gallbladder. En-bloc resection of the tumor was performed, including the distal part of stomach, Part of the transverse colon, and the gall-bladder. The tumor mass measured 26.0 x 21.0 x 9.0 cm, weighted 2750 g, and showed central necrosis and hemorrhage. The histopathological diagnosis was a primary embryonal carcinoma originating in the mesentery. Primary mesenteric embryonal carcinoma is extremely rare. To our knowledge, no other cases have been reported. We describe this case and briefly discuss the related literature.

Aged↗

PubMed1982

Surgical resection of the rat colon: effects on carcinogenesis by 1,2-dimethylhydrazine.

Following a 3-month treatment with 1,2-dimethylhydrazine (DMH) given weekly (sc), outbred Sprague-Dawley rats were subjected to partial resection of the transverse colon. After surgery, DMH treatment was continued for 6 months, after which the rats were killed. At autopsy, 63% of the tumors were found in the transverse colon. By contrast, only 29% of the tumors found in the "sham-operated" control animals occurred in the transverse colon. Surgical trauma in the colon mucosa subjected to the action of carcinogenic agents appeared to promote the conditions suitable for the development of tumors in that organ.

Animals↗

PubMed1994

Dilatation of the colon complicating acute self-limited colitis.

Colonic dilatation has been reported as an occasional complication of infectious colitis in single case reports and short series, but no large series has been published. We analysed 19 cases of self-limited colitis complicated by colonic dilatation, with infective agents identified in 14, admitted to a Regional Infectious Diseases Unit. Colonic dilatation, defined as a minimum transverse colonic diameter of 7 cm on plain abdominal X-ray, was associated with approximately 1% of cases of notifiable diarrhoea requiring hospital admission. The clinical course was associated with pyrexia (in 90%), tachycardia (in 90%), hypoalbuminaemia (in 100%), anaemia (in 84%) and reactive thrombocytosis (in 63%). There was a history of antidiarrhoeal agents or opiate analgesia in eighteen patients (95%). Intensive medical management, consisting of intravenous antibiotics, steroids, supplementary nutrition and withdrawal of anti-motility agents, resulted in resolution in 17 patients. Two patients required subtotal colectomy for perforation of the transverse colon, but neither developed severe peritonitis, and both subsequently underwent reversal of ileostomy. With early recognition and close observation of colonic dilatation in patients with acute diarrhoea, most cases can be successfully managed conservatively with preservation of the colon. Surgical intervention should be considered in patients with progressive colonic dilatation despite intensive medical management. There were no clinically useful parameters distinguishing self-limited colitis from inflammatory bowel disease acutely, so initial management should cover both possibilities.

Acute Disease↗

PubMed1999

Regional differences in the sympathetic innervation of the guinea pig large intestine by neuropeptide Y- and tyrosine hydroxylase-immunoreactive nerves of divergent extrinsic origin.

Region-specific patterns of nerves with immunoreactivity to neuropeptide Y (NPY) have been described previously in the submucous plexus of guinea pig large intestine. Because these may have functional significance, the possibility of similar, characteristic variations of NPY-like immunoreactivity (NPY-ir) in the myenteric plexus was explored. Regional differences were found in the occurrence and pattern of distribution of NPY-ir in the myenteric plexus of the guinea pig large intestine. NPY-ir was present rarely within neuron somata in any region of the large intestine, and NPY-ir nerve fibers were present only within the distal large intestine, increasing progressively in density from the distal spiral to the rectum. Lesion of the colonic nerves, but not the hypogastric, intermesenteric, or lumbar splanchnic nerves, resulted in a loss of NPY-ir in the distal spiral and transverse colon but not in the descending colon or rectum. Ring myotomies in the descending colon resulted in a loss of NPY-ir proximal to the lesion. Dual-labeling immunohistochemical studies revealed that the NPY-ir nerve fibers rarely contained immunoreactivity for tyrosine hydroxylase (TH). Extrinsic nerve lesions resulted in an unequivocal reduction in NPY-ir in intraganglionic fibers of the submucosal plexuses of the transverse colon and a partial loss in the distal spiral and descending colon: the rectum was unaffected; in only a minority of guinea pigs, however, was any decrease in the NPY-ir innervation of submucosal blood vessels detected. The principal projections of NPY-ir nerves were from and through the inferior mesenteric ganglion; however, NPY-ir was not colocalized with TH-ir. It is proposed that nonnoradrenergic, NPY-containing neurons located in the inferior mesenteric ganglion project through the colonic nerves and that these proximally directed fibers innervate the transverse colon and the distal spiral. Nonnoradrenergic, NPY-ir neurons lying in the pelvic ganglia or sacral sympathetic chain may make an important contribution to the innervation of the myenteric plexus of the rectum and the descending colon.

Animals↗

PubMed1999

Doppler sonography of hemodynamic changes of the inferior mesenteric artery in inflammatory bowel disease: preliminary data.

OBJECTIVE: To our knowledge, Doppler data for the inferior mesenteric artery are currently restricted to healthy patients. The present study was conducted to evaluate changes in inferior mesenteric artery flow in patients with inflammatory bowel disease. SUBJECTS AND METHODS: Doppler sonography of the inferior mesenteric artery was prospectively performed in 24 patients with Crohn's disease (active, n = 15; inactive, n = 9), in 22 patients with ulcerative colitis (active, n = 14; inactive, n = 8), and in 40 healthy controls. Disease activity was determined with clinical and laboratory indicators (medical history, physical examination, laboratory data, and endoscopy with histology). Flow velocity, pulsatility index, and estimated flow volume were measured in all patients and compared with the corresponding values for control subjects. Hemodynamic parameters were then correlated with location of disease (small bowel and right and proximal transverse colon versus distal transverse and left colon) and disease activity or inactivity. RESULTS: Among patients with active disease, inferior mesenteric artery flow was significantly greater in those with left colon involvement (group 1, 20 patients) than in patients with involvement of the small bowel or right colon (group 2, nine patients) and in control subjects. Median flow values for group 1 were peak systolic velocity, 1.96+/-0.57 m/sec; mean velocity, 0.63+/-0.25 m/sec; minimum velocity, 0.17+/-0.20 m/sec; pulsatility index, 3.07+/-1.24; and estimated flow volume, 0.40+/-0.17 l/min. Median flow values for group 2 were peak systolic velocity, 1.27+/-0.56 m/sec; mean velocity, 0.29+/-0.14 m/sec; minimum velocity, 0.06+/-0.10 m/sec; pulsatility index, 4.71+/-0.98; and estimated flow volume, 0.14+/-0.11 l/min. Median flow values for control subjects were peak systolic velocity, 1.41+/-0.48 m/sec; mean velocity, 0.43+/-0.19 m/sec; minimum velocity, 0.10+/-0.16 m/sec; pulsatility index, 3.49+/-0.49; and estimated flow volume, 0.13+/-0.06 l/min. Compared with control subjects, patients with acute disease involving the left colon (group 1) presented increases in flow velocity (systolic velocity, p < .001; minimum velocity, p = .01; mean velocity, p < .001) and estimated flow volume (p < .001) and a decreased pulsatility index (p = .01). A significant increase in inferior mesenteric artery flow was also found when group 1 patients were compared with those of group 2 (active disease affecting the small bowel and right colon) and group 3 (13 patients with quiescent disease of the left colon). CONCLUSION: In this preliminary study, active inflammation of the left colon in patients with Crohn's disease or with ulcerative colitis was associated with a substantial increase in inferior mesenteric artery flow that could be seen on Doppler sonography.

Adolescent↗