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PubMed1993

Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair.

As the mortality rate for penetrating colonic injuries approaches zero, emphasis has shifted toward reducing associated morbidity. This study was done to identify patients at low risk for colon-related extensive morbidity after primary repair of a penetrating colonic injury. The records of 100 consecutive patients admitted to the District of Columbia General Hospital (DCGH) between 1984 to 1990, surviving more than 24 hours after full-thickness penetrating colonic injuries, were retrospectively reviewed. Data collection included mechanism, management and anatomic location of the colonic injury. Severity of injury was evaluated by the Trauma Score (TS), Penetrating Abdominal Trauma Index (PATI), Flint Colon Injury Score (FCIS), time in the operating room, blood transfused during the first 24 hours and presence of preoperative shock (systolic blood pressure less than 90 millimeters of mercury). Mechanism of injury included 97 gunshot wounds and three stab wounds. Fifty-seven patients had primary repair (17 having resection and anastomosis) and 43 had colostomy. The anatomic location of injury was right colon in 37, transverse colon in 27, left colon in 35 and multiple sites (two) in one patient. In this series, only two patients had colon-related extensive morbidity--a parastomal hernia and wound dehiscence, both requiring operative intervention. There were no instances of intraperitoneal abscess formation. One patient died from overwhelming pneumonia after segmental resection of the colon with primary anastomosis. The literature reports a 12 to 42 percent colon-related morbidity rate in patients sustaining penetrating colonic injuries. This series from DCGH represents the lowest colon-related extensive morbidity and mortality rates reported to date in any substantial series of penetrating abdominal trauma. We attribute the 2 percent extensive morbidity rate to high TS (mean of 15.7), low PATI (mean of 24.2), low FCIS (mean of 1.9) and few associated intra-abdominal injuries (59 percent of patients with less than two). We have identified a group of patients with full-thickness penetrating injuries to the colon, few associated intra-abdominal injuries, high TS, low PATI and low FCIS who can be managed safely and judiciously by primary repair without undue morbidity and mortality.

Colon↗

PubMed1998

Differentiation of prolonged colonic transit using scintigraphy with indium-111-labeled polystyrene pellets.

UNLABELLED: Prolonged colonic transit can be caused either by slow transit constipation or by pelvic outlet obstruction needing different therapeutic regimes. The aim of this study was to prove the value of scintigraphic assessment. METHODS: Colon scintigraphy was performed in 32 patients (28 women, 4 men; age range 8-68 yr) with idiopathic constipation at 8, 24 and 48 hr in ventral and dorsal projection after oral administration of a pH-sensitive, methacrylate-coated capsule of nonresorbable 111In-labeled polystyrene (cathion exchanger) micropellets (3.5 MBq/capsule). The geometric center (GC) as the sum of products of colon segment activity and colon segment number (1 = colon ascendens; 2 = transverse colon; 3 = colon descendens; 4 = rectosigmoid colon; and 5 = stool) dividing by the total counts was used to determine the velocity of colonic transit at least at 24 hr as the proximal colonic emptying (PCE) rates. Stool activity was evaluated indirectly as decay-corrected colon activity loss between two examinations. Results were compared with data obtained from 22 healthy subjects. RESULTS: Twenty-six patients had a significant prolongation of colonic transit after 24 and 48 hr (the 95% confidence interval of the patient's GC showed no overlap to the 95% confidence interval of GC calculated from 22 healthy controls as normal range) revealing slow transit constipation. Six patients had normal or accelerated transit (GCs and PCE rates) up to the rectum but delayed rectal emptying indicating pelvic outlet obstruction. CONCLUSION: By the help of this method it was possible to differentiate the two subtypes of colon transit prolongation by use of the reported scintigraphic technique, which leads to different therapeutic management of the patients. Compared with x-ray methods (Hinton test), this method has the capability of a continuous observation of colonic transit without increasing radiation exposure.

Adolescent↗

PubMed2001

Application of the Malone antegrade continence enema principle in degenerative leiomyopathy.

An 1-year-old boy with degenerative leiomyopathy (DL) presented with a volvulus of the transverse colon. After derotating the volvulus, we constructed a tube colostomy (TC) from the transverse colon. This TC has been used for the past 2 years by the patient for regular deflation of the colon and antegrade colonic enemas (ACE). We present this as a preliminary report of the use of the Malone ACE procedure in a patient with DL and review the relevant literature.

Child↗

PubMed1992

Massive gastric cancer in a patient with a negative Gregory antigen (Gy (a-)), a rare blood group.

A case of a massive advanced gastric cancer of the Borrmann type III in a patient with the rare blood group of negative Gregory antigen (Gregory (a-)) is reported. On admission, he was found to have a severe anemia (Hb 6.1 g/dl) requiring a direct blood infusion. He had never received a blood infusion, previously. In blood crossmatching tests, his blood was agglutinated by all the antisera for the common antigens, and he was discovered to have a rare blood type of Gregory (a-). There was no appropriate blood donor in his family. Before the operation, only 600 ml (6 i.u.) of frozen red blood cells could be found in storage from only 2 people with Gregory (a-), O blood type and Rh (+) in Japan. To increase the RBC, erythropoietin (3000 i.u.) was administered 6 times; and the Hb increased to 7.4 g/dl. However, the anemia remained and 200 ml (2 i.u.) Gregory (a-) blood was infused, preoperatively. The final preoperative Hb was 7.8 g/dl and the RBC was 283 x 10(4)/mm3. A massive gastric cancer directly infiltrated the pancreas, the transverse colon and the mesocolon. A palliative subtotal gastrectomy with combined resection of the transverse colon was performed. The intraoperative blood loss was 460 ml and the volume of blood infused was 400 ml (4 i.u.). The postoperative Hb was 7.9 g/dl, and more blood was needed. However, there was no more Gregory (a-) donor blood in storage in Japan.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1987

Non-simultaneous primary cancers in five different organs in a case of cancer family syndrome.

Non-simultaneous primary malignant tumors in five different organs were detected in a case of cancer family syndrome, and the patient's offspring were found to have colorectal cancers during follow-up. The first cancer in the patient was found in the transverse colon at the age of 47, and partial colectomy was carried out. The second and third were cancers of the cecum and gallbladder which were found concurrently at the age of 61, and ileocecal resection and cholecystectomy were carried out simultaneously. The fourth was cancer of the urinary bladder which was found at the age of 66, and partial cystectomy with interstitial irradiation using a radon seed in the residual urinary bladder was carried out. The fifth was cancer of the stomach at the age of 72, and subtotal gastrectomy was carried out. All of the resected specimens were demonstrated to be different carcinomas histologically. The father and 5 of the 7 siblings of this patient suffered from gastrointestinal or uterine cancers. Furthermore, two daughters of this patient were affected with cancer; the younger with cancer of the descending colon at the age of 47, and the elder with cancers of the transverse colon and rectum at the age of 54. Thus, familial clustering of cancer was shown. Genetic characteristics may have contributed to the development of multiple primary cancers in this family.

Aged↗

PubMed1991

Liver abscess as the initial manifestation of colonic Crohn's disease: report of a case.

Liver abscess is a rare complication of Crohn's disease and in most of the reported cases, the diagnosis of Crohn's disease preceded that of liver abscess. We report herein a case in which a liver abscess was the initial clinical manifestation of Crohn's disease in a 36 year old man who presented with high fever and weakness. The diagnosis of liver abscess was established by abdominal ultrasonography, computed tomography and an arterial blood culture. The abscess was resolved with antibiotic therapy alone and during the drug therapy, a barium enema examination was performed which revealed a stricture at the transverse colon. Resection of the transverse colon was performed and macroscopic and microscopic examination of the resected specimen established the diagnosis of Crohn's disease. The liver abscess was thus speculated to be secondary to the inflamed bowel. Although rare, Crohn's disease should be included in the differential diagnosis of diseases causing liver abscess.

Adult↗

PubMed1977

Carcinoma of the colon in the adolescent: a report of survival and an analysis of the literature.

A case of adenocarcinoma of the transverse colon in a fourteen year old girl is presented. Five years after radical resection of this Dukes' C2 lesion, the patient is alive and well without recurrent disease. The incidence of large bowel carcinoma in adolescents remains low, but there is an increasing tendency toward neoplasia in younger patients. Factors that affect patient survival included late stage at presentation, delay in treatment, paucity of symptoms, and a higher incidence of tumors of the transverse colon. An increased incidence of colloid carcinoma is noted. The etiology and pathogenesis of large bowel cancer as it pertains to childhood are reviewed.

Adenocarcinoma↗

PubMed2006

Surgical management of inflammatory bowel disease.

AIM: To evaluate the outcome and morbidity after major surgical interventions for inflammatory bowel disease (IBD). METHODS: Retrospective case note analysis of 227 children referred to a tertiary referral centre between 1994 and 2002 for treatment of IBD. RESULTS: 26 of 125 children with Crohn's disease (21%) required surgical management. 13 with disease proximal to the left colon underwent limited segmental resections and primary anastomosis, without significant morbidity. Primary surgery for 13 children with disease distal to the transverse colon included 6 subtotal-colectomies or panprocto-colectomies. All seven children undergoing conservative segmental resections (three with primary anastomosis, four with stoma formation), required further colonic resection or defunctioning stoma formation. All three children undergoing primary anastomosis developed a leak or fistula formation. 22 of 102 children with ulcerative colitis (22%) required surgery. Definitive procedures (n = 17) included J-pouch ileoanal anastomosis (n = 11), ileorectal anastomosis (n = 2), straight ileoanal anastomosis (n = 3), and proctectomy/ileostomy (n = 1). Five children await restorative surgery after subtotal colectomy. Median daily stool frequency after J-pouch surgery was 5 (range 3-15), and 10 of 11 children reported full daytime continence. All three children with straight ileoanal anastomosis had unacceptable stool frequency and remain diverted. CONCLUSION: The complication rate after resectional surgery for IBD was 57% for Crohn's disease, and 31% for ulcerative colitis. In children with Crohn's disease, limited resection with primary anastomosis is safe proximal to the left colon. Where surgery is indicated for disease distal to the transverse colon, subtotal or panproctocolectomy is indicated, and an anastomosis should be avoided. Children with ulcerative colitis had a good functional outcome after J-pouch reconstruction. However, the overall failure rate of attempted reconstructive surgery was 24%, largely owing to the poor results of straight ileoanal anastomosis.

Adolescent↗

PubMed2000

Genetic analysis of multiple sporadic colon carcinomas from a single patient.

At least two separate genetic pathways of carcinogenesis in sporadic colon cancer involving the accumulation of mutations at various genetic loci have been described. About 15% of sporadic colorectal carcinomas arise via a mechanism associated with microsatellite instability (MSI) and mutations in transforming growth factor beta receptor II (TGFbetaRII), insulin-like growth factor II receptor (IGFIIR) and BAX, whilst the remaining 85% are associated with aneuploidy and gross chromosomal rearrangements. An 81-year-old woman had a sigmoid colon carcinoma resected and 18 months later developed two additional carcinomas of the caecum and transverse colon. To investigate whether there was a common genetic mechanism of carcinogenesis for the three lesions, MSI status was assessed, TGFbetaRII, IGFIIR and BAX were analysed for mutations and protein expression of transforming growth factor beta1 (TGFbeta1) and p53 were studied using immunohistochemistry. The caecal and transverse colonic carcinomas were both MSI positive but different mutations were identified in each lesion. No genetic abnormalities were identified in the sigmoid colonic carcinoma. This suggests that each carcinoma arose via a separate genetic mechanism of carcinogenesis.

Adenocarcinoma↗

PubMed1990

Long survival of a woman with a huge leiomyosarcoma of the duodenum after pancreaticoduodenectomy and transverse colectomy: a case report.

A woman with a huge leiomyosarcoma of the duodenum that had invaded the pancreas and transverse colon is living and well 10 years after pancreaticoduodenectomy combined with resection of the transverse colon. Malignant potential of the tumor was determined by the mitotic rate and nuclear deoxyribonucleic acid content. The mass exceeded 10 cm yet was characterized by low mitotic activity and a near-diploid pattern. The long survival is attributed to the extensive surgery and low-grade malignancy of the tumor.

DNA, Neoplasm↗

PubMed2003

Are colonic regular contractile frequency patterns in slow transit constipation a relevant pathophysiological phenomenon?

BACKGROUND: Pathogenesis of slow transit constipation still remains elusive. Some studies have shown several colonic motor abnormalities; however, it is not easy to understand the relative importance of the single ones. AIMS: Since it has been hypothesized that an excess of periodic distal motor activity may be of pathophysiological importance in patients with slow transit constipation, we evaluated regular colonic contractile frequencies in a homogeneous cohort of these patients. PATIENTS: A total of 26 female patients (age range 34 to 67 years) fulfilling the Rome II criteria for constipation entered the study. No patient had evidence of secondary forms of constipation and distal obstruction. METHODS: Twenty-four hour colonic manometric studies were obtained for each patient. Regular contractile patterns (with frequencies ranging from 2 to 8 cycles/min) were calculated for the entire recording period and in single colonic segments. RESULTS: Overall, regular patterns accounted for about 3% of the total colonic motor activity (average 30 min/day per subject), with the 3 cycles/min being the predominant contractile rhythm. Most of this activity was present in the sigmoid colon, accounting for >50% of the total amount of motility, and it was more prevalent than in the descending and transverse colon; no differences were revealed in the descending with respect to the transverse colon. No daily fluctuations of regular contractile activity, nor a cyclic pattern, nor migration between recording points were observed. CONCLUSIONS: Regular colonic frequency patterns are probably of minor pathophysiological importance in slow transit constipation, even in the light of the scant amount of such phenomena previously documented in healthy subjects.

Adult↗

PubMed2001

Primary osteosarcoma arising in the colon: report of a case.

A 53-year-old female presented with abdominal pain, and computed tomography scan revealed a small, calcified lesion in the wall of the transverse colon. The symptoms later disappeared spontaneously, and she remained in good health. However, four years later, she developed lancinating abdominal pain and was admitted to our hospital. A large tumor with calcification was found in the left upper abdominal cavity. Curative resection of the tumor was performed, and the histology was compatible with extraskeletal osteosarcoma. We speculated that the tumor originated from the colonic wall, because a small calcification was observed in the wall of the transverse colon four years before surgery. To the best of our knowledge, this is the first report of primary colonic osteosarcoma.

Bone Neoplasms↗

PubMed2001

Intussusception in children: US-guided pneumatic reduction--initial experience.

PURPOSE: To assess the feasibility and effectiveness of ultrasonography (US)-guided pneumatic reduction of intussusception in children. MATERIALS AND METHODS: The study group consisted of 49 consecutive patients (aged 2 months to 7 years; 36 boys, 13 girls) who underwent 52 reductions of intussusception during 9 months. Intussusception was diagnosed in all patients with the known US criteria, and all patients underwent a US-guided pneumatic reduction attempt wholly within the US examination room. A pressure of 60 mm Hg was maintained for 30 seconds, with US guidance. The procedure was considered to be successful when US showed the disappearance of the intussusceptum and the edematous terminal ileum with an abrupt transition into the normal proximal ileum. When the intussusception was not reduced, the procedure was repeated, with pressure increased to 120 mm Hg. RESULTS: The overall success rate of US-guided pneumatic reduction was 92% (48 of 52 reductions), with no immediate recurrence. Of the two patients who had intussusceptions that were irreducible, one had residual ileoileal intussusception at surgery, and the other had an ileal polyp as a lead point. Perforation occurred in two (4%) of 52 cases; one patient underwent right hemicolectomy due to bowel necrosis and had a pinpoint perforation in the normal proximal transverse colon, and the other underwent manual reduction of ileoileocolic intussusception, with microperforation in the proximal transverse colon. CONCLUSION: US-guided pneumatic reduction seems to be a feasible and effective method for the treatment of intussusception in children because of its radiation-sparing effect and high success rate.

Child↗

PubMed2004

[Squamous cell carcinoma of gallbladder].

Adenocarcinoma is the most common malignant neoplasm of the gallbladder, but squamous cell carcinoma (SCC) is rare with an incidence of 1.4 approximately 3.3%. We present a recent case of a 63-year-old man complaining of abdominal distention. Preoperative US and CT revealed a large tumor of the gallbladder infiltrating the liver and transverse colon. Cholecystectomy, subsegmental resection of the liver, lymph node dissection, and partial resection of the transverse colon were performed. The resected specimen was histologically diagnosed as SCC without nodal metastases.

Carcinoma, Squamous Cell↗

PubMed2003

Alpha-fetoprotein-producing carcinoma of the colon: report of a case and review of the literature.

PURPOSE: We describe a rare case of an alpha-fetoprotein-producing carcinoma originating in the transverse colon of a 59-year-old Japanese male. METHODS: The patient reported an abdominal mass and weight loss. On examination, a tumor of the transverse colon and multiple masses in the liver were found. The serum alpha-fetoprotein level was extremely high (12,873 ng/ml). The patient underwent right hemicolectomy and intraoperative biopsy of a liver mass. RESULTS: Histologically, the colon cancer was composed of three different components: a well-differentiated tubular adenocarcinoma, a tubulopapillary carcinoma consisting of cells with clear cytoplasms, and a "hepatoid carcinoma." The hepatoid carcinoma was composed of large polygonal cells with abundant eosinophilic or clear cytoplasms, arranged in a trabecular or solid pattern, and showing marked vascular invasion. Immunohistochemically, alpha-fetoprotein was strongly expressed, largely in the hepatoid carcinoma and partially in the tubulopapillary carcinoma. The liver biopsy specimen showed morphologic and immunohistochemical features similar to those of the hepatoid carcinoma of the colon and was therefore diagnosed as a metastasis. The patient died of the cancer two months after surgery. CONCLUSION: Based on our experience of this patient and a review of the literature, alpha-fetoprotein-producing colorectal carcinomas are generally associated with a poor prognosis because of the frequent occurrence of blood-borne metastases.

Adenocarcinoma↗

PubMed2006

A technique to improve vascularity in colon replacement of the esophagus.

OBJECTIVE: The aim of this study was to present a simple method to improve the results of colon replacement of the esophagus in children with post-corrosive esophageal stricture or long gap esophageal atresia. TECHNIQUE: At the gastrostomy operation, the abdomen and colon are explored and the segment of colon to be used for replacement is chosen. The trunk of the middle colic artery supplying the transverse colon is ligated and divided proximally to the marginal artery or, if another segment of the colon is chosen, the corresponding vessel is ligated. METHODS: Between November 1999 and October 2002, 11 children had their middle colic vessels ligated during a gastrostomy operation. They were six boys and five girls. Five neonates had long gap esophageal atresia with or without fistula. The other 6 had long segment esophageal stricture due to swallowing caustic potash. Their ages ranged from one day to 40 months. The hospital stay ranged from 10 to 14 days. The interval between vascular ligation and the replacement was one to three months, depending on the general condition of the patient. The follow-up period was between 21 and 56 months. RESULTS: After the definitive operation for colon replacement of the esophagus, the children resumed feeding through the gastrostomy on day five. They were fed by mouth from day eight and all had returned home by day 15. COMPLICATIONS: There was no wound infection, no fistula, or chest complications. One patient developed stricture at the colo-esophageal anastomosis two months after surgery. The esophageal anastomosis was excised six months after the colon interposition surgery and re-anastomosis was performed through the same neck incision, after which the patient was sent home seven days later. CONCLUSIONS: Ligation of the middle colic vessels during the gastrostomy operation increases the blood supply to the transverse colon through the left upper colic and marginal vessels. This adds an extra ten minutes to the gastrostomy operation. This technique has increased the success rate in colonic replacement and minimized morbidity in our unit. Although the principle is commonly used in plastic surgery in pedicled flap reconstruction and in pediatric surgery for high abdominal testis (Fowler Stephens procedure), to our knowledge, this has never been applied in intestinal surgery before.

Burns, Chemical↗

PubMed1990

Selective stimulation of colonic motor response to a meal by sigma ligands in dogs.

The influence of central vs. peripheral administration of sigma ligands (dl- and l-N-allylnormetazocine, 1-3-di-o-tolylguanidine, (+) cinnamyl-1-phenyl-1-N-methyl-N-cyclopropylene and phencyclidine on colonic motility was investigated in fasted and fed dogs equipped with strain-guage transducers implanted on proximal and transverse colon. When injected intravenously at a dose of 0.25 mg/kg just before feeding, dl- or d-N-allylnormetazocine, 1-3-di-o-tolylguanidine, and (+) cinnamyl-1-phenyl-1-N-methyl-N-cyclopropylene (but not phencyclidine) enhanced the colonic motor response to a meal by increasing the 0-4-hour motility indexes from 64.1%-159.3% in both the proximal and transverse colon but had no effect on colonic motility in fasted animals or animals injected intracerebroventricularly. The motor-stimulatory effects of d-N-allylnormetazocine (1 mg/kg), 1-3-di-o-tolylguanidine (0.25 mg/kg), and (+) cinnamyl-1-phenyl-1-N-methyl-N-cyclopropylene (1 mg/kg) were abolished after previous treatment with haloperidol (0.5 mg/kg, intravenous) but not after sulpiride (0.1 mg/kg) or (+) R-(+)-8-chloro-2,3,4,5-tetrahydro-3- methyl-5-phenyl-1-H-3-benzozepine-OH. Prazosin (0.1 mg/kg, intravenous) and 1-methyl-3-(2-indolyl)amino-5-phenyl-3H-1,4-benzodiazepin-2-one (0.01 mg/kg) also suppressed the enhancement of the colonic motor response to eating induced by d-N-allylnormetazocine, 1-3-di-o-tolylguanidine, and (+)cinnamyl-1-phenyl-1-N-methyl-N-cyclopropylene whereas naltrexone did not affect their effects. It is concluded that d-N-allylnormetazocine, 1-3-di-o-tolylguanidine, and (+)cinnamyl-1-phenyl-1-N-methyl-N-cyclopropylene stimulate the postprandial colonic motility in dogs by acting selectively on sigma receptors located peripherally and probably by affecting the release of cholecystokinin octapeptide through a central adrenergic mechanism.

Animals↗

PubMed1985

Omental cakes: colonic involvement by omental metastases.

The authors describe 7 cases of pelvic malignancy (4 ovarian, 1 bladder, 1 cervical, and 1 endometrial) in which pathological examination demonstrated involvement of the transverse colon by contiguous spread from the greater omentum. Most patients had a pelvic mass at the time of presentation. All also had evidence of intraperitoneal seeding in the anterior rectosigmoid, the superior border of the sigmoid, or the medial border of the cecum, ascending colon, or ileum. Barium-enema examination showed predominant involvement of the superior border of the transverse colon with a mass effect, nodularity, and tethered mucosal folds, although focal or diffuse areas of circumferential narrowing were also identified. This appearance may be indistinguishable from direct extension of gastric carcinoma via the gastrocolic ligament; however, a pelvic mass or intraperitoneal colonic seeding should alert the radiologist to possible malignant spread from the greater omentum.

Aged↗