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PubMed1974

Adenocarcinoma of the colon and rectum.

The site and the sex incidence of 555 carcinomas of the colon surgically resected at The Hospital of the Good Samaritan in Los Angeles were reviewed. Most of the carcinomas of the right and transverse colon were in female patients, and slightly more than half of the cancers of the left and rectosigmoid were in male patients. The largest tumors were found in the right and transverse colon. The incidence of carcinomas in the proximal colonic segments, especially the cecum, appears to be greater in patients of middle or upper socioeconomic groups, a phenomenon possibly related to diet.

Adenocarcinoma↗

PubMed1993

[Intestinal occlusion due to a colonic lipoma. Apropos 2 cases].

Lipomas occur through the intestinal tract, from the hypopharynx to the rectum, the colon having the highest incidence, where lipomata are the commonest benign neoplasm after adenomata. Nevertheless they are uncommon. CASE REPORT. 1) A 68-year-old man presented as an emergency with abdominal pain associated with bowel obstruction. He had a 2 to 3 month history of intermittent right-sided abdominal pain, constipation spontaneously resolved. At laparotomy there was a mass of the transverse colon, next hepatic flexure. A right hemicolectomy was performed. The patient made an uneventful recovery. Histologic examination showed a lipoma of the submucosal plane. 2) A 65-year-old man presented as an emergency with lower abdominal pain associated with a prolapsed rectal polyp. He had 1 month history of passing fresh blood per rectum. Ap ast colonoscopy revealed a large polypoid lesion in the descending colon. Transanal examination revealed a polypoid lesion with a maximum diameter of 4 cm, acting as an intussuseptum. Transanal polypectomy was performed. At laparotomy there was an intussuseptum of the descending colon into the rectum: a left hemicolectomy was performed. Histology showed the polyp to be a submucosal lipoma. DISCUSSION. Lipomas are the most common benign nonepithelial tumors of the colon. Lipomata of the large bowel are reported as incidental findings in 0.3-0.5% of cases in large series of autopsies. In the wall of the intestine most lie in the submucosal plane, less frequently they are found in the subserosal plane. The commonest site for symptomatic solitary large bowel lipoma is the ascending colon, including the caecum, followed by the transverse colon, including both hepatic and splenic flexure, descending colon, sigmoid colon and rectum. The peak incidence for lipomata of the large bowel is in fifth-sixth decade. Colonic lipomas are generally asymptomatic but occasionally patients may have intermittent crampy abdominal pain secondary to intussusception of a pedunculated lipoma or with intermittent fresh rectal bleeding. On barium enema lipomas appear circular, ovoid, well demarcated, and smooth. A barium enema showing a relatively radiolucent mass, caused by the radiolucency of fat, is suggestive of a lipoma. The water enema, with water as the contrast agent, accentuates the difference in density between a lipoma and surrounding tissues. Another characteristic feature of lipomas on barium enema is said to be their fluctuation in size and shape during the study: "squeeze sign". Lipomas of the large bowel can be seen, however, by colonoscopy. On computerized tomography scan the lipoma has a uniform appearance and density. In expert hands pedunculated and sessile lesions can be removed endoscopically, but often large bowel lipomata are treated on the basis of a presumptive malignant diagnosis with exploratory laparotomy. CONCLUSION. Colonic lipomas, although unusual, continue to present difficulties in the preoperative differentiation between malignant and benign colonic neoplasm. Two cases of colonic lipomas are reported.

Aged↗

PubMedDate not supplied

A case of primary adenosquamous/squamous cell carcinoma of gallbladder directly invaded duodenum.

A rare case of primary gallbladder carcinoma is reported. A 67 year-old woman was admitted to our hospital for treatment of suspected duodenal carcinoma. A series of radiographic examinations demonstrated a giant tumor involving the duodenum, gallbladder, pancreatic head, and transverse colon. These extensions made it difficult to identify the primary origin of the carcinoma. Pancreatoduodenectomy, cholecystectomy, and resection of the transverse colon were performed. Macroscopically, ulcerative lesions were seen in both the gallbladder and the duodenum. Microscopic examination revealed adenosquamous cell carcinoma of the gallbladder, invasive of the adjacent organs, including circumferential invasion of the second portion of the duodenum. The patient tolerated the operation well and was discharged 28 days post-operatively, but died of liver metastasis 4 months after surgery. Local invasion of the surrounding tissues is characteristic of adenosquamous/squamous cell carcinoma of the gallbladder. Although surgery for cure is deemed possible, the rapid growth rate of this type of tumor may cast doubt on the value of extensive radical surgery.

Aged↗

PubMed1995

[Surgical treatment of benign stenosis of the esophagus].

From Nov. 1972 to 1983 Oct., 88 patients with benign stenosis of the esophagus were operated on. The youngest patients was 18 months, and the oldest 63 years. From corrosive injury of esophagus to operation, the shortest period was 13 days and longest 10 years (mean 120 days). In 85 patients, transverse colon was used to replace the esophagus substernally. In 2 patients, reconstruction was done by gastric tube. One patient used transverse colon and part of descending colon. Preoperative gastrostomy was made in 5 patients. There was no operative mortality. One patient developed anastomotic stenosis postoperatively. He refused reoperation and died. The remaining patients survived with a normal life. For the reconstruction of esophagus, problems such as choice of grafts, time of operation, resection of scar or not, and place of anastomosis were discussed.

Adolescent↗

PubMed1998

Pericolonic mass containing chyle as a presumed sequela to chronic pancreatitis in a dog.

A 9-year-old dog was admitted because of recurrent episodes of chronic pancreatitis. Ultrasonography revealed a multiloculated, fluid-filled cystic mass at the caudal portion of the stomach. Guided fine-needle aspirates yielded a fluid consistent with chyle. The dog underwent surgery during which a 6- to 8-cm mass was found adhered to the mesocolon and serosa of the transverse colon. Intraoperative lymphangiography revealed lymphangiectasia, but contrast medium did not accumulate within the mass. The mass and a portion of transverse colon were removed en bloc. Results of histologic examination were consistent with an abscess. Pancreatic enzymatic digestion may allow abscesses to extend beyond pancreatic parenchyma, cause severe local inflammation, and encapsulate and incorporate adjacent abdominal lymphatics. Subsequent lymphatic leakage can result in chyle within the abscess. Inflammatory masses of the pancreas are a rare, but serious, complication of pancreatitis in dogs. Familiarity with these types of lesions can aid in selection of appropriate treatments.

Abscess↗

PubMedDate not supplied

Lymphangioma of the colon: a case report and review of the Japanese literature.

Intraabdominal lymphangiomas are rare, although these lesions can occur in the mesentery, omentum, retroperitoneum, or gastrointestinal tract wall. Here we report a case of lymphangioma of the transverse colon and review the other cases reported in the Japanese literature. Our patient presented with lower abdominal pain and barium enema revealed a filling defect in the transverse colon. Colonoscopy disclosed a submucosal tumor, which changed shape with alteration the patient's position and showed the cushion sign. This lesion was covered with normal-looking mucosa. A correct diagnosis was made from these findings. Knowledge of these endoscopic features may help physicians to provide appropriate diagnosis and treatment of colonic lymphangioma.

Biopsy, Needle↗

PubMed2004

Acinar cell carcinoma of the pancreas eroding the pylorus and duodenal bulb.

A 74-year-old woman presented at the National Defense Medical College Hospital in April 2001 with a chief complaint of upper abdominal pain. She had been diagnosed as having adenocarcinoma on the basis of results of examination of a biopsy specimen taken from an ulcer of the duodenal bulb at a local hospital. On admission, she showed no jaundice, but a hard mass, about 10 cm in diameter, was palpated in the right upper quadrant. Laboratory data showed high levels of serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9. Abdominal computed tomography (CT) and angiography demonstrated a giant enhanced mass in a pattern of eccentric gradation extending to the pylorus, duodenal bulb, and pancreatic head. She underwent pancreatoduodenectomy with combined resection of the transverse colon. The histologic diagnosis was acinar cell carcinoma (ACC), originating in the pancreatic head and extending to the stomach, duodenum, and transverse colon, without any lymph node involvement. In most reported cases of ACC, the preoperative diagnosis was a pancreatic mass or endocrine tumor of the pancreas. The correct diagnosis in those cases was made by postoperative or postmortem pathological examination. If criteria for detecting the slight differences between ACC and endocrine tumors on some images were to be established, the diagnostic skill for ACC would improve dramatically.

Aged↗

PubMedDate not supplied

Incidence of Paneth cells in colorectal adenomas of Japanese descendants in Hawaii.

The main purpose of the present study was to demonstrate the incidence of Paneth cells in colorectal tubular adenomas of Japanese descendants in Hawaii. Paneth cells were found in 73 of 322 adenomas (22.7%) of Japanese descendants in Hawaii. The incidence of Paneth cells in adenomas located from the caecum to the transverse colon was significantly higher than that of adenomas from the descending colon to the rectum. The same trend of a higher incidence of Paneth cells in adenomas from the caecum to the transverse colon was observed in Japanese descendants and Caucasian residents in Hawaii and in native Japanese. The incidence of Paneth cells in adenomas of Japanese descendants in Hawaii was higher than that of native Japanese, and also that of Caucasian residents was higher than that of native Japanese.

Adenoma↗

PubMed1992

[Spontaneous gastrocolic fistula in stomach ulcer].

Spontaneous development of a gastrocolic fistula following a benign unoperated gastric ulcer is a rare complication. This complication seems to occur more frequently, however, as a side-effect of increased use of anti-inflammatory medication. A 61-year-old woman developed abdominal pain and diarrhoea, and lost weight, after several years of treatment with indomethacin. During diagnostic endoscopy the gastroscope unexpectedly passed to the transverse colon through a relatively large ulcerous gastrocolic fistula. The patient was successfully treated by en bloc resection of the stomach and transverse colon.

Colonic Diseases↗

PubMedDate not supplied

[Surgical treatment of colonic volvulus. 10-year experience at the Instituto Nacional de la Nutrición Salvador Zubirán].

OBJECTIVES: To analyze morbidity-mortality and results of surgical treatment for colonic volvulus. METHODS: Retrospective review of 33 patients who underwent surgical treatment for colonic volvulus from 1986 through 1996. RESULTS: Mean age was 62 +/- 20 years (SD) with predominance of female sex (2:1). There were 25 cases of sigmoid volvulus (76%), 7 in the cecum (21%) and 1 in the transverse colon (3%). Colonic necrosis and/or perforation were most frequently seen in the right and transverse colon (50%) than in the sigmoid (4%) (P < 0.002). Operative morbidity was 45% with mortality of 21%. Age was the only variable statistically significant for operative morbidity (52 +/- 23 years in patients without morbidity vs 71 +/- 17 years in patients with morbidity, P = 0.02). Surgical procedures for sigmoid volvulus were resection in 13 and fixation in 12. Recurrence after fixation was 38% to 12 months and 69% to 24 months (Kaplan-Meier), with associated mortality of 50%. There was no recurrence after resections. Treatment for cecal volvulus was cecopexy in 4 cases, with one recurrence; and right hemicolectomy without recurrence. CONCLUSIONS: The results should encourage resective procedures in sigmoid volvulus because the risk of recurrence after fixation is high and the morbidity-mortality is similar. Elderly patients are more susceptible to complications.

Adult↗

PubMed2006

[Submucosal lipoma of the colon: abdominal cramps with rectal bleeding and weight loss].

An 81-year-old woman had abdominal cramps, rectal bleeding since 2 weeks and weight loss. Colonoscopy showed an ulcerating tumour of about 4 cm in the transverse colon. Pathological examination of biopsies taken during colonoscopy indicated moderately active chronic colitis. Based on the colonoscopy findings, the tumour appeared to be malignant and laparotomy was performed and the transverse colon was resected. Pathological examination of the resected lesion revealed a submucosal lipoma. The patient recovered fully. Lipomas account for 4% of benign gastrointestinal tumours and 90% of lipomas are submucosal. Their presentation is often similar to malignant tumours. The naked fat sign after biopsy and the elasticity of the lesion are typical features encountered during colonoscopy. Given the high fat content of these lesions, they are easily discernible with CT and MRI. Lipomas with a diameter < 2 cm can be safely removed endoscopically. Larger lesions should be removed by segment resection.

Abdominal Pain↗

PubMed2006

Cytomegalovirus: a cause of colonic stricture in a premature infant.

A 27-week-old infant developed symptoms of bowel obstruction when full enteral feeds were started. Laparotomy revealed strictures in the ascending and proximal transverse colon. Right hemicolectomy was performed. Histological examination of the resected large bowel demonstrated the presence of Cytomegalovirus inclusion bodies. Cytomegalovirus infections of the gut are extremely rare in neonates. This case report alerts neonatologists and microbiologists to consider Cytomegalovirus infection as a possible cause of bowel obstruction and necrotising enterocolitis like symptoms.

Colon, Ascending↗

PubMed1984

Distribution and spread of colonic lesions in shigellosis: a colonoscopic study.

In a study of the distribution and severity of colonic lesions in patients with shigellosis, colonoscopy was performed for 33 men with this disease. All 33 patients had inflammatory lesions in the rectosigmoid area; in 18 (55%) the lesions extended to the splenic flexure, in 14 (42%) the disease extended to the distal transverse colon, in nine (27%) the area of involvement included the proximal transverse colon, and in five (15%) pancolitis was evident. In most patients lesions were continuous and diffuse, with the intensity of inflammation decreasing in a proximal direction. Biopsied samples from proximal lesions usually showed less severe inflammation than did those from more distal lesions. Aphthoid erosions, which have not previously been described in shigellosis, were observed in five patients. Proximal colitis was associated with diarrhea of four or more days' duration (P less than .01, Fisher's exact test). These findings indicate that the rectosigmoid is the most frequently and most severely affected area of the colon in shigellosis and suggest that during the course of shigella infection, colonic lesions extend in a proximal direction.

Adult↗

PubMed1993

Measurement of colonic transit time using radionuclide imaging: analysis by condensed images.

A polymer-coated capsule has been used in eight volunteer subjects to deliver 111In-resin into the ileocaecal region. The images were acquired for up to 3 days to follow transit through the colon. Expressing the results of individual studies is difficult and time-activity curves for each region are confusing. Calculation of the geometric centre indicates only where the middle of the activity has reached. We describe a new method of presenting colonic transit data as parametric images. The parametric images show the amount of activity in each area of interest as the study progresses. This is readily understood and allows segmental movement of the isotope, either forward or retrograde, to be examined. The geometric mean of activity in four areas of the colon were also calculated. Four hours after reaching the ileocaecal region, 65% (S.D. 24%) of the activity was in the caecum and 26% (S.D. 20%) in the transverse colon. By 24 h three controls had excreted most of the activity, in two the activity was mainly in the rectum and in two there was still some activity in the transverse colon. A protocol for colonic transit studies, problems with analysis and a new method of presentation of data are discussed.

Acrylic Resins↗

PubMed1999

Mucinous carcinoma of the colon in a 16-year-old Turkish boy with Bloom syndrome: cytogenetic, histopathologic, TP53 gene and protein expression studies.

A 17-year-old Turkish boy with Bloom syndrome (BS) developed mucinous carcinoma of the transverse colon. He was followed from 2 to 17 years of age. Increased sister chromatid exchanges (SCE) were observed, and he was diagnosed with BS at the age of 7. Sun-sensitive skin lesions were examined by skin biopsy, and histopathological studies of these lesions were done. During the follow-up period, an intraabdominal mass at the transverse colon was found, and mucinous carcinoma of colon was diagnosed at the age of 16. We examined TP53 protein expression from paraffin-embedded colon tissue of the patient with an immunohistochemical method. Polymerase chain reaction products of exons 4-9 of the TP53 gene were examined by SSCP. No evidence of overexpression of TP53 protein or mutations of the TP53 gene was observed. The patient in this report is the first case with a mucinous carcinoma of colon diagnosed at an early age in the Bloom Syndrome Registry. Based on our results, carcinoma of the colon in BS patient may occur earlier than 35 years of age and the TP53 gene may not be directly related to carcinoma in Bloom syndrome.

Adenocarcinoma, Mucinous↗

PubMed2000

Acute abdomen with colonic necrosis induced by Kayexalate-sorbitol.

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration. Prompt surgical resection of the necrotic transverse colon permitted rapid recovery of bowel function. Although SPS crystals are seen microscopically in the necrotic bowel, experimental evidence implicates the sorbitol component of the SPS-sorbitol in the pathogenesis of colonic necrosis. A high index of suspicion for the unusual complication of colonic necrosis after oral or rectal administration of SPS-sorbitol may allow prompt recognition and surgical cure.

Abdomen, Acute↗

PubMed1989

[Diffuse ulcerative lesions in the colon with intestinal Behçet's disease].

Ileocecal region is most commonly affected in intestinal Behçet's disease. Localized deep ulcerations which have a punched-out or undermining appearance with well-defined margin placing in this region had been noted in many cases. 41 patients with intestinal Behçet's disease were observed by colonofiberscope in Teikyo University Hospital from January 1982 to June 1988. In 10% (4 cases) of these patients, diffuse ulcerative lesions in the transverse colon and the distal colon were found. These diffuse lesions in the colon with Behçet's disease were seemed to be much like those associated with inflammatory bowel disease as ulcerative colitis and Crohn's disease in morphological characteristics. The clinical symptoms of these four cases with Behçet's disease including oral aphtha, genital ulcer, joint pain, skin eruptions, and eye involvement, preceded each colonic ulceration. The first two cases were affected with ulcerative lesion in the distal portion of the recto-sigmoid colon and the descending colon. And the last two were involved in the whole transversing colon by multiple deep ulcerations. Wide-spreading ulcerative lesion in the colon with Behçet's disease is a rare condition in the Japanese, and only two papers has been reported previously. Because clinical manifestations between Behçet's disease and inflammatory bowel disease are very similar in many points as oral aphthous ulcers, arthritis, eye involvement, skin eruptions, phlebitis, arterial occlusions, then, an overlapping field or a part of a spectrum of disease has been suggested by some authors. But, in the present circumstances, they are distinct disease entities, we think that these four cases are in an atypical condition with intestinal Behçet's disease.

Adult↗

PubMed2003

Isolated trans-hiatal colonic herniation.

Isolated herniation of the colon through congenital or traumatic diaphragmatic defects are well documented. However, trans-hiatal herniation of the colon in the absence of an intrathoracic stomach has been reported only once. A 67-year-old man presented with intragastric abdominal pain and a chest x-ray film documenting a posterior mediastinal air-fluid level. Computed tomography showed gastrointestinal contents within the thorax. The findings on an upper gastrointestinal film with small bowel follow-through were normal. Finally, a barium enema identified transverse colon within the thoracic cavity. At laparoscopy, the entire transverse colon was reduced with the hernia sac. The crural defect was repaired, and a Toupet fundoplication was performed. A gastropexy was also added. The patient was discharged on postoperative day 2 able to tolerate a regular diet, and he has been asymptomatic for 5 months. This defect most likely represents a congenital deformity of the diaphragm with intact posterior gastric attachments, including the posterior phrenoesophageal ligament. An intact gastric mesentery enabled isolated colonic herniation with retention of the stomach its normal anatomic position. An antireflux procedure was performed in addition to the crural repair because of the circumferential dissection of the esophagus. This article is the second report of an isolated trans-hiatal herniation of the colon and the first report of laparoscopic repair of this entity.

Aged↗