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PubMed1987

Autotransplantation of colonic tumors into the colonic wall of the rat.

Colonic tumors were induced in Sprague-Dawley rats by weekly subcutaneous injections of 1,2 Dimethylhydrazine (DMH) for 4 months. The animals were thereafter laparotomized and a palpable tumor was transplanted into the same animal in a tumor-free area of the transverse colon. Autotransplanted tumors were considered those tumors growing in the wall of the transverse colon, covered by intact colonic mucosa. The frequency of autotransplanted tumors was 34%. The possibility that autotransplantation may also occur in humans by accident, during procedures to remove a colorectal adenocarcinoma, is discussed.

1,2-Dimethylhydrazine↗

PubMed1994

[An extended operation for scirrhous gastric cancer--its significance and procedure].

We have been performing an extended operation for scirrhous gastric cancer, namely left upper abdominal exenteration plus Appleby's method, and compared the prognosis among macroscopic subtype classifications. The surgical procedure of left upper abdominal exenteration plus Appleby's method is to resect the neighboring organs of the stomach in an en bloc fashion. It consists of total gastrectomy, partial pancreatectomy, splenectomy, transverse colectomy, cholecystectomy, resection of the left adrenal gland, and ligation and resection of the common hepatic artery. D4 lymph node dissection is carried out. Extended operations were performed for 45 cases of P0-1 scirrhous gastric cancer in 1983-1990. There were 25, 17 and 3 cases of giant fold type, erosive type and stenotic type scirrhous gastric cancers, respectively. Positive lymph node metastases were found in 64% of giant fold type cases and 82% of erosive type cases. In Po, T3-4 cases, cytology of intraoperative peritoneal lavage was positive in 27% of giant fold type cases and 50% of erosive type cases. Although there were no obvious macroscopic invasions found during the operative procedure, later histological study showed invasion to the left adrenal gland in 14% of giant fold type cases and 0% of erosive type cases, and invasion to the transverse colon in 21% of giant fold type cases and 15% of fold type and erosive type scirrhous gastric cancer according to the histological invasion of transverse colon were 25% in positive cases and 27% in negative cases (p = 0.27), 0% in positive cases and 27% in negative cases (p = 0.27), respectively. In giant fold type scirrhous gastric cancer, the extended operation is favorable. In erosive type scirrhous gastric cancer, peritoneal dissemination is observed with a high incidence. Therefore, prophylactic therapy is significant.

Adenocarcinoma, Scirrhous↗

PubMed1993

[Transverse transcolonic cutaneous ureterostomy after pelvic irradiation].

The late urological sequelae of pelvic radiotherapy for cancer sometimes require cutaneous urinary diversion. The local conditions often exclude the use of direct or transileal ureterostomy. Three cases of cutaneous ureterostomy using the transverse colon are presented. There was no operative mortality. A single ureterocolonic stenosis was observed at 12 months and was treated endoscopically. The choice of the transverse colon was based on its position away from the field of irradiation and, consequently, teh absence of radiation lesions, its blood supply which can be used to form pedicles and the possibility of resecting irradiated ureteric segments allowing anastomoses with the proximal ureters. The results reported in the literature show an operative mortality of 0 to 4% and a low morbidity. This technique can be considered to be a technique of choice for cutaneous urinary diversions in urological complications of pelvic radiotherapy.

Adenocarcinoma↗

PubMed2000

[Retrogastric colon mimicking foramen of Winslow hernia or left paraduodenal hernia: case report].

We report the case of a 54-year-old woman who developed epigastralgia and vomit. Because of the abnormal gas in the epigastrium on abdominal X-ray, ileus due to foramen of Winslow hernia or left paraduodenal hernia was suspected. However, abdominal CT and barium study revealed the gas in the epigastrium to be the air in the transverse colon interposed between the stomach and pancreatic body. This anomalous interposition of the transverse colon is called retrogastric colon. The ileus was due to non-specific inflammatory duodenal stenosis. It is important to prevent misdiagnosis of retrogastric colon as lesser sac pathologic condition such as abscess, bowel perforation and internal hernia.

Barium↗

PubMedDate not supplied

Postoperative results of left upper abdominal evisceration for advanced gastric cancer.

BACKGROUND/AIMS: In spite of the improvement of surgical techniques, the prognosis of patients with advanced gastric cancer still remains poor. With the aim of achieving en bloc resection of primary tumor, peritoneal dissemination on the greater omentum and lymph node metastasis, left upper abdominal evisceration (LUAE) was performed for 75 patients. In this report, we investigated the prognostic difference between the LUAE group and standard gastrectomy (total gastrectomy + pancreatosplenectomy). METHODOLOGY: In the LUAE group, total gastrectomy was performed with the en bloc resection of the transverse colon, pancreas body and tail, spleen and left adrenal gland. In addition, omental bursa, covering retroperitoneum and pancreas body and tail was resected in combination with greater omentum, transverse mesocolon, and lesser omentum. RESULTS: There were 3 (4.1%) postoperative death in the LUAE group, and 2 (1.7%) in the control group. However, there was no statistical difference in the incidence of postoperative complications between these 2 groups. The overall 5-year survival rates of the LUAE and control groups were 33% and 39%, respectively. There was no statistical survival difference between these 2 groups. Survival difference between the LUAE and control group was not found in terms of tumor location, wall invasion, lymph node status, peritoneal dissemination, and macroscopic type. CONCLUSIONS: From these results, LUAE cannot improve the survival of patients with advanced gastric cancer. Consequently, LUAE should be indicated for T4 tumors, which directly invade into the transverse colon.

Adrenalectomy↗

PubMedDate not supplied

[Orthotopic neobladder in a female patient after radiotherapy and anterior exenteration with ileal conduit].

OBJECTIVE: To demonstrate the viability of a neobladder created after radiotherapy, anterior pelvic exanteration and previous ileal conduit. METHODS: We report the case of a female patient who underwent anterior pelvic exanteration, radiotherapy and ileal conduit as treatment for uterine cervix cancer. A transverse colon neobladder was performed and anastomosed to the urethral stump. It was also constructed an independent self-catheterizable conduct connected to the abdominal wall, with an adjacent segment of transverse colon using the Monti's technique. This was an alternative route for catheterization in the case of problems with the urethral anastomosis. RESULTS: Patient achieved complete continence but requires intermittent catheterization to empty her neobladder. Upper urinary tract has remained stable. The patient presented with urethral stenosis that required periodic dilations. The catheterizable conduit presented incontinence and obstruction problems due to granuloma formation and had to be removed. CONCLUSIONS: Undiversion with creation of a neobladder and urethral anastomosis is viable in female patient after radiotherapy. Urethral stenosis was an important complication.

Adult↗

PubMed1994

Colonic volvulus in children: value of barium enema for diagnosis and treatment in 14 children.

OBJECTIVE: Colonic volvulus is a rare type of intestinal obstruction in children. We reviewed our experience in 14 cases to determine the specific portion of the colon involved and the value of barium enema for diagnosis. MATERIALS AND METHODS: We retrospectively reviewed medical and radiologic records of 14 cases of colonic volvulus in children at the Children's Hospital of St. Paul from 1955 to 1992. Both abdominal plain radiographs and barium studies were examined. The children were 3 months to 15 years old. RESULTS: Two cases involved the transverse colon, two were cecal, and 10 occurred in the sigmoid colon. Findings on barium enema indicated colonic volvulus in all 14 children. The barium enema also was successful therapy in 11 of the 14 cases. CONCLUSION: As unusual as colonic volvulus is in children, it should remain in the differential diagnosis of abdominal pain of sudden onset in this age group. Fourteen cases were detected at our institution alone, two of which involved the transverse colon. The barium enema can be used to confirm the diagnosis and frequently is therapeutic.

Barium Sulfate↗

PubMed1992

Aggressive resection for advanced pancreatic carcinoma.

An aggressive pancreatectomy was performed on a 53 year old Japanese man with advanced cancer of the pancreas. The tumor originated from the body of the pancreas and invaded the stomach, duodenum, left kidney, transverse colon and common hepatic artery. An unexpected cancer was also found in the head of the pancreas during the operation. Therefore, total pancreatectomy, total gastrectomy, left adrenonephrectomy, resection of the left transverse colon and dissection of the regional lymph nodes were performed. Resection of the common hepatic artery was also performed, followed by an end-to-end anastomosis between the common hepatic artery and celiac trunk. The postoperative course was uneventful and the patient was doing well until nine months after the operation when multiple metastatic lesions were noted in the liver. He died 391 days after the operation from hepatic failure.

Adenocarcinoma↗

PubMed1998

Regional and transmural density of interstitial cells of Cajal in human colon and rectum.

The interstitial cells of Cajal (ICC) are thought to play an important role in the control of gut motility. The regional and transmural pattern of distribution of ICC in the normal human colon and rectum was evaluated with immunohistochemistry using an anti-c-kit antibody. The transmural distribution of ICC was constant throughout the whole colon, the density of ICC was significantly greater at the myenteric plexus than at either the longitudinal or circular muscle layers, and in the rectum the transmural distribution was more even. Regionally, at the myenteric plexus, the transverse colon had a significantly greater density of ICC compared with the right colon (P = 0.038), left colon (P = 0.006), and rectum (P = 0.008). The pattern of distribution of ICC identified in this study is consistent with the proposed roles of ICC as colorectal pacemakers, intermediaries of the neural control of muscle activity, and coordinators of colorectal muscle activity. The highest density of ICC was at the myenteric plexus of the transverse colon, which is the proposed region of pacemaking activity.

Adult↗

PubMed2001

Bowel management with antegrade colonic enema using a Malone or a Monti conduit--clinical results.

During this last decade, major surgical improvements have been proposed for the treatment of patients suffering from faecal incontinence or intractable constipation. Between 1996 and 1999, 12 patients mainly presenting with spina bifida were operated for antegrade colonic enema (ACE). In seven cases, a Malone procedure was performed. In 5 cases we used a Monti plasty to create a continent catheterisable conduit. In 4 cases the neoconduit was placed between the transverse colon and the umbilicus. The mean follow-up was 15 months. Bowel control and continence were obtained in 11 cases, postoperatively. One early complete stenosis of the cutaneous stoma occurred, after which the patient did not wish to carry on. Another patient stopped using his ACE stoma after several months because he was able to manage his bowel evacuation voluntarily without requiring an enema. The other ten patients have greatly improved their quality of life. Complications included principally stomal stenosis which can be regularly dilated by the patient himself using the Hegar dilator. Patients with umbilical stoma have a result comparable to patients with Malone procedure. Our series shows that ACE can be performed without an appendix using a Monti plasty. Implantation of the continent conduit in the caecum or in the transverse colon does not modify the overall results of ACE.

Adolescent↗

PubMedDate not supplied

A hepatocellular carcinoma with lymph node metastasis and invasion into the gallbladder: preoperative difficulty ruling out a gallbladder carcinoma.

We present a case of resected hepatocellular carcinoma (HCC) which invaded the gallbladder with a metastasis to a lymph node. It was extremely difficult to make a differential diagnosis between HCC and gallbladder cancer preoperatively. A 68-year old man was admitted to hospital with complaint of a fever. Ultrasonography (US) and CT scan showed a mass, growing invasively from the gallbladder bed of the liver (S4) to the lumen of the gallbladder. A selective arteriography showed the mass stained by the cholecystic artery, internal branch of the left hepatic artery, and frontal branch of the right hepatic artery. Endoscopic retrograde cholangiopancreatography (ERCP) showed the non-visualized gallbladder, a constriction of the common hepatic duct with suspicion of metastatic lymph nodes in the hepatoduodenal ligament. The tumor markers were: alpha-fet-protein 13175 ng/ml, PIVKA-II 26200 mAU/ml and CA19-9 0.0 U/ml. Both HBs antigen and HCV antibody were negative. We performed cholecystectomy with en-block resection of the anterior and middle inferior segment of the liver, the common bile duct and a part of the transverse colon, with dissection of the lymph nodes. The tumor, 8 cm in diameter, was brown colored without a capsule, growing diffusely in the liver, to the inside of the gallbladder and the transverse colon. Histopathological inspection of the specimen revealed moderately differentiated hepatocellular carcinoma with a metastatic lymph node along the common hepatic artery. TNM classification was IVB phase [T3,N0,M1 (LYM,OTH)]. There are only 3 previous cases of HCC reported with invasion into the gallbladder. At most 2.2% of the resected cases of HCC had metastatic lymph nodes at resection, while it was as high as 20-50% of the autopsy cases. Operation on such an invasive HCC case should consider lymph node metastasis.

Aged↗

PubMed2002

Bilateral giant adrenal myelolipomas: a case report.

Myelolipoma is a relatively rare benign tumor composed of fatty tissue and bone marrow elements. It is frequently associated with the adrenal glands but may exist as a solitary mass elsewhere. Adrenal myelolipomas are typically nonfunctioning and asymptomatic. They may be associated with an endocrine disorder such as Cushing's disease, Addison's disease, or hyperaldosteronism; however they are most often discovered incidentally. Their size is usually less than 5 cm and they are managed nonoperatively. We report a case of bilateral giant adrenal myelolipoma producing abdominal pain in a 54-year-old man, who presented to his primary care physician with complaints of right shoulder pain with vague abdominal discomfort. Imaging studies identified bilateral suprarenal masses measuring 12 x 14 cm on the right and 8 x 10 cm on the left. These masses were consistent with fatty tissue radiographically. In addition a focal 5 x 4-cm mass was identified in the transverse colon. Because the patient was symptomatic and a diagnosis of liposarcoma could not be excluded he was taken to the operating room for exploratory laparotomy with excision of the masses and a transverse colectomy. Final histologic analysis identified bilateral adrenal myelolipomas and a solitary lipoma of the transverse colon. His postoperative course was uneventful with relief of the pain. Despite its benign nature and rare growth beyond 5 cm myelolipoma of the adrenal gland is best managed with excision in the symptomatic patient. Preservation of adrenal tissue is vital so as not to commit patients to a lifetime of steroid replacement.

Abdominal Pain↗

PubMed2002

Asymptomatic chronic intestinal ischemia caused by idiopathic phlebosclerosis of mesenteric vein.

Phlebosclerosis of the mesenteric vein is a rare condition causing chronic intestinal ischemia, it has only been reported in Japan. A 56-year-old man with liver cirrhosis and hepatic tumor presented with phlebosclerosis of mesenteric vein without any abdominal symptoms. He was admitted for examination of suspected hepatic tumor. Abdominal plain x-ray films and computed tomography revealed calcification of the mesenteric vein. Barium enema revealed narrowing and thumbprinting from the cecum to transverse colon. On colonoscopic examination, blue-black vessels were visible in the terminal ileum, and hyperemic nodular mucosa with small irregular ulcers surrounded by dark purple mucosa was found from the cecum to transverse colon. The etiology of mesenteric vein phlebosclerosis is unknown, although a physical mechanism rather than inflammatory changes appear to be involved in this rare and usually progressive condition of chronic intestinal ischemia.

Calcinosis↗

PubMed1999

Colonic perforation following prolonged hypovolaemia in a major burns injury.

Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.

Adult↗

PubMed1986

The role of preoperative intravenous pyelogram in operations performed for carcinoma of the colon and rectum.

The relationship between preoperative intravenous pyelogram (IVP) and urologic complications after potentially curative operations for carcinoma of the colon and rectum was studied in 511 patients who underwent operation from 1976 to 1983. Forty per cent of the patients had preoperative IVP and these patients were significantly more likely to have undergone resection distal to the transverse colon than patients without preoperative IVP. Sex, age, urologic history, physical findings, abnormal urinalysis, elevated blood urea nitrogen (BUN) or serum creatinine levels and identity of the surgeon did not appear to influence whether or not an IVP was obtained before operation. Postoperative urologic complications were noted in 9.4 per cent of the patients; 87 per cent of the complications were retention or infection. Complications were significantly more common in male patients, particularly those with preoperative symptoms of retention, patients with elevated preoperative BUN or serum creatinine levels and patients who had resections distal to the transverse colon. Age, urologic history, physical findings, abnormal urinalysis results and the identity of the surgeon were not associated with postoperative urologic complications. The incidence of complications was the same in patients with normal and abnormal IVP results as well as for patients who did not undergo IVP. The findings of this study do not support the routine use of preoperative IVP for patients who undergo potentially curative resection for carcinoma of the colon and rectum.

Colonic Neoplasms↗

PubMed1989

Splenic hamartoma: report of a case and review of the literature.

A 39-year-old Japanese man with a splenic hamartoma who underwent surgery, is reported herein. The patient had a volvulus of the transverse colon and acute Type A hepatitis. His symptoms included fever, abdominal pain and icterus and the serum chemistry showed liver dysfunction and an elevation of hepatitis A antibody levels. Barium enema revealed a volvulus of the transverse colon. Ultrasonogram showed a hypoechoic mass and angiogram showed evidence of stretching of the intrasplenic vessels in the arterial phase and a hypovascular mass lesion in the venous phase. Macroscopically, the tumor was a well-defined, whitish-yellow, hard nodule. Microscopically, the tumor was composed of fibrous scar tissue containing scattered red pulp tissues and the histologic diagnosis was a splenic hamartoma of the fibrous type. The patient's postoperative recovery was uneventful. The clinical features of splenic hamartoma are reviewed in this report and the differential diagnosis is also discussed.

Adult↗

PubMedDate not supplied

Middle mesenteric artery visualized by computed tomographic angiography.

The middle mesenteric artery, a third mesenteric artery arising from the aorta that principally feeds the transverse colon, is an extremely rare anomaly. We identified a middle mesenteric artery branching into the ileocolic artery and into the right, middle, and accessory middle colic arteries. It supplied the cecum and the entire ascending and transverse colon. This anomaly was detected with computed tomographic angiography.

Angiography, Digital Subtraction↗

PubMed2003

Covered expandable metallic stent placement for hemostasis of colonic bleeding caused by invasion of gallbladder carcinoma.

A 72-year-old Japanese man was admitted to our hospital complaining of right upper-quadrant abdominal pain, blood in his stool, and symptoms of anemia. On physical examination a hard mass, about 6 cm in diameter, was palpable in the right upper quadrant of the abdomen. Computed tomography revealed a gallbladder carcinoma which had invaded the transverse colon, with liver metastasis. We diagnosed gallbladder carcinoma, stage IVB. Colonoscopy was performed for persistent blood in the stools. This revealed an elevated lesion which appeared to be an invasion of gallbladder carcinoma, with diffuse bleeding from the right-side of the transverse colon. It proved difficult to stop this bleeding by ordinary therapeutic endoscopy. In order to achieve hemostasis we therefore inserted a covered Ultraflex metallic stent to compress the tumor. After stent placement, blood was no longer seen in the patient's stools, he became able to eat soft food and was discharged. This treatment was uninvasive and effective. Covered stent placement appears to be a new and useful method in the management of bleeding from malignant gastrointestinal tumors.

Aged↗