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PubMed1998

[Histological and histochemical study of hyperplastic and dysplastic lesions of the large intestine in Cebus Apella (primate) treated with 1,2-dimethylhydrazine].

The main objective of this study was to assess the histological changes of colon ephitelium in Cebus apella induced by 1,2-dimethylhydrazine (DMH) administration. Twelve monkeys, males, (aged x: 30 months) with an average body weight of 2,800 g were utilized. The DMH was injected subcutaneously at 25 mg/kg and continued once a week for 16 weeks. The body weight was assessed once a week during the first 4 months and every 30 days until the end of the experience. Histological changes of intestinal ephitelium and mucins were assessed at the end of the experience in specimens sectioned at 5 microns, stained with Haematoxylin and Eosin, PAS and Alcian blue pH 2.5. The histological and histochemical study permitted to characterize the normal morphology, as well as the mucins characteristics in the three regions: caecum, transverse colon and distal colon. The histological changes in the DMH treated animals were hyperplasia, dysplasia and mucins decreasing. The hyperplastic changes were localizated in glandular crypts, and in the epithelio located over the lymphoid nodules. The dysplastic crypts were observed in the transverse colon and in the last portion of distal colon. These lesions were located in the upper portion as well as the bottom of the mucosa. A decrease of neutral and acids mucopolysaccharides were observed in the crypts. The results of this study suggest that the DMH induced hyperplastic changes in the crypts and in the epithelium located over the lymphoid nodules and dysplastic focus, as well as a decrease of neutral and acids mucopolysaccharides.

1,2-Dimethylhydrazine↗

PubMed1984

[Variability in the localization of cryptosporidia in the intestines of spontaneously infected calves].

31 to 37 localities were examined in the small and large intestines of 48 calves spontaneously infected with cryptosporidiosis. It was found that cryptosporidia occurred the most frequently in the distal part of small intestine, within the range of six metres of small intestine, in front of the ostium ileocecale (OIC); at the ileocecal valve the incidence of cryptosporidia dropped rapidly. In none case were the protozoans revealed in duodenum and in the adjacent four to six metres of proximal jejunum. The small intestine was invaded by cryptosporidia in a variable manner, in some cases a major part was continuously invaded, in other cases only one or two metres of distal jejunum without any changes in the ileum and vice versa. Approximately half the calves had cryptosporidia in the cecum, fewer cryptosporidia were found in the transverse colon. Cryptosporidia in the rectum were found in about 25% of cases. Some calves had cryptosporidia only in the large intestine. The intensity of the mucous membrane invasion varied: mass incidence of cryptosporidia was found only in caudal parts of small intestine, with high variability of the extent and with sudden cases of negative findings. In the large intestine only the cecum was invaded more intensively and in a diffusive manner, in the transverse colon and in the rectum the groups of parasites were usually found at the openings and in the wall of Lieberk uhn 's crypts.

Animals↗

PubMed2004

Internal hernias after laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic gastric bypass (Lap-RYGB) is an increasingly common procedure performed for severe obesity. Internal hernias are a potential problem associated with Lap-RYGB, and little is known about the clinical presentation and the diagnostic accuracy of this potentially serious complication. METHODS: A retrospective review of 1,000 retrocolic Lap-RYGB was performed to identify those who developed postoperative internal hernias. Clinical symptoms, radiologic characteristics, and operative outcomes were analyzed to determine clinical and radiologic diagnostic accuracy (including computed tomography [CT] scan and upper gastrointestinal imaging). Subsequent independent review was performed to match operative intervention with radiologic imaging and interpretation. Operative outcomes, including the hernia closure technique, hospital length of stay, and mortality were obtained. RESULTS: Of 1,000 Lap-RYGB procedures, 45 internal hernias were identified (4.5%) in 43 patients. Hernia location included transverse colon mesentery (n = 43, 95%) or Petersen's defect (n = 2, 5%). The most common clinical symptoms included intermittent, postprandial abdominal pain, and/or nausea vomiting (86%), although 20% had no abdominal tenderness. Initial radiologic imaging studies were diagnostic in 64%, although subsequent review of all imaging studies showed diagnostic abnormalities in 97%. CT findings suggestive of internal hernia include small bowel loops in the left upper quadrant and evidence of small bowel mesentery traversing the transverse colon mesentery. All patients with internal hernias underwent operative repair (98% performed laparoscopic). One patient had a negative laparoscopy, although the preoperative CT suggested an internal hernia was present. The mean time to intervention for an internal hernia repair was 225 days (range 2 to 490), whereas hospital length of stay was 1.2 days (range 1 to 4). No deaths were noted. CONCLUSIONS: Internal hernias after retrocolic lap-RYGB are associated with vague abdominal complaints and limited radiologic imaging results. A high index of clinical suspicion should be used in this patient population, and surgeon review of radiology imaging studies should be performed. Prompt surgical intervention is successful and can commonly be performed laparoscopically.

Adult↗

PubMed1996

[Subcellular localization of blood group substances ABH in human gastrointestinal tracts].

Authers investigated subcellular localization of ABH substances in normal human stomach, duodenum and transverse colon by post-embedding immunogold method using monoclonal antibodies specific for A, B and H antigens. The immunoreactivity was usually restricted to the following organelles: mucigen granules of epithelical cells of gastric mucosa, zymogenic granules of chief cells of the gastric gland, both mucigen granules and Golgi cisternae of neck mucous cells of the gastric gland and of epithelial cells of the duodenum mucosa as well as the Brunner's gland. ABH antigens were also visualized in microvilli of absorptive cells and mucigan granules of goblet cells of the transverse colon. The results suggested that ABH substances in those cells were produced in Golgi cisternae and were transfered to secreting granules, then were secreted with mucus. The mosaic distribution of ABH substances in cells and the effect of embedding resins on ABH antigens and the ultrastructure of cells were discussed.

ABO Blood-Group System↗

PubMed1982

Urinary diversion in patients undergoing pelvic exenteration.

Between October, 1969, and April, 1981, gynecologic oncologists at the University of Alabama Medical Center in Birmingham have performed 119 pelvic exenterations. One hundred fifteen of these patients had a concurrent supravesical urinary diversion. Fifty-six patients (48.7%) had an anterior exenteration and 59 patients (51.3%) had a total exenteration. An ileal segment was used as a conduit in 97 patients while the segment of transverse colon was used in 16 patients. Two patients had sigmoid conduits. Eighty-five patients (73.9%) had the intestinal anastomosis and conduit constructed with gastrointestinal staplers. Stapler use shortened the mean operating time for the exenterative procedure by approximately 30%. No increase in postoperative gastrointestinal complications was noted. Urinary diversion preformed as part of a pelvic exenteration has been associated with short- and long-term complications. The use of ureteral stents and the gastrointestinal staplers shortens the procedure without predisposing the patient to major urologic complications. The use of a segment of unirradiated bowel (transverse colon) in conjunction with these techniques constitutes the preferred method of supravesical urinary diversion in patients undergoing a pelvic exenteration.

Colon↗

PubMed2002

Physiological assessment of the function of the ileocecal junction with evidence of ileocecal junction reflexes.

BACKGROUND: The ileocecal junction (ICJ) appears to be a specialized segment of the gut which regulates the passage of the chyme from the ileum to the cecum. We investigated the response of the ICJ to cecal and ileal distension and the nature of this response (direct or reflex). MATERIAL/METHODS: Nine patients who had early cancer in the proximal transverse colon were studied during right hemicolectomy. The pressure response of the ICJ to cecal and ileal balloon distension was determined before and after cecal and ileal anesthesia. The balloon and manometric catheters were introduced into the cecum and ileum by colotomy and ileotomy, respectively. ICJ length was measured by the pull-through technique. RESULTS: The ICJ high pressure zone had a mean length of 3.6 cm. Chyme flow to the cecum occurred in jets. Large-volume cecal distension caused a significant rise in cecal and ICJ pressures and decreased ileal pressure; the balloon was dispelled to the transverse colon. Large-volume ileal distension caused an increase in ileal pressure, decreased ICJ and cecal pressures, and aboral balloon movement. No pressure response was produced by small volume distension or anesthesia of the cecum or ileum. CONCLUSIONS: Ileal distension is suggested to initiate reflex ICJ and cecal relaxation which is mediated through the 'ileocecal inhibitory reflex' and which allows the chime to pass to the cecum. Cecal distension appears to evoke reflex ileal and ICJ contraction, thus preventing ceco-ileal reflux and allowing time for chyme to accumulate in, and distend, the terminal ileum; we call this reflex the 'ceco-ileal excitatory reflex'. These 2 reflexes are thought to regulate chyme passage through the ICJ.

Adult↗

PubMed2006

Migrating mesh mimicking colonic malignancy.

The use of prosthetic mesh is the current acceptable standard for the repair of hernias. Recurrence rate has been greatly reduced since Lichtensen in 1986 first described mesh repair of inguinal hernias. The most common complication arising from inguinal hernia repair even with mesh is recurrence. There are isolated reports of migrated mesh in the three decades of mesh use in hernia repair. We present a case report of a migrated mesh plug presenting with features highly suggestive of an intra-abdominal neoplasm in a 63-year-old man who presented with weight loss, anorexia, fatigue, and a palpable right lower quadrant mass. Work up had revealed a large inflammatory mass involving the cecum and not amenable to percutaneous or colonoscopic biopsy, thus requiring diagnostic laparoscopy. He had a right inguinal hernia repair with mesh 8 years earlier. At diagnostic laparoscopy, an extensive right lower quadrant mass involving the cecum, bladder, and transverse colon and extending to the midline was found, necessitating conversion to open laparotomy and a right hemicolectomy. A mesh plug was found intimately involved with the specimen. Plugs used in inguinal hernia repair rarely migrate. It is rarer still for them to present as a possible colonic mass. This is the first known case report of mesh plug migration presenting as a suspected colonic malignancy.

Colectomy↗

PubMed2002

Effect of early intrajejunal nutrition on pancreatic pathological features and gut barrier function in dogs with acute pancreatitis.

BACKGROUND: In patients with major trauma and burns, total enteral nutrition (TEN) significantly decreases the acute phase response and incidence of septic complications when compared with total parenteral nutrition (TPN). Traditionally, it was believed that early intrajejunal nutrition (EIN) in severe acute pancreatitis (SAP) may exacerbate the clinical pathological features, lead to recurrence of symptoms and delay complications. OBJECTIVE: To compare the effect of EIN vs TPN on the pancreatic pathological features and gut barrier function in dogs with acute pancreatitis (AP). METHODS: Fifteen dogs (surviving over 7 days, the death rate being 32%, 7/22) were divided into parenteral nutrition (PN) group (n=7) and EIN group (n=8). SAP model was induced by injecting 1 ml/kg of combined solution of 2.5% sodium taurocholate and 8000-10000 BAEE units trypsin/ml into the pancreas via the pancreatic duct. Nutrients were delivered to the EIN group by catheter via a jejunostomy feeding 24 h postoperatively. The two groups were isocaloric and isonitrogenous. Systemic blood samples were obtained before and 1, 4, 7 d following AP, and cultured by aerobic as well as anaerobic bacterial growth. Systemic plasma and portal vein endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Portal vein blood and specimens of tissue from mesenteriolum and mesocolon lymph nodes, lung, pulmonary portal lymph nodes and pancreas were adopted before the experiment was finished. Aliquots of the homogenata were cultured as blood mentioned above. Serum glucose, calcium, amylase and lysosomal enzymes were determined. All dogs were injected with 50 microCi (125)I-BSA 4 h at the 7th day before being sacrificed. The (125)I-BSA indexes of the pancreas/muscle and pancreas/blood were measured, and pancreatitic pathological scores (PPSs) of the different partial pancreas were observed. The content of mucosa protein, DNA and the villi, the thickness of mucosa and the whole bowel wall of the ileum and transverse colon were measured. RESULTS: The study showed that serum glucose in the PN group was higher than in the EIN group after SAP 3 d; the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ reduced significantly in the EIN group P<0.01. There were no differences between the two groups in the data of serum calcium, amylase and lysosomal enzymes, P>0.05; the (125)I-BSA index of pancreas/muscle and pancreas/blood, and PPS of the head, body, tail and total pancreas did not reach significant difference between the two groups, P>0.05. The contents of protein and DNA, the height of villi, the thickness of mucosa and the whole bowel wall of the ileum and transverse colon in the EIN group were higher than that in the PN group,P <0.01. CONCLUSION: Our results suggested that EIN was safe and effective to be adopted by intrajejunal delivery of nutrients in SAP dogs, did not make SAP clinical pathological features deteriorate, and decreased the occurrence rate of endotoxin and gut bacterial translocation.

Acute Disease↗

PubMed2006

Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases.

BACKGROUND: This study aimed to evaluate the feasibility of using a robotic assistant for colon resections. This report describes the experience, advantages, and disadvantages of using the DaVinci system for a colectomy on the basis of 30 consecutive cases managed by a minimally invasive surgery fellowship-trained surgeon. METHODS: Data were prospectively collected on 30 consecutive colectomies performed using the DaVinci system from September 2002 to March 2005. RESULTS: A total of 13 sigmoid colectomies with splenic flexure mobilization and 17 right colectomies were performed for 14 men and 16 women. The preoperative diagnoses for the procedures were cancer (n = 5), diverticulitis (n = 8), polyps (n = 16), and carcinoid (n = 1). The right colectomies required 29.7 +/- 6.7 min (range, 22-44 min) for the port setup, 177.1 +/- 50.6 min (range, 103-306 min) for the robot, and 218.9 +/- 44.6 min (range, 167-340 min) for the total case. The length of stay was 5.2 +/- 5.8 days (range, 2-27 days). The robot portion was 80.9% of the total case time. The sigmoid colectomies required 30.1 +/- 9.6 min (range, 15-50 min) for the port setup, 103.2 +/- 29.4 min (range, 69-165 min) for the robot, and 225.2 +/- 37.1 min (range, 147-283 min) for the total case. The hospital length of stay was 6.0 +/- 7.3 days (range, 3-30 days). The robot portion was 45.8% of the total case time. Six complications occurred: left hip paresthesia, cecal injury, anastomotic leak, patient slipped from the operating table after the robotic portion of the case, transverse colon injury, and return of a patient to the office with urinary retention. Two sigmoid colectomies were converted to laparotomy. The specific advantages and disadvantages of using the DaVinci system for colectomies are discussed. CONCLUSIONS: The 30 consecutive cases demonstrated the technical feasibility of using the DaVinci system for a colectomy. The longevity of the DaVinci system's use for colectomy will be determined by comparison of its cost and outcomes with those for conventional laparoscopic colectomy.

Adult↗

PubMed1989

Colonic complications of severe acute pancreatitis.

Colonic complications are rare in acute pancreatitis. Over the last 9 years at St. Mary's Hospital, London, UK, we have managed severe acute pancreatitis by intensive supportive therapy followed by sub-total pancreatic resection and/or debridement in those who fail to improve. Of the 22 patients who have undergone this form of surgery, nine were found to have colonic involvement in the form of either necrosis or perforation. In addition, one patient presenting at West Middlesex University Hospital, Isleworth, UK, had severe acute pancreatitis and almost total colonic necrosis as an unexpected finding at emergency laparotomy. These ten patients comprised seven men and three women of median age 59 years and with a median of four Ranson criteria. In seven patients, colonic involvement was discovered at the time of pancreatic surgery or laparotomy for pancreatitis and in the remainder it presented between 1 and 3 weeks later as either a faecal fistula (n = 2) or persistent abdominal sepsis (n = 1). The ascending colon was involved in one patient, the splenic flexure and descending colon in one, the transverse colon in three, the splenic flexure alone in four, and one patient had almost total colonic involvement. All patients underwent resection of the involved colon and exteriorization with either a proximal colostomy (n = 7) or ileostomy (n = 3) and a distal mucous fistula. Pathological examination of the resected colons revealed a spectrum of changes from pericolitis through to ischaemic necrosis suggesting at least two possible mechanisms. Six patients died from overwhelming sepsis between 1 day and 4 weeks (median 11 days) after colonic resection. Severe acute pancreatitis must be recognized as a cause of colonic ischaemia and necrosis; this complication is associated with a very poor prognosis despite surgical intervention.

Acute Disease↗

PubMed1992

Surgical treatment of colon and rectum adenocarcinoma in elderly patients.

The results are presented of disease-free interval and overall survival in 53 elderly patients with colon or rectum adenocarcinoma treated with curative surgery. The average age was 75.3 years (median = 75.0); 21 patients were male and 32 were female. Tumor location was as follows: rectum 18 (34%), sigmoid 17 (32.1%), right colon 14 (26.4%), and transverse colon 4 (7.5%) All patients were surgically treated following the classical patterns for tumor resection. After pathological examination, which included the histological grade differentiation, the disease stage was reevaluated following the pTNM system. Overall and disease-free survival at 5 years, for all patients, independent of histological grade differentiation and disease stage, were 75.3% and 55.5%, respectively. Overall survival at 5 years for patients with grades I and II histological differentiation was 74.1% and 85.0%, respectively. None of the grade III patients (2 cases) survived more than 1 year. The 5 years disease-free survival for patients with histological grade differentiation I and II was 56.8% and 60%, respectively. There was no statistically significant difference in overall survival for patients with stages SI, SII, and SIII, but the disease-free survival at 5 years by stages was found to be significant with rates of 100%, 67.6%, and 22.6%. Postoperative mortality was 4 (7.5%). The postoperative mortality and survival rates obtained in this group of patients encourage us not to consider age as a limiting factor for curative surgical treatment.

Adenocarcinoma↗

PubMed1993

Hemorrhage following colonoscopic polypectomy.

Clinically significant hemorrhage following colonoscopic polypectomy may occur primarily as the polyp is removed or manifest itself days to weeks later secondary to clot dissolution. The rate of hemorrhage following colonoscopic polypectomy ranges widely from 0.3 to 6.1 percent, depending on whether the data are derived from studies using the number of patients or number of polypectomies. A retrospective study was performed in our institution to study 4,721 patients who underwent polypectomy between January 1987 and December 1991. Twenty (0.4 percent) of these patients required hospital admission because of 9 primary and 11 delayed hemorrhages. Fifty-four polyps were removed from these patients: 11 in the right colon, 7 in the transverse colon, 17 in the descending colon, and 19 in the sigmoid colon. Eight polyps were 2 cm or larger, 10 were pedunculated, and 44 were sessile. Six patients underwent cauterization or resnaring of the bleeding polyp site, one patient underwent subtotal colectomy, and the remainder of the patients stopped bleeding spontaneously. Factors that could be associated with the outcome of hemorrhage include patient age, size, location, number and morphology of polyps (i.e., sessile or thick stalk), and use of anticoagulants. An experienced endoscopist with knowledge of electrosurgical and technical principles may be the most important factor for prevention of postpolypectomy bleeding.

Adult↗

PubMedDate not supplied

Distribution of large-bowel cancers detected by occult blood test in asymptomatic patients.

A randomized, controlled study on occult blood in stool was conducted in 48,000 asymptomatic participants, ages 50 to 80 years. Those with positive hemoccult test results underwent a complete colonic workup including colonoscopy and, in some cases, an air-contrast barium-enema examination when total colonoscopy could not be accomplished. From April 1976 to December 1980, 113 patients (62 men and 51 women), with an average age of 66 years, were found to have invasive carcinomas of the large bowel: right colon--25 per cent, transverse colon (included both flexures)--9 per cent, descending colon--10 percent, sigmoid and rectosigmoid--42 per cent, rectum--12 per cent, anal canal--2 per cent. The stages of the cancers were: Dukes' A--57 per cent, Dukes' B--21 per cent, Dukes' C--19 per cent, Dukes' D--3 per cent. The findings suggest that a complete colonic workup is required for the detection and diagnosis of large-bowel cancers in asymptomatic patients.

Aged↗

PubMed2004

Colonoscopic manifestations of typhoid fever with lower gastrointestinal bleeding.

BACKGROUND: Intestinal bleeding in patients with typhoid fever usually occurs in the ileum. However, endoscopic findings in such patients are not well established. We examined the colonoscopic manifestations of intestinal lesions with bleeding in patients with typhoid fever. PATIENTS AND METHODS: The colonoscopic findings of seven patients who presented with haematochezia due to typhoid fever were reviewed retrospectively. Typhoid fever was diagnosed when the Salmonella typhi was isolated or when the Widal test showed strongly positive reactions. RESULTS: Clinical data and colonoscopic findings were reviewed in seven patients (four men and three women with an average age of 42 years). The most commonly involved area was the terminal ileum (100%), followed by the ileocecal valve (57%), the ascending colon (43%), and the transverse colon (29%). Left colon was intact in all cases. The most common colonoscopic finding was multiple variable-sized punched-out ulcers with slightly elevated margin, as found in five patients. In two patients, only several oedematous hyperaemic mucosal patches with haemorrhagic spots or shallow erosions were seen. Active bleeding was noticed only in one patient, who received endoscopic haemostasis twice. The remaining six patients were treated by conservative treatment including antibiotic therapy. There was no complication during or after the colonoscopic examination. CONCLUSIONS: Intestinal bleeding in typhoid fever usually occurs from the ulcers in the ileum or proximal colon, and the most common colonoscopic manifestations are multiple variable-sized punched-out ulcerations.

Adult↗

PubMed2005

Investigating painless rectal bleeding--is there scope for improvement?

INTRODUCTION: Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding. METHODS: Retrospective review of 314 patients aged 1 to 15 years who underwent colorectal endoscopy for recurrent rectal bleeding. Two hundred six underwent total colonoscopy, whereas 108 patients had endoscopy limited to the rectum in 22, sigmoid colon in 34, descending colon in 43, and transverse colon in 9. Diagnoses were recorded according to the endoscopic and histological findings. RESULTS: After total colonoscopy, a diagnosis was established in 70% of children compared with 35% of those undergoing limited endoscopy (P < .001). This difference was most noticeable in children with inflammatory bowel disease. Juvenile polyps were diagnosed with similar frequency in both groups, reflecting the rectosigmoid distribution of most polyps. CONCLUSIONS: For children presenting with painless rectal bleeding, a diagnosis can be established in the majority if total colonoscopy is performed. This is particularly true for inflammatory bowel disease. Unless a rectal polyp is suspected, full colonoscopy should be planned.

Adolescent↗

PubMed1981

Colon interposition for advanced nonmalignant esophageal stricture: experience with 40 patients.

This report details our experience in 40 patients with benign strictures of the esophagus who underwent colon (or gastric) interposition with our without esophageal resection between 1972 and 1980. There were 23 men and 17 women ranging from 5 to 76 years old. Twenty-seven patients had fibrotic strictures secondary to reflux esophagitis including 12 after failure of antireflux procedures; 4 had caustic strictures; 3 had a Barrett's esophagus; 2 had systemic candidiasis; 2 had scleroderma; and in 2 the etiology was undetermined. the right colon was used in 27 patients, the left colon in 4, the transverse colon in 1, and the jejunum in 1. In 7 patients the stomach was employed because of vascular insufficiency of the colon. Three surgical approaches were utilized. Manometric studies were done post-operatively in 10 patients. Complications occurred in 7 patients: cervical leaks, 4; reflux colitis, 2; and a late cervical stricture, 1. There were 4 deaths, only 1 of which was related directly to technique. This report summarizes the beneficial effect of right colon interposition for long esophageal strictures. Its vasculature is adequate, and it functions properly to propel food into the stomach irrespective of the peristaltic orientation.

Adolescent↗

PubMed1985

Diagnosis and management of gastrointestinal perforations in childhood dermatomyositis with particular reference to perforations of the duodenum.

Four children with dermatomyositis were recently seen with gastrointestinal perforations. The sites of perforation in the four cases were: (1) the duodenum, esophagus, and colon; (2) the duodenum; (3) the distal stomach; and (4) the traverse colon. The gastric and transverse colon perforations were intraperitoneal and easily diagnosed. The gastric perforation was treated successfully by partial gastrectomy. The patient with the colon perforation underwent exteriorization; death occurred from cerebral complications possibly related to vasculitis. Both duodenal perforations were posterior in the distal descending portion. Enzymatic dissection into the right lower quadrant produced confusing clinical and radiographic signs and extensive retroperitoneal necrosis. Successful treatment was obtained by partial gastrectomy, sump drainage of the perforation, and parenteral nutrition. Gastrointestinal perforation is a well-recognized complication of vasculitis in childhood dermatomyositis. In particular, perforations of the distal duodenum, as reported by others, are associated with delay in diagnosis and high mortality.

Child↗

PubMed1997

More than 10 years' follow-up to total colonic aganglionosis--severe iron deficiency anemia and growth retardation.

Seven cases of total colonic aganglionosis were reviewed with a follow-up period of 10 to 26 years, focusing on the relationship between the length of aganglionic ileum and postoperative metabolic disorders. Pulled-through ileum ranged from 0 to 65 cm from the ileocecal valve, and suprapelvic side-to-side anastomosis was performed between the pulled-through ileum and 17 to 40 cm of aganglionic colon (left side and transverse colon, four; right side colon, one; no colonic patch, two). Hemoglobin level in three out of four patients with ileal involvement of more than 25 cm was below 11 g/dL (10.9, 7.7, 6.6 g/dL, respectively). Serum iron level was less than 30 micrograms/dL (27, 21, 20, 18 micrograms/dL, respectively) in four out of five patients with ileal involvement of more than 10 cm. Serum vitamin B12 level was below 100 (100, 46 pg/dL, respectively) in two patients whose pulled-through ileum was 45 cm and 65 cm, respectively from the ileocecal valve. One patient needs periodical parenteral iron therapy and one was treated as megaloblastic anemia. In the patients with ileal involvement of more than 25 cm, both weight and height for age are very low at less than the fifth percentile, except for one patient whose side patch was at the right colon. One patient still needs parenteral nutritional support. Severe iron deficiency anemia, low level of B12, and growth retardation are apparent in the patients with total colonic aganglionosis with ileal involvement. Colonic side-to-side anastomosis does not substitute for the loss of terminal ileum.

Anastomosis, Surgical↗