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PubMed2002

[Hospital study of the incidence of inflammatory bowel disease in the health district of Mérida (Spain)].

OBJECTIVES: To study the incidence of inflammatory bowel disease (IBD) in the health district of Mérida (Spain). MATERIAL AND METHODS: Retrospective hospital study of all patients diagnosed with IBD between 1/1/96 and 31/12/00 in the Hospital de Mérida, which is the reference center for a population of 158,407 inhabitants. Overall rates, standard rates based on the standard European population at 10-year age intervals, and accumulated rates were calculated. The standard error of these rates was calculated to establish a 95% confidence interval. RESULTS: In the five years analyzed, 54 new cases of IBD were observed. Of these, there were 39 cases of ulcerative colitis (UC) with a sex distribution of 24 men (61.6%) and 15 women (38.4%), and 15 cases of Crohn's disease (CD) in seven men (46.7%) and eight women (53.3%). The mean age at diagnosis was 47.2 years for UC and 40.8 years for CD. In UC, involvement was as follows: proctitis in eight patients (20.5%), proctosigmoiditis in three (7.7%), left colon in 18 (46.1%), transverse colon in four (10.3%) and entire colon in six (15.4%). In CD, the following distribution was found: small intestine in six patients (40%), ileocolic in five (33.3%) and colic in four (26.7%). The incidence rates adjusted for age (15-64 years) and sex and expressed in cases/100,000 inhabitants were as follows: UC: 9.57 (95% CI, 0-16.3) for men and 2.09 (95% CI, 0-5.44) for women; CD: 3.15 (95% CI, 0-7.27) for men and 1.16 (95% CI, 0-3.52) for women.

Adolescent↗

PubMed1998

Trends in colorectal cancer incidence in Sweden 1959-93 by gender, localization, time period, and birth cohort.

OBJECTIVES: This study examined invasive colorectal cancer incidence-rates in Sweden from 1959 through 1993 (n = 134,643 cases). METHODS: Age-standardized rates were calculated using the Swedish population in 1970 as a reference. RESULTS: In right-sided colon cancer (ascending and transverse colon including right and left flexures), male age-standardized rates rose from 8.0 to 15.0 (1.8 percent annually, 95 percent confidence interval [CI] = 1.3-2.4) and female rates increased from 9.1 to 14.4 (1.5 percent annually, CI = 1.0-2.0). For left-sided colon cancer (descending and sigmoid colon), the rates have been stable recently. For rectal cancer, the rates among men rose from 18.8 to 23.0 and among women from 10.7 to 14.7. For both men and women, the relative risk (RR) of right-sided colon cancer had been increasing in successive generations, until leveling-off in those born after 1930. The RR of left-sided colon cancer had been almost constant for cohorts born before 1930 but steadily decreasing in later-born cohorts. The RR of rectal cancer was slightly increasing in successive cohorts. CONCLUSIONS: Changes in lifestyle or carcinogenic exposures during early life probably explain Swedish colorectal cancer incidence-trends better than improved diagnostic activities.

Adult↗

PubMed1999

Stool water content and colonic drug absorption: contrasting effects of lactulose and codeine.

PURPOSE: By varying stool water content using lactulose and codeine, we investigated the influence of luminal water content on the absorption of quinine, a transcellular probe, and 51Cr-EDTA, a paracellular probe, from the distal gut. METHODS: Sixteen volunteers entered a three-way cross-over trial in which absorption of probe markers from a timed-release delivery system was determined following treatment with lactulose 20 mls tds (increasing water content), or codeine 30 gms qds (decreasing water content), and compared with control untreated values. Stool water content was assessed by freeze drying stool samples. Site of release was determined by gamma scintigraphy, and absorption was measured by plasma levels and urinary recovery of the marker probes. RESULTS: Lactulose accelerated ascending colon transit (3.7 +/- 0.8 vs 4.5 +/- 1.4 hrs, p < 0.05), increased stool water content (75 +/- 2 vs 71 +/- 2%, p < 0.01), caused greater dispersion of released material (dispersion score 3.4 +/- 0.3 vs 1.8 +/- 0.2, p < 0.01), and enhanced absorption of the transcellular probe quinine (4.66 +/- 0.78 vs 3.02 +/- 0.63%, p < 0.05) compared to control. Conversely codeine slowed ascending colon transit (8.9 +/- 1.8 hrs), reduced stool water content (61 +/- 2 vs 71.2%, p < 0.05), and tended to diminish absorption (2.60 +/- 0.77 vs 3.02 +/- 0.63%, p = 0.20). Within the ascending colon specifically, there was a significant trend for treatments increasing luminal water content to enhance quinine absorption (medians: codeine = 1.2%, [n = 81 < control = 2.3%, [n = 5] < lactulose = 3.2%, [n = 71, p < 0.01). Delivery site also had an important influence on absorption, with more distal release resulting in less absorption in the control arm (medians: small intestine = 4.4% [n = 5] > ascending colon = 2.3% [n = 5] > transverse colon = 1.5% [n = 6], p < 0.005). CONCLUSIONS: Lactulose accelerates transit, increases stool water content, and enhances drug absorption from the distal gut whilst codeine slows transit, decreases stool water content, and tends to diminish absorption, compared to controls. We conclude that water content may be an important determinant in colonic drug absorption.

Adult↗

PubMed2000

Colon injuries in children.

BACKGROUND/PURPOSE: Colonic injuries are rare in childhood, but when they do occur, they are mostly associated with penetrating abdominal injuries. The primary repair of colon injuries without stoma is still controversial within surgical experience, and the potential risk factors affecting morbidity and mortality is not sufficiently known. METHODS: Between 1985 and 1997, 34 children presenting with traumatic colonic perforations were reevaluated by analyzing the relationship between the overall morbidity and mortality and the potential risk factors. RESULTS: Of the 34 children in the case study, 27 boys and 7 girls, there were 7 (21%) isolated colonic injuries. The remaining 27 (79%) patients showed colonic injuries most frequently associated with the small bowel, the liver, and the bladder. Localization of injury was distributed thus: 21% in the right colon, 29% in the transverse colon, and 50% in the left colon. Primary repair, with or without intestinal resection, was performed in 27 (79%) of the patients. In total, postoperative complications occurred in 10 (29%) of the patients. Risk factors such as age, abdominal contamination, and associated abdominal organ injuries were found significant in these complications, however, the mechanism of injury, shock, blood transfusion, and localization of injury were not correlated significantly to postoperative complications. "'Flint's Colon Grading System" was used to ascertain the sensitivity of trauma scoring systems for postoperative complications. CONCLUSION: Colonic wounds can be repaired primarily without the need of colostomy in the majority of cases in children when the required selections are established.

Adolescent↗

PubMed1983

[Innominate grooves. A discussion].

Innominate grooves are delicate, inconstant speculations on the colonic margin which may be seen on barium enemas; their origin and significance are matters for discussion. Three hundred and fifty-three double contrast enemas (divided into four groups, depending on the techniques uses) were studied in respect of the presence, localisation and circumstances under which innominate grooves could be seen. The results showed that the incidence of grooves depended on the technique used and varied between 91% and 3%. The most common localisations were the descending and sigmoid colon and in the transverse colon, near the hepatic flexure. The grooves could be seen only towards the end of the examination. It follows that innominate grooves are a normal phenomenon in a healthy mucosa, which can be recognised under optimal circumstances. It is probably due to visualisation of the relief pattern of the mucosa, the delicate folds being particularly noticeable in relation to lymph follicles. Innominate grooves should not be misinterpreted as abnormal findings, but must be distinguished from somewhat similar changes in the colon due to inflammatory disease.

Colon↗

PubMed2004

Impact of proximal colon retroflexion on adenoma miss rates.

BACKGROUND: Small adenomas are commonly missed during routine colonoscopy. The aim of this study was to determine whether routine retroflexion in the proximal colon would improve adenoma detection rates. METHODS: One hundred patients underwent colonoscopy from the cecum to the splenic flexure by a gastroenterology fellow, with the removal of all visualized polyps. The cecum was then reintubated and patients were randomized to a second exam of the proximal colon by an experienced staff physician in either the forward view or a retroflexed view. RESULTS: Two patients were excluded due to a difficult initial cecal intubation. Forty-eight patients were randomized to forward view and 50 patients were randomized to a retroflexed view. Retroflexion was successful in the cecum in 60%, the ascending colon 100%, and the transverse colon 98%. The success in retroflexion was determined in part by the type of colonoscope used. If any portion of the retroflexed examination could not be performed, that reexamination was performed in the forward view. The calculated miss rates for all polyps and adenomas among patients randomized to second examination in the forward view was 36.8% and 33.3%, respectively. The calculated miss rate for all polyps and for adenomas among patients randomized to a second examination in the retroflexed view was 38.1% and 23.7%, respectively. There was no difference in miss rates for all polyps or for adenomas (p= 0.31) when the second examination was performed in the forward view versus retroflexed view. CONCLUSIONS: A second examination by retroflexion in the proximal colon did not increase the calculated miss rate relative to that performed by a forward view examination. These results do not support the addition of routine right colon retroflexion to colonoscopy.

Adenoma↗

PubMed2005

Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting.

OBJECTIVES: The aim of this study was to clarify the usefulness of the management of acute colorectal obstruction using a transanal drainage tube before surgery or stenting. METHODS: Fifty-four patients (34 males and 20 females, aged 46-94 yr, mean = 69.7) treated between May 1998 and March 2004 for acute colorectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. Based on abdominal computed tomography findings, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a Dennis Colorectal Tube (DCT) was attempted. RESULTS: Endoscopic decompression using the DCT was technically successful in 52 of 54 patients (96.3%). The site of obstruction was the cecum in 4, the ascending colon in 2, the transverse colon in 7, the descending colon in 11, the sigmoid colon in 18, and the rectum in 12. The etiology of obstruction was primary colorectal carcinoma in 45, non-colonic metastatic carcinoma in 4, postoperative obstruction in 4, and retrograde intussusception in 1. Following adequate cleansing of the colon, 44 patients underwent a one-stage surgery after 7+/- 3 days (SD; range, 4-10 days). Stenting was successfully used as the final palliative treatment in 4. The use of the DCT alone relieved postoperative stenosis (3 patients) and retrograde intussusception (Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 1982;143:742-7). During these treatments, perforation occurred in one patient with postoperative stenosis of the cecum. CONCLUSIONS: Management of acute colorectal obstruction using the DCT was found to be effective and safe, irrespective of the site or etiology of the obstruction. Therefore, this procedure should be considered as a primary method for decompression of the obstructed colon before considering surgery or stenting.

Acute Disease↗

PubMed2005

Intraductal papillary mucinous neoplasm of the pancreas in a patient with attenuated familial adenomatous polyposis.

A 67 year old man with a clinical diagnosis of attenuated familial adenomatous polyposis (AFAP) and a past history of synchronous colon cancers in the transverse colon was also found to have an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. In addition, several foci of heterotopic gastric oxyntic mucosa were noted in the duodenum, interspersed with flat and polypoid adenomas. The duodenal adenomas showed low grade dysplasia, loss of adenomatous polyposis coli (APC) protein expression, but retention of beta catenin staining, localised to the nucleus and cytoplasm. The IPMN in the pancreas showed an identical immunohistochemical profile to the duodenal adenomas. The heterotopic gastric foci in the duodenum were negative for the APC protein, and beta catenin staining was membranous in location. Although the patient did not show germline truncating APC mutations or mutations in the MYH gene, the past history, clinical features, and immunohistochemical profile of the various lesions suggest strongly that the IPMN is part of the spectrum of lesions encountered in AFAP. Whether the heterotopic oxyntic gastric mucosa in the duodenum is also related is unclear, but it may represent a forme fruste of fundic gland polyps.

Adenomatous Polyposis Coli↗

PubMed2004

Positional change in colon polyps at CT colonography.

PURPOSE: To determine the frequency with which polyps change positions with respect to the bowel surface and the cause of this movement. MATERIALS AND METHODS: From December 2001 to March 2003, 113 patients underwent computed tomographic (CT) colonography prior to colonoscopy. For all confirmed polyps that were 5 mm and larger, images obtained with CT colonography were retrospectively analyzed by one author to determine if the polyp was present on both data sets or on only one data set. Retrospective evaluation of these polyps for ventral or dorsal location within the colonic lumen was performed for data sets obtained with patients in the prone and the supine position. The data sets were further reviewed by another author to determine the cause of positional change, when present. RESULTS: Twenty-six patients had a total of 49 histologically proved colorectal polyps that were 5 mm and larger. Eight of 49 colorectal polyps were depicted only on images obtained with the patient in the supine or prone position. Of the remaining 41 polyps that were depicted on images obtained with the patient in the supine and the prone position, 11 moved from a dorsal to a ventral location or vice versa relative to the colonic surface when the patient changed position. Five of these polyps were pedunculated on a stalk. Six were sessile; two were located in the sigmoid colon, two in the transverse colon, one in the ascending colon, and one in the cecum. In these cases, polyp mobility was related to positional changes of the colon in the mesentery, as opposed to true mobility of the polyp. CONCLUSION: In this series, 27% of polyps moved from a ventral location to a dorsal location relative to the colonic surface when the patient was turned from the supine to the prone position; thus, polyps appeared to be mobile. Thus, a mobile filling defect cannot be assumed to be residual fecal material at CT colonography.

Aged↗

PubMed1989

Colonic volvulus. Etiology and management.

Colonic volvulus accounts for 1-7% of cases of large bowel obstruction in the United States and Western Europe. It is, however, a much commoner condition in parts of Africa, South Asia and South America. Volvulus is thought to be an idiopathic condition, probably with an anatomical basis, particularly in cecal volvulus. Some cases are, however, secondary to a known condition such as Chagas' disease. The sigmoid colon is involved in 65-80% of cases and the right colon in 15-30%. Transverse colon and splenic flexure volvulus are rare. Emergency surgery has in the past been associated with a high mortality. Nonoperative, tube decompression of sigmoid volvulus has been the single most important advance in the management of the condition--this has allowed surgery to be deferred to an elective schedule and performed on a fitter patient with a prepared bowel. Emergency surgery is still required for a minority of patients--those in whom tube decompression is unsuccessful; in those with signs of gangrenous bowel and patients with volvulus proximal to the sigmoid. When the bowel is not viable, resection is mandatory. In patients with a viable colon, there are several options. Sigmoid resection and colostomy for sigmoid volvulus and detorsion, cecopexy and tube cecostomy as a combined procedure for cecal volvulus are the usually recommended procedures.

Colonic Diseases↗

PubMed1999

Angioplasty-bypass surgery combination therapy: case study of an elderly patient with unstable angina and colon cancer.

An 83-year-old man was admitted with refractory unstable angina and severe anemia. Colonofiberscopy revealed hemorrhagic colon cancer in the transverse colon. Coronary angiography showed total occlusion of the right coronary artery (RCA), diffuse, calcified 90% stenosis of the middle portion of the left anterior descending artery (LAD); and fair collaterals from the LAD to the RCA. Coronary revascularization was considered prior to colectomy, but because of the patient's advanced age and hemorrhagic cancer, conventional coronary aorta bypass grafting (CABG) using extracorporeal circulation, as well as coronary stenting requiring antiplatelet therapy, were regarded as inadvisable. Percutaneous transluminal coronary angioplasty (PTCA) for the LAD carried the risk of suboptimal coronary stenting. Thus, the patient was first treated with PTCA for the occluded RCA, followed 7 days later by a left internal thoracic artery graft to the LAD on the beating heart without extracorporeal circulation. The patient was stable thereafter. This approach to coronary revascularization may be suitable for patients for whom anticoagulation or antiplatelet therapy are contraindicated, or when complete revascularization would be difficult with CABG or PTCA alone.

Aged↗

PubMed1987

Peptide YY-like immunoreactivity in normal colon mucosa, muscle layer and adenocarcinoma.

Peptide YY (PYY)-like immunoreactivity was detected in the mucosa and muscle layer of normal human colon and rectum and in well to moderately differentiated adenocarcinoma derived from the mucosa of the colon and rectum, using a sensitive and specific radioimmunoassay for PYY. The content of PYY-like immunoreactivity in the mucosa was markedly higher than those in the muscle layer and adenocarcinomatous tissue of any part of the colon and rectum. A high concentrations of PYY-like immunoreactivity was demonstrated throughout the colon mucosa (ascending colon 94.14 +/- 15.34 pmol/g, transverse colon 137.19 +/- 13.44 pmol/g, descending colon 168.89 +/- 15.63 pmol/g, and sigmoid colon 223.69 +/- 35.31 pmol/g), the highest being observed in the rectum (313.15 +/- 45.90 pmol/g). The major molecular form of PYY-like immunoreactivity both in the mucosa and muscle layer of normal human colon and rectum and in adenocarcinomatous tissue was judged by gel exclusion chromatography to be identical to pure porcine PYY. This study revealed the presence of PYY-like immunoreactivity not only in normal tissue of the colon and rectum but also in adenocarcinomas with the same elution pattern, and the mucosal concentrations of PYY-like immunoreactivity were found to be increasing distally throughout the colon and rectum.

Adenocarcinoma↗

PubMed1993

Metastases to the pancreas and peripancreatic lymph nodes from carcinoma of the right side of the colon: CT findings in 12 patients.

OBJECTIVE: Our objective was to describe the CT findings of metastases to the pancreas from carcinoma of the colon and to discuss the pathways of metastasis based on the anatomic relationship between the mesocolon and the pancreas. MATERIALS AND METHODS: Clinical features and CT scans of 12 patients who had proved metastases to the pancreas from adenocarcinoma of the colon were retrospectively reviewed to define the characteristics of pancreatic lesions. The primary tumors were in the cecum (three patients), ascending colon (five patients), and transverse colon (four patients). Direct extension of the tumor to the pancreas was excluded. Metastases were diagnosed by aspiration or surgical biopsy. RESULTS: Seven patients (58%) had obstruction of the bile duct and/or pancreatic duct. Four others had symptoms related to the mass, including pain and gastrointestinal obstruction. In eight patients (67%), metastatic tumors involved the pancreas as a focal mass; in the other four (33%), the masses were lobulated and engulfed the pancreas and were indistinguishable from peripancreatic nodal disease. The masses were hypodense in nine patients (75%) and isodense in three patients (25%). Extra-pancreatic metastatic disease was seen in nine patients (75%). CONCLUSION: Clinical features and CT findings in patients with pancreatic metastases from carcinoma of the colon are similar to those of primary pancreatic ductal adenocarcinomas. The diagnosis of metastasis should be considered when a patient has a pancreatic mass and a history of colon carcinoma.

Adenocarcinoma↗

PubMed2001

Reconstruction of ureter with transverse retubularized colon segments.

PURPOSE: We present a technique in which colon segments are reconfigured as substitutes for ureteral defects. MATERIALS AND METHODS: Via a flank incision a 3 cm. segment was obtained from the ascending or descending colon and reconfigured into a well vascularized tube. In 2 patients a single retubularized colon segment was interposed into an extensive defect of the upper and mid ureter, respectively. In an additional 2 patients 2 combined anastomosed reconfigured colon segments were used for pyelo-colo-cutaneostomy. RESULTS: At a followup of 9 to 27 months (mean 15), no complications related to the reconfigured colon segments were noted. One patient died of progressive disease 9 months postoperatively but with no evidence of ureteral substitute malfunction. CONCLUSIONS: Reconfigured colon segments may be used successfully to reconstruct extensive ureteral defects. Access is via a flank or pararectal incision and intraperitoneal surgery is minimal. The colon segments are obtained immediately proximal to the ureteral defect, necessitating little mobilization of the mesenteric pedicle. Metabolic consequences should be absent or low since only minimal amounts of intestine are isolated. In patients with renal insufficiency or a history of irradiation this technique may be superior to the use of ileum.

Adult↗

PubMed2002

Colonic volvulus.

OBJECTIVE: To review the incidence of volvulations in our workplace, to study the procedures employed in its treatment, and to discuss our results during the last 20 years. MATERIAL AND METHODS: A series of colonic volvulus treated between 1978 and 1998 at one hospital is presented. RESULTS: We reviewed 41 cases. Volvulus locations are: sigmoid colon: 21, caecum: 17, transverse colon: 2, and splenic flexure: 1. Mortality rates according to the type of volvulus and type of operative procedure is analyzed. Four cases of volvulus recurrence (9%). CONCLUSIONS: Treatment guidelines for the approach to colonic volvulus are presented.

Aged↗

PubMed2002

[Is mucinous colorectal adenocarcinoma a distinct entity?].

INTRODUCTION: Several publications have demonstrated that mucinous carcinomas of the colon and rectum are associated with certain clinicopathological and genetic peculiarities that distinguish them from non-mucinous carcinomas. The principal aim of this study was to evaluate whether the biological behavior of mucinous carcinomas differs from that of intestinal carcinomas in patients undergoing surgery for colorectal cancer. PATIENTS: Between January 1993 and December 2000, 215 patients. underwent surgery in our hospital for colorectal cancer. The patients were divided into two groups according to histological type: tumors were intestinal in 169 patients (82%) and mucinous in 36 (17.6%). Patients undergoing non-resective surgery and those with tumors of other histological types (n = 10) were excluded. RESULTS: The percentage of patients aged less than 50 years in the group with mucinous carcinoma was 19% (7/36) compared with 4% (7/169) in the non-mucinous group (p = 0.001). Regarding presenting symptoms, anemia was more frequent in patients with mucinous carcinoma (18.2% [n = 6] vs 5.7% [n = 8]) and a change in bowel habits was less frequent (15% [n = 5] vs 34.3% [n = 48]; p < 0.05). A total of 63.9% of mucinous carcinomas (n = 23) were located in the proximal colon (cecum, ascending and transverse colon) compared with 21.3% (n = 36) of non-mucinous carcinomas (p < 0.001). Surgical intention was palliative in 41.7% (n = 23.7) of mucinous carcinomas and in 23.7% (n = 40) of non-mucinous carcinomas (p < 0.05). The mean tumoral size was 6.2 2.5 cm in mucinous carcinomas and 4.7 2 in non-mucinous carcinomas (p = 0.001). Patients with mucinous carcinoma presented a higher percentage of nodal and distant metastases and a lower percentage of early stage tumors (p < 0.05). However, no differences were found in survival between the two histological types. CONCLUSION: Mucinous tumors were more frequently located in the right colon and in patients less than 50 years old and were more likely to be in more advanced stages than non-mucinous tumors but no differences were found in survival according to tumor type.

Adenocarcinoma, Mucinous↗

PubMed1992

[Volvulus of the colon. Apropos of 37 cases].

A retrospective study of 37 case reports of patients with volvulus of the colon was carried out to define diagnostic and therapeutic strategies. The group comprised 22 men and 15 women, mean age 69 +/- 4 years (range 26-88 years), the volvulus being located in the sigmoid colon (n = 23), ascending colon (n = 13) or transverse colon (n = 1). The diagnosis, suggested by the straight abdominal film in almost all cases, was confirmed by a barium enema in 70% of cases. Treatment was surgical in 30 patients (81%) including 12 as emergency operations. Mortality was 5.4% (2 cases), and morbidity high (43% including fatal complications) the majority of adverse reactions being respiratory. Volvulus of the ascending colon was treated by hemicolectomy in 9 cases with no mortality or relapse. In patients with sigmoid volvulus, a "medical" reduction was performed in 7 patients, with success in 5 cases, one recurrence and no mortality, ideal sigmoidectomies in 14 cases resulting in one recurrence and no mortality. Right hemicolectomy appears to be the technique of choice even for urgent cases, there being no contraindications to a one-stage re-establishment of continuity. Inversely, an urgent intervention should at all costs be avoided in cases of sigmoid volvulus, a "medical" reduction (radiology, intubation, endoscopy) allowing preparation of the patient for a deferred ideal sigmoidectomy. Obviously, failure to reduce the volvulus or signs of colon necrosis require urgent surgery and raise the problem of whether or not to re-establish colon continuity.

Adult↗

PubMed1992

[Colon and rectum cancer complicated with obstruction: immediate results and long-term follow-up].

Colorectal cancer is the leading cause of large bowel obstruction in Chile. The aim of this work was to assess the immediate results and long term survival of the surgical treatment of this complication. The clinical features of 113 patients (48 male and 65 female) with a mean age of 65 years, operated in a period of 10 years, were reviewed. The follow up was made by clinic appointments or home visits. The tumor was localized in the right colon in 30 cases, transverse colon in 20, splenic angle in 14, left colon in 39 and rectum in 10. Operative mortality was 34% for tumors of the right colon and 14% form tumors of the left colon. The follow up of the 89 survivors was accomplished in 97% with a mean follow up of 54 months (range 6 months-10 years). The principal prognostic factor was the initial stage of the tumor; survival was 87% for Dukes-Turnbull stage A, 70% for stage B and 32% for stage C1. The maximal survival period for stages D was 28 months. Patients subjected to an initial resective surgical procedure fared better, although not significantly, than colostomized patients. Present tendency is to perform one surgical procedure, avoiding colostomies that worsen patients quality of life and require a second intervention that increases surgical morbidity.

Adult↗