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PubMed1983

Segmental colonic duplication presenting as a sigmoid volvulus.

This is a case report of a four-year-old girl who presented with severe intermittent abdominal pain. She had an infra-levator imperforate anus repaired as a newborn. Operation demonstrated duplications of the right and left colons, separated by a normal transverse colon. The left colon duplication was closed at both ends, and it contained 500 cc of intestinal secretions. The sigmoid colon and its duplication volvulized. The terminal ileum was also duplicated; one ileum joining a normal ascending colon duplication, which was patent proximally, but closed distally.

Child, Preschool↗

PubMed1985

Volvulus of the colon. Incidence and mortality.

Between 1960 and 1980, 137 patients with colonic volvulus (52% cecal, 3% transverse colon, 2% splenic flexure, and 43% sigmoid) were seen at the Mayo Clinic. Among the 59 patients with sigmoid volvulus, four (7%) had colonic infarction. Total mortality with sigmoid volvulus was seven per cent. There were 71 patients with cecal volvulus. Colonoscopic decompression was accomplished in two of these patients; in 15 (21%), gangrenous colon developed and mortality was 33%. Total mortality for cecal volvulus patients was 17%. Mortality for all forms of volvulus in patients with viable colons was 11%. Mortality for all patients with volvulus was 14%.

Adult↗

PubMedDate not supplied

Correlations between colonic wall thickening in patients with virally induced cirrhosis on CT and clinical status.

PURPOSE: The purpose of this work was to determine the frequency and CT imaging spectrum of colonic wall thickening and correlate these with the clinical severity of virally induced cirrhosis. METHOD: Fifty-nine patients were identified with virally induced cirrhosis and no other causes of colonic wall thickening. The abdominal CT scans of these patients were retrospectively reviewed by two radiologists to determine the presence of colonic wall thickening from the ascending colon to the descending colon, to assess the segmental distribution, and to correlate these findings with the clinical status assessed by Child-Pugh classification, presence of ascites, splenic volume index, varices score, and serum albumin levels. RESULTS: Colonic wall thickening was identified in 18 (31%) patients. The frequency of the affected distribution of colonic wall thickening was as follows: ascending colon in 17 (29%) patients, transverse colon in 11 (19%) patients, and descending colon in 7 patients (12%). The ascending colon was the most common site of colonic wall thickening (p < 0.001). Ten (17%) patients had multisegmental distributions. Colonic wall thickening had a statistically significant association with Child-Pugh grades A, B, and C (p < 0.0001), presence of ascites (p < 0.0004), splenic volume index (p = 0.0026), varices score (p < 0.0001), and serum albumin levels (p = 0.0364). The segmental distribution of wall thickening significantly correlated with Child-Pugh grades A, B, and C (p = 0.0005), presence of ascites (p < 0.001), varices score (p < 0.0001), serum albumin levels (p < 0.0001), and splenic volume index (p = 0.0135). CONCLUSION: Colonic wall thickening occurs commonly in patients with virally induced cirrhosis. The presence and number of colonic wall thickening were correlated with the grading of the severity of cirrhosis.

Adolescent↗

PubMed1993

Management of colorectal polyps in children.

Forty-two patients each with a colorectal polyp have been treated in our hospital over the past 10 years. In twenty-two cases the polyps were noted in the rectum, nine in the sigmoid colon, seven in the descending colon and four in the transverse colon. Each patient had only one polyp. Hematochezia was the main symptom in 29 patients, prolapse of the polyp from the anus in 10, abdominal pain due to intussusception in two and no symptoms were observed in one. Auto-amputation of the polyp was considered to have occurred in five patients. Twelve rectal polyps were resected from a transanal operation, and another 25 polyps were removed endoscopically with electric cautery. We have had no experience of endoscopic complications such as bleeding or perforation. A histological examination revealed an adenoma in one patient. Other polyps were non-neoplastic and were classified as juvenile, inflammatory and hyperplastic in 30, two and four patients, respectively. There have been no recurrences of polyps to date.

Child↗

PubMed1992

Acetic acid-induced colitis in the rat: a reproducible experimental model for acute ulcerative colitis.

There exists no ideal model for experimental ulcerative colitis in common laboratory animals. Therefore, we tried in the present study to establish a reproducible model for inducing colitis in rats by using acetic acid. A blind loop of the colon including the cecum, ascending colon and part of the transverse colon, was brought out through two colostomies. After mechanical washing with warm normal saline, acetic acid was instilled at different doses (4, 6 and 8%) for different exposure times (10, 15, 20, 25 and 30 s). The excluded colon was examined by light microscopy on the 1st, 2nd, 3rd, 4th, 7th and 14th days after operation and acetic acid instillation. We found that 4% acetic acid for 15 s produced a moderate, superficial colitis on the 1st day after operation, whereafter a uniform colitis evolved in all rats on the 4th day after operation. The developed colitis showed morphological similarities with human ulcerative colitis. Signs of healing and regeneration of the mucosa were seen on the 7th day, and the mucosa became almost normal at the 14th day after operation. 6 or 8% acetic acid solution or exposure times exceeding 15 s resulted in severe, deep colitis with a concomitant high mortality rate. In contrast, at exposure times less than 15 s, acetic acid induced only mild superficial colitis. We conclude that by using 4% acetic acid for 15 s in the excluded colon a uniform and reproducible colitis pathologically resembling human ulcerative colitis could be achieved. Furthermore, no mortality was encountered and the general health of the rats was similar to that of the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetates↗

PubMed1999

Cell cycle flow cytometric analysis in the diagnosis and management of colorectal carcinoma.

OBJECTIVE: To establish prognostic models and protocols for individualized management in colorectal carcinoma patients based on both clinical and DNA flow cytometric parameters. STUDY DESIGN: Prospective study of 88 colon carcinoma patients with a minimum follow-up of 12 months, operated on with the intent to cure and not treated with radiotherapy or chemotherapy. All the cases were subjected to a clinical evaluation: age, sex, tumor localization and size, histologic grade, tumor stage, disease-free interval, survival and flow cytometric study (ploidy, DNA index and S-phase fraction [SPF]). RESULTS: From the total of 88 neoplasms studied, 56 (63.6%) were from males and 32 (36.4%) from females; 30 (34%) were located in the right side of the colon, 7 (8%) in the transverse colon and 51 (58%) in the left side of the colon. Eleven (12.5%) were stage I, 52 (59.1%) stage II and 25 (28%) stage III. Forty-two (47.7%) were diploid and 46 (52.3%) aneuploid. The S-phase mean was 14.6% (12% for diploids and 16.9% for aneuploids). During the follow-up period, 26.1% of diploid tumors recurred, whereas aneuploid tumors recurred in 36.9% (P < .05). SPF from diploid and aneuploid tumors was analyzed separately. CONCLUSION: Regarding relapse-free interval, the behavior of diploid tumors with a high SPF was similar to that of aneuploid ones. Two kinetic profiles were established, favorable (diploid tumors with low S phase) and unfavorable (diploid with high S phase and all aneuploid tumors), that had significant prognostic value for progression and survival and that allowed identification of patients at high risk of recurrence. We formulated a prognostic index according to SPF and tumor stage that has discriminatory capacity for biologic behavior in colorectal tumors.

Adenocarcinoma↗

PubMed2001

Nonspecific bowel activity in imaging inflammation with Tc-99m labelled monoclonal anti-NCA-90 Fab' fragment MN3.

AIM: Since the Tc-99m labelled monoclonal anti-NCA 90 granulocyte antibody Fab' fragment MN3 (MN3 Fab') might be of interest for imaging abdominal inflammation which could be hampered by nonspecific bowel activity, we prospectively investigated the appearance of bowel activity in MN3 Fab' imaging. METHODS: Eighty consecutive patients (age range 12-85 years) referred for suspected nonabdominal, mostly musculoskeletal infection, were included. Abdominal inflammation was excluded clinically and there were no signs of inflammatory bowel disease in the patients' histories. One, 5, and 24 hours after intravenous injection of up to 1.1 GBq of MN3 Fab' planar images of the abdomen were performed. Bowel activity was graded visually using a 5-point scale. RESULTS: The one (N = 80), 5 (N = 79), and 24 (N = 52) hour images revealed 46 (10%), 162 (34%), and 173 (55%) accumulating bowel segments, respectively, in 37 (46%), 69 (87%), and 52 (100%) patients. The mean intensity score per accumulating segment was 1.1, 1.8 and 2.7 (p = 0), respectively. Relative frequencies of appearance of the small intestine were 38%, 57%, and 21%, ileocaecal region 6%, 53%, and 48%, ascending colon 5%, 67%, and 89%, transverse colon 1%, 9%, and 69%, descending colon 8%, 15%, and 67%, and rectosigmoid 0%, 4%, and 38%, respectively. Follow-up investigations in 13 patients revealed diverging uptake patterns. CONCLUSION: Nonspecific bowel activity is often present in the early and almost always and more intense, in the delayed images. Early imaging at one hour after administration seems feasible, but a loss in sensitivity has to be considered. Thus, nonspecific bowel activity can be anticipated to be a pitfall in imaging abdominal inflammation with MN3 Fab'.

Abdomen↗

PubMed2002

Colostomy in the newborn: technical pitfalls.

Colostomy is a commonly performed procedure in the neonatal period but the procedure is frequently underestimated. This report is aimed at raising awareness to technical errors made in performing the procedure. In a period of 4 years, 5 patients who had colostomy in the neonatal period developed problems, which were attributed to errors made in performing the procedure and have been retrospectively reviewed. In 3 patients, the sigmoid colon was erroneously used for transverse colostomy resulting in poor function. There was increased blood loss and increase in operation time from colostomy take down at subsequent definitive surgery in all 3. In one other patient, the ileum was mistaken for the transverse colon and opened, requiring closure; the closure leaked necessitating laparotomy, resection and anastomosis but death occurred from peritonitis. The fifth patient developed stoma necrosis due to ligation of the marginal artery and narrow fascial opening. Colostomy refashioning was necessary but death occurred from overwhelming infection. The colostomies were performed at a peripheral hospital and by unsupervised residents. Colostomy in the newborn can be associated with significant morbidity and mortality and great care is necessary to avoid these. Some technical points to avoid these errors are highlighted.

Anal Canal↗

PubMedDate not supplied

[Surgical treatment of locally advanced esophago-gastric cancer; preliminary results].

UNLABELLED: The aim of this paper is to sustain the palliative resection in neoplasm of the esophago-gastric junction, as a surgical approach that allows a better post-operative life comfort in comparison with simple gastrostomy. 62 observations with proximal neoplasm of the stomach (12.5%) were identified between January 1996-August 2001, representing 12.5% of the 496 patients with gastric neoplasm admitted in our unit in the same period. Out of these 62 cases, 55 (88.71%) underwent surgical procedures. Our attitude was aggressive in 25 cases. 40.32%, including the locally advanced lesions with palliative surgical indications (18 obs.). The other 30 patients underwent: 10 laparotomies, 5 gastrostomies and 15 jejunostomies. Local invasion to the neighboring organs imposed partial resection of the transverse colon--1 obs., of the transverse mesocolon--2 obs., and corporeo-caudal pancreatectomies--3 obs. The surgical approach was a left abdomino-thoracic incision, with total gastrectomy and distal esophagectomy, with N1 and N2 lymphadenectomy, splenectomy, and esojejunal intrathoracic anastomosis, with a Roux-en-Y loop, with or without jejunostomy (13 obs.). The immediate post-operative complications were 8 anastomotic leakage, one duodenal stump fistula, one occlusion due to a jejunostoma, and 13 extradigestive complications. There were 5 post-operative deaths. CONCLUSION: Neoplasm of the esophago-gastric junction is lately diagnosed, but whenever is possible, total gastrectomy with distal esophagectomy should be carried out.

Adenocarcinoma↗

PubMed2003

[A case report of the laryngeal edema and peripheral cyanosis after extubation of the tracheal tube].

A 65-year-old male in malnutrition due to advanced colon cancer underwent resection of transverse colon tumor and the invaded abdominal muscles with necrosis and abscess. After epidural catheter insertion between Th 10-11 for 9 cm cephalad, anesthesia was induced with thiopental 200 mg and fentanyl 50 micrograms. Tracheal intubation was done with vecuronium 5 mg, and anesthesia was maintained with sevoflurane with nitrous oxide in oxygen and epidural block. During surgery, systolic blood pressure often went up to 130 to 140 mmHg and down to 50 to 60 mmHg. Dopamine 3-5 micrograms.kg-1.min-1 was administered but occasional ephedrine bolus injection was still necessary. The intestine, including the intact part, was edematous. After the surgery, when systolic blood pressure was stable at about 130 mmHg and his consciousness was clear with regular spontaneous respiration, the tracheal tube was removed. However, soon after the extubation, expiratory stridor and cyanosis of the bilateral hands and feet were observed. Hydrocortisone 200 mg and nicardipine 0.5 mg were administered and room temperature was raised. About 30 minutes later, stridor and cyanosis subsided. In the ward after surgery, only hoarseness was observed. The stridor might have been due to the laryngeal edema, which could be attributed to stimulation by tracheal tube in the patient with malnutrition. The hemodynamic instability during surgery and cyanosis after extubation might have come from changes of the vascular resistance by sepsis.

Aged↗

PubMed2004

[Ulcerative colitis--contemporary morphological criteria].

Regular bioptical examinations of patients with ulcerative colitis (UC) performed in recent years show that the inflammatory changes of the mucosa of the large intestine are not necessarily diffuse, and that their extent may vary in the course of the disease. To establish the diagnosis of UC and to assess the treatment efficacy it is important to examine histologically multiple mucosal specimens from different levels of the large intestine. In our series of 27 patients with ulcerative colitis (18 men and 9 women at the age of 17 to 76 years), active or active and inactive pancolitis was diagnosed in 25 cases (93%). In 11 of these, the whole of the large intestine was affected. Two patients showed diffuse pancolitis without caecal involvement, in 5 cases there was inactive inflammation in the rectum or in the sigmoid colon. Seven patients had active colitis of the rectum and sigmoid. In another 2 patients (7%), the inflammation was limited to several segments of the large intestine only (the descending colon, and the descending and transverse colon). On bioptical examination of 6 patients repeated after 2-29 months (mean 14 months), there were changes in the distribution and appearance of the inflammation. Thus our findings correspond with the results of previous studies: UC does not always affect the mucosa of the large intestine diffusely. Further, the extent and distribution of inflammatory changes vary in the course of the disease.

Adolescent↗

PubMed2005

Giant submucosal lipoma of the cecum: report of a case and review of literature.

Lipoma of the colon is a relatively rare benign tumor. A case with intermittent subacute colon obstruction due to a giant lipoma of the cecum is reported. A 51-year-old woman presented with intermittent, abdominal crampy pain in the right upper and lower quadrants, accompanied by alternative episodes of diarrhea and constipation. She had had similar symptoms over the last three months. A double-contrast barium enema showed a large (approx. 7 cm in diameter) polypoid mass occluding the lumen of the cecum and the ascending colon. Colonoscopy revealed a submucosal mass suspected of benign tumor but too large for endoscopic resection. Surgery revealed a hard elongated mass in the right colon, which telescoped into the transverse colon and caused colo-colonic intussusception. Right hemicolectomy was performed and pathology documented a mature, submucosal lipoma of the cecum. Six years after the surgery, the patient has not showed any of the previous symptoms. Along with a review of the literature, the incidence, diagnosis complications and treatment of colonic lipomas are discussed.

Barium Sulfate↗

PubMed1989

[Colonic lesion caused by acute pancreatitis. Use of minimal catheter jejunostomy. Apropos of 6 cases].

Colonic affectation in the context of acute pancreatitis is undoubtedly a rare complication to judge from the number of cases reported in the literature, but its appearance is increasing, perhaps because it is receiving more attention. The "infrequent" complications of so-called acute pancreatitis range from massive necrosis of the colon to fistula of the transverse colon, colonic stricture as a chronic manifestation and finally, colonic varices as a sign of segmental portal hypertension due to involvement of the mesenteric portal axis. A retrospective study was made of 6 cases treated in our General and Digestive Surgery Department and the literature on this etiopathogenic situation was reviewed to study the clinical manifestations, diagnosis and treatment of these uncommon complications. We propose minimal catheter jejunostomy as a technique for the prevention and treatment of possible complications, with epidural analgesia of these patients.

Acute Disease↗

PubMed1988

[Improvements in placement of implantable drug delivery catheter for prevention and treatment of hepatic metastases from colorectal cancer].

Intra-arterial infusion chemotherapy was carried out using a subcutaneously implantable drug delivery system in 7 patients with rectal cancer, 5 patients with sigmoid colon cancer, 2 patients with transverse colon cancer, and 1 patient with ascending colon cancer, for prevention and treatment of hepatic metastases. The transport of intra-arterially infused drugs to the liver was examined during surgery using an infusion catheter, which was inserted by the fluorescence technique using Fluorescein-Na. The gastroepiploic artery was shifted to the abdominal wall to avoid leaving the infusion catheter as a foreign body after removal of the port. The fluorescein test, which is safe and can be performed in a short period by a simple procedure, is considered to be useful for intraoperative evaluation of the distribution of the drug to the liver. Since the infusion catheter remaining in the body after removal of the port may cause thrombosis and infection, measures to avoid leaving foreign bodies are considered to be necessary.

Antineoplastic Agents↗

PubMed1981

Influence of papaverine on bethanechol or OP-CCK stimulation of feline colonic muscle.

Papaverine relaxes smooth muscle from various organ systems throughout the body. The purpose of this study was to determine the effects of papaverine on colonic smooth muscle from the transverse colon of the cat. Myoelectrical activity was recorded with monopolar glass pore electrodes. Papaverine was administered alone and simultaneously with bethanechol or the octapeptide of cholecystokinin. Higher concentrations of papaverine (10(-4) M, 10(-5) M) abolished both slow-wave activity and migrating spike bursts. Lower concentrations of papaverine (10(-6) M) had no effect on slow waves or the migrating spike burst. Bethanechol (10(-6) M) or OP-CCK (4 x 10(-9) M, 4 x 10(-10) M) stimulated spike activity (p < 0.001). Papaverine (10(-6) M had a minimal effect on the increase in spike activity that occurred after octapeptide of cholecystokinin in a concentration of 4 x 10(-10) M (p < 0.05). Papaverine had no effect on the stimulation of the colonic smooth muscle by 4 x 10(-10) M octapeptide of the colonic smooth muscle by 4 x 10(-9) M octapeptide of cholecystokinin. These studies show that (a) papaverine can inhibit smooth muscle myoelectrical activity, (b) papaverine is a potent inhibitor of cholinergic stimulation of colonic smooth muscle, but (c) papaverine has a minimal effect on octapeptide of cholecystokinin stimulation of the isolated colonic smooth muscle.

Animals↗

PubMed1982

[Colonic localization of pseudopolypoid type disclosing Recklinghausen's neurofibromatosis].

A case of colonic Recklinghausen neurofibromatosis found in a forty-two-year-old woman is presented. Only the colon was affected. The first symptom was rectal bleeding. Widespread polypoid lesions involving the rectum, sigmoid, left colon and part of the transverse colon were demonstrated upon barium enema and rectosigmoidoscopic examinations. As demonstrated by a review of the medical literature, colonic involvement in Recklinghausen disease is very infrequent and forms restricted to the colon are exceptional. The pathologic findings and the clinical, radiological and endoscopic features in colonic neurofibromatosis are described. It seems that total colectomy should be advocated. Our patient underwent total colectomy ten years ago and has experienced neither recurrence nor other manifestations of Recklinghausen disease.

Adult↗

PubMed1984

Operations of choice for cancers of the colon and rectum. An overview.

Despite proven guidelines, rational management proposals, and effective surgical therapies, surgical resections not in accord with national norms continue to be used. Refinement of existing knowledge can improve the marginal results of the past. A simple overview is presented. Management of cancer of the cecum, ascending colon, hepatic and splenic flexures, transverse colon, descending, sigmoid, and rectosigmoid colon are graphically presented. Multiple large bowel polyps, chronic ulcerative colitis with tendency to neoplasia, and multiple polyposis are briefly discussed as to proper surgical management. A similar succinct overview of individual polyp management is diagrammatically shown. Cancer management of the rectum including adenocarcinoma, squamous cell, cloacogenic and villous tumors are shown as well as the management of basal cell and squamous cell lesions of the anal verge.

Cecal Neoplasms↗

PubMed1981

[Fiber colonoscopic and histomorphological characteristics of true polyps of the large intestine].

By fibrocolonoscopy, fibrocolonoscopic biopsy, polypectomy, operation resp., one hundred and eight true polypi in the colon of 75 patients were studied, grouped according to localization: in caecum -- 2.8 per cent, in ascending colon -- II. I per cent, transverse colon -- 13.9 per cent, descending colon -- 19.4 per cent, in sigmoid colon -- 40.8 per cent and in rectum -- 12 per cent. Endoscopically they were grouped as follows: adenomatous -- 91.7 per cent and villous -- 8.3 per cent and after the pathohistological examination as: adenomatous 73.3 per cent, adenovillous -- 17.2 per cent and villous -- 9.5 per cent. In 40 (52.8%) of the cases, well differentiated polypi were concerned (I grade); in 30 (38%) -- moderately differentiated polypi (II grade) and in 5 (6.5%) -- poorly differentiated polypi (III grade). The studies revealed that the pathohistological examination was a method, specifying the morphological structure of polypus, determining the therapeutic behaviour of the clinicists. Fibrocolonoscopic polyrectomy solves the problem of diagnostics and treatment of the true polypi, contributing to the prophylaxis of colon carcinoma.

Adult↗