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This experimental study describes the pressure changes of the descending colon before and after total and selective vagotomy combined with Finney's pyloroplasty as estimated by telemetry. The results obtained from the study of 20 dogs show that the motility of the descending colon is extremely reduced after total vagotomy with no change after selective vagotomy.
A cow was evaluated for acute onset of abdominal pain and decreased milk production. Physical examination revealed narrowing of the descending colon. Exploratory laparotomy revealed mesocolic defect and torsion of the cecum around the descending colon. After surgical correction of the cecal torsion, the cow recovered rapidly. The mesocolic defect could not be closed, and the history did not indicate a cause for the mesocolic defect.
Two mares were referred for evaluation after dystocia and rectal prolapse. Diagnostic laparoscopy, performed while the horses were standing, was used to evaluate the condition of the distal portion of the colon, rectum, uterus, and mesocolon. In both horses, laparoscopic observation revealed tears in the mesocolon of the descending colon. Exploration from the left or right flank was adequate. Because of the poor prognosis associated with the findings, euthanasia was elected at completion of laparoscopy. Tears in the mesocolon are not easily detected by use of traditional tests. Laparoscopy proved to be a more thorough means of evaluating the caudal portion of the abdomen including the digestive and urogenital tracts in these horses. As a less invasive diagnostic tool, laparoscopy can be performed earlier in the course of disease than alternative approaches for direct viewing. Furthermore, laparoscopy can be used to access the viability of tissues as well as the location and severity of lesions for prognostic purposes. The distal portion of the descending colon can also be evaluated to determine whether celiotomy with anastomosis or colostomy may be the surgical procedure of choice.
This is the first report of a primary mucinous cystadenoma (MCA) arising from behind the posterior peritoneum of the descending colon in a paediatric patient. A large intra-abdominal cystic lesion was found incidentally during renal ultrasonography in a 14-year-old girl. Imaging studies showed a 13 x 9 x 15 cm homogeneous cystic lesion with mild contrast enhancement of the wall. The cyst appeared to originate from the retroperitoneum, but was separated from the left kidney, ovary, and pancreas. At laparotomy, there was a cyst behind the posterior peritoneum of the descending colon. The cyst was successfully excised, and histopathology showed MCA. Although primary MCA in the retroperitoneum is extremely rare in children, it should be considered in the differential diagnosis of an intra-abdominal cyst, since it needs to be excised to eliminate the risk of infection, recurrence, and malignancy.
A rare case of primary linitis plastica carcinoma of the colon seen in a 44 year old Japanese man is described herein. The patient had a complete obstruction of the descending colon and was treated with a loop colostomy followed shortly afterward by a left hemicolectomy. At the time of the second operation, the entire thickness of the colonic wall was found to be infiltrated by cancer cells, however, the other intraabdominal organs were free of cancerous involvement. The histopathological diagnosis made at this time was primary linitis plastica carcinoma of the descending colon. Nine months later, the patient developed an intestinal obstruction and relaparotomy revealed diffuse peritoneal dissemination. Two years after the first operation, upper GI films and a gastrofiberscopic examination revealed gastric involvement. The patient died 28 months after his initial operation, and autopsy revealed widespread metastases in the peritoneal surface, paraaortic lymph nodes, small intestine, remaining colon and stomach.
An unusual localization of localized colitis cystica profunda in a 31-year-old man is described. The patient presented as anal bleeding and a protruding mass at the descending colon; the mass was polypoid and was made up of papillary epithelial hyperplasia with downward herniation of glands into the submucosa. Only one similar case involving a descending colon has been reported in the world literature.
A retrospective survey was carried out on 87 patients with diverticulosis and 223 control subjects with a view to studying the incidence of colon pathology in association with diverticulosis of the colon. All subjects were given colonoscopies of the distal section of the colon. The survey revealed that the group of diverticulosis patients was, on average, older than the control group (72 v. 59 years). There was no significant difference in the performance or totality of the endoscopic examination. Subjective and objective symptomatology revealed no a priori evidence of pathology associated with diverticulosis. There was no statistically significant difference in the incidence of polyps, neoplasias, haemorrhoids or colon melanosis in the two groups.
A case of abscess of the abdominal wall associated with a ventriculoperitoneal (V-P) shunt following penetration into the descending colon is reported. A 49-year-old male was diagnosed as having hypertensive intracerebellar hematoma with hydrocephalus, and he was treated by V-P shunt. One year later he experienced left hypochondrial pain with rebound tenderness during a period of one week. He was doing well until 4 years and 10 months after, when barium enema examination and colonoscopy incidentally demonstrated that the abdominal catheter had penetrated into the descending colon. However, he had no symptoms. He remained in good health during a period of observation. A year later he was readmitted to our department with an abscess of the abdominal wall. Plain radiograph of the abdomen demonstrated disconnection of the shunt catheter and it was thought that the abdominal catheter had been passed via the rectum. At operation a subcutaneous abscess was found and cultures grew proteus mirabilis. We discussed the mechanism of the developing of the abscess on the abdominal wall following penetration of the bowel. It is believed that abscess of the abdominal wall may occur due to spontaneous extraction of a previously inserted shunt catheter which has penetrated into the bowel.
Unidirectional mucosal-to-serosal (Jm leads to s) and serosal-to-mucosal (Js leads to m) fluxes of potassium and sodium were determined simultaneously on paired sections of descending colon from the same rabbit under short-circuit conditions. In 13-16 pairs of tissues, net potassium secretion and sodium absorption averaged 0.49 +/- 0.08 and 4.0 +/- 0.8 mueq.cm-2.h-1, respectively. Short-circuit current (Jsc) averaged 3.7 +/- 0.4 mueq.cm-2.h-1 and was approximately equal to the algebraic sum of net potassium and sodium fluxes. Treatment of both sides of the colon with 10(-4) M ouabain reduced the Jsc and transmural potential difference to near zero. Ouabain abolished net potassium secretion by reducing JKs leads to m and abolished net sodium absorption by inhibiting JNam leads to s. In the presence of ouabain, net potassium absorption averaging 0.15 +/- 0.07 mueq.cm-2.h-1 (n = 11) was observed. In the presence of 10(-3) M 2,4-dinitrophenol, both net potassium and net sodium fluxes were abolished, primarily as a result of a reduction in JKs leads to m and JNam leads to s without altering JKm leads to s and JNas leads to m. These results suggest that the rabbit descending colon has the capacity to secrete and possibly to absorb potassium by active mechanisms requiring metabolic energy. Comparison of potassium and sodium fluxes suggest that the paracellular pathway in the rabbit colon is not potassium selective.
1. Fluorescence recovery after photobleaching (FRAP) of fluorescein isothiocyanate (FITC)-labelled 10 and 250 kDa dextran (FITC dextran) in isolated rat descending colonic crypts was measured at 35 degrees C using laser scanning confocal microscopy. 2. FRAP of either 10 or 250 kDa FITC dextran in crypt lumens was almost complete within 2-3 min. 3. In the presence of amiloride (0.1 mM), or in the absence of Na+, the rate of FITC dextran uptake into the crypt lumens was reduced by 70-80 %. 4. The rate of fluid uptake into the crypt lumen, as estimated from the rate of total FITC dextran uptake into the crypt lumen and its adjacent pericryptal region after FRAP, was between 1.3 x 10(-3) and 1.7 x 10(-3) cm x s(-1). 5. Convective flow during FRAP was also determined from the initial rate of FITC dextran advance along the crypt lumen. This effect was almost completely blocked by amiloride (0.1 mM). 6. The permeability of 10 kDa FITC dextran across the descending colonic crypt wall was found to be higher than that of 250 kDa FITC dextran (3.7 (+/- 0.6) x 10(-5) and 1.8 (+/- 0.3) x 10(-6) cm x s(-1), respectively; n = 3 for both, P < 0.01). The permeability of the caecal crypt wall to 10 kDa dextran was higher than that of the descending crypt wall (2.03 (+/- 0.21) x 10(-5) cm x s(-1); n = 3, P < 0.025). 7. Simulation of the flow of Na+, water and FITC dextran into the crypt lumen and across the crypt wall and pericryptal sheath corroborates the observed parameters of water and Na+ flows.
The kinetics of epithelial cell replacement in the descending colon of the mouse were studied using cell counts and other measurements in mice given a single injection of 3H-thymidine at 10:00 a.m. Cell migration occurs from the base of the crypts in the direction of the colonic lumen. The mean turnover time of epithelial cells as measured after the single injection of 3H-thymidine has been estimated at 4.85 days. Since this figure is in agreement with published data based on continuous infusion of the labeled precursor, it is concluded that the time selected for the analysis provides an index of proliferation which is representative of the mean proliferative activity of the epithelium. If each side of a crypt cut along its axis is referred to as a "crypt column," the mean number of cells per crypt column has been found to be 32.9; after a one-hour pulse labeling starting at 10:00 a.m., the mean number of labeled cells per column was 2.8; and the overall labeling index of the epithelium, 8.6%. The frequency of labeled cells in each cell position along the crypt column varies according to a Poisson distribution with a peak close to position 3. Presumably then, cell proliferation is taking place in a random manner and is, therefore, asynchronous, despite evidence to the contrary in the literature. The kinetic analysis supports the view that cell migration occurs along the crypt column in the direction of the colonic lumen at a velocity averaging 0.28 cell position per hour, or 4.48 microns per hour. The results support the view that vacuolated-columnar, mucous, and caveolated cells migrate jointly; whereas entero-endocrine cells migrate separately from these cell lines, except during the initial stages of the migration.
Two cases of pneumatosis cystoides intestinalis of the descending colon are described in which the presenting symptoms were abdominal pain and changed bowel habits, respectively. The diagnosis in both cases was established radiologically and sigmoidoscopically. Because the symptoms were persistent and severe, surgical excision of the involved segment of the large bowel was performed. The postoperative result was good and both patients remain free of symptoms.
The blood supply to the descending colon of the horse was studied by gross dissection and methyl methacrylate corrosion casts. The arterial supply is derived from the left colic artery and cranial rectal artery with the left colic artery supplying approximately the proximal three fourths. Each artery gives off four to eight arcuate arteries that form a series of anastomosing arcades. The arcade pattern continues to form a marginal artery that parallels the long axis of the colon. Small branches from the marginal artery anastomose with adjacent branches to form a secondary arcade. The secondary arcade lies approximately 1 cm proximal to the mesenteric teniae and sends off long arteries at regular intervals that course circumferentially around the bowel. The long arteries begin under the serosal mesothelium and perforate the muscular layers to course in the submucosal layer. The long arteries branch off supplying the wall of the colon and arborize over the antimesenteric surface, anastomosing with the vessels from the opposite side. The result is the formation of a series of vascular rings surrounding the colon. Venous return, in general, parallels the arterial supply.
Electrogenic, cAMP-mediated Cl secretion across rabbit descending colon in vitro is independent of the rate or presence of active Na absorption. Yet, several observations indicate that this process is Na dependent: a) Cl secretion requires the presence of Na in the serosal solution alone, b) the kinetics of Cl transport as a function of external Na concentration are virtually identical to the Cl concentration dependence, and c) exchange of cell Cl with isotopic Cl added to the serosal solution is inhibited by Na-free media and by addition of furosemide to the serosal solution; the diuretic also inhibits Cl secretion. These findings suggest that Cl entry into the secretory cells across the basolateral membrane is mediated by NaCl cotransport. Addition of ouabain to, or removal of K from, the serosal solution inhibits Cl secretion so that Na entering the secretory cell across the basolateral membrane may be returned to the serosal solution by the Na-K pump. Finally, increasing the K concentration of the serosal solution inhibits Cl secretion under short-circuit conditions. This appears to result from K-induced depolarization of the electrical potential difference across the apical membrane so that diffusional Cl exit from cell to mucosal solution is reduced.
A case is described where the descending colon and the sigmoid were sited totally in the right side of the abdomen, verified radiologically and in connection with an operation for perforated tumour of the colon.
We carried out this work with the purpose of studying the effects of protein and vitamin B deficiency on the morphologic and quantitative aspects of the myenteric plexus of the descending colon of adult Rattus norvegicus. Twenty-eight rats were divided in two groups, one of them receiving chow with 22% protein level (control) and the other fed with chow having 8% protein level without vitamin B supplementation, during 120 days. Whole-mounts of the descending colon were prepared and stained with Giemsa, NADH-diaphorase and NADPH-diaphorase. The undernourished rats had a body weight 11.84% less than the control group. Relative to the controls, the experimental group had a colonic area 48% smaller, 51.9% less Giemsa-stained neurons, 28.3% less NADH-diaphorase positive neurons and 24.2% less NADPH-diaphorase positive neurons.
A 54-year-old male who had no history of previous surgery presented with chronic intermittent constipation. A barium enema showed a 2-cm stenotic lesion at the junction between splenic flexure and descending colon. A colonoscopy revealed extra-luminal compression without mucosal lesion. Laparotomy revealed a parietocolic band compressing the proximal part of the descending colon. The band was lysed. The patient's symptom has improved since the procedure.
BACKGROUND: Visceral hypersensitivity is one of the mechanisms of irritable bowel syndrome (IBS), but it does not explain the entire symptomatology, i.e., altered bowel habit with abdominal pain relieved by defecation. We tested our hypothesis that an abnormal link between luminal stimulation and mural response may have some role in the pathophysiology of IBS. METHODS: Patients with IBS (n = 10, median 21 years old, 5 male patients, 5 female patients) and healthy control subjects (n = 10, median 21 years old, 5 men, 5 women) were studied. A manometric catheter with three transducers was inserted to the descending colon and a balloon was placed in the distal sigmoid colon. Another catheter with three transducers was inserted to the duodenum. After baseline for 30min, the sigmoid colon was stimulated by balloon distention for 30min followed by recovery for 30min. Balloon distention was repeated 100 times, and each stimulation consisted of a 5-s inflation and a 10-s deflation, with a volume of 50ml maximum. The sensory threshold of balloon inflation was then examined, and plasma adrenocorticotropic hormone (ACTH) was measured with radioimmunoassay. RESULTS: Repetitive colonic distention induced a significant increase in motility indices (mmHg s/s%) of the descending colon in the IBS patients (from 118 +/- 25 to 333 +/- 108, P < 0.05) but not of those in controls (from 90 +/- 16 to 89 +/- 19). A significant group difference (P < 0.05), period effect (P < 0.02), and group x period interactions (P < 0.01) were detected with two-way ANOVA. Duodenal motility indices in controls were significantly reduced by colonic distention (from 169 +/- 25 to 104 +/- 14, P < 0.01), but those in the IBS patients were not (from 156 +/- 17 to 124 +/- 20). The sensory threshold of balloon inflation in the IBS patients (74 +/- 10ml) was significantly lower than that in controls (125 +/- 6ml, P < 0.001). There was no significant difference in plasma ACTH levels between the IBS patients and controls. CONCLUSIONS: Repetitive distention of the distal sigmoid colon below the sensory threshold induced orad exaggerated motility of the colon in IBS patients. The distention inhibited motility of the small intestine in healthy subjects, but this inhibition was blunted in IBS patients. These results suggest that IBS patients may have not only visceral hypersensitivity, but also an abnormal intestinal reflex.