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Colon interposition. Long-term radiographic results.

Colon interposition was carried out in 12 patients with oesophageal carcinoma and on 38 patients with benign oesophageal disease an average of 71 months before the radiographic examination. Various ischaemic changes including "jejunization", loss of haustration and stricture formation were observed in 15 cases. In 12 patients one or several diverticula were seen in the colon graft. Reflux was observed in 17 cases in supine position. Double contrast technique in the examination of interposed colon is recommended.

Adolescent↗

[Gigantic diverticulum of the colon. A complication of diverticulosis?].

We present a patient affected of diverticular disease of the colon, with diverticulosis and two giant diverticula of the sigma, both located at the mesenteric edge. We would like to stress the low incidence of reports about this entity in the medical literature, its uncommon location and the fact of a double lesion coinciding in a single patient. We discuss the most important nosocomial aspects and the different diagnoses. Finally, we support the idea of distinguishing three different entities that in the medical literature are usually unified as a single "giant diverticulum of the colon". We reaffirm ourselves on the importance of an early diagnosis and a correct indication for surgery.

Aged↗

[Mass screening for the early detection of colon cancer in patients with endometrial cancer].

A mass screening has been performed for the early detection of colon cancer by evaluating Hemocult II slides of blood relatives of patients with endometrial cancer. Though the defect of this screening is that the subject of the investigation, which was undertaken in all parts of Japan, is restricted, one case of colon cancer, two cases of colon polyposis, two cases of hemorrhoids, and one case of colon diverticulum have been uncovered by this screening. The rate of discovery of colon cancer proved to be 0.45%, a rate that is higher than seen in usual screening method. It has been concluded that blood relatives of patients with endometrial cancer should be screened, since they represent a high risk group for developing colon cancer.

Adenomatous Polyposis Coli↗

Angiodysplasia of the colon, Meckel's diverticulum and cardiac malformation. A case report.

A clinical case of angiodysplasia of the colon, Meckel's diverticulum and mitral valve prolapse is reported in a 20 year old man. Association of vascular ectasia of the colon and Meckel's diverticulum has been reported in a few cases but rarely with other kinds of malformation. This brief clinical paper reports a congenital aetiology of an uncommon disease of the colon, such as angiodysplasia in a young male.

Adult↗

Extranasal T/NK-cell lymphoma presenting as intestinal diverticulum.

A case of intestinal angiocentric T/NK-cell lymphoma in a 58-year-old man is reported. The patient presented initially with panperitonitis because of perforation of sigmoid colon diverticulum. He underwent segmentectomy of involved bowel. Histologically, the intestinal wall showed diffuse infiltration of medium or large size lymphoma cells with angiocentric growth and necrosis. The lymphoma cells were CD56+, CD45RO+, CD3+, CD4-, CD8-, CD20-, and CD30- in paraffin sections with germline configuration of TCR-gamma gene, consistent with T/NK-cell lymphoma. Further staging revealed splenomegaly. Intestinal angiocentric T/NK cell lymphoma represents a distinct etiology of diverticulum with perforation.

CD56 Antigen↗

Giant diverticulum of the colon: report of two new cases and review of the literature.

Diverticulosis coli affects more than one in three individuals older than 65 in the Western world. Giant diverticulum of the colon is an extremely rare complication of diverticular disease; only 113 cases, mostly situated in the colon sigmoideum, have been reported in the world literature. Two new cases of giant diverticulum of the colon sigmoideum, with totally different clinical presentation, diagnosis, and management, are reported-one being the cause of chronic anemia and the other presenting as an acute abdomen. Based on a review of the literature, an update on symptomatology, diagnosis, pathogenesis, and therapeutical options of this rare disorder is provided.

Aged↗

[Solitary perforated diverticulum of the right colon. Five cases].

Solitary perforated diverticulum of the right colon is a very uncommon acute disease in emergency surgery, and usually a preoperative diagnosis of acute appendicitis is performed. Five cases of solitary perforated diverticulum of the right colon are presented. Preoperative diagnostic difficulties as well as surgical procedures are discussed.

Adult↗

Perforated diverticulum: rare complication of interposed substernal colon.

Substernal colon interposition is a good reconstruction option after salvage surgery for caustic ingestion injury. Although redundancy and reflux sometimes complicate these cases, there have been no reports in the English literature of perforated diverticula in interposed colon segments. We report a 23-year-old man who underwent substernal colon flap reconstruction after caustic ingestion injury. He had perforated colon diverticulitis develop, which led to a lung abscess 7 years later, followed by resection of the necrotic lung parenchyma and colon repair. This rare case illuminates the importance of including perforated diverticula in interposed colon in the differential diagnosis for such patients.

Adult↗

Laparoscopic treatment of caecal diverticulitis.

Right-sided diverticulitis is difficult to distinguish from other sources of right-sided abdominal pain and, in particular, is frequently indistinguishable from acute appendicitis preoperatively. Because of the problems concerning preoperative diagnosis and controversies in the management, the choice of the best therapy on the surgeon's part is still open. A total of 1150 patients with a clinical diagnosis of right acute abdomen observed in our surgical department from 1995 to 2003 was analysed. Three patients had a pathologically confirmed diagnosis of caecal diverticulitis. The mean age of the patients was 37 years. Right lower quadrant pain and local tenderness were the only clinical findings in 95.3% of the cases, with a preoperative diagnosis of acute appendicitis in 2 of 3 patients. The operative findings were an inflammatory mass in the caecum and the presence of a minimal amount of free peritoneal fluid. Two patients underwent laparoscopic ileocecectomy and one had a diverticulectomy. The postoperative course was uneventful. Because of the difficulties in diagnosis and surgical treatment, caecal diverticulitis has been the subject of much discussion in the literature and many questions remain unanswered. Right-sided diverticulitis is easily confused with acute appendicitis because it occurs at a somewhat younger age than sigmoid diverticulitis. Caecal diverticulitis needs a high index of suspicion for achieving a preoperative diagnosis. Diverticulectomy should be performed in patients with small diverticula with a limited inflammatory reaction. Right colectomy should be performed in patients with perforation of the diverticulum, caecal phlegmon or abscess formation. A correct intraoperative diagnosis is therefore crucial for selection of the surgical procedure. Laparoscopic treatment of a solitary, acutely infected colon diverticulum is feasible in this setting. A minimally invasive procedure could be performed, therefore, in patients with right acute abdomen, allowing not only the right diagnosis but also the treatment of the commonest pathologies responsible for this clinical picture.

Adult↗

[Role of colonoscopy in the diagnosis and management of lower gastrointestinal hemorrhage].

The purpose of he study was to analyze the role of the Colonoscopy in the diagnosis and treatment of low intestinal hemorrhages. We studied retrospectively all patients with Hematochezia, seen by the author, from april 1984 to december 1997. We studied the clinical symptoms, causes, localizations of the bleeding and the treatment applied, either endoscopic or surgical. We also reviewed the security and tolerance of the procedure. We could detect without doubt the cause in 74 patients (51.7%), including patients with multiple colon diverticulum, where the bleeding is sometimes very difficult to detect. We concluded that the Colonoscopy is the best method to find the source of bleeding in the lower portion of the colon. The procedure is well tolerated and safe in elderly patients.

Adolescent↗

Intestinal perforation in a parastomal hernia by a migrated plastic biliary stent.

Organ perforation is a well-described complication of plastic biliary stent placement [1, 2, 3, 4, 5, 6, 7, 8, 9, 10][1-10]. Most commonly, a stent will cause duodenal perforation while still in the area of the biliary system. This often occurs in the setting of a periampullary diverticulum. Less frequently, a perforation occurs as a result of stent migration into the distal lumenal gastrointestinal tract. These cases have involved a migrated stent impacting at the level of the ileum or a sigmoid colon diverticulum. A plastic biliary stent causing perforation inside an incarcerated small bowel hernia sac has been reported [10]. We describe the first reported case of a plastic biliary stent causing perforation inside a parastomal hernia.

Aged↗

[Indications and surgical treatment of acute complicated diverticulitis].

Although the surgical treatment of acute and complicated diverticulitis has been refined over the years, discussion is still ongoing about whether a single or two stage procedure (Hartmann's procedure) should be performed in patients with peritonitis from perforation of a colonic diverticulum. A retrospective review was completed for patients undergoing surgery for acute complicated diverticulitis from 1980 to 1997. All patients were categorized according to Hinchey classification. Of the 186 patients treated, emergency operation was performed in 52 (28 per cent; group I) and an elective operation in 134 (72 per cent; group II). All patients had a resection of the involved colon and anastomosis was performed using CEEA staplers. In the group I, 50 patients underwent resection with immediate reconstruction with or without colostomy and two an Hartmann's procedure. Among the group II, primary anastomosis with or without proximal diversion was performed in 132 patients; two patients underwent an Hartmann's procedure. Post-operative mortality was of 5.76% in the group I and 2.9% in the group II. Nine anastomotic leaks occurred in the group I and 18 in the group II. Comparing these results with the recent literature, we have concluded that primary resection is virtually always possible in acute and complicated diverticulitis. Primary anastomosis with or without colostomy, in expert hands, is a safe procedure for patients in stage I of Hinchey's classification or II, but should be considered on an individual basis in presence of peritonitis. In case of fecal peritonitis, persistent hypotension, ascites, severe immune compromise and extreme malnutrition the Hartmann procedure represent the procedure of choice.

Acute Disease↗

Perforation of the sigmoid colon in a rheumatoid arthritis patient treated with methylprednisolone pulses.

We describe a 61 year-old caucasian male diagnosed with rheumatoid arthritis. He was started on methylprednisolone pulses because of a severe flare of symmetric polyarthritis while he was on weekly intramuscular methotrexate and low-dose oral prednisone. After the second pulse of methylprednisolone the patient suddenly developed severe abdominal pain with free air under the right hemidiaphragm in the chest roentgenogram. The emergency surgery revealed the perforation of a colonic diverticulum. We suggest that methylprednisolone pulses should be carefully used in those patients over 50 years of age and/or people with demonstrated or suspected diverticular disease.

Arthritis, Rheumatoid↗