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PubMed1972

Three cases of spontaneous duodeno-colic fistula.

Three cases of duodeno-colic fistula are presented, where a communication was demonstrated between the anterior aspect of the third part of the duodenum and the transverse colon at the point of mesocolic attachment. At operation the fistulae were found to be some 6 to 9 cm in length, and histological examination showed a well marked muscular layer with an intact epithelium. In view of the absence of any explanatory pathology, an embryological basis is suggested as the likeliest explanation for their origin.

Colon↗
PubMed1989

Non-cryptosporidial diarrhoea in human immunodeficiency virus (HIV) infected patients.

Thirty of 81 consecutive HIV antibody positive patients referred with non-cryptosporidial diarrhoea had no potential infectious cause; most had AIDS related complex rather than the full blown syndrome. Opportunistic infections with cytomegalovirus (CMV), mycobacterium avium-intracellulare (MAI), and herpes simplex virus (HSV), which allowed a diagnosis of AIDS to be made, were found in 19 patients and were the presenting features of AIDS in five. Other potential pathogenic species included entamoeba, giardia, campylobacter, and salmonella (without septicaemia). Cytomegalovirus infection was often accompanied by abdominal pain. Severe weight loss (greater than 10 kg) at presentation was found in patients with CMV infection and MAI. Bloody diarrhoea was confined to the group with HSV procitis. Malignant causes of diarrhoea were rare. Two patients developed a squamous carcinoma of the anorectal margin and one a non-Hodgkin's lymphoma. In only two of 12 patients who had Kaposi's sarcoma was this considered as a cause of diarrhoea. Rigid sigmoidoscopy showed macroscopic abnormalities in over a third (32) of the 81 patients with non-cryptosporidial diarrhoea. Most commonly this was severe inflammation (17) or discrete ulceration (four) [three of whom had CMV colitis]. Kaposi's sarcoma was identified in 11 patients. Non-specific inflammation was seen histologically in 40 of the 60 patients with no sigmoidoscopic inflammatory changes. Barium enema only revealed an abnormality in a minority of the patients and a colonoscopy only revealed information additional to rigid sigmoidoscopy in two patients--one with CMV ulcers in the transverse colon and the other with evidence of Kaposi's sarcoma not seen in the rectum. Ten patients had a rectal biopsy examined by electron microscopy as no infective cause of diarrhoea was uncovered. In four of these microtubular structures which are commonly seen in viral infections were found and two had prelymphomatous changes and in one of these frank lymphoma has developed. We recommend multiple stool analysis, sigmoidoscopy and rectal biopsy as the initial investigations in these patients reserving tests of malabsorption, colonoscopy, and barium enema for the small number of more difficult cases.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Promotion of colorectal neoplasia in experimental murine ulcerative colitis.

BACKGROUND: The mechanisms underlying the frequent development of colorectal carcinomas in patients with ulcerative colitis are still unknown. AIMS: To evaluate whether mucosal necrosis and regeneration act as enhancing or promoting factors in colorectal tumorigenesis, development of multiple colorectal tumours was studied in a murine model of ulcerative colitis with azoxymethane pretreatment. METHODS: Periods of chronic ulcerative colitis in mice were induced by three repeated administrations of 3% dextran sulphate sodium subsequent to a single azoxymethane pretreatment, to give conditions similar to the clinically observed active and remission phases. RESULTS: In the chronic colitis group with carcinogen exposure, multiple mucosal tumours (10.5/mouse) developed in the colorectum. This occurred primarily on the left side of the large intestine or transverse colon, the sites of the most severe colitic injury. The observed lesions were high grade dysplasias and invasive adenocarcinomas. Increased cell proliferation was evidenced by high uptake of bromodeoxyuridine, and increased activities of thymidylate synthetase and thymidine kinase. No tumours were induced in the control groups with azoxymethane pretreatment or chronic colitis alone. CONCLUSIONS: Repeated mucosal erosion with necrosis and regeneration is critical for the development of colorectal tumours in this experimental colitis system.

Animals↗
PubMed1987

Recurrent gastric outlet obstruction due to an inguinal hernia.

Although gastric strangulation in an inguinal hernia has been reported on three previous occasions, recurrent gastric outlet obstruction due to this hernia has not been previously documented. Prolonged traction on the distal stomach by omentum and transverse colon can draw the antrum and pylorus into the hernia and produce gastric outlet obstruction.

Hernia, Inguinal↗
PubMed1977

Jejunal diverticulitis.

Two patients with jejunal diverticulitis are presented. Each demonstrated a wide spectrum of clinical and radiographic findings over several years. Radiographic abnormalities including incomplete jejunal obstruction, an omental mass displacing jejunal loops, leakage of barium into adjacent mesenteric abscess, and extrinsic serosal changes involving the transverse colon have permitted a correce preoperative diagnosis in each patient.

Aged↗
PubMed1979

Sonographic patterns of distended, fluid-filled bowel.

When small or large bowel is distended with fluid, certain characteristic features can be seen on ultrasound which cannot be visualized when the bowel is collapsed. The proximal and distal portions of the small bowel can frequently be differentiated both in vitro and in vivo by the echoes emanating from the valvulae conniventes ("keyboard sign"). This depends upon the angle at which the bowel segment is scanned in relation to its long axis, the relative amount of intraluminal fluid and gas, the diameter of the bowel in relation to the beam width of the transducer, and the intrinsic resolution of the scanning system. Similarly, the ascending and transverse colon can be recognized by haustral sacculations, the distal rectosigmoid colon and rectum by the rectal valves. The tubular shape, characteristic arrangement and location, and peristaltic motion of most fluid-filled bowel segments are helpful in differentiating loops of bowel from cystic masses in the abdomen or pelvis.

Colon↗
PubMed2003

Multi-detector row CT colonography: effect of collimation, pitch, and orientation on polyp detection in a human colectomy specimen.

PURPOSE: To investigate the effects of orientation, collimation, pitch, and tube current setting on polyp detection at multi-detector row computed tomographic (CT) colonography and to determine the optimal combination of scanning parameters for screening. MATERIALS AND METHODS: A colectomy specimen containing 117 polyps of different sizes was insufflated and imaged with a multi-detector row CT scanner at various collimation (1.25 and 2.5 mm), pitch (3 and 6), and tube current (50, 100, and 150 mA) settings. Two-dimensional multiplanar reformatted images and three-dimensional endoluminal surface renderings from the 12 resultant data sets were examined by one observer for the presence and conspicuity of polyps. The results were analyzed with Poisson regression and logistic regression to determine the effects of scanning parameters and of specimen orientation on polyp detection. RESULTS: The percentage of polyps that were detected significantly increased when collimation (P =.008) and table feed (P =.03) were decreased. Increased tube current resulted in improved detection only of polyps with a diameter of less than 5 mm. Polyps of less than 5 mm were optimally depicted with a collimation of 1.25 mm, a pitch of 3, and a tube current setting of 150 mA; polyps with a diameter greater than 5 mm were adequately depicted with 1.25-mm collimation and with either pitch setting and any of the three tube current settings. Small polyps in the transverse segment (positioned at a 90 degrees angle to the z axis of scanning) were significantly less visible than those in parallel or oblique orientations (P <.001). The effective radiation dose, calculated with a Monte Carlo simulation, was 1.4-10.0 mSv. CONCLUSION: Detection of small polyps (<5 mm) with multi-detector row CT is highly dependent on collimation, pitch, and, to a lesser extent, tube current. Collimation of 1.25 mm, combined with pitch of 6 and tube current of 50 mA, provides for reliable detection of polyps 5 mm or larger while limiting the effective radiation dose. Polyps smaller than 5 mm, however, may be poorly depicted with use of these settings in the transverse colon.

Colon↗
PubMed1985

Reversed intestinal rotation.

The authors report a case of reversed intestinal rotation and review the embryology, clinical presentation, and radiographic findings of this disorder. Although this developmental anomaly of the bowel is rare, it may be diagnosed by the distinctive position, course, and narrowing of the transverse colon.

Adolescent↗
PubMed2001

Internal hernia: clinical and imaging findings in 17 patients with emphasis on CT criteria.

PURPOSE: To review the clinical and radiologic features of internal hernia and to derive useful radiographic and CT criteria to assist in diagnosis. MATERIALS AND METHODS: Retrospective review of medical records revealed 17 patients with surgically proved internal hernia (three paraduodenal, 14 transmesenteric) who had 15 computed tomographic (CT) scans and three small-bowel follow-through (SBFT) images. RESULTS: CT signs common to all types of internal hernia included evidence of small-bowel obstruction; clustering of small bowel; stretched, displaced, crowded, and engorged mesenteric vessels; and displacement of other bowel segments, especially the transverse colon and fourth portion of the duodenum. Left-sided paraduodenal hernias demonstrated a sac-like mass of small-bowel loops interposed between the stomach and pancreatic tail and a posterior mass effect on the stomach. All three paraduodenal hernias were diagnosed confidently at retrospective review of CT and SBFT findings. Transmesenteric hernias demonstrated clustered small-bowel loops adjacent to the abdominal wall without overlying omental fat and central displacement of colon and were frequently complicated by small-bowel volvulus (five of 14) and bowel ischemia (six of 14). CT demonstrated signs of volvulus in four of six patients with ischemia. CT findings considered definitive or suggestive of internal hernia were demonstrated in 15 patients. CONCLUSION: Internal hernia is an important and underdiagnosed condition. Transmesenteric hernia is most common in our experience and is usually related to prior abdominal surgery, especially with creation of a Roux-en-Y anastomosis. CT may allow confident diagnosis in most patients.

Adult↗
PubMed2003

Musings on the wanderer: what's new in our understanding of vago-vagal reflexes? III. Activity-dependent plasticity in vago-vagal reflexes controlling the stomach.

Vago-vagal reflex circuits modulate digestive functions from the oral cavity to the transverse colon. Previous articles in this series have described events at the level of the sensory receptors encoding the peripheral stimuli, the transmission of information in the afferent vagus, and the conversion of this data within the dorsal vagal complex (DVC) to impulses in the preganglionic efferents. The control by vagal efferents of the postganglionic neurons impinging on the glands and smooth muscles of the target organs has also been illustrated. Here we focus on some of the mechanisms by which these apparently static reflex circuits can be made quite plastic as a consequence of the action of modulatory inputs from other central nervous system sources. A large body of evidence has shown that the neuronal elements that constitute these brain stem circuits have nonuniform properties and function differently according to status of their target organs and the level of activity in critical modulatory inputs. We propose that DVC circuits undergo a certain amount of short-term plasticity that allows the brain stem neuronal elements to act in harmony with neural systems that control behavioral and physiological homeostasis.

Animals↗
PubMed2001

Receptors and transmission in the brain-gut axis: potential for novel therapies. V. Fast and slow extrinsic modulation of dorsal vagal complex circuits.

Vago-vagal reflex circuits in the medulla are responsible for the smooth coordination of the digestive processes carried out from the oral cavity to the transverse colon. In this themes article, we concentrate mostly on electrophysiological studies concerning the extrinsic modulation of these vago-vagal reflex circuits, with a particular emphasis on two types of modulation, i.e., by "fast" classic neurotransmitters and by "slow" neuromodulators. These examples review two of the most potent modulatory processes at work within the dorsal vagal complex, which have dramatic effects on gastrointestinal function. The reader should be mindful of the fact that many more different inputs from other central nervous system (CNS) loci or circulating humoral factors add to this complex mix of modulatory inputs. It is likely that similar long-term modulations of synaptic transmission occur with other neurotransmitters and may represent an important mechanism for the integration and regulation of neuronal behavior. Of course, this fact strongly militates against the success of any single drug or approach in the treatment of motility disorders having a CNS component.

Animals↗
PubMed1996

Isolated late metastasis of a renal cell cancer treated by radical distal pancreatectomy.

A 53-year-old man underwent right nephrectomy for a locally renal cell carcinoma with concomitant resection of a solitary metastasis in the right lung. Ten years later, he presented with haematochezia caused by a tumour in the tail of pancreas, invading the transverse colon and the greater curvature of the stomach. The tumour was radically resected, and histological examination revealed a solitary metastasis of the previous renal cell carcinoma. This case illustrates a rare indication for pancreatic resection because of pancreatic metastasis.

Carcinoma, Renal Cell↗
PubMed1998

Intestinal leiomyosarcoma as the cause of severe hemoperitoneum.

Leiomyosarcomas represent 10-20% of malignant tumors in the small bowel and 1% of those located in the large bowel. These tumors have aspecific symptoms depending on their size, location and histology. Intestinal leiomyosarcomas may be the cause of numerous types of surgical emergency. We report 2 cases of intestinal leiomyosarcoma in the jejunum and transverse colon. Both were diagnosed during an emergency exploratory celiotomy. The clinical features on admission were similar to those of acute abdomen. The main cause of surgical emergency was an extremely rare complication of gastrointestinal leiomyosarcoma: a severe hemoperitoneum. We briefly describe the surgical emergencies caused by intestinal leiomyosarcomas as well as the surgical methods employed in these cases.

Colonic Neoplasms↗
PubMed1999

Late radiogenic small bowel damage: guidelines for the general surgeon.

BACKGROUND/AIMS: The majority of late radiogenic small bowel injuries presents with obstruction or peritonitis. Owing to an average latency period of years, many of these patients are admitted to community hospitals and treated by general surgeons, who in turn see only a few pertinent patients in their professional lifetime. This study intends to provide the general surgeon with comprehensive guidelines for safer surgical management. MATERIAL AND METHODS: Forty-one publications were analyzed in a search for clinical, procedural and outcome data. RESULTS: After a mean interval of 3.4 years following radiotherapy, patients with a mean age of 57 years present with obstruction (71%), fistula (17%), perforation (10%) or hemorrhage (2%) due to small bowel radiation injury. 22% have associated colorectal injury. The intestinal compartments most frequently affected are lower ileum, cecum and rectosigmoid, whereas the midgut and transverse colon are usually free. Consequently, the dehiscence rate of resection and ileoileostomy is 26%, jejunoileostomy 12%, ileoascendostomy 9% and ileotransversostomy 4%, and the pertinent rate of progressive radiation injury is 9.1%. Bypass procedures yield an overall dehiscence rate of 9%, ileotransverse bypass 1.6%, and the rate of progressive radiation injury is 37%. The lethality of suture line insufficiency is 85%. Lysis carries a lethal perforation rate of 6%. Only 58% of patients survive over 2 years, and of those not succumbing to unrelated disease, 37% die from progressive radiation injury and 63% from tumor progression. CONCLUSION: If resection is warranted, a reasonably extended ileal resection, right hemicolectomy and ileotransversostomy, is safe. Likewise, ileotransverse anastomosis is the best choice for bypass. Lysis should not be enforced in radiation-injured bowel compartments. Terminal enterostomy with distal mucous fistula alleviates otherwise untreatable fistulae.

Humans↗
PubMed1999

Vesicocolonic fistula four years after augmentation colocystoplasty.

An 8-year-old girl was born with crossed fused renal ectopia and neurogenic bladder due to sacral agenesis. Due to progressive upper tract deterioration and incontinence despite clean intermittent catheterization and pharmacotherapy with anticholinergic agents, the patient underwent augmentation colocystoplasty at the age of 4 years. Four years after surgery the girl was readmitted because of persistent febrile urinary tract infection, persistent metabolic acidosis, and intermittent watery diarrhea. A cystogram revealed a fistula between the dome of the augmented bladder and the transverse colon. The fistula was successfully resected. The presence of enterovesical fistula should always be suspected in a patient with augmented bladder who have late onset of urinary tract infection, metabolic acidosis, and diarrhea.

Abnormalities, Multiple↗
PubMed2003

Use of photoplethysmography to determine gastrointestinal perfusion pressure: an experimental canine model.

OBJECTIVES: To develop an experimental model to assess the parietal perfusion pressure (PPP) of the digestive tract using photoplethysmography. MATERIALS AND METHODS: Twenty-two mongrel dogs were used. Progressive external compression was applied to the intestinal wall and the PPP was assessed with photoplethysmography. The study group was divided into two groups. In group 1 PPP was measured at the levels of the stomach, duodenum, jejunum and transverse colon. In group 2 PPP was measured after temporary occlusion of the truncal and marginal circulation of the jejunum to provide further variables. RESULTS: The PPP decreased significantly for each successive distal section. Correlation coefficients and indices for PPP and mean arterial pressures were statistically significant (p < 0.005). Truncal occlusion provoked a drop in PPP whereas marginal occlusion scarcely modified the basal results. CONCLUSIONS: Photoplethysmography, through measurements of the residual arterial wave amplitude, is a valid method of determining quantitatively the PPP of the digestive tract and could be useful in a clinical environment.

Animals↗

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