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Fifty-five patients with advanced carcinoma of the cervix and vesicovaginal fistula were managed by urinary diversion using the transverse colon as a conduit. The surgical technique is described and this form of urinary diversion is recommended for these patients.
Based on selected case studies the pathways of spread of malignancies arising from the pelvis are discussed. Secondary involvement of the transverse colon with characteristic lesions at the inferior border may be seen in these cases, caused by metastatic spread via the greater omentum. Ultrasonography and computed tomography may prove this diagnosis by showing peritoneal metastatic spread and tumorous infiltration of the greater omentum.
The use of radiation therapy in pelvic malignancies increases the risk of urinary complications, sometimes being necessary urinary diversion. The risk of utilizing previously irradiated bowel should be avoided. The use of transverse colon is a safe and effective alternative. We present a heterotopic continent colonic reservoir with an easily catheterizable conduit.
A redundant limb of ileum left after a hemicolectomy is postulated to be the causative factor in a case of volvulus of the transverse colon and distal ileum after hemicolectomy 20 years before. A case is presented and the etiology of volvulus briefly discussed.
A 3-year child presented with episodic lower abdominal pain; during the eighth attack, a mass was palpable in the left upper quadrant, and a barium enema revealed a stenotic area in the transverse colon. This was resected and an uneventful postoperative course followed. Subsequently, the child has remained symptom-free. instruments are no longer in use.
In order to determine if the rat colon is capable of adaptation when placed in another location within the intestinal tract and/or subject to different luminal contents, a 3 cm segment of transverse colon was transposed into the ileum. Sixteen days later, the animals were injected with tritiated thymidine (1 microCi/g body weight) and killed one hour later. Autoradiographs were analyzed for number of cells per crypt column, number of labeled cells per crypt column, position of labeled cells in the crypt column, and formation of Paneth cells or villi in the transposed colon. Proliferative activity of the epithelium was measured by isolating whole crypts and determining disintegrations per minute per crypt. Except for alterations in the positions of labeled cells, as determined by crypt profiles, no changes from normal were observed in any of the parameters measured. Hence, unlike the small bowel, the colon is refractory to the influences of a new environment.
Yersinia enterocolitica abscess of the bowel is a rare entity. Only five cases have previously been reported--none in the surgical literature. A unique presentation for Yersinia infection, abscess of the transverse colon, is described, and the literature of Y. enterocolitica intestinal perforation and abscess is reviewed.
Primary ciliary dyskinesia, characterized by chronic airway infection, impaired fertility, and situs inversus in half the number of cases, was detected in a 58-year-old Japanese woman, along with carcinoma of the transverse colon. She was of complete situs inversus and subfertile and had chronic bronchitis and nasal polyposis. Ultrastructurally, the cilia of the nasal mucosa lacked dynein arms. This is the first documentation of this disease coupled with cancer.
A 72-year-old woman with cirrhosis of the liver was treated repeatedly by transcatheter arterial embolization for multifocal hepatocellular carcinomas. She developed gastrointestinal bleeding secondary to direct invasion of the wall of the transverse colon. The diagnosis was made pre-operatively by colonoscopy and the patient was treated successfully. This rare complication of hepatocellular carcinoma was due to the protrusive type of growth exhibited by this tumour and may have been affected by the transcatheter arterial embolization.
In the light of findings emerging from a critical review of the literature, the Authors present a case of solitary non-specific ulcer of the transverse colon successfully treated by surgery. The various pathogenetic theories are examined, and the diagnostic work-up to which the patient must be subjected is discussed. The study concludes with a description of the choice of therapy.
This very rare affection of unknown origin, achieves a macroscopic and microscopic aspect similar to that described by Cruveillhier at the level of the stomach. The authors present a case of ulcer located on the transverse colon, at the free margin, with stenosing evolution and coexisting with duodenal ulceration of chronic character. The patient also had portal hypertension in the third stage and arteriopathy that had been diagnosed previously.
A variety of radiographically demonstrable colon abnormalities associated with pancreatitis are illustrated. Extensive changes of either localized or diffuse inflammation are more common than has generally been appreciated. Localized changes may mimic carcinoma. Transverse colon inflammation secondary to pancreatitis may be appreciated on plain abdominal radiographs and to better advantage with a contrast enema. This pattern is distinctive and suggests a severe underlying pancreatitis. A water soluble contrast enema is recommended if there is any evidence of colon necrosis or fistula. Recognition of all of the changes of pancreatitis may lead to earlier management of the severe complications.
We report the case of a 53-year-old man with a long history of ulcerative colitis in whom an elevated lesion in the epithelium of the affected transverse colon was initially diagnosed as a benign inflammatory polyp by endoscopic biopsies. After 4 years of follow-up, because the tumor had enlarged and villous components were endoscopically observed on the surface, a colonic resection was performed. The tumor was found to consist of hyperplastic colonic epithelium associated with multiple mucinous cysts lined with dysplastic colonic epithelial cells. Moreover, the mucinous cysts were primarily located beneath the submucosal layer and appeared to intrude into the muscularis propria of the colonic wall. This lesion had a unique pathological feature, presumably indicating neither benign inflammatory epithelium nor a neoplastic lesion of the colonic epithelium. Mucinous cysts lined with colonic epithelial components in the muscularis propria suggest a loss of normal integrity of the colonic wall. Areas of the epithelial cell lining of the mucinous cysts showed apparent structural and nuclear atypia and positive expression for p53, suggesting that this portion of the specimen was dysplastic epithelium. These pathological findings may indicate one longitudinal aspect of tumor development which could provide evidence of premalignant change or initial pathological features during the long-standing course of ulcerative colitis.
A 62-year-old woman developed fulminant neuteopenic colitis following aggressive chemotherapy for limited-stage small cell lung cancer. An urgently performed computerized tomographic [CT] study demonstrated the predominant involvement of the transverse colon. We present a brief description of the CT features of neutropenic colitis in this unusual presentation.
A seventy-four years old man had been suffering from symptomatic and infectious complications associated with conjoined cutaneoureterostomy following the radical cystectomy for advanced transitional cell carcinoma of the bladder 3 years ago. He underwent urinary reconstruction using transverse colon conduit after diagnostic exclusion of recurrent urothelial tumor in the upper urinary tract, evaluation of performance status and endoscopic examination of the colon. Enteroscopy incidentally revealed he had an early stage adenocarcinoma in his sigmoid colon to be resected, and the resection was followed by the urinary diversion. Postoperatively he is satisfied to be free from urinary complications and frequently visits the outpatient clinic for painful and troublesome ureteral catheter exchange.
The motor activity of the isolated colon is understood less than that of any other part of the gastrointestinal viscus. Thus, the aim of the present study was to evaluate the motor activity of the interposed transverse colon following total gastrectomy through a study of 21 patients. Manometric studies were carried out with a 5-lumen, open-tipped catheter in the resting state, in response to dry swallows, and swallowing distilled water and a liquid meal. Contractile waves in the interposed colon grafts were divided into three types, namely, high-amplitude propagated contractions (HAPCs), low-amplitude propagated contractions (LAPCs), and low-amplitude nonpropagated contractions (LANPCs). No retrograde contractions were observed during the entire recording. Motor activity in the interposed colon increased to a greater extent after swallowing distilled water or liquid meals than during the resting period or after dry swallows; however, there was no significant difference between the effect of distilled water and liquid meals. The motor activity of the interposed colon was lower in patients with symptoms than in asymptomatic patients. These results suggest that the volume, rather than the composition, of the lumen contents is an important factor for inducing interposed colon graft contractions, and that contractions of the interposed colon can help to propel the contents of the colon into the duodenum and clear any duodenal juice if reflux should occur.
Reconstruction of cervical esophagus and hypopharynx following cervical esophagectomy and laryngopharyngectomy is generally performed using jejunal autograft interposition. However, this method has some disadvantages and is not suitable for optimal swallowing function. In our institution, free transverse colonic graft has been successfully applied for reconstructive purposes in 12 cases since 1986. The present report describes a case of upper esophageal web accompanying superficial squamous cell carcinoma and details the operative techniques utilized.
The incidence of carcinoma of the large bowel is very low in children, and it is also known that the prognosis of this tumour in children is very poor. Recently the authors experienced a case of adenocarcinoma of the transverse colon in a 12 year old boy who survived more than 6 years without evidence of disease. This particular case is reported here with a review of the literature.