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PubMed2003

Colonoscopically placed hemoclips as treatment for massive appendiceal stump bleeding.

Massive bleeding from an appendiceal stump is a rare but occasionally seen severe complication. The bleeding may drain into the abdominal cavity, the retroperitoneum, or the digestive tract. Gastrointestinal hemorrhage may occur early or even years after appendectomy. The typical management includes ligation of the bleeding vessel or cecal resection done by either emergency laparotomy or laparoscopy. An alternative treatment option would be an angiographic embolization of the bleeding vessel. We report on a 33-year-old woman with severe lower gastrointestinal hemorrhage 1 day after an apparently uncomplicated appendectomy for acute phlegmonous appendicitis with ligation and invagination of the appendiceal stump. Hemoglobin level dropped to 6.3 g/dl and made blood transfusion necessary. The cause of bleeding was a small intramural branch of the appendiceal artery at the appendiceal stump, which was diagnosed by emergency colonoscopy. The hemorrhage could be controlled endoscopically by placing hemoclips on the distinct vessel in combination with a biological tissue adhesive. The patient recovered thereafter without further intervention. Endoscopic clipping for the treatment of appendiceal stump bleeding is a novel, effective, and safe procedure. Thereby, conventional emergency laparotomy or laparoscopy or angiographic embolization can be avoided.

Adult↗

PubMed1998

Colonoscopic diagnosis of lymphoid hyperplasia causing recurrent intussusception: report of a case.

This paper describes a 6-year-old boy with recurrent ileocecal intussusception due to lymphoid hyperplasia in the terminal ileum, which was diagnosed preoperatively by colonoscopy. At the age of 3 years, he developed diarrhea and a tender abdominal mass. He was diagnosed as having intussusception by ultrasound and was treated by hydrostatic barium enema. After resolution, he had three recurrent episodes of intussusception. A contrast barium enema revealed a small mass in the ileocecal region. Colonoscopy showed several exaggerated folds of the terminal ileum and a biopsy showed lymphoid hyperplasia. Because the repeated intussusception seemed to have been caused by the lymphoid hyperplasia in the terminal ileum, he underwent an ileocecal resection without any subsequent recurrence. Based on the above findings, we conclude that a colonoscopy may thus be useful both for diagnosing lymphoid hyperplasia in the terminal ileum as a cause of recurrent intussusception and for deciding how to manage it.

Child↗

PubMed2004

Surveillance for dysplasia in patients with inflammatory bowel disease: a national survey of colonoscopic practice in New Zealand.

BACKGROUND: Patients with chronic ulcerative colitis and Crohn's colitis have an increased risk of colorectal cancer. Because of this, surveillance colonoscopy is practiced. AIMS: We aimed to describe the practice of surveillance colonoscopy in New Zealand, with comparison among specialties, and with practice internationally. SUBJECTS: New Zealand colonoscopists (both physicians and surgeons) looking after patients with inflammatory bowel disease were surveyed to evaluate attitudes about surveillance colonoscopy and ways in which colonoscopy results are interpreted. METHODS: A postal survey assessed the colonoscopist's understanding of how and why surveillance colonoscopy is undertaken and their interpretation of the results from such evaluations. RESULTS: Of the 196 physicians and surgeons surveyed, 180 responded (92 percent). Sixty responses were excluded. Only 24 of 120 respondents (20 percent) correctly defined dysplasia. The median number of biopsies taken at colonoscopy was 17. Eighty of 120 (67 percent) and 77 of 120 (64 percent) doctors underestimate the risk of invasive malignancy if low-grade or high-grade dysplasia, respectively, is identified. The colectomy referral rate for dysplasia-associated lesion or mass was 115/120 (96 percent); that for high-grade dysplasia was 110/120 (92 percent); and that for low-grade dysplasia was 26/120 (22 percent). Thirty of 120 (25 percent) doctors offer patients the option of colectomy after 20 years of colitis. Seventy of 120 (58 percent) doctors sought the opinion of a second pathologist if dysplasia was found. There were differences in responses between specialist groups, with colorectal surgeons most likely to correctly define dysplasia and appreciate the significance of low-grade dysplasia. CONCLUSIONS: Many New Zealand colonoscopists have a poor understanding of the definition and importance of dysplasia associated with colitis. Although colectomy referral rates are higher in this study than in similar studies, low-grade dysplasia is often not referred for colectomy. Improved education may improve surveillance practice.

Attitude of Health Personnel↗

PubMed2002

Colonoscopic detection of a malignant melanoma metastatic to a tubular adenoma of the colon: report of a case.

PURPOSE: Metastasis of a malignant neoplasm to a benign tumor is an infrequent event. Adenomatous polyps of the colon have only been reported on three occasions acting as host tumors. We report the first case where a malignant melanoma metastasizing to a tubular adenoma in the colon was detected during colonoscopy. METHODS: An 85-year-old male with dementia and right hemiparesis presented to the hospital with change of bowel habits, signs and symptoms of anal incontinence, and a perianal ulcer. On physical examination, multiple subcutaneous nodules over his chest and abdominal wall were detected, and laboratory data revealed iron deficiency anemia. A colonoscopy was performed. RESULTS: During colonoscopy, a pedunculated, greenish-brown-colored polyp measuring 2 cm in greatest dimension located in the transverse colon was identified and snared. Pathology of this polyp was consistent with a malignant melanoma infiltrating into a tubular adenoma. Subsequently, one of the subcutaneous lesions was biopsied and this revealed malignant melanoma cells metastatic in soft tissue. The primary site of the malignant melanoma could not be identified. CONCLUSION: Polyp-cancer sequence is well documented in colorectal cancer. The vast majority of malignant lesions found in adenomatous polyps in the colon are the consequences of malignant transformation from benign neoplastic colonic adenomatous tissue. The possibility that colonic adenomatous polyps could harbor metastatic tumors should also be entertained. This could change the treatment and may require an appropriate workup.

Adenocarcinoma↗

PubMed2000

Stents and lasers for colonoscopic lesions.

The use of self-expanding metal stents (SEMS) in the colon is now becoming more commonplace. These devices can be employed to decompress large bowel that has become obstructed from either benign or malignant disease. Many studies in the past year have validated the use of colonic SEMS to allow preoperative bowel preparation in resectable patients, or as an alternative to surgery in those requiring palliative therapy alone. Laser therapy has also gained new ground in recent months because it has been shown to help in recanulation of obstructed bowel to aid in SEMS placement. In addition, laser therapy alone can be used to treat some colonic lesions that had formerly been treated surgically.

Colorectal Neoplasms↗

PubMed1974