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PubMed2003

[Acute abdomen secondary to intra-abdominal hibernoma].

The hibernoma is a rare benign tumor derived of embrionary fat seen in adult, which is usually localized in scapular and interscapular region. It express as a slowing growth bulk without symptoms. The authors present a 2 years old boy with acute abdomen requiring urgent laparotomy, that shows a tumor connected to mesocolon by a vascular pedicle that had undergone torsion. No other similar case published been found. The treatment is surgical resection although recurrences have been reported due to incomplete resection.

Abdomen, Acute↗
PubMed2002

Early intrajejunal nutrition: bacterial translocation and gut barrier function of severe acute pancreatitis in dogs.

OBJECTIVE: To evaluate the effect of early intrajejunal nutrition in attenuating bacterial and/or endotoxin translocation and improving gut barrier function of severe acute pancreatitis (SAP) in dogs. METHODS: 15 dogs were divided into parenteral nutrition (PN) group (7 dogs) and early intrajejunal nutrition (EIN) group (8). EIN was delivered nutrients via a needle jejunostomy catheter feeding at 48 h after operation. SAP model was induced by injecting 1 ml/kg of combined solution of 5% sodium taurocholate and 8000-10 000 BAEE units trypsin/ml into the pancreas via the pancreatic duct. Systemic blood samples were obtained before and 1, 3, 5, 7 d following SAP, and cultured by aerobic as well as anaerobic bacterial growth. Systemic plasma and portal vein endotoxin levels were quantified by the chromogenic limulus amebocyte lysate (LAL) technique. Portal vein blood and specimens of tissue from the mesenteriolum and mesocolon lymph nodes, lung, pulmonary portal lymph nodes, pancreatitistissue and periopancreas tissue were adopted before the experiment was finished. Aliquots of the homogenata were cultured as blood mentioned above to determine the magnitude of the bacteria. DNA, protein and the villi, the thickness of mucosa, and the whole bowel wall of the ileum and transverse colon were measured. RESULTS: The study showed that the levels of systemic plasma endotoxin and the magnitude of bacterial translocation to the portal and systemic blood and distant organ were reduced significantly in the EIN group as compared with the TPN group. The contents of Protein and DNA, the height of villi, the thickness of mucosa and whole bowel wall of the ileum and transverse colon in the EIN group were higher than those in the PN group. CONCLUSION: Our results suggested that EIN is safe and effective to be adopted by intrajejunal delivery of nutrients in SAP, decreases the occurrence of gut bacterial translocation, and improves the gut barrier function.

Acute Disease↗
PubMed2004

Solid-pseudopapillary tumor of the pancreas: two cases in male patients.

Solid-pseudopapillary tumor (SPT) of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of two cases in young male patients. Clinical data were retrieved retrospectively from a prospective database of patients with pancreatic tumors. The two patients were caucasian males, ages 34 years (Pt1) and 41 years (Pt2) at the time of diagnosis. Pt1 presented with intermittent epigastric pain, nausea, and vomiting. Computed tomography (CT) scan showed a 9-cm mass involving the pancreatic head. He underwent pancreaticoduodenectomy, with en bloc segmental colectomy due to mesocolon involvement. Pt2 was asymptomatic, diagnosed with abdominal mass by screening ultrasound. He had an 11-cm tumor involving the pancreatic tail encasing the splenic vessels on CT. He underwent distal pancreatectomy with splenectomy en bloc. Pathology in both cases was reviewed by staff pathologists as well as outside consultants. SPT is a rare tumor of the pancreas that is diagnosed primarily in young women. The cases presented here demonstrate SPT of the pancreas in two men. In both cases, the clinical presentation was relatively unremarkable. Both have had benign late postoperative courses, consistent with the low malignant potential of this lesion.

Adult↗
PubMedDate not supplied

[Critical update on the no-touch technique in colonic cancer using the grasping tie].

The time honoured strategy of "no-touch" in the surgery of colon cancer does not stand an anatomical and patho-physiological criticism, also on the basis of some results of the literature. The personal experience of the problem leads to the proposal of an alternative realization of the procedure, that is an up-to-date of the classic method, and is really worth and easy to be overall adopted. The suggestion is to seal bipolarly the colon tract with the tumour by mean of the original grasping tie from the very beginning of the operation, and then to temporarily clamp the mesocolon close to the gut, before going on with the surgical dissection, lymphectomy and exeresis as usual. This procedure is able to completely isolate from the first steps of the operation the affected tract of the colon, so opposing the possible spreading of tumour cells in the portal and in the systemic venous stream during the following surgical manipulations. The rationale of the proposal is that of a more efficacy of the "no-touch" strategy based on strict anatomical and patho-physiological considerations.

Colonic Neoplasms↗
PubMed2003

Intra-abdominal desmoplastic small cell tumour--a case report.

Intra-abdominal desmoplastic small cell tumour is a rare malignant neoplasm of childhood. We report a case of this uncommon tumour in a 14-year-old boy. The tumour originated from transverse mesocolon. The case is notable because there was no pain and ascites on presentation and there was transmural infiltration of the transverse colon.

Abdominal Neoplasms↗
PubMedDate not supplied

The role of extended total gastrectomy in advanced gastric cancer.

BACKGROUND/AIMS: Extended total gastrectomy represents, in our experience, 52 out of 443 (11.7%) surgical resections for gastric cancer (1976-1998, 269 total gastrectomies). METHODOLOGY: Enlarged resections were performed on left liver lobe (5 cases), transverse colon (8 cases), pancreas body-tail (35 cases), mesocolon (4 cases), diaphragm (6 cases), jejunum (1 case), and adrenal gland (1 case). RESULTS: Morbidity rate was 18 out of 52 cases (34.60%); 1 esophagus-jejunum anastomosis leakage, 6 cases of pneumonia, 1 pancreatic fistula, 1 p.o. pancreatitis, 3 subphrenic abscesses, 4 cardiocirculatory complications, successfully resolved with conservative therapy. There was one case of postoperative death (1.9% due to cardiac failure). There was a 5-year survival rate for 36.5% of the patients, with follow-ups from 6 months to 11 years. The authors, based on their data, international literature (Roder 1993, Cordiano 1996, Shchepotin 1998) and taking into account mortality and morbidity rates estimate a 5-year survival rate in 30-52% of the cases. CONCLUSIONS: In conclusion, we believe that major surgical procedures for gastric cancer are indicated for every case of suspected neoplastic infiltration of contiguous organs.

Adult↗
PubMed2004

Ampullary carcinoma in a group of aged rhesus macaques (Macaca mulatta).

Ampullary carcinoma was diagnosed in 6 rhesus macaques that ranged in age from 20 to 35 years. Signalment, premonitory signs of disease, and results of clinical biochemical and hematologic analyses varied among animals. Histologically, the neoplastic cells obliterated the ampulla, with regional spread to the duodenum in all 6 animals and to the pancreas in one animal. Two animals had metastases to the lung, and another two had metastases to the pancreoduodenal lymph nodes and liver. One animal had mesocolonic metastasis. Malignant tumors of the ampullary region are rare in domestic animals, and account for less than 5% of all cancers of the digestive tract in humans.

Aging↗
PubMedDate not supplied

Lifting of the colon for laparoscopic-assisted colectomy for colon and rectal cancer.

BACKGROUND AND OBJECTIVES: Laparoscopic-assisted colectomy for colon and rectal cancer causes less surgical trauma than does open colectomy. However, current methods are more costly and require highly skilled staff. In addition, the technique for lymphadenectomy has yet to be standardized. We developed a technique that uses a nylon suture to elevate the colon. This method reduces costs without compromising the completeness of the resection. METHODS: Three trocars are introduced and a 1-0 nylon suture is passed into the abdominal cavity and through the mesocolon. The colon is retracted anteriorly and is fixed by this suture to the abdominal wall. The main mesenteric vessels are under tension, and lymph node dissection is performed easily. This method requires only 2 surgeons, an operator, and a scopist, because the colon is fixed to the abdominal wall. In addition, the working space is more stable because the colon is fixed to the abdominal wall. The procedure is relatively independent of the skill of the first assistant. RESULTS: From April 2000 to August 2002, this method was performed in 52 patients. The mean number of dissected lymph nodes was 16.9+/-9.0 (range, 6 to 41). Nine patients had lymph node metastases (17.3%). One patient developed hepatic recurrence; all patients are alive. No complication occurred that was related to lifting the colon. CONCLUSIONS: Using a suture to lift the colon is a useful method for performing laparoscopic-assisted colectomy with lymphadenectomy. This method reduces the number of surgical staff and the expense of the procedure.

Colectomy↗
PubMed2004

[Anatomic variations of the colon detected on abdominal CT scans].

PURPOSE: The frequency of anatomic variations of the colon detected on abdominal CT scans was examined. MATERIALS AND METHODS: 296 consequtive abdominal tomography were evaluated prospectively for the presence of retrorenal colon, retrogastric (pancreaticogastric interposition or retrosplenic) colon, high positioned colon, interposition of the colon between the psoas muscle and the kidney and hepatodiaphragmatic interposition (anterior or posterior). RESULTS: We observed 2 retrogastric colon [1 pancreaticogastric (0.3%), 1 retrosplenic (0.3%)], 7 retrorenal colon (1.2%) being bilateral in two cases, 2 interposition of colon between the psoas muscle and the kidney (0.7%), 1 posterior (0.3%) and 6 anterolateral hepatodiaphragmatic interposition (2.1%) and 12 high positioned cecum (4.2%) (in 4 of them cecum was totally subhepatic in location). Terminal ileum was lying in Morrison's pouch and anterior to renal hilus in two of the cases with subhepatic cecum. CONCLUSION: Anatomic variations of the colon probably result due to mild embryologic abnormalities of bowel rotation and fixation, short transvers mesocolon, intraperitoneal ascending or descending colon, increased intraperitoneal pressure or decreased retroperitoneal fat. Pancreaticogastric interposition occurs in approximately 0.2%, partial retrorenal colon in 9-10%, complete retrorenal colon 1%, interposition between psoas muscle and kidney in 0.7-1.7%, anterolateral hepatodiaphragmatic interposition in 1.3-3% of individuals. When located in lesser sac it simulates several pathologies of this area. On intravenous urography images it may cause mass effect. In percutaneous interventions and surgical procedures colon may be perforated. For these reasons tomography images should be evaluated for the presence of these anatomic variations.

Adult↗
PubMedDate not supplied

Gigantic post-traumatic pseudocyst of sigmoid mesentery.

A 29-year-old man presented with dull abdominal pain and a lump occupying almost the entire abdomen, four months after a fall from a height. Ultrasonography revealed a cystic lesion with debris occupying almost the entire abdomen. Diagnostic tap revealed brownish fluid. Exploration revealed a huge thick-walled cyst of the sigmoid mesocolon, which could be enucleated out entirely. Histology suggested it to be a false cyst.

Abdominal Injuries↗
PubMed1992

Microvascular circulation of the descending colon in horses.

The microvascular circulation of the descending colon was studied in 5 adult horses, using microangiography and light microscopy combined with gross studies and scanning electron microscopy of vascular replicas. After heparinization, horses were euthanatized, and 3 segments of the descending colon and its mesentery containing 1 vascular arcade were removed from each horse. The fecal balls were gently massaged from the lumen, and the blood was flushed free of the circulation with isotonic NaCl. In 5 segments, the vascular system was injected with a modified radiopaque medium and evaluated radiographically. Specimens examined radiographically also were prepared for histologic examination, using standard methods. Ten segments were injected with 1 of 2 types of plastics and studied grossly or by scanning electron microscopy. Arcuate arteries gave rise to a descending colonic rete that surrounded the vein and supplied numerous descending colonic lymph nodes. The rete also supplied the mesocolon and the descending colonic tissue. Short filamentous vessels arising from the rete directly penetrated the mesenteric tenia to supply an intermuscular plexus between the longitudinal and circular muscle layers of the muscularis externa. Larger vessels arising from either side of the rete divided into the long- and short-terminal arteries that supplied an extensive submucosal plexus, which was continuous around the circumference. The submucosal plexus supplied the mucosa, the tunica muscularis, and the serosa. Vessels running centrifugally from the submucosal plexus formed an intermuscular plexus between the longitudinal and circular muscle layers of the muscularis externa. The intermuscular plexus at the mesenteric angle also was supplied by vessels branching from the short-terminal arteries as they penetrated the muscularis externa.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed2005

[A case of cecal cancer with multiple liver metastases responding to irinotecan (CPT-11)/cisplatin (CDDP) combination therapy for elevation of CA19-9 after complete response (CR) by l-leucovorin(LV)/5-fluorouracil(5-FU) therapy].

A 62-year-old woman complained of abdominal pain and diarrhea from February 2, 2002. She was diagnosed with advanced cecal cancer with simultaneous multiple liver metastases. The serum level of CA 19-9 was 420 U/ ml. Ileoceal resection with D3 lymphnode dissection. The replacement of reservoir for hepatic arterial infusion (HAI) was performed on February 2, 2002. As the dissemination was seen near the mesocolon at laparotomy, we could resect all together. Pathological examination demonstrated II, 5.0 x 2.5 cm, mod, se, INFgamma, ly(1), v(1), n(2), stage IV. Systemic l-leucovorin/5-fluorouracil (l-LV/5-FU) + HAI of weekly high-dose 5-FU combination therapy was initiated at postoperative 14 days. The serum CA 19-9 level decreased immediately but was not within the normal range. On abdominal computed tomography (CT), liver metastatic lesions decreased 9 9% on May 27, 2002 and disappeared on August 26, 2002. Though there were no signs of recurrence, the serum CA 19-9 level elevated as of October, 2002. Since the hepatic artery was occluded, HAI was discontinued on November 28, 2002. The serum CA 19-9 level elevated inspite of the continuation of the l-LV/5-FU therapy which we increased an amount of 5- FU. Thus, we changed low-dose irinotecan (CPT-11)/cisplatin (CDDP) therapy. The serum level of CA 19-9 decreased gradually and got with in normal range on March, 2004. It did not elevate since then. Low-dose CPT-11/CDDP therapy may be useful for patients with advanced colon cancer thought to be resistant to 5-FU as second-line chemotherapy.

Adenocarcinoma↗
PubMed2006

[Internal hernia of the small intestine after laparoscopic nephrectomy].

The authors report the case of a woman operated by transperitoneal laparoscopic left nephrectomy for destroyed kidney. At the third postoperative week, she developed small bowel obstruction requiring reoperation by laparotomy. This complication was due to a transmesocolic internal hernia of the small intestine via a breach created during access to the renal pedicle by the peritoneal incision at the duodenojejunal flexure that was not closed. Four other cases of transmesocolic internal hernia have been reported in the literature following left laparoscopic nephrectomy. An accidental breach of the left mesocolon was considered to be responsible. This rare complication appears to be facilitated by creation of a mesocolic breach and by positioning the patient in the lateral supine position. These breaches must be closed.

Aged↗
PubMed2006

Treatment of colon conduit redundancy in a child with esophageal atresia.

We recently revised a redundant colon conduit in a boy who was born with isolated esophageal atresia. In view of the paucity of reports dealing with correction of this common complication of esophageal replacement, it seemed appropriate to report our experience. Because of effective medical therapy of acid peptic disease, patients who formerly required conduit replacement may now be candidates for revision; however, the medical literature does not specify when conduit revision, as opposed to conduit replacement, is indicated; also, no guidance is provided regarding what constitutes effective operative revision. Innovative techniques that stretch and elongate the atretic esophagus will likely lessen the use of conduits in esophageal atresia; nevertheless, colon conduits are useful in many other clinical situations and will remain an essential part of the armamentarium of pediatric, general, and thoracic surgeons. This report highlights the DeMeester and Tannuri technique, whereby a colon conduit is prepared like a Roux limb. The mesentery is divided only once; the conduit's blood supply is not severed from the distal mesocolon. This innovation improves a conduit's blood supply and lessens its attendant complications. Lastly, we describe a muscle splitting, posterolateral thoracotomy technique that is simpler than the alternatives and is useful in a variety of clinical situations.

Anastomosis, Surgical↗
PubMed2005

The new laparoscopic proctocolectomy training (in soft cadaver).

OBJECTIVES: The purpose of the present study was to evaluate the quality of preservation (tissue plane, named vessels identification, consistency of colon and rectum), quality of performing procedures, difficulties and problems and finally the satisfaction of surgeons in laparoscopic proctocolectomy in soft cadaver. SETTING: Colorectal Division, Department of Surgery and Surgical Training Center Department of Anatomy, Faculty of Medicine, Chulalongkorn University. DESIGN: Prospective descriptive study MATERIAL AND METHOD: 10 soft cadavers were scheduled for laparoscopic proctocolectomy. The procedures (colon-rectum mobilization and named vessels identification) were performed by 14 experienced surgeons (8 colorectal surgeons) and assisted by surgical residents. The quality of preservation, successfulness and the satisfaction in performing the procedures were recorded using questionnaires for evaluation. RESULTS: The preservation was very good in every aspect especially tissue plane between colon, mesocolon and retroperitoneum which was clearly dissected, same asfasciapropria of rectum. The named vessels and the tissue consistency were very well preserved and tolerated to laparoscopic equipment handling. The surgeons were satisfied with the tissue handling and dissections. There were two difficulties, the first was air leakage but simply corrected with purse string suture and the second was unflavored smell which was not concerned. Laparoscopic proctocolectomy could be completely performed in soft cadaver. CONCLUSION: Laparoscopic proctocolectomy could be performed in soft cadavers with great satisfaction. Repeated practice is possible, so the surgeons can gain their experiences outside the operating theatre. This success may shorten the learning curve and may be the new era in cadaver-based training.

Attitude of Health Personnel↗
PubMed2006

Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy.

CONTEXT: We report a rare case of a repeated pancreatic resection in the remnant distal pancreas 18 months after a Whipple R0 procedure. CASE REPORT: In September 2003, a 63-year-old man underwent a Whipple procedure with an extended lymphadenectomy, portal vein resection and direct reconstruction for pancreatic cancer. In September 2004, the tumor marker level increased and MR revealed a tumor in the remnant pancreas. There were no findings of invasion into the surrounding tissue or distant metastasis. After three months of systemic chemotherapy and a radiological reevaluation (PET and CT) in March 2005, we removed the remnant pancreas. Histopathologically, the tumor was classified as a ductal adenocarcinoma like the tumor which had been removed during the first operation, with infiltration of peripancreatic adipose tissue and a segmentary tract of the transverse mesocolon, without lymph node metastasis. CONCLUSIONS: There are very few reports of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy in the literature. In most of these cases, it is difficult to assess whether the remnant pancreatic cancer is a recurrence or a second primary cancer. In our patient, the first hypothesis seems to be more realistic due to the brief recurrence-free survival period. Otherwise the high rate of multicentricity in pancreatic cancer may also explain the development of a secondary cancer in the remnant pancreas, even though the interval was relatively brief.

Adenocarcinoma↗
PubMed1991

Mesenteric tears of the descending (small) colon as a postpartum complication in two mares.

Segmental ischemic necrosis of the descending colon associated with discrete tears of the mesocolon were diagnosed in 2 mares following foaling. After foaling, both mares had a slow onset of signs of abdominal pain and gradual deterioration of clinical status. Increases in peritoneal fluid total protein concentration and WBC count and a palpable impaction of the descending colon on examination per rectum were useful diagnostic aids. Surgical intervention was successful in one mare, but not in the other.

Anastomosis, Surgical↗
PubMed1991

[A case of a right-sided sigmoid colon].

During dissecting practice by students at Chiba University in 1991, a rare anomaly was found in a cadaver of a 50-year-old Japanese male. The distal part of the colon, including the sigmoid colon, was excessively long and formed a loop behind the ascending colon. This anomalous colon consisted of four parts. The first part began in the left iliac fossa and passed across the lower posterior abdominal wall into the right iliac fossa; the second turned upward and ascended along the posterior surface of the ascending colon to the inferior surface of the right lobe of the liver; the third turned backward and descended to the right iliac fossa and was in contact with the posterior abdominal wall; the fourth curved medially and downward and ended in the rectum at the median line. Only the anterior surface of the anomalous colon was covered with the peritoneum, and its mesocolon was not found. The inferior mesenteric artery gave off four branches toward the distal three-fourths of the excessively long colon and the superior rectal artery to the upper part of the rectum. Since it did not directly give off any branches toward the descending colon and the first part of the anomalous colon (these portions were supplied by a marginal artery), the branch supplying the second part was considered to be equivalent to the left colic artery. Thus, the proximal half of the long colon (parts 1 and 2) can be regarded as a part of the descending colon, and the distal half as the sigmoid colon.(ABSTRACT TRUNCATED AT 250 WORDS)

Colon, Sigmoid↗