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PubMed1991

Ruthenium red selectively antagonizes capsaicin-induced release of vasoactive intestinal polypeptide (VIP) from the human colon.

Ruthenium red (RR) is an inorganic dye that has shown to block the actions of capsaicin on primary sensory neurons in different animal models. The aim of this study was to assess whether RR is able to antagonize the release of vasoactive intestinal polypeptide (VIP) evoked by capsaicin in the human colon. Samples of descending colon were collected from patients undergoing colectomy for carcinoma of the colon. Tissue slices from the muscle of human colon were exposed to either 10 microM capsaicin or an isotonic high K+ medium (KCl 80 mM), in the absence or presence of 10 microM RR. Either capsaicin or high K+ produced a prompt release of VIP. RR (10 microM) completely antagonized the capsaicin-induced release of VIP from muscle of human colon. This effect was elective, since VIP release evoked by high K+ was unaffected by the presence of RR. These findings indicate that RR acts as a selective antagonist of capsaicin in human tissue and that the mechanism underlying peptide release by capsaicin is preserved across species. Multiple mechanisms leading to VIP release exist in the human colon.

Aged↗
PubMed2005

Investigating painless rectal bleeding--is there scope for improvement?

INTRODUCTION: Most patients with recurrent painless rectal bleeding warrant endoscopic examination of the lower gastrointestinal tract. This is often limited to rectum or distal colon. The purpose of this study was to compare the diagnostic yield of limited colorectal endoscopy with total colonoscopy in children with recurrent painless rectal bleeding. METHODS: Retrospective review of 314 patients aged 1 to 15 years who underwent colorectal endoscopy for recurrent rectal bleeding. Two hundred six underwent total colonoscopy, whereas 108 patients had endoscopy limited to the rectum in 22, sigmoid colon in 34, descending colon in 43, and transverse colon in 9. Diagnoses were recorded according to the endoscopic and histological findings. RESULTS: After total colonoscopy, a diagnosis was established in 70% of children compared with 35% of those undergoing limited endoscopy (P < .001). This difference was most noticeable in children with inflammatory bowel disease. Juvenile polyps were diagnosed with similar frequency in both groups, reflecting the rectosigmoid distribution of most polyps. CONCLUSIONS: For children presenting with painless rectal bleeding, a diagnosis can be established in the majority if total colonoscopy is performed. This is particularly true for inflammatory bowel disease. Unless a rectal polyp is suspected, full colonoscopy should be planned.

Adolescent↗
PubMed1990

Intraoperative tissue oximetry in the human gastrointestinal tract.

Tissue oxygen tension was measured using a modified Clark oxygen electrode in the gastrointestinal tract of 33 patients undergoing laparatomy. The electrode, which incorporated a thermistor, had a linear response to oxygen tension (r = 0.995, p less than 0.001). The patients were all maintained on an inspired oxygen concentration of 33 +/- 3% and had a mean arterial oxygen tension (PaO2) of 124.9 +/- 31.9 mm Hg. Tissue oxygen tension measurements (mm Hg, mean +/- SD) were recorded from the serosal surfaces of the stomach (46.3 +/- 15.4), mid-ileum (36 +/- 9.7), terminal ileum (33.5 +/- 11.5), cecum (30.3 +/- 7.4), transverse colon (38.5 +/- 10), descending colon (29.3 +/- 11), and sigmoid colon (39.2 +/- 7.7) and tended to increase with increasing PaO2 (r = 0.70, p less than 0.001). Arterial occlusion resulted in a gradual decrease in tissue oxygen tension. It is concluded that intraoperative tissue oxygen tension measurement is feasible, and that the technique may have clinical applications in the assessment of intestinal viability.

Adult↗
PubMed1997

Mutation analysis of the RET, the endothelin-B receptor, and the endothelin-3 genes in sporadic cases of Hirschsprung's disease.

To date, three genes have been identified as susceptibility genes for Hirschsprung's disease (HSCR), the RET proto-oncogene, the endothelin-B receptor gene (EDNRB) and the endothelin-3 gene (EDN3). However, the question of whether these genes play a role in sporadically occurring HSCR has not been fully clarified. In this study, the authors performed mutation analysis of these three genes in 41 sporadic HSCR patients without any family history by using single-strand conformational polymorphism or denaturing gradient gel electrophoresis methods. Exon 2, 3, 5, 6, 12, 13, 15, and 17 of the RET gene, 7 exons of the EDNRB gene, and the region of the EDN3 gene including sequences corresponding to proteolytic cleavage sites and mature endothelin-3 were analysed. By direct sequencing, three causative RET mutations were confirmed; a Phe to Ser substitution at codon 174, a Cys to Tyr substitution at codon 197, and a point mutation at the splice acceptor site of intron 12, in patients with aganglionosis confined to the rectosigmoid colon, the transverse colon, and the total colon, respectively. In the EDNRB locus, two mutations were observed; a nonsense mutation of Trp to stop at codon 275, and a T insertion at nucleotide 878, in patients with aganglionosis confined to the rectosigmoid colon, and the descending colon, respectively. No mutation was detected in the EDN3 gene. Mutation rates were 7.3% in the RET and 5% in the EDNRB gene. Our data indicate that RET and EDNRB mutations have a role in the aetiology of some sporadically occurring HSCR. However, the low mutation rate of susceptibility genes in sporadically occurring HSCR suggests that other genes or environmental factors are involved in the development of the disease.

Endothelin-3↗
PubMed1984

Ultrastructural localization of thiamine pyrophosphatase activity in the intestinal epithelial cells of adult rats.

Ultrastructural localization of thiamine pyrophosphatase (TPPase) activity was studied in the small and large intestinal epithelial cells of adult rats. In the duodenal and jejunal absorptive cells, TPPase activity was localized on the microvilli, on the lateral cell membrane, and on the lysosome-like bodies. In the ileal epithelial cells, TPPase activity was detected on the lysosome-like bodies, and weak phosphatase activity was observed on the microvilli and on the cisternae of the rough-surfaced endoplasmic reticulum (rER). In the principal cells of the caecum, the ascending colon, and the descending colon, the lysosome-like bodies and the cisternae of the rER showed TPPase activity. Almost all Golgi lamellae, vesicles and GERL elements (NOVIKOFF 1964) in the duodenal absorptive cells were strongly TPPase positive. The 1st to 3rd of the inner Golgi lamellae and the vesicles of the jejunal, ileal, and large intestinal epithelial cells usually showed positive TPPase activity, while the GERL elements were totally negative.

Animals↗
PubMed1997

Neuropeptides in idiopathic chronic constipation (slow transit constipation).

Tissue specimens from the large bowel of 18 patients with long-standing slow transit constipation were investigated to determine the distribution and density of several neuropeptides and amines in the enteric nerve system, and also of endocrine cells in comparison to normal individuals. CGRP (calcitonin gene-related peptide), galanin, glucagon, GRP (gastrin-releasing peptide), metenkephalin, motilin, neuropeptide Y (NPY), PACAP, peptide YY (PYY), serotonin, somatostatin, substance P and VIP were studied by immunohistochemistry. Tissue concentrations of VIP, substance P and galanin were also measured by radioimmunoassay. Significantly increased VIP, SP and galanin contents were found in specimens from the ascending colon. Levels of VIP and galanin were also increased in the transverse colon. Immunohistochemistry revealed only marginal changes with an increased density of PACAP nerve fibres in the smooth muscle and of VIP and PACAP nerves in the myenteric plexus of the transverse colon. In the descending colon substance P and NPY immunoreactivity were also increased in the myenteric plexus while the density of VIP nerve fibres was reduced in the mucosa/submucosa. The frequency of PYY-containing cells and the 5-HT-containing cells in the ascending colon was significantly increased in the constipated patients.

Adult↗
PubMed2001

Current trends in colorectal cancer: site, incidence, mortality and survival in England and Wales.

The objective was to examine trends in colorectal cancer (CRC) incidence and mortality in England and Wales over the last 30 years. Age-standardized incidence, mortality and survival rates for CRC, based on data from the National Cancer Intelligence Centre at the Office for National Statistics, were calculated and trends assessed. Between 1971 and 1997 the total number of cases of CRC increased by 42%, from 20,400 to 28,900. The site distribution of CRC between 1971 and 1994 was: rectum 38%, sigmoid 29%, caecum 15%, transverse colon and flexures 10%, ascending colon 5%, and descending colon 3%. Between 1971 and 1997 the direct age-standardized incidence increased by 20% in males and by 5% in females. The direct age-standardized mortality fell by 24% in males and by 37% in females. Age-standardized relative 5-year survival in adults improved from 22%-27% for patients diagnosed during 1971-1975 to over 40% for those diagnosed during the period 1991-1993. In conclusion, the incidence of CRC in England and Wales has been steadily rising. It is more common in males and has increased more rapidly in males than in females. The reasons for these trends remain unclear. Five-year survival has improved substantially, but rates are still below those in comparable countries elsewhere in Europe and in the USA.

Adolescent↗
PubMed1999

Correlation between DNA content and p53 deletion in colorectal cancer.

OBJECTIVE: To find out whether tumour DNA content correlates with allelic loss of p53 and other pathological features in primary colorectal carcinomas. DESIGN: Ongoing prospective study. SETTING: University hospital, Italy. SUBJECTS: 128 patients who had undergone radical resections for colorectal carcinoma. INTERVENTIONS: Flow cytometric measurement of tumour DNA content and detection of allelic loss on the short arm of chromosome 17 by Southern blot (restriction fragment length polymorphism) analysis in fresh tumour specimens. MAIN OUTCOME MEASURES: Correlation between DNA ploidy and deletion of p53, as well as between these two genetic events and clinicopathological variables. RESULTS: Interpretable DNA histograms were obtained for 122 tumour specimens. Forty-three tumours (35%) were diploid and 79 (65%) aneuploid. The diploid tumours were significantly more common in the proximal colon (from the caecum to the splenic flexure) than in the distal colon (from the descending colon to the rectum) (p = 0.002). The allelic state on the short arm of chromosome 17 was evaluated in 80 heterozygous patients. Forty-four tumour specimens (55%) showed deletion of 17p. Allelic loss of p53 was significantly more common in the distal and rectal tumours than in the proximal ones (p < 0.0001). Aneuploidy was more common among those tumours which had shown deletion of p53 than in those that had not (p = 0.0008). CONCLUSIONS: DNA aneuploidy was significantly associated with the deletion of the p53 gene. This suggests that the functional loss of p53 may favour the growth and establishment of an aneuploid cell population within tumours. Tumours of the proximal and distal colon differ in their genetic nature.

Adenocarcinoma↗
PubMed2001

Oral administration of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) yields PhIP-DNA adducts but not tumors in male Syrian hamsters congenic at the N-acetyltransferase 2 (NAT2) locus.

2-Amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) is a heterocyclic amine carcinogen present in well-done meat. PhIP must undergo host-mediated bioactivation to exert its mutagenic and carcinogenic effects. Following N-hydroxylation, N-acetyltransferases catalyze the O-acetylation (activation) of N-hydroxy-PhIP to an electrophile causing DNA damage. A well-defined genetic polymorphism in N-acetyltransferase 2 (NAT2) activity exists in humans and the Syrian hamster. Since some human epidemiological studies suggest an association between acetylator genotype and cancer susceptibility in individuals who consume well done meats, this study was designed to investigate the specific role of acetylator genotype in PhIP-induced tumors using a Syrian hamster model congenic at the NAT2 locus. Following oral administration of PhIP to male rapid and slow acetylator Syrian hamsters, DNA adducts were identified in each tissue examined with levels in the relative order: pancreas > heart and urinary bladder > prostate, small intestine and transverse colon > ascending colon, liver, cecum, descending colon, and rectum. However, no tumors were observed in male rapid and slow acetylator congenic hamsters administered 11 oral doses of PhIP (75 mg/kg) and maintained on a high fat diet for one year.

Acetylation↗
PubMed1995

Ca2+ currents in human colonic smooth muscle cells.

Voltage-gated Ca2+ currents were investigated in single smooth muscle cells freshly isolated from the circular layer of the human colon (ascending and descending portions) using the whole cell voltage-clamp technique. Tissue samples were obtained at the time of therapeutic surgery. In physiological salt solution (containing 2 mM Ca2+), an inward current was observed when the cell membrane was depolarized in the presence of tetrodotoxin. This current disappeared when Ca2+ was removed from the bath solution and was inhibited when Ca2+ channel blockers were applied, indicating that the inward current was a Ca2+ current (ICa). Changing the holding potential (HP) from -100 mV to more positive potentials (e.g., -60 and -40 mV) markedly decreased the amplitude of ICa. The voltage dependence of steady-state activation and inactivation was represented by Boltzmann distributions; there was a substantial amount of overlap (window current) between -60 and -10 mV. A fast-inactivating ICa component followed by a slow-inactivating ICa component was observed in some cells from both ascending and descending colons. The fast ICa component was observed only when cells were held at -80 or -100 mV, and had a more negative threshold potential (-70 to -60 mV). This component was sensitive to low concentrations of Ni2+ (30 microM) but was resistant to nifedipine (10-20 microM). In contrast, the slow (sustained) ICa component was observed at all HPs (-40 to -100 mV) and had a more positive threshold potential (about -40 mV). This component was insensitive to low concentration of Ni2+ but was sensitive to nifedipine and BAY K 8644.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

GSTM1, GSTT1, and GSTP1 polymorphisms and risk of advanced colorectal adenoma.

Cigarette smoking is a risk factor for colon adenoma. The glutathione S-transferase enzymes are involved in the detoxification of carcinogenic compounds including those found in tobacco smoke, and thus, may be important modifiers of individual risk of developing this disease. We examined the prevalence of GSTM1 and GSTT1 gene deletions, and two GSTP1 polymorphisms in 772 cases with advanced colorectal adenomas (>1 cm, villous elements or high-grade dysplasia) of the distal colon (descending or sigmoid colon or rectum) and 777 sigmoidoscopy negative controls enrolled in the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Epidemiologic data on smoking was collected by self-administered questionnaire and DNA was extracted from whole blood or buffy coat. For GSTM1 and GSTT1, we used a newly developed TaqMan-based assay capable of discriminating heterozygous (+/-) individuals from those with two active alleles (+/+) and homozygous deletions (-/-). For GSTP1, the I105V and the A114V substitutions were identified using end point 5' nuclease assays (TaqMan). Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were determined using unconditional logistic regression, controlling for age, race, and gender. Advanced adenoma risk was increased in current/former smokers (OR, 1.4; 95% CI, 1.2-1.8). Risks were decreased in subjects with > or =1 inactive GSTM1 alleles (OR, 0.6; 95% CI, 0.4-0.9); and the association was independent of smoking status (P interaction = 0.59). Having > or =1 inactive GSTT1 allele was associated with increased risk among smokers (OR, 1.4; 95% CI, 1.1-1.9; P trend = 0.02) but not among never smokers (OR, 0.9; 95% CI, 0.6-1.3) and a significant interaction between smoking and genotype was observed (P interaction = 0.05). In summary, this is the first study to report associations between colorectal adenomas and GSTM1 wild-type and GSTT1 null allele among smokers. These findings only became apparent using a newly developed assay able to distinguish heterozygous from wild-type individuals. Our data provide evidence that phenotypic differences between these two groups exist.

Adenoma↗
PubMed1985

Regional distribution and alterations of lectin binding to colorectal mucin in mucosal biopsies from controls and subjects with inflammatory bowel diseases.

Glycoconjugate composition of colorectal goblet cell mucin was characterized according to the anatomical distribution of lectin-binding sites in mucosal biopsies from 35 control subjects and 55 patients with inflammatory bowel disease. 24 of the controls had mucosal inflammation on biopsy, without clinical evidence of inflammatory bowel disease. These inflamed controls showed a similar rate of presence of lectin-binding sites as the normal noninflamed group. In the controls, the frequency of binding of Ricinus communis agglutinin I to galactosyl residues was consistently higher than that found with either Ulex europaeus agglutinin I to fucosyl or Dolichus biflorus agglutinin to N-acetyl galactosyl groups. A significant proximal to distal gradient for Ulex europaeus agglutinin I binding sites was identified in the controls group. These binding sites were present four times more often in the proximal colon than in the distal colon (P less than 0.025). In the ulcerative and Crohn's colitis groups, this gradient effect was lost, predominantly as a result of decreased availability of fucosyl residues in the proximal colon. In the descending colon of Crohn's colitis tissues, there was a complete absence of Dolichus biflorus agglutinin binding sites compared with the 62.5% incidence in the control group (P less than 0.05). These results demonstrate that the expression of lectin-binding sites in human large intestinal goblet mucin is specifically altered in inflammatory bowel disease, indicating that there are changes in glycosylation of colorectal mucin consistent with alterations in goblet cell differentiation.

Adolescent↗
PubMed1999

Radioautographic studies on radiosulfate incorporation in the digestive organs of mice.

The sulfate uptake and accumulation in mouse digestive organs were studied by light microscopic radioautography. Two litters of normal ddY mice 30 days after birth, each consisting of 3 animals, were studied. One litter of animals were sacrificed 30 min after the intraperitoneal injections with phosphate buffered Na2(35)SO4, and the other litter animals were sacrificed 12 hr after the injections. Then several digestive organs, the parotid gland, the submandibular gland, the sublingual gland, antrum and fundus of the stomach, the duodenum, the jejunum, the ileum, the caecum, the ascending colon and the descending colon were taken out. The tissues were fixed, dehydrated, embedded in epoxy resin, sectioned, picked up onto glass slides, coated with radioautographic emulsion by a dipping method. AFter the exposure, they were developed, stained with toluidine blue and analyzed by light microscopy. As the results, many silver grains were observed on serous cells of the salivary glands, mucosa and submucosa of the stomach, villous cells and crypt cells of the small intestines and whole mucosa of the large intestines at 30 min after the injection. Then at 12 hr after the injection silver grains were observed on mucous cells of the salivary glands, some of the stomach glands, and mucigen granules of goblet cells in the small intestines and the large intestines. The numbers of silver grains observed in respective organs at 30 min were less than those at 12 hr. From these results, it is concluded that glycoprotein synthesis was demonstrated in several digestive organs by radiosulfate incorporation. In the salivary glands the silver grains were more observed in serous cells at 30 min, while in mucous cells more at 12 hr than 30 min after the injection. In other organs the silver grains were more at 30 min than at 12 hr. These results show the time difference of glycoprotein synthesis in respective organs.

Animals↗
PubMed2000

Malignant colonic obstruction due to extrinsic tumor: palliative treatment with a self-expanding nitinol stent.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of self-expanding nitinol stents for palliative treatment of malignant colorectal obstruction caused by unresectable extrinsic tumor, colorectal metastasis, or peritoneal seeding. SUBJECTS AND METHODS: One covered stent and 10 uncovered stents were deployed in eight patients with colorectal obstruction due to extrinsic tumor under fluoroscopic guidance. The sites of obstruction were located in the rectum (n = 5), in the rectosigmoid colon (n = 2), and from the transverse colon to the descending colon (n = 1). Clinical usefulness and complications were analyzed. RESULTS: Stents were placed successfully in all patients. Minor modifications of the delivery system were required in the tortuous rectosigmoid and lower rectum strictures. Symptoms of obstruction were initially resolved in all but one patient. In that patient, the presence of other points of obstruction was suspected. Bowel obstruction recurred in two patients: one obstruction was due to migration of a covered stent 4 days after the procedure, and the other obstruction was due to peritoneal seeding 33 days after the procedure. Both required colostomy or ileostomy. All patients died 12-111 days after stent placement (mean, 56 days). In five patients (63%), colonic obstruction was palliated by placing a stent until the patients' death between 39 and 111 days after stent placement (mean, 62 days). Six complications occurred in four patients and included stent migration (n = 1), anal bleeding (n = 2), anal pain that required analgesia (n = 1), and fever (n = 2). CONCLUSION; This self-expandable nitinol stent adequately palliated 63% of patients with colonic obstruction due to extrinsic tumor in this small series. Patient selection is very important to the success of this treatment.

Alloys↗
PubMed1999

Collagenous colitis: a practically orientated approach to diagnosis.

The condensed article reports the results of 40 women and 16 men with a mean age of 59 +/- 2.6 years diagnosed with collagenous colitis between 1980 and 1993 at the UCLA Medical Center. Diarrheal symptoms lasted from 3 months to 15 years and a total of 291 biopsies were obtained from four sites in the large intestine (rectum and sigmoid colon, n = 141; descending colon, n = 60; transverse colon, n = 46; cecum and ascending colon, n = 44). Fifty randomly selected specimens from 30 patients were independently investigated to test concordance of histopathologic interpretation. Thickness of collagen band, inflammatory cells, and epithelium were assessed by grading with H&E stained sections; measurement of the subepithelial collagen band on trichrome-stained sections was compared with the subjective grading. The results of the study appeal both to endoscopists and histologists: 1) If sigmoidoscopy is applied in the differential diagnosis of diarrhea, biopsies including the most proximal extent visualized, are mandatory. 2) Inflammatory changes parallel the collagen deposition. 3) Subjective sensitivity in the estimation of collagen thickness in H&E stained slides is low. 4) Collagenous colitis without increase of inflammatory cells and a special type of collagen deposition is doubtful.

Adult↗
PubMed2000

[Injury of large intestine in urgent surgery].

The results of examination and surgical treatment of 108 patients (93 males, 15 females), aged from 19 to 73 years, with large intestine injuries of different origin are presented. Large intestine injuries as a result of stab-incised abdominal wounds was in 58 patients, gunshot wounds--in 29, blunt trauma--in 21. The diagnosis of large intestine injuries was based on clinico-laboratory, X-ray and instrumental examinations. The injury of blind intestine was revealed in 8 patients, ascending colon--in 11, transverse colon--in 39, descending colon--in 5, sigmoid colon--in 45. All the patients were operated. The method of choice in the surgical treatment of these injuries was suturing of damaged portion of large intestine, which was performed in 72 patients. In 14 patients the suturing was complemented by decompressive colostomy, in 3--by extraperitonisation of the damaged site, in 4--by extraperitonisation and decompressive colostomy, in 2--by terminal ileostomy. Resection of damaged intestinal segment with primary anastomosis was performed in 4 patients, right-side hemicolectomy--in 7, Hartmann's operation--in 17, resection of large intestine with bitrunk colostoma creation--in 3, transfer of damaged segment of large intestine--in 5. Repeated operations for intestine integrity repair and fistula closure were performed in 47 patients. 18 (16.7%) patients died after operation as a result of peritonitis (7), shock and acute hemorrhage (10), denutrition due to intestinal fistula (1).

Abdominal Injuries↗
PubMed2002

Spiral hydro-CT in the evaluation of colo-sigmoideal cancer.

PURPOSE: To evaluate the accuracy of spiral hydro-CT in the diagnosis and preoperative staging of colo-sigmoideal neoplasms and the impact of this technique on therapeutic decisions. MATERIALS AND METHODS: Sixty patients with colo-sigmoideal neoplasms, 16 in caecum-ascending colon, 2 in transverse colon, 14 in descending colon, and 28 in sigmoid colon, diagnosed with fiberoptic colonoscopy and histopathological specimen, under-went spiral hydro-CT with IV contrast medium administration. Local invasion (T factor) and nodal involvement (N factor) were evaluated. In all cases, the CT reports were compared with the result of the histopathological examination of the surgical specimen. TNM and Dukes staging classifications were applied. RESULTS: Local invasion was correctly identified in 80% of cases. There was overstaging in 18.3% and understaging in 1.7% of the patients. Sensitivity, specificity and accuracy for nodal involvement were 57.9%, 67.5% and 63.3%, respectively. There was overstaging in 23.3% and understaging in 15% of patients. With Dukes classification, CT correctly staged 38.8% of patients. Significant differences were detected in different stages. The stage with the highest concordance was A/B1 with 58.8% (10/17), whereas the one with the lowest concordance was B2 with 9.1% (2/22). All of the three patients in stage D were correctly staged and none of the patients with stage C was overstaged. CONCLUSIONS: Spiral hydro-CT with intravenous contrast medium administration, despite the limits in the correct evaluation of local depth invasion and nodal involvement, proved useful for selecting patients likely to benefit from surgery.

Adult↗
PubMed2003

[Clinical application of three-dimensional imaging with multislice CT for laparoscopic colorectal surgery].

PURPOSE: Laparoscopic colorectal surgery, while minimally invasive, is a complicated technique. Therefore, prior to this surgery, it is important to determine the anatomical information of colorectal cancer. MATERIALS AND METHODS: Fifty-eight cases of patients with a confirmed diagnosis of colon cancer [caecal (n = 4), ascending colon (n = 6), transverse colon (n = 7), descending colon (n = 2), sigmoid colon (n = 22), and rectal (n = 17) cancer] were evaluated using multislice CT before laparoscopic surgery. CT examination was performed in an air-filled colorectum by colon fiberscopy. Contrast-enhanced images on multislice CT were obtained at arterial and venous phases. All images were reviewed on a workstation, and three-dimensional (3D) images of vessels, colorectum, cancer, and swollen lymph nodes were reconstructed by volume rendering and fused (integrated 3D imaging). We evaluated the usefulness of integrated 3D imaging with multislice CT for laparoscopic colorectal surgery. RESULTS: Integrated 3D imaging demonstrated clearly the distribution of arteries feeding the colorectal cancer and the anatomical location of colorectal cancer and arterial and venous systems. Moreover, measurement of the distance between the aortic bifurcation and the origin of the inferior mesenteric artery and that between the base of the inferior mesenteric artery and the origin of the left colic artery on integrated 3D imaging contributed to safe, prompt ligation of the vessels and excision of lymph nodes. CONCLUSION: Integrated 3D imaging with multislice CT was useful for simulation of laparoscopic colorectal surgery.

Colorectal Neoplasms↗