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PubMed2004

[Ulcerative colitis--contemporary morphological criteria].

Regular bioptical examinations of patients with ulcerative colitis (UC) performed in recent years show that the inflammatory changes of the mucosa of the large intestine are not necessarily diffuse, and that their extent may vary in the course of the disease. To establish the diagnosis of UC and to assess the treatment efficacy it is important to examine histologically multiple mucosal specimens from different levels of the large intestine. In our series of 27 patients with ulcerative colitis (18 men and 9 women at the age of 17 to 76 years), active or active and inactive pancolitis was diagnosed in 25 cases (93%). In 11 of these, the whole of the large intestine was affected. Two patients showed diffuse pancolitis without caecal involvement, in 5 cases there was inactive inflammation in the rectum or in the sigmoid colon. Seven patients had active colitis of the rectum and sigmoid. In another 2 patients (7%), the inflammation was limited to several segments of the large intestine only (the descending colon, and the descending and transverse colon). On bioptical examination of 6 patients repeated after 2-29 months (mean 14 months), there were changes in the distribution and appearance of the inflammation. Thus our findings correspond with the results of previous studies: UC does not always affect the mucosa of the large intestine diffusely. Further, the extent and distribution of inflammatory changes vary in the course of the disease.

Adolescent↗
PubMed2001

Subsite-specific incidence rate and stage of disease in colorectal cancer by race, gender, and age group in the United States, 1992-1997.

BACKGROUND: Subsite specific incidence rates of colorectal cancer vary considerably by age, gender, and race. This variation may be related not only to distinctions in exposure to genetic and environment factors but also to current strategies of early detection screening. Patterns of stage of disease in anatomic subsite may reflect the effect of screening. This study used the largest aggregation of cancer incidence data in the U.S. to examine subsite specific incidence rates of colorectal cancer and the relation of stage of disease to anatomic subsites by race, gender, and age group. METHODS: Data on the incidence of invasive colorectal cancer were obtained from 28 population-based central cancer registries. Age-specific and age-adjusted rates and stage distributions were analyzed by subsite, race, and gender. RESULTS: The impact of screening can be observed in the percentage of localized disease, which increased from 31.9% among cancers in the proximal colon to 37.0% in the descending colon to 41.5% in the distal colorectum. Within the same subsite, blacks were less likely than whites to receive a diagnosis of localized disease and more likely to receive a diagnosis of distant disease whereas stage distributions were approximately the same for males and females. Blacks were more likely than whites to receive a diagnosis of proximal colon cancer than distal colorectal cancer. The male-to-female rate ratios progressively increased from the proximal colon to the distal colorectum. The ratios of proximal-to-distal colorectal cancer gradually increased with advancing age. CONCLUSIONS: Differentials in stage of disease by subsites indicate a need for a targeted effort at early detection of cancer in the proximal colon. Risk factors and higher risk populations for colorectal cancers in each subsite need to be studied further to guide actions for improving the efficacy of screening.

Age Factors↗
PubMed1996

Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis.

The technical flaws that result in a leak from a low colorectal or a coloanal anastomosis are inadequate blood supply and tension on the suture line. An adequate blood supply is dependent on a patent and nontraumatized marginal artery. Lack of tension is achieved by gaining added length from the left colon through the release of its abdominal attachments. This chapter describes the maneuvers that allow progressive release of the left colon to provide a tension-free anastomosis to the low rectum, even with extensive resections of the sigmoid colon and portions of the descending colon. In most instances a well-vascularized and tension-free stapled anastomosis does not require a diverting ostomy. These maneuvers will result in a safer and less expensive colorectal resection.

Anal Canal↗
PubMed2005

[Open colon surgery].

Open resection of the colon is one of the most frequent abdominal operations, which clearly indicates the great importance of colon carcinomas. The surgical aim is resection of the affected intestinal region and the according lymph drainage region. In this respect, the techniques employed are strictly standardized: right hemicolectomy for right colon carcinoma, transverse resection for right colon carcinoma, left hemicolectomy for descendent colon carcinoma, and sigmoid resection for sigmoid carcinoma. In case of benign underlying disease, the operational method depends largely on the extent to which the intestine is affected and can include anything from simple colotomy and polyp removal to colectomy for toxic megacolon. Elective colon surgery is usually primary, but in emergencies a protective stoma might be necessary. Standardized indication and operational techniques enable low perioperative mortality and complication rates that make open colon resection usually un-problematic even in very old patients.

Anastomosis, Surgical↗
PubMed2002

Dry preparation for virtual CT colonography with fecal tagging using water-soluble contrast medium: initial results.

The purpose of this study was to evaluate the feasibility of a dry bowel preparation, i.e. without laxative fluids, for virtual CT colonography (VCTC), and its impact on patient acceptance compared with conventional colonoscopy (CC). A randomly chosen patient population scheduled for CC ( n=11) was first submitted to VCTC after a dry preparation, consisting of low-residue meals combined with a small amount of a iodinated water-soluble contrast medium during each meal 3 days before VCTC. In different colon segments and between different persons, the degree of tagging in VCTC was evaluated and graded. Patient acceptance and future preference were assessed for both preparations as well as for both investigations. The mixing of the contrast with the intestinal content results in contrast impregnated stool, the tagged feces. The degree of fecal tagging was good in the majority of the patients and the colonic segments, especially in the descending colon and sigmoid. Furthermore, patient acceptance and preference were clearly in favour of VCTC compared with CC merely because of the non-invasiveness of the dry preparation. Dry bowel preparation and VCTC is a promising approach towards a patient-friendly colon cancer-screening setup.

Adult↗
PubMed2004

Colonic obstruction caused by adhesive splenomegaly: report of a case.

INTRODUCTION: Splenomegaly caused by hematologic or infectious diseases is a well-known complication that may cause discomfort because of increased intra-abdominal pressure; however, complete obstruction of the large bowel usually never occurs. METHODS: We present a case of a 76-year-old male with polycythemia vera admitted with symptoms of complete colonic obstruction. At operation, the descending colon was found to be completely obstructed by a large adhesive spleen. Incision of the adhesions, complete colonoscopy, and mobilization of the colon was performed. RESULTS: Afterward, the patient had a normal colonic function; however, four days later he had a magnetic resonance-confirmed cerebral thrombosis followed by an episode of aspiration pneumonia, which he died of ten days after the operation. CONCLUSIONS: Colonic obstruction caused by splenomegaly is extremely rare, but may happen in patients with hematologic diseases.

Aged↗
PubMed1976

Gunshot wounds of the colon. A review of 100 consecutive patients, with emphasis on complications and their causes.

The cases of one hundred civilian patients with gunshot wounds of the colon treated at the Louisville General Hospital have been reviewed. Most injuries were in the transverse colon (44%), followed by the ascending colon (27%), rectosigmoid (19%), and descending colon (10%). Associated injuries occurred in 81 per cent of the patients; the small bowel was the most common structure injured. Primary closure was used in 52% of the patients, with a resultant 19% rate of wound infection and 14% rate of serious complication. When the extent of contamination or tissue destruction required resection, an attempted primary anastomosis was followed by a high rate of wound infection (57%) and serious complications (36%) as compared with end-colostomy and mucous fistula, which resulted in a 24% rate of wound infection and 24% rate of serious complication. The rate of wound infection between these groups is significant (p = 0.05). Results end-colostomy and mucous fistula were better than with attempted primary anastomosis.

Bacterial Infections↗
PubMed1999

Clinical applications of the Monti procedure as a continent catheterizable stoma.

OBJECTIVES: Monti et al. recently described a technique for the construction of a continent catheterizable conduit using short segments of small bowel in a canine model. We review our experience with 25 adult and pediatric patients in whom the Monti procedure was used in their reconstructive efforts. METHODS: Since October 1995, 25 patients (13 males and 12 females), aged 4 to 67 years (median 29), underwent the construction of 29 catheterizable stomas with a short (2.5 cm) segment of bowel following the Monti technique. Twenty-seven tubes were created as urinary stomas and two as part of the Malone antegrade continent enema procedure (MACE). Continence is based on the Mitrofanoff flap valve mechanism. Tubes were created when the appendix was unavailable as part of urinary reconstructive efforts or after exenterative oncologic surgery of the lower urinary tract. Tubes were created using ileum (24) and sigmoid colon (5). Ten tubes (34.5%) were done in combination with a simultaneous bowel patch in the same pedicle for bladder augmentation. Tubes were implanted in the ileum (13), bladder (9), sigmoid colon (3), stomach (1), and descending colon (1). The two tubes created to do a MACE procedure were anastomosed into the cecum. Double tubes were necessary in 7 adult patients for adequate length. The length of the tubes varied from 6 to 14 cm. RESULTS: Follow-up ranged between 3 and 26 months (mean 13). One adult patient (4%) with bladder cancer died of myocardial infarction 14 days postoperatively. Three patients (12%) received a new Monti tube because of ischemic stenosis of the tube. All of them were continent at a follow-up of 1, 6, and 20 months, respectively. Two patients (8%) experienced leakage through the stoma, requiring additional procedures and pharmacologic manipulation to become continent. All patients used intermittent catheterization through the stoma without problems. CONCLUSIONS: Although the appendix remains the tissue of choice, the Monti procedure has substantial advantages over other efferent catheterizable tubes, including the need for a very short segment of bowel (2.5 cm), adequate lumen size (16F to 18F), length, reliable blood supply, and the versatility to combine with a simultaneous bowel patch in the same pedicle for bladder augmentation.

Adolescent↗
PubMed2002

Neuropeptide Y, Y1, Y2 and Y4 receptors mediate Y agonist responses in isolated human colon mucosa.

1. The aim of this study was to provide a pharmacological characterization of the Y receptor types responsible for neuropeptide Y (NPY), peptide YY (PYY) and pancreatic polypeptide (PP) effects upon electrogenic ion transport in isolated human colonic mucosa. 2. Preparations of descending colon were voltage-clamped at 0 mV in Ussing chambers and changes in short-circuit current (I(sc)) continuously recorded. Basolateral PYY, NPY, human PP (hPP), PYY(3 - 36), [Leu(31), Pro(34)]PYY (Pro(34)PYY) and [Leu(31), Pro(34)]-NPY (Pro(34)NPY) all reduced basal I(sc) in untreated colon. Of all the Y agonists tested PYY(3 - 36) responses were most sensitive to tetrodotoxin (TTX) pretreatment, indicating that Y(2)-receptors are located on intrinsic neurones as well as epithelia in this tissue. 3. The EC(50) values for Pro(34)PYY, PYY(3 - 36) and hPP were 9.7 nM (4.0 - 23.5), 11.4 nM (7.6 - 17.0) and 14.5 nM (10.2 - 20.5) and response curves exhibited similar efficacies. The novel Y(5) agonist [Ala(31), Aib(32)]-NPY had no effect at 100 nM. 4. Y(1) receptor antagonists, BIBP3226 and BIBO3304 both increased basal I(sc) levels per se and inhibited subsequent PYY and Pro(34)PYY but not hPP or PYY(3 - 36) responses. The Y(2) antagonist, BIIE0246 also raised basal I(sc) levels and attenuated subsequent PYY(3 - 36) but not Pro(34)PYY or hPP responses. 5. We conclude that Y(1) and Y(2) receptor-mediated inhibitory tone exists in human colon mucosa. PYY and NPY exert their effects via both Y(1) and Y(2) receptors, but the insensitivity of hPP responses to either Y(1) or Y(2) antagonism, or to TTX, indicates that Y(4) receptors are involved and that they are predominantly post-junctional in human colon.

Aged↗
PubMed2001

Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction.

BACKGROUND: Colonoscopic decompression has been attempted in patients with acute colonic obstruction caused by colon cancer to avoid emergency surgery and multiple subsequent operations but has usually been unsuccessful. This is an evaluation of the usefulness of a new device for endoscopic decompression in these patients. METHODS: Nine consecutive patients (6 men, 3 women; 65 to 89 years of age) with acute colonic obstruction resulting from colon cancer underwent endoscopic decompression with a Dennis Colorectal Tube. RESULTS: In all 9 patients (1 with carcinoma of the sigmoid colon, 3 with carcinoma of descending colon, 2 with carcinoma of the transverse colon, 2 with carcinoma of the ascending colon, and 1 with carcinoma of the cecum), endoscopic decompression was successful. After decompressing and cleansing the colon for several days, a one-stage operation was possible in all patients. CONCLUSION: Dennis Colorectal Tube is an excellent device for endoscopic decompression of acute, malignant colonic obstruction.

Acute Disease↗
PubMed1987

Extensive gastric varices demonstrated by technetium-99m red blood cell scintigraphy.

An alcohol abuse patient complicated by chronic pancreatitis had splenic vein thrombosis leading to gastric varices and underwent abdominal Tc-99m red blood cell scintigraphy. First pass study, sequential images up to 1 hour, and a 2.5 hour image showed abnormal radioactivity in the left side of the abdomen and midabdomen. In 24 hour images, the high level of activity in the left side persisted; in addition, there was accumulation of radioactivity in the cecum, ascending, transverse colon, the splenic flexure, and descending colon. A splenectomy was performed and during the surgical procedure, a large dilated vein in the greater omentum was noted. It is reemphasized that delayed imaging up to 24 hours is important when the results of earlier images are equivocal or negative.

Alcoholism↗
PubMed1990

Ciprofloxacin absorption in different regions of the human gastrointestinal tract. Investigations with the hf-capsule.

1. The absorption of ciprofloxacin from different regions of the human gastrointestinal tract was investigated in four healthy males using a remote-controlled drug delivery device (hf-capsule). 2. Significant differences in AUC were observed in the control study (oral administration of ciprofloxacin solution without the hf-capsule = 100%) and after release of ciprofloxacin in the jejunum (geometric mean: 37%), the ileum (mean: 23%), the ascending colon (mean: 7%) and the descending colon (mean: 5%), whereas tmax showed no difference for any of the absorption sites. Ciprofloxacin release in the stomach resulted in the greatest AUC (mean: 140%). Thus, it is concluded that the main absorption site of ciprofloxacin is the upper gastrointestinal tract, up to the jejunum. 3. Differences in presystemic metabolism of known drug metabolites along the gut could be excluded, as the pattern of urinary recovery of desethylene-, sulpho-, and oxo-ciprofloxacin and the parent compound was similar for all drug release sites.

Administration, Oral↗
PubMed2001

Nonspecific bowel activity in imaging inflammation with Tc-99m labelled monoclonal anti-NCA-90 Fab' fragment MN3.

AIM: Since the Tc-99m labelled monoclonal anti-NCA 90 granulocyte antibody Fab' fragment MN3 (MN3 Fab') might be of interest for imaging abdominal inflammation which could be hampered by nonspecific bowel activity, we prospectively investigated the appearance of bowel activity in MN3 Fab' imaging. METHODS: Eighty consecutive patients (age range 12-85 years) referred for suspected nonabdominal, mostly musculoskeletal infection, were included. Abdominal inflammation was excluded clinically and there were no signs of inflammatory bowel disease in the patients' histories. One, 5, and 24 hours after intravenous injection of up to 1.1 GBq of MN3 Fab' planar images of the abdomen were performed. Bowel activity was graded visually using a 5-point scale. RESULTS: The one (N = 80), 5 (N = 79), and 24 (N = 52) hour images revealed 46 (10%), 162 (34%), and 173 (55%) accumulating bowel segments, respectively, in 37 (46%), 69 (87%), and 52 (100%) patients. The mean intensity score per accumulating segment was 1.1, 1.8 and 2.7 (p = 0), respectively. Relative frequencies of appearance of the small intestine were 38%, 57%, and 21%, ileocaecal region 6%, 53%, and 48%, ascending colon 5%, 67%, and 89%, transverse colon 1%, 9%, and 69%, descending colon 8%, 15%, and 67%, and rectosigmoid 0%, 4%, and 38%, respectively. Follow-up investigations in 13 patients revealed diverging uptake patterns. CONCLUSION: Nonspecific bowel activity is often present in the early and almost always and more intense, in the delayed images. Early imaging at one hour after administration seems feasible, but a loss in sensitivity has to be considered. Thus, nonspecific bowel activity can be anticipated to be a pitfall in imaging abdominal inflammation with MN3 Fab'.

Abdomen↗
PubMed2006

[Necrosis of epiploic appendages of the colon].

Fifty-two patients with necrosis of epiploic appendages (EA) of the colon were treated. Necrosis of EA of the appendix was diagnosed in 4 (7,7%) patients, caecum - in 7 (13,5%), ascending colon - in 5 (9,6%), descending colon - in 2 (3,8%), and sigmoid colon - in 34 (65,4%) cases. Multiple necrosis was revealed in 3 (5,8%) patients. Surgical treatment of these patients is radical and justified. It prevents progress of destruction and development of complications. Long-term results are evaluated for the first time.

Adult↗
PubMed1990

[Clinical aspects and therapy of intestinal non-rotation in adults].

The intestinal non-rotation is a rare fetal disorder of the gut torsion. Its manifestation is very rarely seen in the adult, either in form of a volvulus of the midgut or ileocecal with an acute onset, or as chronic recurrent abdominal pain. Each diagnostic or therapeutic delay increases the risk of strangulation and may end as an abdominal disaster. We describe three own cases and we try to elucidate the diagnostic and therapeutic problems. Our proceeding: In the acute symptomatic form the explorative laparotomy with a consequent staging of the abdominal situs is the safest way to get an exact diagnosis. Therapeutically the procedure described by LADD is the best torsion prophylaxis; the ascending colon is sawn to the descending colon. Due to a paratopia, the appendectomy is recommended. In the chronic forms the contrast enema and the gastrointestinal barium study are the main diagnostic procedures. In the operation described by Fitzgerald and the ascending colon and the mesentery of the small bowel are--after incision of the common mesentery--fixed at their anatomical site.

Cecum↗
PubMedDate not supplied

[Perforated carcinoma of the colorectum. Computerized tomography findings].

PURPOSE: To describe the possible CT features of perforated colorectal tumors and to discuss the practical value of detecting this complication. MATERIAL AND METHODS: The CT examinations of 16 patients with perforated large bowel neoplasms were retrospectively reviewed. The most frequent locations were the sigmoid colon (6 cases), the cecum and ascending colon (4 cases) and the descending colon (4 cases). A correlation with barium enema findings was possible in 12 patients while in 14 subjects surgical confirmation was obtained. RESULTS: The colorectal neoplasm was depicted on CT scans in 94% of cases, as a mural thickening or a mass, and was usually in the advanced stage. Phlegmonous tissue was shown only in 19% of the cases, while an abscess was detected in 81%, more frequently appearing as a well-defined fluid-filled collection near the tumor. Large bowel enema was positive for perforated neoplasm only in 5 cases. CONCLUSION: CT demonstrates perforated colorectal tumors better than conventional methods, which is a relevant information for both surgery and prognosis. In the diagnostic phase CT is indicated when clinical and/or barium enema findings are atypical. In the staging phase, the detection of this complication represents a valuable information.

Adult↗
PubMed1991

[New aspects of the ontogenetic development of the human colon].

The parts of the fetal colon--later retroperitoneally located (ascending and descending colon)--were examined in 31 human fetuses in order to determine their ontogenetic formation, position, and dorsal attachment. The present data cast doubt upon so-called "descending of the caecum" described in current textbooks of embryology. Considering the literature available a new concept of the formation of the right colon flexure and the ascending colon is presented.

Cecum↗
PubMed1998

Endoluminal stenting for benign colonic obstruction.

We report a case of complete descending colon obstruction due to diverticular disease that was initially managed by endoscopic stent placement followed by single-stage left colectomy with primary anastomosis. Traditional management of complete large bowel obstruction, whether due to benign or malignant disease, most often requires a temporary colostomy because of unprepared colon. In this case, preparation of the colon was accomplished by successful stenting of the benign colonic obstruction. We believe that endoscopic colonic stenting is an effective way of avoiding a temporary colostomy in patients with complete large bowel obstruction.

Colonic Diseases↗