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PubMed2003

Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature.

BACKGROUND: Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. As this condition is not widely appreciated by pathologists or clinicians, we describe herein a case of colonic polyposis and sigmoid colonic carcinoma with obstructive colitis. PATIENT PRESENTATION: A 47-year-old Taiwanese woman presented to Cardinal Tien Hospital with a 3-day history of acute onset of abdominal pain, vomiting, and watery diarrhea. A lower gastrointestinal series using water-soluble contrast medium revealed annular narrowing of the sigmoid colon and showed polyposis at the rectosigmoid colon and regional colitis over the proximal descending colon. She was treated by total colectomy. Microscopic sections showed poorly differentiated adenocarcinoma, tubular adenomas, and a segment of obstructive colitis measuring 25 cm in length 5 cm proximal to the colon tumor. The tumor was also retrieved for simultaneous analyses of replication error and loss of heterozygosity. A total of three instances of loss of heterozygosity were demonstrated at the P53, MET, and D8S254 gene loci. No examples of replication error were detected. CONCLUSION: Obstructive colitis can cause diagnostic and therapeutic problems. Colitis areas may be a source for septicemia or may perforate and lead to peritonitis. The frequently normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications. Awareness of the features and incidence of obstructive colitis should help physicians avoid these diagnostic and therapeutic problems.

Adenocarcinoma↗
PubMed1985

Ca2+ channel blockers stimulate ileal and colonic water absorption.

The effects of calcium channel blockers on water transport in the rat ileum and distal colon were studied in vivo using the single-pass perfusion technique. Parenteral but not intraluminal verapamil, and parenteral nifedipine increased ileal water absorption, with effects lasting at least 60 min. In contrast, i.p. verapamil had no effect on rat distal colonic water absorption, whereas intraluminal verapamil significantly stimulated colonic water absorption. Similarly, perfusing the rat descending colon with low-Ca2+ Ringer's-HCO3 stimulated colonic water absorption. Verapamil was not antisecretory because the theophylline-induced decrease in ileal water transport was similar in control animals and in animals pretreated with i.p. verapamil. In addition, nifedipine stimulated active Na and Cl absorption in rabbit ileum. These studies demonstrate that the Ca2+ channel blockers verapamil and nifedipine stimulate basal absorption of water in rat ileum and distal colon in vivo, and stimulate active Na and Cl absorption in rabbit ileum in vitro. The verapamil stimulation of colonic water absorption from the luminal surface was duplicated by perfusion with a low-Ca2+ bathing solution. This suggests the presence of apical membrane Ca2+ channels in rat colon, which appear to be involved in regulation of basal water transport, and that these Ca2+ channels are in a partially open state under basal conditions. Because verapamil stimulates absorption systemically (ileum) as well as intraluminally (colon), Ca2+ channel blockers have properties that might be useful in treatment of diarrheal diseases.

Animals↗
PubMed1987

Serial observations of colonic carcinogenesis in the rat. Premalignant mucosa binds Ulex europeus agglutinin.

We evaluated certain histochemical tests for their ability to detect premalignant mucosa in the dimethylhydrazine model of colonic carcinogenesis. Biweekly colonoscopic biopsies of the descending colon were performed for 29 wk in control and dimethylhydrazine-treated rats. Biopsy specimens of the splenic flexure, rectum, and any visualized tumors were taken. The specimens were stained with periodic acid-Schiff to detect neutral mucins, high-iron diamine alcian blue to detect sialylated and sulfated mucins, fluoresceinated peanut agglutinin, and fluoresceinated Ulex europeus agglutinin. None of the first three tests consistently detected premalignant mucosa. However, Ulex europeus agglutinin, which bound to only 3% of control biopsy specimens throughout the course of the study, bound to increasing numbers of biopsy specimens in the dimethylhydrazine-treated animals, reaching a maximum of 90% positivity by 13-16 wk. Moreover, Ulex europeus agglutinin bound strongly to all biopsy specimens from tissues adjacent to tumors and to 93% of tumors. Mucosal atrophy and focal dysplasia were present more frequently in specimens taken from the rectum (but not the splenic flexure) of dimethylhydrazine-treated animals than of control animals, but there was no correlation between the histochemical markers and either atrophy or dysplasia. We conclude that Ulex europeus agglutinin binding is a consistent feature of premalignant colonic mucosa in dimethylhydrazine-treated rats.

Animals↗
PubMed1992

Ileocolonic transit does not change after right hemicolectomy.

The role of the human ileocolonic junction in the transit of solid contents through the entire gut was evaluated. Eight patients, well compensated after right hemicolectomy for localized colon cancer, and eight age-matched healthy controls were enrolled. Scintigraphic transit was quantified after subjects ingested a mixed meal containing 111In-labeled Amberlite beads (average diameter, 1 mm; Sigma Chemical Co., St. Louis, MO). Gastric emptying was initially faster in the postoperative group, but overall emptying was not different from controls; small bowel transit also did not differ between the groups. In patients in whom the distal ileum, ileocolonic sphincter, and proximal colon were absent, isotopes moved from small to large bowel in a manner that was qualitatively and quantitatively no different from that of controls. Major episodes of coloileal reflux could not be identified in either group. After hemicolectomy, the residual transverse colon, and to a lesser degree the descending colon, were able to store solid residue, although in lesser amounts than the unoperated large bowel. The ileocolonic sphincter in humans appears to play only a minor role, at most, in ileocolonic transit, and the colon remaining after right hemicolectomy stores residue so that bowel habits are not greatly disturbed.

Aged↗
PubMed1990

Blunt abdominal trauma causing a 'degloving injury' to the colon.

A case of an unusual degloving injury of the descending colon resulting from a crushing injury to the mid-torso is reported. The diagnosis was made at laparotomy for associated injuries. The colon was stripped of its muscle layers and mesentery for 10 cm without perforation.

Abdominal Injuries↗
PubMed1975

Detection of carcinoembryonic antigen in tissue sections by immunoperoxidase.

A triple-bridge, indirect, immunoperoxidase method for detecting and localizing carcinoembryonic antigen (CEA) in tissue sections is described. By this technique, a cell-surface localization of CEA in colonic carcinoma and ovarian mucinous cystadenocarcinoma cells could be visualized. In the case of the colonic cancer, both the tumor from the descending colon and a metastasis to the skin gave positive peroxidase reactions for CEA. This immunocytochemical method for demonstrating the presence of CEA functioned in both frozen, ethanol-fixed and formalin-fixed, paraffin-embedded tissues, thus making it applicable for use with tissue sections conventionally prepared for light microscopy.

Adenocarcinoma↗
PubMed2000

Colon pouch (Mainz pouch III) for continent urinary diversion after pelvic irradiation.

OBJECTIVES: Urinary diversion after previous pelvic irradiation is challenging. The use of irradiated bowel in particular is associated with an increased rate of early and late complications. We therefore performed continent cutaneous urinary diversion using exclusively nonirradiated bowel segments in this group of patients. METHODS: A continent colon pouch for urinary diversion was performed in 44 female patients after pelvic irradiation. The indications were irreparable vesical fistula in 20, local recurrence of gynecologic tumors in 22, and radical cystectomy for bladder cancer in 2 patients. Depending on the length of the nonirradiated bowel segment, a transverse-ascending colon pouch (n = 8) or transverse-descending colon pouch (n = 36) was performed. The efferent segment was created from a tapered bowel segment embedded in the pouch wall. The ureters were implanted using a submucosal (n = 67) or subserosal (n = 17) extramural tunnel. RESULTS: No pouch-related complications were observed during the immediate postoperative period. In long-term follow-up (mean 52.2 months), upper urinary tract dilation was seen in five renal units. All five of these had been dilated preoperatively, and none required ureteral reimplantation. Incontinence occurred in 2 patients; both underwent reoperation with subsequent continence. Umbilical stoma stenosis was observed in 6 patients. CONCLUSIONS: The technique of the colon pouch for continent urinary diversion in previously irradiated patients is safe and has a low complication rate. The use of nonirradiated bowel segments should be the method of choice in this group of patients.

Adult↗
PubMed1997

Standardization of barostat procedures for testing smooth muscle tone and sensory thresholds in the gastrointestinal tract. The Working Team of Glaxo-Wellcome Research, UK.

An international working team of 13 investigators met on two occasions to develop guidelines for standardizing the procedures used to test gastrointestinal muscle tone and sensory thresholds using a barostat. General recommendations were: (1) Use a thin-walled plastic bag that is infinitely compliant until its capacity is reached. Maximum diameter of the bag should be much greater than the maximum diameter of the viscus. (2) The pump should be able to inflate the bag at up to 40 ml/sec. (3) Pressure should be monitored inside the bag, not in the pump or inflation line. (4) Subjects should be positioned so that the bag is close to the uppermost surface of the body. (5) For rectal tests, bowel cleansing should be limited to a tap water enema to minimize rectal irritation. Oral colonic lavage is recommended for studies of the proximal colon, and magnesium citrate enemas for the descending colon and sigmoid. (6) If sedation is required for colonic probe placement, allow at least one hour for drug washout and clearance of insufflated air. Ten to 20 min of adaptation before testing is adequate if no air or drugs were used. (7) The volumes reported must be corrected for the compressibility of gas and the compliance of the pump, which is greater for bellows pumps than for piston pumps. (8) Subjects should be tested in the fasted state. For evaluation of muscle tone: (9) The volume of the bag should be monitored for at least 15 min. For evaluation of sensory thresholds; (10) It is recommended that phasic distensions be > or = 60 sec long and that they be separated by > or = 60 sec. (11) Sensory thresholds should be reported as bag pressure rather than (or in addition to) bag volume because pressure is less vulnerable to measurement error. (12) Tests for sensory threshold should minimize psychological influences on perception by making the amount of each distension unpredictable to the subject. (13) Pain or other sensations should be reported on a graduated scale; not "yes-no." The working team recommends verbal descriptor scales, containing approximately seven steps, or visual analog scales in which subjects place a mark on a straight line marked "none" on one end and "maximum" on the other end. (14) It is recommended that subjects should be asked to rate the unpleasantness of distensions separately from their intensity.

Animals↗
PubMed2001

Clinical results and development of variable-stiffness video colonoscopes.

BACKGROUND AND STUDY AIMS: This study was designed to assess the usefulness of variable-stiffness video colonoscopes, compared with conventional videoscopes. PATIENTS AND METHODS: The first prototype XCF-QAY1 and the latter prototype XCF-Q240A1 used in this study can be varied to 4 levels of stiffness of tube insertion during examination. In 352 consecutive colonoscopic examinations performed using these and two conventional scopes, the following data were recorded: time for intubation to the cecum, frequency of changes in the patients' posture, frequency of abdominal pressure attempts, and pain score. The degree of stiffness of the insertion tube and the examiners' impressions score were recorded only in procedures where the variable-stiffness scopes were used. RESULTS: There was no significant difference between colonoscopes in the pain score. Total colonoscopy rate was 97.4%. The frequency of usage of the varying stiffness control in the colon according to site was as follows: descending colon, 57.3%; transverse colon, 32.8%, sigmoid colon, 7.6%; and ascending colon, 2.3%. A significant difference in the mean time for intubation to the cecum between the XCF-Q240A1 and conventional scopes was observed. Moreover, there were significant differences in the frequency of abdominal pressure attempts and changes in the patient's posture between conventional scopes and the new scopes. CONCLUSIONS: These results suggest that only one scope, the XCF-Q240A1, is needed for any colonic examination by any examiner.

Aged↗
PubMed1995

Reversible ischemic colitis in young women. Association with oral contraceptive use.

Ischemic colitis, a condition of middle-aged to elderly patients, occurs uncommonly in younger persons. In this study, we describe the clinical and pathological features of 18 young adults (mean age, 29 years; age range, 17-39 years) with spontaneous ischemic colitis, 17 of whom were women. All presented with abrupt onset of severe, cramping abdominal pain followed by hematochezia. Colonoscopic visualization of the mucosa showed segmental hyperemia, friability, and erosion affecting the distal transverse colon (three cases), splenic flexure (three cases), descending colon (five cases), and sigmoid (seven cases). Mucosal biopsy documented superficial ischemic necrosis in seven patients; 11 patients had full-thickness mucosal necrosis with regeneration. Colonic mucosa proximal and distal to the ischemic segment was endoscopically normal in all patients and histologically normal in the eight patients in whom biopsies were obtained. All patients recovered with supportive care. Median duration of illness was 2.1 days (range, 1-4 days). Ten women (59%) were using low-dose estrogenic oral contraceptive agents, compared with the 1988 national average of 18.5% oral contraceptive users among females aged 15 to 44 years. The calculated odds ratio yielded a greater than sixfold relative risk for the occurrence of ischemic colitis among oral contraceptive users. In addition, four women not currently on hormonal contraceptive therapy had a past history of oral contraceptive use; the three remaining women were taking estrogen as replacement therapy after oophorectomy. In one patient, documented reversible ischemic colitis recurred on resumption of oral contraceptive use; four women reported symptoms and signs of recurrent ischemia but did not seek further medical evaluation. Our data indicate that transient colonic ischemia represents a form of acute segmental colitis in young adults; before the 5th decade of life, spontaneous ischemic colitis is a disorder found almost exclusively in women and is associated with the clinical use of exogenous estrogenic agents.

Adolescent↗
PubMed1977

Transient megacolon after gastroscopy.

A 38-year-old man who developed abdominal distention and pain following fiberoptic gastroscopy is described. The patient had had an upper gastrointestinal roentgenographic series earlier, and the dilatation of the colon was thought to be due to entrapment of air in the proximal colon secondary to inspissated barium in the descending colon. Premedication with meperidine hydrochloride and atropine also may have been contributory. A saline enema relieved the patient's symptoms and a barium enema examination later showed a normal colon.

Adult↗
PubMed2005

Contractile response to colonic distention is influenced by oscillation frequency.

Static colonic mechanical properties are characterized by stepwise balloon distention. It is unclear whether the state of contractile activation affects frequency-dependent differences in biomechanical properties. Our aim was to investigate the frequency-dependence of colonic mechanical properties by sinusoidal oscillation. A descending colonic balloon was sinusoidally oscillated by 25 mL at 5, 10 and 20 cpm in randomized order for 20 min at each frequency in six healthy subjects before and after neostigmine. Volume oscillation was between 75-100 mL before, and 25-50 mL after neostigmine. Pressure waveforms were most variable shortly after commencing oscillation, reflecting an initial contractile response to distention. Elastance (i.e. pressure response to imposed volume) and hysteresivity were estimated; hysteresivity represents the proportion of energy added to the system during inflation, which cannot be recovered during deflation. Colonic elastance was frequency dependent, being highest and most variable at 10 cpm. In contrast, hysteresivity was not significantly different across frequencies. Neostigmine increased mean colonic elastance at all frequencies, and hysteresivity only at 5 cpm. Thus, colonic mechanical properties, particularly elastance are frequency-dependent. The frequency-dependence of colonic mechanical properties is worthy of future study because it may provide insights into reflex responses in health and disease.

Acetylcholine↗
PubMed2002

Metallic stents in the treatment of benign diseases of the colon: preliminary experience in 10 cases.

PURPOSE: To assess the effectiveness of and complications associated with metallic stent placement for treatment of benign diseases of the colon. MATERIALS AND METHODS: With radiologic guidance, the authors placed metallic stents in 10 patients with benign diseases of the colon: Nine stents were placed in the rectosigmoid colon, and one was placed in the descending colon. The stents were placed in two cases of diverticulitis complicated by pelvic abscess, four cases of colonic fistula following surgery, and four cases of postsurgical anastomotic stricture. Coated stents were placed in the cases involving fistulas and diverticulitis. RESULTS: In the two cases of diverticulitis complicated by pelvic abscess, the coated stents helped to resolve the abscesses, but both patients subsequently developed complications: fistula and perforation. Of the four cases of colonic fistula, two were resolved with stent placement. In the four cases of postsurgical stenosis, the stents temporarily relieved the symptoms of obstruction, but additional treatments were required before the patients became entirely asymptomatic. CONCLUSION: Metallic stents may represent an effective temporary treatment for certain benign colonic conditions in the absence of other therapeutic alternatives.

Aged↗
PubMed2002

Rectal and colonic distension elicit viscerovisceral reflexes in humans.

Colonic transit is slowed in patients with disordered rectal evacuation, but the mechanism of this phenomenon is unclear. Our objective was to investigate rectocolonic inhibitory reflexes in humans to provide potential insight into patients with obstructed defecation. In 30 healthy subjects, a barostat-manometric assembly recorded colonic tone and phasic activity in the descending colon during rectal distension and recorded rectal tone during colonic distension. Phasic distensions were 8, 16, and 32 mmHg above balloon operating pressure, and staircase inflations were comprised of balloon inflation then deflation in 2-mmHg increments at 30-s intervals from 0 to 36 mmHg. Colonic balloon volumes increased to a similar extent during phasic rectal distensions 8, 16, and 32 mmHg above operating pressure, reflecting reduced colonic tone; balloon volumes also increased and phasic pressure activity decreased during staircase rectal distensions. In contrast, rectal balloon volume declined, reflecting increased tone during phasic and staircase colonic distensions. Thus rectal distension inhibited colonic motor activity, indicative of a viscerovisceral inhibitory reflex.

Adult↗
PubMed2005

Colo-colonic intussusception caused by a solitary Peutz-Jeghers polyp.

A case of acute large bowel obstruction by colo-colonic intussusception in a healthy 19-year-old man is presented. The lead point of the intussusception is a rare solitary colonic Peutz-Jeghers polyp in the descending colon of a man without the full Peutz-Jeghers syndrome. The clinical presentation, imaging findings on plain radiographs, single contrast enema and CT, and findings at colonoscopy and surgery are correlated with pathology results and a brief review of the literature.

Adult↗
PubMed2004

Determination of carcinoembryonic antigen levels in peripheral and draining venous blood in patients with colorectal carcinoma.

BACKGROUND: The problem of the relationship between blood carcinoembryonic antigen (CEA) levels and tissue CEA content in colorectal carcinoma, and the mechanisms for CEA release from tumor cells in tissue adjacent to the neoplasm is important to understanding the biology of colorectal carcinoma. It has not been adequately explained whether CEA in the peripheral blood is drained mainly by portal system blood or by the lymphatic system, or indeed by both systems. AIM: To study the behavior of CEA levels in peripheral blood (CEA-p) and venous effluent blood (CEA-d) among patients with colorectal tumors, who underwent curative operation. METHOD: A total of 28 patients were studied (12 male [42.9%] and 16 female [57.1%], mean age 66.1 years [range: 43 - 84]). Immediately after laparotomy, peripheral venous blood was extracted by antecubital venous puncture and venous effluent blood was collected from the main drainage vein of the lesions. Values of CEA-p, CEA-d and the gradient between CEA-d and CEA-p that were less than 5.0 ng/mL were considered normal. RESULTS: Eight (28.6%) patients were stage A in Duke's classification, nine (32.1%) stage B and 11 (39.3%) stage C. The neoplasm was located in the rectum of 14 patients (50.0%), in the transverse colon in five (17.9%), in the sigmoid in four (14.3%), in the cecum and/or ascending colon in three (10.7%), and in the descending colon in two (7.1%). The histopathological examination revealed well-differentiated adenocarcinoma in all the patients. Only one patient (3.6%), Duke's classification stage C, presented neoplasm with venous invasion. The gradient between the CEA-p and CEA-d levels were normal in 25 patients (88.3%) and high in three (10.7%). The mean value for CEA-p was 3.8 +/- 4.1 ng/mL (0.1-21.1 ng/mL) and for the drained CEA (CEA-d) it was 4.5 +/- 4.3 ng/mL (0.3-20.2 ng/mL), without significant difference between these values. There was a significant difference between the mean value for CEA-p and CEA-d levels greater than 5 ng/mL. CONCLUSION: The CEA-p and CEA-d levels in the colorectal carcinoma patients were not shown to be different. The results from this study suggest that, in colorectal neoplasm without venous invasion, there may not be notable CEA drainage from the tumor by the portal vein effluent blood.

Adenocarcinoma↗
PubMed1999

[A case of amyopathic dermatomyositis presenting blister and oral ulcer].

An 84-year old man was admitted to Mitoyo General Hospital because of progressive malaise and edematous erythema on both eyelids (Heliotrope erythema). He also noted blister on his neck as well as erythema on the extensor surface of finger joints (Gottron's sign), elbows and knees. Neither weakness nor pain of his proximal muscle was elicited on physical examination on admission. His blood test disclosed positive inflammatory signs (i.e., mild elevation of ESR and positive CRP) without elevated value of muscle enzymes. Electromyogram showed normal pattern. Infiltration of inflammatory cells was not revealed by histological examination of biopsied muscle. A diagnosis of 'amyopathic dermatomyositis' was made based on these observations. Computed tomography of his chest disclosed interstitial pneumonia spreading over both lower lung fields. Colon fiberscopy revealed a polyp in his descending colon, which was classified into group I on cytological examination. He was treated with two sets of methylprednisolone (mPSL) pulse therapy (500 mg/day, 3 consecutive days, intravenously) followed by 30 mg/day of oral prednisolone (PSL). His skin lesions responded well to the above treatment and the dose of oral PSL was tapered. One month after the initiation of treatment, severe stomatitis as well as a large ulcer beneath his tongue developed accompanying an intractable pain. Mucosal biopsy revealed necrotizing vasculitis in medium-sizedartery at the bottom of ulcer. Another set of mPSL pulse therapy brought a prompt relief of his symptom and prohibited the recurrence of oral lesion. It should be noted that our patient did not fulfill the diagnostic criteria for DM because of the lack of muscular symptoms whereas he had characteristic skin lesions. Regarding the frustration possibly encountered at the time of diagnosing amyopathic DM, both sensitivity and specificity of the skin lesion for the diagnosis of DM were investigated. Moreover, the rarity of blister as a skin manifestation of DM was discussed as well.

Aged↗
PubMed1984

Manometric study on anal sphyncteres and intestinal MTT before and after extensive surgery on patients affected by cervical carcinoma. Clinical experiences.

The Authors report the preliminary results of a study performed on patients submitted to radical hysterectomy according to Wertheim-Meigs for cervical-carcinoma, in order to evidence possible changes of the intestinal functionality, by means of a manometric investigation of the anal sphyncteres and measurement of the intestinal transit times. The manometric survey showed that no essential parameter was uniformly altered whereas the transit time measurement proved in some cases the slowing-down of the intestinal progression at the level of the ascending and transverse colon, and a normal transit in the descending colon as well as in the rectum in all examined cases.

Adult↗