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The authors refer a case report of the Peutz-Jeghers tumour localised in transverse colon found during a systematic clinical examination of the 4-day-old newborn, without any signs of intestinal occlusion. The end-to-end colic resection was made. Post-operative course was without any complications. The observation is rarely due to the tumour's atypical localisation as well as its presence in the newborn.
In a woman 31 year old, with a 21 week pregnancy, an adenocarcinoma was found in transverse colon, it was excised; she received chemotherapy. At week 33, a healthy female baby was obtained by cesarean section. The patient died four months after the diagnosis. Estrogen receptors in colon tumor were negative.
In the ascending colon of adult male rats, large accumulations of differentiated, mucous-type cells were observed which formed the deep one-half to one-third of the crypts almost exclusively. Mitotic activity was localized to the midcrypt, to columnar-type cells. The mucous-type cells were designated as "deep crypt secretory" (DCS), and their histological study was initiated. In the light microscope, the apical cytoplasm was distended with mucous vacuoles which stained differently from goblet cells after using periodic acid-Schiff (PAS), alcian blue, or a Masson stain. In electron-micrographs, a well-developed Golgi complex and rough edoplasmic reticulum in addition to a large number of electron-opaque vacuoles indicated active production of a glycoprotein. The midcrypt mitotic activity was further demonstrated by using the colchicine technique and 3H-thymidine radioautography. A gradual increase of mucus content and a decrease of nuclear and nucleolar size in the DCS cells from midcrypt to crypt base indicated that these cells originate in midcrypt and mature as they progress toward the crypt base. Cell counts showed that the number of cells constituting the crypts was about the same all along the colon, but the percentage of DCS cells varied: 33% in ascending and 21% in transverse colon. Only 5% and 8% deep-crypt mucous-type cells were found in descending colon and cecum, respectively; but these cells differed in appearance from the mature DCS cells. In conclusion, the presence of a large number of nonmitotic end cells with intense secretory activity has been ascertained for the deep crypts of the ascending colon. The exact relation of these cells to the vacuolated or other epithelial cell types remains for further study.
The parts of the colon differ in motor function and in responses to extrinsic and intrinsic nerve stimulation. The distribution of myelinated nerve fibers in the colonic myenteric plexus is not known. Because these fibers might be largely extrinsic in origin, their distribution might indicate the domain of influence of extrinsic nerves and help to explain the different behaviors of the different parts of the colon. Myelinated fibers were examined by electron microscopy in cross sections of the ascending nerves and in myelin-stained whole-mount preparations in the colon. The ascending nerves are much like one another. They have the structure of peripheral nerves, not that of myenteric plexus. The proportion of myelinated fibers in the ascending nerves declines rostrad with no uniform change in total nerve fiber number. Cross-sectional areas of ascending nerves, 3,304 to 7,448 microns 2; total number of nerve fibers per profile, 703-2,651; and mean myelin coat thickness, 0.45 +/- 0.01 micron, do not change uniformly along the ascending nerves. Myelinated fibers are about 2% of total fibers in the extramural colonic nerves, 7-9% in the ascending nerves in the sigmoid colon, and 2-3% at the rostrad ends of the ascending nerves in the transverse colon. Blood vessels lie at the core of each ascending nerve and on the nerve sheath. Myelinated fibers in the ascending nerves degenerate after section of colonic branches of the pelvic plexus and after section of the pudendal nerves, indicating that myelinated nerves reach the colon through both pathways.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty male Sprague-Dawley rats received weekly injections of dimethylhydrazine for three months. They were subsequently laparotomized and tumors were palpated in 21 rats. The colonic tumor was removed and a fraction was autotransplanted into the wall of the transverse colon and a second fraction into the subcapsular space of the left kidney. The results demonstrated successful autotransplantation of colonic tumors in 13 of 21 rats (i.e., 62 percent). In 11 of the 21 rats (52 percent) the tumor grew in the left kidney. Of the various experimental methods proposed for the study of tumor metastases, the one described herein appears to be the first in which primary and secondary tumors were studied in the same individual, since dimethylhydrazine-treated rats usually develop more than one colonic tumor per individual. The model may be useful to monitor the effect of various drugs known to affect tumor growth, not only at the primary site, but also at the site of metastasis.
To determine whether the presence of unabsorbed fat in the colon altered colonic motility, intraluminal pressures were recorded in the terminal ileum and proximal colon, and serial 1-min gamma camera scans were obtained while test solutions labeled with diethylenetetramine pentaacetic acid chelate of indium 111 were infused into the middle portion of the ascending colon. Seven subjects received a control solution, and 6 subjects received an emulsion of oleic acid (4.3 g/100 ml). Oleic acid accelerated colonic transit; isotope accumulated in the rectosigmoid faster in the first 120 min (4343 +/- 1175 cpm) than it did during control infusion (1236 +/- 348 cpm; p less than 0.01). Accelerated transit of oleate was accompanied by high amplitude (greater than 60 mmHg, range 60-95 mmHg), prolonged (greater than 10 s, range 10-48 s), propagated pressure waves; they originated near the ileocecal junction at a median frequency of 1.3 times/hour (mean 4.1, range 0.4-15.7). These were associated with a narrow image of the ascending colon on scintiscan and movement of 65.9% +/- 6.5% of counts from the ascending to transverse colon over the succeeding 4 min. A similar sequence was seen only once in 33 h of infusion with control solutions (p less than 0.01). Associated with these responses, the total volume of infusate tolerated before defecation was less with oleate than with control solutions (311 +/- 21 ml vs. 1049 +/- 71 ml; p less than 0.01). Long-chain fatty acids stimulated unusual motor patterns and reduced the reservoir function of the ascending colon; these effects may contribute to the diarrhea of patients with fat malabsorption.
The diagnosis of adenocarcinoma of the colon in juvenile subjects usually poses a difficult problem due to its clinical presentation, which usually mimics disorders that are commonly found in children. This article presents the case of a 13-year-old boy who was admitted 2 weeks earlier to another hospital, where his condition was not recognized. He presented with abdominal signs and symptoms suggestive of diseases such as gastroenteritis, appendicitis, and intussusception which are common in this age group. The x-ray film showed dilated loops of small bowel and the proximal portion of colon, suggesting intestinal obstruction. At surgery, a 4 X 4 cm tumor in the transverse colon was resected. Microscopically, the lesion showed moderately differentiated adenocarcinoma with foci of mucin production.
We report a case of rare solitary neurofibroma of the transverse colon in a patient without neurofibromatosis. The patient was found to have an intussuscepting tumor prolapsing transanally, with massive lower gastrointestinal bleeding. This case represents only the second documented report of an isolated colonic neurofibroma.
The normal contours and relationships of the colon have been described in a previous publication. I have attempted to show how enlargement of these organs or tumefactions arising within them affect the colon in a characteristic manner. Hopefully this will become useful in: (1) determining the normality of the external contour and variation of the external contour of the colon; (2) detecting a clinically unsuspected mass by an abnormal indentation on the colon; and (3) providing, for the diagnostic work-up of abdominal masses, a primary classification fo abdominal masses. Further, I have tried to emphasize that the lateral aspects of both colic flexures are posterior and tend to reflect abnormality of the posterior structures. The medial aspects of the colic flexures are anteior and likewise reflect abnormality of anterior structures. In addition, I reemphasize that what in the past has been called the splenic flexure (the area of marked angulation of the colon in the left upper quadrant) in reality is merely a portion of distal transverse colon. The more subtle angulation of the colon related to the "splenic angle" and left kidney is the true splenic flexure, the area of the phrenicocolic ligament.
Colonic complications of severe acute pancreatitis are quite uncommon and always occur in the transverse colon and splenic flexure. Here we report the case of a 47-year-old male with mild acute pancreatitis (Ranson's score 1) who suffered from acute right lower quadrant pain during hospitalization. After conservative treatment failed, he underwent open appendectomy under the impression of acute appendicitis. However, the pathology revealed only periappendicitis. Small bowel ileus was noted on plain film of the abdomen and a high ascitic lipase level was found during operation suggesting that the periappendicitis resulted from the spreading of the pancreatic inflammatory exudate via the small bowel mesentery route. This report suggests that although rare, periappendiceal involvement mimicking acute appendicitis remains possible in even mild acute pancreatitis.
OBJECTIVE: To test the accuracy of initial diagnosis of colonic volvulus and the results of different treatment regimens. DESIGN: Retrospective population based study. SETTING: Tampere University Hospital (major referral center). SUBJECTS: All patients who presented with colonic volvulus from 1973-1990, 58 patients had sigmoid, 23 caecal and one had transverse colonic volvulus. MAIN OUTCOME MEASURES: Findings of endoscopic or operative treatment compared with the clinical diagnosis and plain abdominal radiographs. Association between treatment and risk factors. RESULTS: Diagnosis was difficult, despite some differences in clinical presentation. Gangrenous bowel was diagnosed only at operation, although caecal volvulus with gangrenous bowel was associated with a high white cell count. In 23 patients with caecal volvulus both right hemicolectomy (n = 11) and tube caecostomy (n = 7) were successful with one death after each procedure and no recurrences. In sigmoid volvulus, resection (n = 19) and detorsion with or without sigmoidopexy (n = 21) resulted in similar numbers of complications and deaths (6 and 4, and 5 and 3, respectively), though recurrences were more common after detorsion (1 (5%) compared with 5 (24%)). Endoscopic decompression was tried in 30 and was successful in 26 cases; it was the only treatment in 17/58 patients, with two deaths (12%) and five recurrences (29%). The overall mortality was 15%, but this was associated more with neuropsychiatric diseases, old age, and residence in mental or nursing homes than with gangrene of the bowel. CONCLUSIONS: Poor diagnostic accuracy is a problem. Caecal volvulus can be safely treated by resection or tube caecostomy. Sigmoid volvulus is best treated by endoscopic detorsion followed by operation in otherwise fit patients. Mortality is associated with neuropsychiatric diseases and old age.
A 57-year-old woman underwent right hemicolectomy (D3) due to transverse colon cancer with multiple liver and peritoneal metastasis. Administration of oral UFT+Leucovorin was started postoperatively. After 6 months, the multiple liver metastases completely disappeared without any adverse reaction. After 14 months, no other recurrence was found by CT scan. This case suggests the usefulness of oral UFT+Leucovorin for progressive recurrent colorectal cancer as home chemotherapy.
We retrospectively evaluated DNA content flow cytometrically in a series of 124 colonic adenocarcinomas selected for uniformity of stage (A and B), anatomical location (right or transverse colon), and treatment (surgical only) in order to precisely define the significance of ploidy. Aneuploid populations were detected in 43% overall and more commonly with advancing stage (31% Stage A versus 45% Stage B), although this trend did not reach statistical significance (P = 0.16). Overall, as well as stage corrected, 5-yr patient survival was higher for patients with diploid range tumors, but not significantly (71% diploid range versus 60% aneuploid, P = 0.19). Dukes' stage, in contrast, was strongly predictive for 5-yr survival (89% Stage A versus 61% Stage B, P less than or equal to 0.005). Abnormal DNA content was significantly associated with increased patient age (P = 0.02) and presence of angiolymphatic invasion (P = 0.013) but not tumor grade (P = greater than or equal to 0.10). We conclude that flow cytometrically determined abnormal DNA content is weakly related to pathologic features of biologic aggressiveness in colonic adenocarcinoma and is less predictive of patient outcome than conventional Duke's stage.
The proximal and distal ends of the transverse colons of 16 noninbred Sprague-Dawley rats were severed and stitched to their abdominal walls. The ascending and descending colons were anastomosed end-to-end. The disarticulated colon loop was rinsed 30 times over 15 days to remove all traces of dimethylhydrazine (21 mg/kg body wt) for 27 weeks. When rats were killed 3 weeks later, 4 had invasive carcinomas and 2 had tubular adenomas in the end-to-end anastomosed (function-isolated) colons. Three rats developed invasive carcinomas in the isolated (defunctionalized) colon loops. The carcinogen probably reached the isolated colon loop through the circulation and induced (independently of bile acids) mucosal changes that led to invasive carcinoma.
Fibrosarcomas of the colon are extremely rare. This is the report of a patient with fibrosarcoma of the transverse colon who had perforation and peritonitis.
Although Dieulafoy lesion is generally located in the proximal stomach, other locations have been reported. We present two cases of bleeding colonic Dieulafoy in patients with chronic renal failure who were treated with mechanical methods. In the first case, an active arterial bleeding without mucosal defect was localized in the descending colon. In the second case, a protruding vessel with active bleeding was found in the transverse colon. The two patients were initially treated with epinephrine and hemostatic clips. In the second patient, an endoloop was attached to the base of the previously placed hemoclips because of rebleeding. To our knowledge, this is the first case of combined endoscopic approach with hemostatic clips and endoloop to treat a colonic Dieulafoy lesion. Colonic Dieulafoy lesions reported in the relevant literature and the hemostatic treatments used are reviewed.
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.
A case of high jejunal atresia with midgut deletion in the newborn is reported. The remnant of proximal jejunum near the ligament of Treitz shared a common supporting mesentery/mesocolon with the remaining midtransverse colon. The patient was managed by side-to-side anastomosis of the jejunal and transverse colonic remnants.