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PubMed1992

Colonic cancer during pregnancy: case report and review of the literature.

Colonic cancer during pregnancy is rare. Herein we describe a case of adenocarcinoma of the transverse colon in a 29-year-old pregnant patient. Early diagnosis is difficult because the initial symptoms of colorectal cancer, such as abdominal pain, nausea and vomiting, constipation, and abdominal distention, are often attributed to a normal pregnancy. Management of colonic cancer during pregnancy depends on gestational age and operability of the tumor. Medical and surgical management considerations are discussed.

Adenocarcinoma↗
PubMed1980

Carcinoma of the colon. Cancer specific long-term survival. A series of 615 patients treated by one surgeon.

The cancer specific survival in 615 patients undergoing resection for carcinoma of the colon is presented. The patients were operated on and managed by one surgeon between 1950--1977. Computer analysis has been made of the prospectively collected data. Results are presented as median survival in months and as percentage survivors at 5, 10, 15 and 20 years. Curative resection gave a cancer specific survival at the seventy-fifth percentile of 66 months, corresponding to 76% survival at five years and 67% at 20 years. Age and sex were not significant prognostic factors. Dukes' Stages A, B and C had five-year survivals of 88%, 78% and 60% respectively, after curative resection. The median survival after palliative resection was 14 months. Site of the primary tumor within the colon was of significant prognostic importance only when the poor survival in tumors of the transverse colon was compared with the favorable survival in those of the splenic flexure, ascending, descending and sigmoid colon.

Adenocarcinoma↗
PubMed1988

Cytologic features of ascites in malignant fibrous histiocytoma of the colon.

The cytologic features of ascitic fluid in a case of malignant fibrous histiocytoma (MFH) of the colon are described. At autopsy, two solid tumor masses were found around the ascending and transverse colon, accompanied by about 3,000 ml of ascites. Tumor cells had infiltrated diffusely into the outer layers of almost all of the gastrointestinal wall, simulating peritonitis carcinomatosa. Cytologic examination of the ascites revealed various kinds of tumor cells; short spindle-like cells, multinucleated giant cells, and round cells with an invaginated nuclear margin, forming small clusters. These cytologic findings were considered to be very useful in the diagnosis of MFH, especially in cytologic examinations of ascites.

Ascitic Fluid↗
PubMedDate not supplied

A catastrophic complication of systemic lupus erythematosus: massive mesenteric infarction.

The AA reports a case of a 64-year-old female patient affected for 3 years by systemic lupus erythematosus who developed a massive perforating mesenteric infarction. An immediate surgical treatment with resection of the small bowel and right colon followed by a side-to-side primary anastomosis between the remaining jejunum and transverse colon were performed. The patient died 15 days after surgery due to recurrence of a mesenteric and pulmonary thromboembolia.

Fatal Outcome↗
PubMed1997

[Spontaneous pyeloduodenal fistula: a case report].

A 71-year-old female presented with recurrent episodes of right flank pain and fever for the past several years. No pathogens were detected in the urine culture. Abdominal X-ray revealed staghorn calculi of the right kidney. Computerized tomography revealed pneumopelvis and staghorn stones of the right kidney. A nephrectomy was indicated based on the results of intravenous pyelography (IVP) and renogram which revealed a right non-functioning kidney. The adhesion of the right kidney with the duodenum and a transverse colon was so strong that a nephrectomy, a wedge resection of the duodenum and a transverse colectomy were performed. There was a fistula between the renal pelvis and the second portion of the duodenum. The fistula was speculated to have occurred by the spontaneous rupture of the renal pelvis to the duodenum. To the best of our knowledge, this is the 15th case of spontaneous nephroduodenal fistula in Japan.

Aged↗
PubMed1984

Spontaneous colonic perforation secondary to cytomegalovirus in a patient with acquired immune deficiency syndrome.

We report a case of spontaneous perforation of the transverse colon due to multiple ulcerations infected with cytomegalovirus (CMV) in a patient suffering from acquired immune deficiency syndrome (AIDS). The authors recommend a thorough clinical and laboratory search (including tissue diagnosis, when possible) for evidence of CMV infection in immunosuppressed patients with new or poorly healing GI ulcerations, who are otherwise at risk for CMV infection, e.g., patients with AIDS. When performing surgery on AIDS patients, operating room protocol should be identical to that used for hepatitis B virus patients.

Acquired Immunodeficiency Syndrome↗
PubMed1980

Establishment of a human colon adenocarcinoma cell line producing carcinoembryonic antigen.

A human adenocarcinoma cell line was successfully established from the lymph-node metastasis of transverse colon cancer. Primary culture was done with the tumor developed in a nude mouse which had been inoculated with the metastatic lymph node. Morphological characteristics, growth kinetics, chromosomes, tumorigenicity and high production of carcinoembryonic antigen by the established cells are described. This cell line should be a useful tool for studies on the mechanism of re-expression of the fetal gene which is responsible for carcinoembryonic antigen expression in colon cancer cells.

Adenocarcinoma↗
PubMed2001

Omental transposition for low pelvic anastomoses.

Surgeons' opinions differ regarding the role of the omentum in low pelvic intestinal anastomoses. This study was undertaken to define the anatomy and surgical technique of omental transposition to the pelvis. We studied 45 cadavers to elucidate surgical aspects of omental mobilization, lengthening, and transposition into the pelvic cavity. In addition, intraoperative studies of omental transposition to the pelvis were performed in 20 patients with chronic ulcerative colitis, familial adenomatous polyposis, and rectal cancer who were undergoing ileal J-pouch anal anastomosis or low anterior resection. The most important anatomic variables for omental transposition are three variants of arterial blood supply: (1) In 56% of patients, there is one right, one (or two) middle, and one left omental artery. (2) In 26% of patients, the middle omental artery is absent. (3) In the remaining 18% of patients, the gastroepiploic artery is continued as a left omental artery but with various smaller connections to the right or middle omental artery. The first stage of omental lengthening is detachment of the omentum from the transverse colon mesentery. This must be performed carefully, as the omentum is closely adherent to the right transverse mesocolon. The second stage is the actual lengthening of the omentum. The third stage is placement of the omental flap into the pelvis. Creation of an omental pedicle is a simple surgical procedure. This procedure can be performed quickly, does not involve significant blood loss, and may reduce the frequency of complications after low pelvic anastomoses.

Adolescent↗
PubMed2006

[Ileal and right colonic strictures due to prolonged non steroidal anti-inflammatory drug intake].

Ileal and right colonic strictures due to long term NSAID intake are well known but rare. We report the case of a patient with rheumatoid arthritis presenting with one ileal, as well as a right and transverse colonic stricture. The latter two were treated by dilatation under colonoscopy, but due to an associated recurrence, and the necessity of treating the ileal stricture which was inaccessible, a transverse ileocolonic shunt was proposed under local anesthesia. Ileal and colonic strictures due to long term NSAID intake should first be treated, if possible, by discontinuing the drug, then by pneumatic dilatations and finally, if necessary, by surgery usually resection. The advantage of a gastrointestinal shunt is that it can be performed under local anesthesia in patients who are often in poor condition.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1995

Neuropeptide Y in submucosal ganglia: regional differences in the innervation of guinea-pig large intestine.

Since information about possible regional differences in the innervation of the guinea-pig large intestine is incomplete, a comparative study was made of the occurrence of neurones and nerve fibres of the submucosa showing immunoreactivity (IR) to neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP). In addition, a quantitative analysis was made of submucosal neurones in regions of guinea-pig large intestine selected for probable differences in their function. There were two principal findings: First, the density of NPY-IR neurone somata was high in the ascending colon (mean +/- SEM 3148 +/- 464 neurones/cm2; n = 5 animals) and progressively declined in an anal direction, the descending colon having 348 +/- 125 neurones/cm2 (in the same 5 animals); immunoreactive cell bodies were rare in the rectum. The reduced density was also reflected in a fall in the number of NPY-IR neurones/ganglion from 3.0 +/- 0.3 in the ascending colon to 0.5 +/- 0.2 in the descending colon. Second, varicose NPY-IR intraganglionic fibres were a conspicuous feature of the duodenum, caecum, transverse colon, descending colon and rectum, but not of the ileum, ascending colon or distal spiral. Moreover, in the descending colon and rectum the fibres were arranged in a loose 'cobweb' structure around non-NPY-IR neurone somata; in the caecum, there was an apparent paucity of NPY-IR somata but the exceptionally dense intraganglionic varicose fibre network may have obscured NPY-IR somata. In all regions, fibre baskets were rare. In the ascending colon, only 25 +/- 5% of ganglia (compared to 92 +/- 2% of ganglia in the descending colon) showed any intraganglionic nerve fibres; furthermore, when they occurred, these were not of the 'cobweb' type but, rather, they gave the ganglia a speckled appearance. In very immature fetuses at a stage of development when no neuropeptide somata could be found in either the myenteric or submucosal plexuses, many NPY-IR nerve fibres were present in the submucosa with a distribution similar to that of adult guinea pigs. With respect to the density of VIP-IR neurones in the large intestine, there was only a 40% reduction in the number of neurones/cm2 from proximal to distal colon, in contrast to the corresponding 90% reduction in the density of NPY-IR neurones. The number of VIP-IR neurones/ganglion (6.4) and the proportion of ganglia with VIP-IR fibres (> 90%) were constant. It is concluded that the striking regional dissimilarities in (i) the occurrence of NPY-IR neurone somata and (ii) in the disposition of intraganglionic NPY-IR nerve fibres indicate potentially important regional differences in the functions of neuropeptide Y as an antisecretory peptide in the local regulation of chloride transport in the mucosa and as a modulator of ganglionic transmission, respectively.

Animals↗
PubMed2002

Radiological palliation of malignant colonic obstruction.

PURPOSE: To evaluate the efficacy of colorectal stenting in the palliation of irresectable malignant colonic obstruction. MATERIALS AND METHODS: Fifteen patients underwent colorectal stenting for irresectable colonic malignancy. Sixteen stents were placed successfully in 13 patients. Two stent insertions, one a proximal transverse colon lesion, were unsuccessful. Twelve patients (80%) had clinical or radiological features of imminent obstruction. Three patients were completely obstructed. Eighty-six percent of lesions were within the rectosigmoid colon. RESULTS: Technical and clinical success was 88%. Early, minor complications occurred in two patients (13%). Late complications included migration (13%) and ingrowth (19%). The median survival was 2 months (0.5-12 months). CONCLUSION: Stenting should be considered as definitive treatment in the context of an inoperable malignant stricture of the colon. It has low morbidity and a high technical and clinical success rate and avoids emergency defunctioning surgery in high-risk patients.

Adult↗
PubMed1998

Psychological and physical stress induce differential effects on human colonic motility.

OBJECTIVE: Stress modulates gut function, but whether the type of stressor influences colonic motor activity is unclear. The motor patterns and regional variations are also poorly understood. Our aim was to determine the effects of psychological and physical stress on colonic motility. METHODS: Ambulatory colonic manometry was performed by placing a six-sensor probe up to the mid-transverse colon, without sedation, in 12 healthy subjects. Five hours later, a dichotomous listening test (psychological stress) was performed, which was preceded by listening to a narrative passage (control); recovery entailed listening to relaxing music (1 h each). Subsequently, intermittent hand immersion in cold (4 degrees C) water (physical stress) was performed, preceded by hand immersion in warm (37 degrees C) water (1/2-h each). Colonic pressure activity and cardiovascular responses were measured throughout the study. RESULTS: When compared with the control period, both stressors induced a greater number of pressure waves (p < 0.05), and the area under the curve (p < 0.01), but only physical stress increased (p < 0.05) pulse rate and blood pressure. There were no regional differences in colonic motility. During recovery, the motor activity returned to baseline after physical stress, but remained high after psychological stress. Psychological stress induced more (p < 0.05) propagated contractions, whereas physical stress induced more (p < 0.05) simultaneous contractions. CONCLUSIONS: Both stressors enhanced colonic motor activity, but psychological stress induced a prolonged response with propagated activity and without appreciable autonomic response. Thus, colonic motor responses may vary depending on the stressor.

Adult↗
PubMed2001

Gender differences in colorectal polyps and tumors.

OBJECTIVES: To use a national endoscopy database (CORI) to determine 1) whether gender differences are noted in the prevalence and location of polyps and tumors; 2) whether women have a higher rate of right-sided polyps or tumors; and 3) whether age influences these results. METHODS: CORI database from April 1, 1997 to February 19, 1999, captured in a computer-generated report, was analyzed. Polyps for this study were defined as sessile or pedunculated and as >9 mm. Tumors were defined as lesions characteristic of adenocarcinoma (mass, apple-core). Pure right-sided colon (PRS) was defined as cecum, ascending, hepatic flexure; right-sided as PRS plus the transverse colon; and left-sided as the splenic flexure, descending, sigmoid and rectum. RESULTS: Men have a greater risk of polyps [odds ratio (OR), 1.5] and tumors (OR, 1.4) than women. The risk of finding polyps and tumors at colonoscopy increases with age, with the highest risk noted in those >69 yr of age relative to patients <50 yr of age (polyps, OR = 2.7; tumors, OR = 4.0). Right-side polyps and pure right-sided polyps as defined by the study design were noted to be more frequent than left-sided polyps in patients >60 yr of age. Women have a greater risk of developing pure right-sided polyps (OR, 1.2), tumors (OR, 1.6) and right-sided tumors (OR, 1.5) than men. CONCLUSIONS: Men have a higher prevalence of colon polyps and tumors than women. A progressive risk of polyp or tumor formation is noted with aging. Women had a greater number of pure right-sided polyps and tumor development. Colonoscopy is needed to correctly diagnose an increasing prevalence of right-sided pathology in the elderly.

Adenocarcinoma↗
PubMed2000

Effects of fat and carbohydrate meals on colonic motor response.

BACKGROUND: Ingestion of a meal stimulates colonic motility. It is unclear whether the nutrient composition of a meal affects colonic motor response. AIMS: To investigate and compare the effects of a predominantly fat or carbohydrate meal on colonic motility. METHODS: In 18 healthy subjects, ambulatory colonic manometry was performed by placing a six sensor, solid state probe from the mid-transverse colon to the rectum. In a randomised, crossover design, 10 and 27 hours after probe placement, subjects received 4.18 MJ meals containing 60% calories from fat or carbohydrate sources. Preprandial and postprandial pressure activity and motor patterns were evaluated. RESULTS: Both meals induced phasic activity with a greater area under the curve (p<0.03) in the first postprandial hour, compared with the control period. Fat induced motor activity persisted longer (p<0.05) than that of the carbohydrate meal, but the onset of motor response was slower (p<0.001). Although both meals induced more (p<0.001) propagating pressure waves, only the fat meal induced more (p<0.05) simultaneous and retrograde waves. After both meals, 50% of subjects exhibited high amplitude (more than 103 mm Hg), prolonged duration (more than 13 seconds) propagating waves. Both meals induced greater activity (p<0.05) in the transverse/descending colon than in the rectosigmoid colon. CONCLUSIONS: Carbohydrate meals induce colonic motor response, but the effects are short lived when compared with fat meals. The prolonged, segmental, and retrograde phasic activity induced by the fat meal may delay colon transit. Thus meal composition influences colonic motor response.

Adult↗
PubMedDate not supplied

[Colorectal Crohn's disease: indications to surgical treatment].

Colorectal Crohns Disease (CRCD) represents the 25% of all cases of Crohns Disease (CD). Between January 1984 and December 2000 we have operated 68 patients with CRCD, that represent 10.3% of the patients operated for CD. Thirtythree patients (48.5%) were men and 35 (51.5%) were women. The median age at diagnosis was 37.3 +/- 13.1 years, with the highest incidence during the fourth decade. In most cases the disease involved the left colon and rectum (65.9%), while in 6.3% and in 3.8% of cases the right and the transverse colon respectively. In the 27.9% of cases the entire colon was involved. At the time of surgery, the disease behaviour was stenosing in 30.9% of patients, inflammatory in 22.1%, and penetrating in 47% of cases with the presence of fistulae (coloenteric in 6 patients, colo-bladder in 2 cases, rectouretral in 1 case, colo-cutaneous in 4 cases and intramesenteric in 2 cases) and abscesses (23.5% of patients). In three patients the CRCD had led to neoplastic transformation. Fourteen patients had undergone an emergency surgical procedure for severe acute colitis, 2 for toxic megacolon, 1 for an intraabdominal abscess and one for intestinal occlusion. In the segmentary forms we have always practiced a resection of the diseased colonic segment without total colectomy. In the cases with diffuse colonic involvement in which the rectum was free from disease a total colectomy with ileorectal anastomosis was performed. In the cases with rectal disease (26 cases) the sphinteric function was preserved with low rectal resection or with colo-anal anastomosis. In 4 patients with rectal disease and in 4 cases with fistulae, we complited the intervention with a permanent stoma. During the median follow-up of 83.7 months (12-207) the surgical relapse was of 27.3%. We suggest to treat CRCD with resections limited to the diseased segment. Moreover, it is possible to preserve the sphinteric function every time the rectum or the anal canal are normal, without postoperative complications or early relapses.

Acute Disease↗
PubMed1994

Purulently infected abdominal aortic aneurysm: in situ reconstruction with transmesocolic omental transposition technique.

A new omental transposition technique was applied to a patient who underwent resection and in situ reconstruction of purulently infected abdominal aortic aneurysm to prevent recurrent retroperitoneal and graft infection. After wide separation from the transverse colon, the omental pedicle was transposed to the infrarenal retroperitoneal space through an opening of the transverse mesocolon to wrap the prosthetic graft and fill the infected space. The postoperative course was uneventful without any sign of recurrent infection in follow-up lasting 8 months. The authors' experience suggest that this 'transmesocolic' technique is an effective modality for critically ill patients with infected abdominal aorta.

Aged↗
PubMed1977

Onset of cell proliferation in the shortened gut. Colonic hyperplasia after ileal resection.

Cytokinetics in colonic mucosa were studied after ileal resection in young female rats. The RNA content of the transverse colon was increased 32% after 7 days; after 14 days the increase was present throughout the colon. The DNA content of the ascending colon increased 29% after 10 days. Specific activity of DNA labeled with [3H-methyl]thymidine was elevated 29% in the ascending colon and elevated 49% in the descending colon on the 7th postoperative day. Colonic cell proliferation is stimulated within 1 week of ileal resection.

Animals↗