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PubMed1986

Recurrent spontaneous perforation of the colon.

A 58-year-old man with recurrent spontaneous perforations of the colon is reported. The first two events were of the sigmoid colon, and a sigmoidectomy was performed after the second perforation. The third spontaneous perforation had occurred in the transverse colon, however, although a patent sigmoid colostomy was present. Neither primary colonic pathology nor elevated intraluminal pressure were found, which means that the cause and pathogenesis of these perforations are unknown. Six months later, a subtotal colectomy with ileo-sigmoid anastomosis was performed with an apparent satisfactory result.

Colonic Diseases↗
PubMed1989

Intraoperative colonic irrigation with povidone iodine. An effective method of wound sepsis prevention.

In the ten-year period between 1975 and 1986, 367 patients underwent colonic resection with subsequent anastomosis using intraoperative colonic irrigation with 10 percent povidone iodine. One hundred thirty three patients underwent resection of the right or transverse colon, whereas 233 patients had left hemicolectomy with low anterior anastomosis or reanatomosis. Twenty individuals underwent emergency resection for perforation and temporary end colostomy. Nineteen of these patients returned for definitive reanastomosis as part of a two-stage procedure. The rate of wound infection, and/or intra-abdominal abscess formation was retrospectively reviewed and found to be completely nonexistent in these patients. This study examines the various techniques used to reduce the rate of wound infection after colonic surgery and addresses the concept of intraoperative povidone iodine irrigation.

Anastomosis, Surgical↗
PubMed1989

Experience with colonic volvulus.

Fifty-eight cases of colonic volvulus were reviewed including 30 cases of sigmoid volvulus, 27 cases of cecal volvulus, and 1 of transverse colon volvulus. Decompression procedures were attempted in 31 instances of sigmoid volvulus in 27 patients and were successful 25 times (81 percent). Seven patients with sigmoid volvulus did not undergo surgery and of those, two died of unrelated causes, one was lost to follow-up, one was well, and three had recurrent volvulus. Twenty-four operations were performed on 23 patients and there were three deaths (13 percent mortality). There was one recurrence in two patients who underwent simple detorsion. Chronic large-bowel motility disturbances were a persistent problem in 9 of 20 (45 percent) surgical survivors. Among 27 instances of cecal volvulus, one was reduced by contrast enema and ten endoscopic attempts at decompression were unsuccessful. Twenty-six operations were done and there were four operative deaths (15 percent mortality). There were no recurrences. Large-bowel motility disorders were noted in follow-up in 3 of 22 patients (14 percent). Overall there were 10 deaths in 58 patients for a 17 percent mortality rate. These data support the importance of endoscopic decompression for sigmoid volvulus but not for cecal volvulus. Definitive treatment of both forms of volvulus should include assessment of colonic motility.

Adult↗
PubMed2000

Metastatic colon carcinoma found within an inguinal hernia sac: report of a case.

We report herein the case of a patient in whom metastatic colon carcinoma was found within an inguinal hernia sac. According to Lejar's classification, colon carcinomas within inguinal hernias are categorized as intrasaccular- and saccular-type tumors. In our patient, asymptomatic transverse colon carcinoma was the primary lesion, and to the best of our knowledge, this is only the fourth case of such a saccular-type tumor to be reported in the literature. To date, 21 cases of intrasaccular tumors have been reported, and saccular-type tumors are considered to be an even rarer entity, unless the patients have obvious ascites, indicating peritonitis carcinomatosa. Histologic examination of the hernia sac is recommended for male patients of advanced age with an inguinal hernia, especially those who have previously undergone surgery for colorectal carcinoma.

Adenocarcinoma↗
PubMed2004

Histologic changes in neuronal innervation of the ileum mucosa after autologic-allotopic ileum mucosa transplantation.

INTRODUCTION: After successful experimental autologic-allotopic ileum mucosa transplantation, we investigated the remodeling of the transplanted submucous and mucous plexus, which is essential for the motility of the created colon coat-ileum mucosa complex. METHOD: In 8 beagles we transplanted ileum mucosa in a demucosed vascularized transverse colon segment, which was reanastomosed with the small bowel immediately after transplantation. Four weeks later the animals were sacrificed and histology specimens taken from the anastomosis site of the colon coat-ileum mucosa complex, allowed comparison between transplanted and normal mucosa in the same section. After fixation in 4% formaldehyde and PBS the samples were embedded in paraffin and 7 micro m sections were prepared. The distribution of nerve fibers and submucous ganglia were examined in dewaxed sections, using antisera against protein gene product (PGP9.5), a general neuronal marker. RESULTS: The submucosal ganglia were prominent in all samples but they were smaller and the submucous nerve cells within the ganglia were less numerous compared to the controls. The innervation of the transplanted ileum mucosa was reduced as the number of nerve fibers in the mucosal villi was decreased. Besides these neuromorphologic changes the transplanted mucosa showed a slightly higher rate of shortened villi compared to normal ileum mucosa. CONCLUSIONS: After ileum mucosa transplantation the submucosal ganglia are smaller and less numerous. Furthermore there is a considerable loss of nerve fibers in the mucosal layer. Additionally a loss of microvilli in the transplanted ileum mucosa was found. Whether these findings represent a state of remodeling or a slow atrophy of the enteric nervous system in the transplanted areas is currently under investigation.

Animals↗
PubMed1981

Comparative effects of morphine and nalorphine on colonic motility in the conscious dog.

The effects of increased doses (0.05-02 mg/kg) of morphine and nalorphine on colonic motility were investigated in 15-22 h fasted dogs fitted with two strain gauge transducers on the transverse colon at 8 and 15 cm from the ileo-colonic junction. These effects were compared to those obtained after previous administration of naloxone (0.3 mg/kg), atropine (0.1 mg/kg) and methysergide (0.1 mg/kg). Both morphine and nalorphine, at a dose of 0.1 mg/kg increased the colonic motility index by 285 and 248% from 0 to 60 min respectively after their administration, these effects lasting 3.2 and 2.6 h. These stimulatory effects were abolished by previous administration of naloxone (0.3 mg/kg) or atropine (0.1 mg/kg) and limited to 60 min after methysergide (0.1 mg/kg). It was concluded that nalorphine may be considered as a potent morphinomimetic substance upon colonic motility and that cholinergic and serotonergic receptors were involved in the colonic response to morphine.

Animals↗
PubMed2003

Colonic motor activity in slow-transit idiopathic constipation as identified by 24-h pancolonic ambulatory manometry.

Colorectal motor activity in slow-transit idiopathic constipation has not been fully evaluated under physiological conditions. The aim of this study was to evaluate colorectal motor activity in chronic idiopathic constipation using 24-h ambulant pancolonic manometry. Ten healthy volunteers (six females) 19-31 years of age, and eight females 25-46 years of age with slow-transit idiopathic constipation were studied. Motor activity was measured using two custom-made silicone-coated catheters, each with five solid-state pressure transducers. Bowel preparation or sedation was not used. Frequency of high-amplitude propagated contractions was reduced in chronic idiopathic constipation, median 1.9/24 h vs 6/24 h (P = 0.01). Contractile frequency of low-amplitude complexes was reduced throughout the colon in slow-transit idiopathic constipation (P < 0.0001). The interval between contractile complexes was reduced in the transverse colon and splenic flexure (P < 0.0001). This study demonstrates that colonic motor activity is abnormal in slow-transit idiopathic constipation; decreased motor activity leads to a reduction in propulsion of intraluminal contents.

Adult↗
PubMedDate not supplied

Upper and lower gastrointestinal endoscopy in children and adolescents with Crohn's disease: a prospective study.

Fifty-six children and adolescents with Crohn's disease were prospectively investigated with gastroscopy and colonoscopy irrespective of localizing symptoms or signs. Routine biopsies were taken from endoscopically normal and abnormal areas. A high incidence (71%) of upper gastrointestinal (GI) involvement was found. In 41%, these findings were instrumental in making the diagnosis. The ileum was viewed in 49 of the 56 cases. Overall, the upper GI tract was involved in 71%, the terminal ileum in 53%, and the colon in 86% (oesophagus 16%, body of stomach 46%, antrum 36%, duodenum 21%, terminal ileum 53%, caecum 69%, transverse colon 71%, sigmoid 60% and rectum 41%). Upper and lower gastrointestinal endoscopy with systematic biopsies should be performed early in the diagnostic assessment of children and adolescents with suspected inflammatory bowel disease to enable accurate diagnosis and assessment of extent of disease.

Adolescent↗
PubMed1994

Antibiotic-induced diarrhea: specificity of abdominal CT for the diagnosis of Clostridium difficile disease.

PURPOSE: To evaluate the specificity of abdominal computed tomography (CT) in the diagnosis of Clostridium difficile disease. MATERIALS AND METHODS: The authors retrospectively reviewed CT scans of 64 patients with C difficile disease and 30 control subjects with diarrhea and negative findings for C difficile disease at stool tests. RESULTS: Colon wall thickening (range, 4-22 mm; mean, 11.7 mm; median, 11 mm) was seen in 39 patients (61%) with C difficile disease. Other findings included focal colon wall thickening (n = 28) and pancolonic thickening (n = 11). Two patients had only right-sided and transverse colon involvement. CT-specific diagnostic features of C difficile disease, such as nodular haustral thickening or the accordion pattern, were present in 17% of patients. No colonic abnormality was detected in 25 patients (39%). Seven of the 30 (23%) control subjects had colon wall thickening. Six of those seven subjects were subsequently determined to have ischemic colitis. The sensitivity of CT in the detection of colon abnormalities in patients with C difficile disease was 85%, and the specificity was 48%. CONCLUSION: Specific CT features of C difficile disease are uncommon. A considerable number of patients (39%) with C difficile disease have normal abdominal CT scans.

Adult↗
PubMed1996

Nonocclusive mesenteric infarction in continuous ambulatory peritoneal dialysis.

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.

Adult↗
PubMed1988

Colonic duplication in an adult.

A case of colonic duplication that was diagnosed radiologically in an adult is reported. A long duplicated segment below the normal transverse colon, with a wide anastomosis at the hepatic flexure level, was observed on barium enema. The rarity of this anomaly unassociated with other malformations is emphasized.

Barium Sulfate↗
PubMed1995

Bleeding from the endoscopically-identified Dieulafoy lesion of the proximal small intestine and colon.

OBJECTIVES: Our goal was to assess the incidence of the endoscopically-identified small intestinal and colonic Dieulafoy-like lesions in our GI bleeding population and to characterize the clinical and endoscopic features and response to endoscopic therapy. METHODS: Patients with GI bleeding from Dieulafoy lesions were identified from our Bleeding Team and GI laser data bases from August 1984 to September 1993. Clinical and endoscopic information contained within the data bases and from each patient's medical record were retrospectively reviewed. Diagnostic criteria that had been used to endoscopically diagnose a Dieulafoy lesion were arterial bleeding or nonbleeding visible vessel stigmata, all without ulceration or erosion. RESULTS: Nine patients (three male; six female; median age, 70 yr; range, 16-94) were identified from a population of 3059 patients. Symptoms included: melena (2); hematochezia (7); and unstable hemodynamics (3). The mean hemoglobin was 8.4 +/- 2.2 g/dl. There was no significant nonsteroidal antiinflammatory drug or alcohol use. Four patients had small bowel and five patients had colonic Dieulafoy's lesions. Specific sites were: distal duodenum (3); jejunum (1); cecum (1); hepatic flexure (3); and transverse colon (1). The diagnosis was made at initial endoscopy in seven patients, after two endoscopies in one patient, and after four in another patient. Active bleeding was encountered in seven patients (three small bowel; four colon). Endoscopic therapy was successful. Two patients rebled, one from the same site (small bowel) 1 yr later. Both were successfully retreated. There were no complications or deaths. CONCLUSIONS: The endoscopic Dieulafoy lesion of the small bowel and colon is infrequently encountered. The diagnosis is most often made during active bleeding. The endoscopic diagnosis requires an aggressive approach, including repeated endoscopy. Endoscopic therapy of proximal small intestinal and colonic Dieulafoy lesions is safe, effective, and should be performed.

Adolescent↗
PubMedDate not supplied

[Resection of a laterally spreading tumor by strip biopsy].

A male white patient 58 years-old was submitted to colonoscopy for follow-up of surgical resection of an advanced colorectal carcinoma 33 months ago. Small polyps were observed in the colons and histopathological examination proved to be tubular adenomas with moderate dysplasia. At the hepatic flexure of the transverse colon a large flat-elevated laterally spreading tumor measuring 2.5 cm in diameter was observed. After spraying of methilene-blue 0.1% the margins of the lesion were demarcated and following saline injection under the lesion it was completely resected in one single procedure. Histologically, the lesion was diagnosed as intramucosal adenocarcinoma.

Adenocarcinoma↗
PubMedDate not supplied

Acute hemorrhage from right-colonic hemangiomas: report of a case.

A rare case of severe rectal bleeding beginning in adult life is reported. A diffuse, cavernous hemangioma of the right transverse colon was visualized by superior mesenteric arteriography and the diagnosis was confirmed by peroperative colonoscopy carried out through a colotomy. The patient was treated by right hemicolectomy. The diagnostic value of selective abdominal arteriography in patients who have severe rectal bleeding is demonstrated.

Colectomy↗
PubMed1983

The influence of surgical transection and anastomosis on the rate of cell proliferation in the colonic epithelium of normal and DMH-treated rats.

Normal and DMH-treated male rats aged 18-20 weeks underwent surgical transection and anastomosis of the transverse colon. Animals were subsequently killed at intervals of 14, 30 and 72 days. Three hours prior to sacrifice animals were injected with vinblastine sulphate and mitotic indices were subsequently estimated in histological sections. Possible differences between experimental and control groups were tested using a Student's t-test. The results show that the accumulated mitotic indices in normal and DMH-treated colon are statistically similar. The results also show that transection and anastomosis stimulates cell division in both normal and DMH-treated colon and that the increase is of greater amplitude and more prolonged duration in the DMH-treated rats. Carcinomas developed close to the line of anastomosis in DMH-treated but not in control rats. The results support the hypothesis that non-specific injury to hyperplastic colonic epithelium promotes carcinogenesis.

1,2-Dimethylhydrazine↗
PubMed1999

Colon stricture and volvulus in a patients with scleroderma.

Gastrointestinal involvement in scleroderma is almost universal. We describe a patient with a benign stricture and volvulus of transverse colon, a life threatening but treatable complication of scleroderma bowel disease. We review the literature on colon volvulus in scleroderma and discuss the importance of recognizing this rare complication.

Adult↗
PubMed1977

Actinomycosis of the colon.

A 44-year-old woman with severe pain in the right upper quadrant, simulating acute cholecystitis, was found to have a large tumour in the transverse colon. Cultures from the mass grew Actinomyces israelii. Actinomycosis may often be missed; involvement of the large bowel is not confined to the appendiceal and cecal areas and may simulate other intra-abdominal conditions.

Actinomyces↗
PubMed1983

Effect of acid secretory capacity and chronic endogenous hypergastrinemia on pancreatic secretion and intestinal morphology in the rat.

To study the trophic effects of gastrin on the gastrointestinal tract, chronic endogenous hypergastrinemia was produced in rats by implantation of the gastric antrum into the colon. Rats were sham-operated (normal gastrin, normal acid) or were prepared with BII gastrojejunostomy and antral resection (low gastrin, low acid), or BII gastrojejunostomy and antral implantation into colon (high gastrin, acid present). To separate effects of hypergastrinemia from those of acid hypersecretion, two additional groups were prepared with total gastrectomy and either resection of the antrum (low gastrin, no acid) or antral implantation into colon (high gastrin, no acid). After 12 weeks, the pancreatic secretory response to secretin was measured. The animals were then sacrificed, and liver, pancreas, small intestine, and colon were weighed. In separate groups of animals villous height and width and crypt depth of small intestine and transverse colon were measured. Serum gastrin concentrations increased three- to fivefold in fasting and fed antral implant animals. Serum gastrin levels in the fed state were lower in antrectomy rats compared to controls but did not differ in the fasting rats. Pancreas and colon were heavier in all hypergastrinemic rats. Liver weights did not differ between hypergastrinemic animals and controls. Stimulated pancreatic bicarbonate secretion following secretin infusion was elevated only in hypergastrinemic, hyperacidic rats. Hypertrophy of the small bowel was seen in antral implant rats only when the gastric remnant was preserved (ie, when acid was present). Colonic mucosal thickness was increased in antral implant rats with or without gastrectomy. No significant increases in small-bowel villous height or crypt depth were found in antral implant rats. Thus, chronic endogenous hypergastrinemia caused pancreatic and colonic hypertrophy independent of acid secretion. In addition to hypergastrinemia, gastric hyperacidity was also needed for enlargement of small bowel or increase in secretin-stimulated pancreatic bicarbonate secretion.

Animals↗