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PubMed2002

Preoperative colonoscopic derotation is beneficial in acute colonic volvulus.

AIMS: Analysis of preoperative and operative management of acute colonic volvulus and development of treatment guidelines in a region of low incidence. METHODS: A study of 42 consecutive patients operated for acute colonic volvulus between 1970 and 2000. RESULTS: There were 20 patients with sigmoid volvulus, 21 with cecal volvulus and 1 with volvulus of the transverse colon. All patients presented as emergencies. The correct preoperative diagnosis was possible for sigmoid volvulus in 95% (19/20) of cases and for cecal volvulus in 67% (14/21). Preoperative colonoscopic volvulus derotation was attempted in 19 patients and successfully completed in 9 patients (47%). The success rates for preoperative colonoscopic derotation were 58 (7/12) and 33% (2/6) for sigmoid and cecal volvulus, respectively. Thirty-four patients (81%) underwent colon resections, 26 times as a single-stage procedure, and 8 patients (19%) underwent non-resectional operative techniques. Overall surgical morbidity was 24%, the reoperation rate 9.5% and mortality 12% (5/42). The subgroup of 9 patients with successful non-operative volvulus derotation, however, underwent semi-elective single-stage colonic resection without surgical morbidity or mortality. There were no recurrences during a median follow-up period of 9.5 years. CONCLUSION: In the absence of clinical, laboratory or radiological signs of bowel necrosis or perforation, colonoscopic volvulus derotation is recommended in all cases of acute colonic volvulus, followed by semi-elective single-stage colonic resection.

Acute Disease↗
PubMed1994

A patient with localized megacolon and intractable constipation: evidence for impairment of colonic muscle tone.

There have been descriptions of a variety of abnormalities in motor function in patients with megacolon; however, colonic tone in megacolon has not been measured to date. Recent data suggest that colonic hypertonicity of carcinoid diarrhea is measurable with an electronic barostat. Using a barostat method, we have evaluated colonic transit, motility, and tone in a patient with severe constipation and localized chronic megacolon. Transit measurements showed a significant delay beyond the mid transverse colon; motility studies in the dilated region of colon showed abnormally low tone but normal phasic contractility, as measured by the barostat. In contrast, manometry showed low amplitude contractions relative to control data; this discrepancy probably results from the large capacity of the segment of colon examined. Chronic megacolon can be associated with abnormal colonic tone, which can be measured by means of an electronic barostat.

Aged↗
PubMed1976

The radiology corner: metastasis to the colon.

This case serves to illustrate the multiple routes which may occur in the dissemination of carcinoma of the stomach of the large bowel. Spread along the gastrocolic ligament involves the superior aspect of the transverse colon with limitation laterally by the phrenicocolic ligament. Once ascites has developed there is spread along the superior border of the sigmoid and lateral margin of the right side of the colon.

Colonic Neoplasms↗
PubMed1985

Scintigraphic localization of occult gastrointestinal bleeding using a combination of 111In-labelled platelets and 99mTc sulphur colloid.

Repeated scintigraphy was performed for 6 days after the injection of autologous 111In-labeled platelets in a patient showing signs of recurrent occult gastrointestinal bleeding. Colonic activity was observed 142 h post injection, at which time a superimposed study using 99mTc sulphur colloid pinpointed the source of bleeding in the transverse colon.

Aged↗
PubMed1997

Expandable metal stent application in obstructing carcinoma of the proximal colon: report of a case.

PURPOSE: The increased mortality of emergency vs. elective colonic surgery applies equally to the right and left colon. Recent interest has surrounded the application of expandable metal stenting in acute obstruction but has been confined to the left colon. We describe successful application of stenting in the right colon, allowing postponement of a particularly high-risk laparotomy. METHODS: A patient with acute bilateral iliofemoral thromboses simultaneously developed complete obstruction of the proximal transverse colon. After heparinization and under fluoroscopic control, a 10-cm-long, self-expanding Wall-stent (Schneider, Bulach, Switzerland), 22 mm in diameter, was manipulated across the obstruction. RESULTS: Immediate decompression with symptomatic relief ensued. The stent prevented obstruction during a 10-week period of anticoagulation, and repeat duplex scanning showed resolution of iliac thrombus. An elective right hemicolectomy was then performed. Postoperative course was uncomplicated, and histopathology confirmed a Dukes B carcinoma. CONCLUSIONS: This case, in which a potentially hazardous laparotomy was delayed until the operative risk improved, defines a new role for stenting in colonic obstruction and demonstrates an extension of its applicability to the right colon. Literature review found no other report of stent application in the right colon.

Acute Disease↗
PubMed2004

Effects of steroid on the healing of colonic anastomoses in the rat.

BACKGROUND: The aim of this experimental study was to evaluate the effects of steroid on colonic anastomosis in a rat model. METHODS: Forty female Wistar rats were randomised into two groups. After resection of a 1-cm segment of the transverse colon, an end-to-end sutured anastomosis was performed. In the rats of the control group 2 ml of solution 0.9% NaCl was injected once daily intraperitoneally perioperatively. Rats of the steroid group received intraperitoneally once daily, and on the same perioperative days, hydrocortisone (5 mg/kg body weight in 2 ml solution NaCl). All the rats were sacrificed on the 8th postoperative day and the anastomoses were examined macroscopically. The bursting pressure measurements were recorded and anastomoses were graded histologically. RESULTS: Dehiscence rate was significantly higher in the steroid group than in the control group (p<0.001). Mean bursting pressure was significantly lower in the steroid group compared to the control group (p<0.001). Colonic healing process assessed as inflammatory cell infiltration and collagen deposition was significantly lower in the steroid group than in the control group (p<0.001, p=0.03 respectively). CONCLUSIONS: Perioperative steroid treatment adversely affects healing of colonic anastomoses in the rat.

Anastomosis, Surgical↗
PubMed1975

[Abdominoanal resection of the rectum with a lowering of different sections of the left half of the colon].

In tumor localization at the level of 7--12 cm aside from the anus the authors performed 168 abdominoanal resections of the rectum with descending of different portions of the left colon. Among these patients in 126 subjects descending of the sigmoid in the anal canal was performed, in 30 of the splenic angle of the transverse colon, and in 12 of a proximal portion of the descending left colon. Some characteristic features of surgery for descending of different portions of the left colon are described.

Abdomen↗
PubMed1990

[Changes in the small and large intestines in systemic sclerosis].

A series of 21 subjects (2 males and 19 females) affected with systemic sclerosis, was examined by small bowel (oral and intubation methods) and colon enema. The underlying process responsible for abnormalities in the small bowel and colon in systemic sclerosis is a variable and pacthy destruction of the muscularis propria, that produces the structural and functional changes detected on X-ray. Pathologic condition is the same affecting the esophagus. The scout film of the abdomen often reveals colonic distension and fecal impaction, so that it may be quite difficult to prepare adequately the patients for a barium enema. Peristalsis may be virtually absent in short segments, and transit time may be several time longer than that in normal patients. For these reasons, intestinal pseudo-obstruction may appear in systemic sclerosis. The observed radiographic changes are: 1) in the small bowel: a) dilatation of the gut, especially in its proximal portions (duodenum and jejunum), in which the valvulae conniventes are straightened, normal or thinned; b) presence of diverticula, 2-4 cm in diameter, with hemispherical shape without the neck-like opening into the bowel lumen; 2) in the colon, the characteristic finding is an increase in size of individual haustra, forming sacculations or pseudo-diverticula, usually on the antemesenteric border of the transverse colon, better demonstrated on post-evacuation film. Moreover, loss of colonic haustration is also observed associated to colonic elongation and dilatation.

Adult↗
PubMed1987

[A case of multiple colorectal cancers repeatedly resected 5 times].

A case of successive metachronous colorectal cancers repeatedly resected 5 times during an 8-year period is reported. The 1st cancer was found in the sigmoid colon when the patient (male) was 32 years old. The 2nd was a mucosal carcinoma of the rectum which was locally excised. The 3rd was found in the ascending colon, and there was detected yet another small cancer in the adenoma in the resected specimen. The 4th and 5th cancers were found in the transverse colon and rectum, respectively. This case is considered to be highly associated with genetic factors. Long-term and careful surveillance is mandatory for early detection of recurrent or additional tumors.

Adenocarcinoma↗
PubMed1977

Leiomyomatosis of the colon.

Excluding the rectum, smooth muscle cell tumors of the large bowel are extremely rare lesions. A unique case is reported of an infiltrating multinodular myomatous growth of semi-constrictive type affecting the ascending and transverse colon along its entire circumference and over a length of 35 cm. In the mesocolon near the colonic wall two tumor foci were present. Contrary to expectations from the growth behavior, histological examination revealed well differentiated smooth muscle cells with distinct myofilaments and absence of nuclear abnormalities and mitotic figures. No clinical evidence of malignancy was found and no recurrence was detected during a 39-month follow-up period which included a second-look operation. The contrasting fidings are discussed and it is concluded that the tumor should be considered a benign multicentric lesion, for which the term "leiomyomatosis of the colon" is suggested.

Adult↗
PubMed2006

Intestinal nitric oxide synthase activity changes during experimental colon obstruction.

OBJECTIVE: The experiments in this study were designed to follow the time course of nitric oxide (NO) synthesis in the large bowel during acute mechanical ileus. MATERIAL AND METHODS: Occlusion of the mid-transverse colon was maintained for 420 min in anesthetized dogs. Strain-gauge transducers were used to analyze motility changes on the hepatic and lienal flexures, respectively. Constitutive NO synthase (cNOS) and inducible NOS (iNOS) activities were determined in tissue biopsies, and plasma nitrite/nitrate (NOx) level was measured in the portal blood. Following completion of the baseline studies, the animals were treated with either 7-nitroindazole (7-NI, selective neuronal NOS inhibitor), or N-nitro-L-arginine (NNA, non-selective NOS inhibitor). RESULTS: In the sham-operated group the cNOS activities differed significantly in the oral and aboral tissue samples (oral: 102.9; versus aboral: 62.1 fmol/mg protein/min). The obstruction elicited a significant increase in portal NOx and elevated tissue inducible NO synthase (iNOS) activity. NNA treatment decreased the motility index in both intestinal segments for 60 min, but 120 min later the motility index was significantly elevated (2.5-fold increase in the oral part, and 1.8-fold enhancement in the aboral segment, respectively). Treatment with 7-NI decreased the cNOS activity in the oral and aboral parts by approximately 40% and 70%, respectively, and suppressed the motility increase in the aboral colon segment. CONCLUSIONS: The motility of the colon was either significantly increased or decreased, depending on the type and selectivity of the NOS inhibitor compounds applied. NO of neuronal origin is a transmitter that stimulates peristaltic activity; but an increased iNOS/nNOS ratio significantly moderates the obstruction-induced motility increase.

Animals↗
PubMed2006

Colonoscopic-assisted laparoscopic resection of a colon lipoma.

We report the case of a 51-year-old man who had abdominal distension and intermittent cramping pain for 4 months. A lower gastrointestinal double-contrast study revealed a protruding mass at the transverse colon. Endoscopic ultrasonography showed a lesion arising from the submucosal layer. Instead of a laparotomy, the lesion was removed laparoscopically with the assistance of a colonoscope. No operative morbidity was noted. With future improvements of this technique, tumors that are difficult to remove with colonoscopy can be excised laparoscopically without the aid of an endoscopic stapler. In our case, the tumor was localized intraoperatively and extracted using the intraoperative colonoscopy. This double-scope technique is safe and cost-effective for some difficult colonic lesions.

Colonic Neoplasms↗
PubMed1985

Urban-rural difference in the trend of colo-rectal cancer mortality with special reference to the subsites of colon cancer in Japan.

In order to study the effect of urbanization on the epidemiological features of colo-rectal cancer in Japan, the age-adjusted death rates (AADRs) for right-sided (cecum, ascending and transverse) colon, left-sided (descending and sigmoid) colon and rectum cancers during three periods, 1969-71, 1974-76 and 1979-81, were compared among five areas with different population sizes; ten metropolitan cities (greater than 1,000,000), large cities (1,000,000-150,000), medium-sized cities (150,000-50,000), small cities (less than 50,000) and counties. The AADR for left-sided colon cancer has been increasing in recent years, especially in males, and was higher in urban areas than in rural areas, which may imply that the recent increase in the incidence of left-sided colon cancer is associated with an urbanization of the life styles of Japanese people. In Japan, the daily consumption of carbohydrate has been decreasing, but that of total fat has been increasing in recent years, and the ratio of fat/carbohydrate consumption as an energy source was strongly correlated with the AADRs for left-sided colon cancer among the five areas in the three periods. From this correlation analysis, it was suggested that urbanization of life style, namely, the recent westernization of eating habits of Japanese people might be associated with the recent increase of the AADRs for colon cancer, especially of left-sided colon cancer, in Japan.

Adult↗
PubMed1979

Epithelial cell kinetics in the descending colon of the rat. II. The effect of experimental bypass.

The influence of experimental bypass on the epithelial cell kinetics in the rat descending colon was studied. It was found that the number of cells per crypt was markedly reduced at 6 weeks after bypass. The percentage of labelled crypt cells, 1 h after 3HTdR, and the distribution of labelled cells in the crypt was normal. Also the life span of the epithelial cells was the same in control and bypassed colon. The response of crypt cell proliferation to ischaemia-induced cell loss in the bypassed descending colon was similar to the one previously described for normal descending colon. This indicates that the absence of the normal luminal contents does not result in a different response of colonic crypts to induced cell loss. Furthermore, it was found that the number of cells per crypt and the proliferative activity did not change in the transverse colon after temporary ischaemia of the bypassed descending colon. This indicates that the increase in crypt cell proliferation after ischaemia-induced cell loss is a local response.

Animals↗
PubMed2004

Autologous-allotopic ileum mucosa transplantation for small bowel elongation. A morphological study.

INTRODUCTION: Since a standard therapy for short bowel syndrome does not yet exist, every search for new surgical methods would be worthwhile. In previous studies we could show that autologous-allotopic ileum mucosa transplantation is feasible. After a modification of our technique a vascularized colon muscle coat lined completely with transplanted ileum mucosa could be engendered. METHOD: In 12 young beagles autologous ileum mucosa was transplanted in a demucosed vascularized transverse colon segment. The colon coat-ileum mucosa complex was anastomosed with the small bowel immediately after transplantation, 4 weeks later the animals were sacrificed and histology specimens were harvested from the colon coat-ileum mucosa complex, normal ileum and normal colon. After fixation in 2.5% glutaraldehyde the samples were frozen (-40 degrees C) and 14 micro m sections were stained with hemalaun and eosin. The lumen diameter, the mucosa, submucosa and colon muscle coat thickness, as well as the mucosal crypt depth were evaluated. RESULTS: The diameter of the colon coat-ileum mucosa-complex was smaller than the diameter of normal ileum and colon with no significant stenosis. There were no marked differences in thickness of mucosa and depth of the mucosal crypts compared to the controls, but the transplanted mucosa showed a slightly higher rate of shortened villi. The submucosal layer was thicker following transplantation and showed good neovascularization. The circular muscle layer of the transplanted colon coat was up to 178% thicker and the thickness of the transplanted longitudinal muscle layer differed between 58% and 143% in comparison to normal colon. CONCLUSIONS: Only a few histologic differences between transplanted and normal ileum mucosa could be observed after autologous-allotopic ileum mucosa transplantation. Therefore a nearly normal function of the colon coat-ileum mucosa complex has to be expected. Long term experiments of the histologic changes as well as further functional studies are on-going in order to finally apply autologous-allotopic ileum mucosa transplantation clinically.

Animals↗
PubMed1999

Magnesium citrate-bisacodyl regimen proves better than castor oil for colonoscopic preparation.

BACKGROUND: A clean colon preparation prior to endoscopy or X-ray examination is essential to obtain an accurate diagnosis. In order to determine which of two easily made preparations is better, this study compares colon cleansing efficacy, patient acceptance and side effects in patients given either a magnesium citrate-bisacodyl or a castor oil regimen prior to colonoscopy. METHODS: Seventy outpatients scheduled for colonoscopy were randomized to receive one of two bowel evacuation regimens on the day prior to the examination. Group 1 (n = 36) received a magnesium citrate solution (250 mL) and bisacodyl (10 mg, orally). Group 2 (n = 34) received castor oil (60 mL, orally). RESULTS: The cleansing effect of the magnesium citrate-bisacodyl regimen was significantly better than that of castor oil in the ascending colon and caecum (cleansing scores 5.2+/-1.2 vs 3.5+/-1.3, P< 0.0001), but similar to that of castor oil in the recto-sigmoid, descending and transverse colon. Abdominal pain (38 vs 11%, P< 0.01) and nausea (29 vs 8%, P<0.05) were significantly more common in patients receiving the castor oil preparation than in patients administered with the magnesium citrate-bisacodyl regimen. More patients complained of poor acceptance with the castor oil regimen than with the magnesium citrate-bisacodyl regimen (24 vs 8%, P=0.06). CONCLUSIONS: A combined oral magnesium citrate and bisacodyl regimen is effective and better than castor oil for colonoscopic preparation.

Administration, Oral↗
PubMed1975

A half-century of experience in the management of colon injuries: changing concepts.

A total of 773 patients who sustained colon injuries during the period 1927-1974 at Charity Hospital of Louisiana in New Orleans was reviewed. For purposes of comparison the patients were grouped into three 15-year periods. The first period (1927-1942) represented patients treated in the pre-antibiotic era exclusively with exteriorization. The second period (1943-1958) included patients in whom a program of selective surgical treatment of colon injuries was instituted, and included the advent of antibiotics and improved resuscitation. The final period (1959-1974) represented the increased use of primary repair of colon injuries. In comparing the three consecutive periods there was a marked increase (106%) in the frequency of colon injuries, primarily due to gunshot wounds in young males. The average age of our patients during this last 15-year period was 27 years. The transverse colon was the most frequent site of the injury (37%) followed by the left colon (31%) and the right colon (20%). From 60 to 75% of the patients also had associated intra-abdominal or other injuries. The mortality from colon injuries has declined steadily from 67.5% in the initial period to a low of 9.2% during the past 15 years. This drop in mortality occurred despite the fact that a larger number of patients sustained associated injuries. When comparing the three methods of therapy, primary repair, repair with proximal colostomy, and exteriorization was used less frequently during the past 15 years. It was the exclusive form of therapy in all patients treated before 1942. With the advent of selective management and antibiotics we have seen a transition from exteriorization to primary repair without colostomy. During the past 15 years primary repair was used in 44% of the patients; repair with a proximal decompressive procedure was utilized in 22%; exteriorization was carried out in 33% of the patients. The selective use of primary repair has been associated with lower mortality, fewer complications, and a shorter hospital stay, despite the increasing incidence of multiple associated injuries in this latter group of patients. Based on these studies, a plea is made for the selective use of primary repair of colon injuries of patients in good general condition when the local injury to the colon appears to warrant such an approach=

Adult↗
PubMed1987

The effect of oral cisapride on colonic transit.

A prospective double-blind cross-over trial of oral cisapride 10 mg and placebo was performed to determine the effects of cisapride on the transit of colonic contents in normal humans. Six male volunteers were studied twice using colonic transit scintigraphy. After passing a tube to the caecum, 50 mu Ci of 111Indium diethylene triamine pentaacetic acid were instilled into the bowel lumen. The movement of radiolabelled material was followed using a gamma camera interfaced to a digital computer. Cisapride decreased the half-emptying of the caecum and ascending colon from 1.68 +/- 0.4 hours to 0.72 +/- 0.15 hours (P less than 0.05). The total colon half-emptying time was reduced from 38.5 +/- 7.2 hours to 11.1 +/- 2.9 hours on cisapride (P less than 0.05). Cisapride accelerated transit through the transverse colon, but not the descending colon. The progression of the geometric centre was faster during cisapride administration than with placebo (P less than 0.05). The number of bowel movements 48-hours-1 increased after cisapride from 2.5 +/- 0.8 to 5.0 +/- 0.4 (P less than 0.05). This study demonstrates that cisapride has a marked prokinetic effect on colonic transit in normal subjects. Cisapride may be a useful agent in the treatment of constipation.

Adult↗