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Anastomotic leakage is a serious complication of colonic surgery, and contributes significantly to morbidity and mortality. A new technique has been developed to reduce the danger from such leaks, which involves exteriorizing a loop of transverse colon without opeining it. Should a leak develop, this loop can be transformed into a colostomy; otherwise, it can be easily remimplanted into the abdomen once the bowel is healed.
Mucosal ridge and fold formation, apoptosis and the occurrence of secondary lumina within the epithelium are morphological features associated with the development of the colon. These processes, however, do not occur synchronously in the various segments of the colon. In the caecum and ascending colon of the rat, fold formation, apoptosis and secondary lumina result in the development of villi by day 22 after conception, and by postnatal day 3 in the transverse colon. These villi persist in the rat colon until approximately postnatal day 10. The presence of colonic villi may be correlated with the increased food intake and fluid absorption during this early postnatal period. Villus formation does not take place in the developing descending colon.
PURPOSE: This study was designed to investigate whether intraperitoneally injected insulin-like growth factor I is able to protect colonic healing from the adverse effects of hydrocortisone therapy. METHODS: Eighty female Wistar rats were randomized into four groups (20 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. Hydrocortisone (5 mg/kg body weight) was injected intramuscularly in rats of cortisone (Group B) and insulin-like growth factor I + cortisone (Group D) groups once daily for seven days before and after the operation. Insulin-like growth factor I (2 mg/kg body weight) was intraperitoneally injected in rats of the insulin-like growth factor I (Group C) and the insulin-like growth factor I + Cortisone (Group D) groups immediately after operation and on the second, fourth, and sixth postoperative days. Rats were killed on the seventh postoperative day. Anastomoses were graded macroscopically and histologically, and bursting pressures and anastomotic hydroxyproline levels were recorded. Statistical analyses were performed by using Fisher's exact test for the comparison of proportions and ANOVA for the comparison of means among groups with subsequent post-hoc analysis using Bonferroni correction. RESULTS: Leakage rate was significantly higher in the cortisone (Group B) group. Bursting pressures were significantly lower in the cortisone group, whereas they were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups (Group C and D). Histology revealed a significant decrease of inflammatory cell infiltration, neoangiogenesis, and fibroblast activity in the cortisone group compared with the control group, whereas these parameters were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. Hydroxyproline levels were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. CONCLUSIONS: Hydrocortisone inhibits the healing of colonic anastomoses. However, insulin-like growth factor I given intraperitoneally mediates the deleterious effects of cortisone and protects colonic healing in rats.
PURPOSE: Esophageal replacement has been achieved using stomach, gastric tube, small intestine, and colon in various positions and in single or multiple stages. Long-term functional results are of prime importance in children with benign disease. The aim of this study is to present the immediate and long-term results of one-stage esophagectomy and in situ colon interposition esophageal replacement in children. METHODS: Seven children have undergone one-stage esophagectomy and in situ colon interposition esophageal replacement for stricture secondary to caustic ingestion (n = 4), battery ingestion (n = 2), and epidermolysis bullosa (n = 1). TECHNIQUE: Via thoracoabdominal and cervical incisions, the transverse colon, isolated on the left colic artery, is pulled through the esophageal hiatus and normal esophageal bed into the neck at the time of simultaneous esophagectomy. The stomach is partially wrapped around the colon as an antireflux procedure and a pyloroplasty are performed. RESULTS: There was no immediate postoperative morbidity or mortality. All patients were discharged taking a soft diet by mouth. There were no anastomotic leaks or strictures, and functional swallowing is excellent. Contrast studies show no dilation of the colon in the chest. Growth and development have been normal up to 7 years postoperatively. CONCLUSION: The one-stage esophagectomy and in situ colon interposition is an excellent technique for esophageal replacement in children. Continued evaluation of this technique will be necessary to confirm these preliminary results.
A family with Gardner's syndrome including one autopsy case is reported. A 22 year-old man had multiple polyposis of the colon and the small intestine, epidermal cysts, soft part tumor of the abdominal skin and osteomas in the calvarium and rib, and died of a carcinoma in the transverse colon and embolism of the brain. Histologically, all polyps were diagnosed as adenomatous polyp. The greater their diameter, the higher the tendency of atypism was observed. However, the polyps around the cancer were few, small, and with low atypism, and we could not obtain evidence showing direct transformation of adenomatous polyps into carcinoma. His two elder brothers had multiple polyposis of the colon, epidermal cysts and osteomas in the calvarium or mandibular bone, but are still alive.
Two cases of chagasic megacolon associated with colon cancer are reported. This is the first communication with complete clinical details of this association. Our two cases presented tumors (adenocarcinomas) in a nondilated segment of the transverse colon. The associated tumor lesions were diagnosed by a barium enema. Both patients had a typical clinical epidemiology and history of chagasic megacolon.
Colonic involvement as a result of pancreatitis is an uncommon but interesting complication of the disease. Among the significant manifestations we have seen are: 1) adynamic ileus of the transverse colon, 2) fibrosing, stenosing pericolitis localized to the splenic flexure area, and 3) colonic hemorrhage secondary to necrosis and fistula formation. Ordinarily, conservative treatment will suffice, but in complicated cases, individualized surgical treatment becomes necessary.
Psyllium has been reported to inhibit lactulose-induced colonic mass movements and to benefit patients with irritable bowel syndrome, improving both constipation and diarrhea. Our aim was to define how psyllium modified the whole-gut transit of a radiolabeled lactulose-containing test meal by using gamma scintigraphy. Eight subjects participated in a randomized crossover study comparing gastric emptying and small bowel and colonic transit after consumption of 20 mL lactulose three times daily with or without 3.5 g psyllium three times daily. Psyllium significantly delayed gastric emptying: the time to 50% emptying increased from a control value of 69 +/- 9 to 87 +/- 11 min (mean +/- SEM; P < 0.05, n = 8). Small bowel transit was unaltered. However, progression through the colon was delayed with an increase in the percentage of the dose at 24 h in the ascending (control group: 2 +/- 3%, psyllium group: 11 +/- 8%; P < 0.02) and transverse colon (control group: 5 +/- 12%, psyllium group: 21 +/- 14%) with correspondingly less in the descending colon. Although the time for 50% of the isotope to reach the colon was not significantly different with psyllium, psyllium significantly delayed the rise in breath-hydrogen concentrations, which reached 50% of their peak at 217 +/- 34 min compared with control values of 155 +/- 27 min (P < 0.05). Psyllium delays gastric emptying, probably by increasing meal viscosity, and reduces the acceleration of colon transit, possibly by delaying the production of gaseous fermentation products.
A 60-year-old woman with a remote history of colon carcinoma was studied with F-18 FDG PET imaging 5 days after admission for acute toxigenic enterocolitis. Marked and diffusely increased uptake was noticed throughout the ascending and transverse colon, which was noticed to be edematous and thickened on contrast CT examination. The study emphasizes the need to consider nonneoplastic entities, such as enterocolitis in the differential diagnosis of intensely hypermetabolic colonic lesions on F-18 FDG PET examinations.
The authors report 6 cases of colonic stenosis (three males and three females, range of age 9 days-4 months) observed from 1982 to 1985 in the Department of Pediatric Surgery in Bambino Gesù Hospital. Three out of six have been admitted with the diagnosis of necrotizing enterocolitis soon after birth. The authors have observed 2 cases of colonic stenosis in neonatal age, 1 case aged month, both suffering from Hirschsprung's disease. A file for the diagnosis has been performed for all patients. Stenosis have been observed in the descending colon, sigmoid colon, rectosigmoid tract, multiple stenosis were present in 2 patients. In 5 patients the surgical treatment has been the removal of stenotic tract. In three patients a colostomy on transverse colon has been performed followed by abdominal perineal intestinal lowering. The authors stress the importance of anorectal manometry among investigations usually performed to exclude Hirschsprung's disease.
To investigate the effects of the colonic environment on duodenal G-cell activity and proliferation, thirty white rats underwent antrectomy with gastroduodenostomy (control group) or antrectomy with interposition of a 15 mm segment of transverse colon between the gastric fundus and the first duodenal portion (experimental group). Three to four months after surgery, serum gastrin determinations were carried out by radioimmunoassay either in fasted or freely fed rats. The duodenum was then removed and its proximal third was used for G-cell count (immuno-peroxidase method) and for assessment of G-cell cytoplasmic granule content (electron microscopy examination). The interposition of a colonic segment between the gastric fundus and the first duodenal portion did not affect either serum gastrin levels or the cytoplasmic granule content of duodenal G-cells, while significantly increasing duodenal G-cell density. These results indicate that the colonic environment enhances duodenal G-cell proliferation, but gastrin release from the enlarged duodenal G-cell mass is not stimulated by the interposition of a colonic segment to replace the antrum, either under fasting or feeding conditions.
Colonoscopy was performed preoperatively in 100 consecutive patients as a prospective study to establish the feasibility of the procedure and its value, which was considered "adequate" when the colon remaining after surgical resection had also been examined preoperatively. Colonoscopy was adequate in 35 of 46 patients (76%) with malignant tumour located in the cecum and ascending and transverse colon, but in only 15 of 54 patients (28%) who had a tumour in the left colon or rectum. Synchronous malignant tumours were present in 2 patients, and 54 additional adenomas were discovered in 29 patients. These adenomas could be removed endoscopically in 13 patients and were included in the standard resection in 12. Extension of the planned operation was necessary in only four patients with synchronous adenomas. Routine preoperative colonoscopy to assess the presence of synchronous colonic tumours is more likely to be adequate in proximal or right-sided large-bowel tumours than in left-sided tumours because of the annular configuration of the latter. Because of the high rate (46%) of synchronous adenomas in adequate examinations, inadequate preoperative colonoscopy should be complemented by a repeat examination 3 to 6 months postoperatively in every patient with a malignant tumour of the large bowel.
Glycoproteins binding to Ulex europaeus agglutinin-I (UEA-I) lectin, which recognizes the terminal alpha-L-fucose residue, were analyzed in 18 cases of human colorectal carcinoma by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by the Western blotting method. In the distal large bowel (descending and sigmoid colon and rectum), high-molecular-weight glycoproteins binding to UEA-I existed in carcinoma tissue but not in normal mucosa. In the proximal large bowel (ascending and transverse colon), high-molecular-weight glycoproteins binding to UEA-I were found both in normal mucosa and in carcinoma tissue, whereas those from the carcinoma tissue had an apparently lower molecular weight as compared to the weight of those from the normal mucosa. Thus there is a biochemical difference in UEA-I binding glycoproteins between the normal mucosa and the carcinoma tissue, although in our previous histochemical study no difference was observed in UEA-I binding glycoproteins of the proximal large bowel between the carcinoma tissue and the normal mucosa. Furthermore, carcinoembryonic antigen from the carcinoma tissue was found to have the same electrophoretical mobility as the UEA-I binding glycoproteins.
Chylous cysts are medical rarities found mainly in the mesentary of the small intestine and the retroperitoneal space. Other localities are extremely rare and difficult to explain. A case of chylous cyst of the mesentery of the transverse colon is presented with brief review of the literature. The etiologic, pathogenetic and clinical features, diagnosis and treatment is discussed.
The effect of varying dietary fiber intake on colon motor and electrical spike activity, transit time, and fecal content were studied in stump-tailed monkeys. Mean dry fecal weight increased with increasing fiber intake, but percentage water content did not change. Mean transit time was delayed when the diet contained less than 10 g dietary fiber daily. The clearance of polyethylene glycol and chromium sesquioxide also was slower on a low-fiber intake. Electrical spike discharge activity was greatest in the cecum and increased with increasing fiber intake. The effect of fiber on electrical spike activity progressively decreased distally along the colon. The contraction frequency of circular muscle, recorded with implanted strain gages, was greater in the cecum on a low-fiber diet, but this effect was less marked in transverse colon, and no significant differences were seen more distally.
A 32-year-old Japanese woman with a 14-month history of ulcerative colitis (UC), pancolitis type, was referred to our institution, because of abdominal distention. Plain abdominal X-ray and computed tomography (CT) showed marked dilatation of the right side of the colon. The patient was treated by immediate total colectomy, with the diagnosis of toxic megacolon. Macroscopically, there was a constricting lesion with giant polyposis in the middle part of the transverse colon. Histologically, there was transmural inflammation with a thickened proper muscular layer overlaid by inflammatory polyposis. This case suggests that giant polyposis in UC patients may result in severe stenosis and that such a condition should not be misinterpreted as toxic megacolon or as colitic cancer.
A case of acute perforation of a diverticulum of the ascending colon is presented. The ultrasound features that helped in making a pre-operative diagnosis are discussed. This rare surgical emergency and the similar clinical entities of perforated caecal or transverse colon diverticula are often clinically misdiagnosed as more common conditions such as acute appendicitis, acute cholecystitis or perforated ulcer. Awareness of this entity will help radiologists in making a correct pre-operative diagnosis.
We aimed to clarify the effects of different enteral nutrients (normal chow, complete balanced nutrition, elemental nutrition enriched with glutamine, immune-enhancing diet and fiber) on colonic anastomotic healing in the stress-free metabolic state. The study was carried out with 50 male Balb-C mice in five groups of 10 animals each. After transverse colon anastomosis, animals were fed with early enteral nutrients using normal chow (group 1), Ensure((R)) (group 2), Alitraq((R)) (group 3), Impact((R)) (group 4), and Benefiber Resource((R)) orange juice drink (group 5) for 7 days. There were no significant differences among the groups in bursting pressure (p > 0.05). There was no statistical difference in terms of hydroxyproline level among groups 1-3. The hydroxyproline levels of groups 4 and 5 were statistically higher than that of the control group (p < 0.05 for both comparisons). Under normal conditions without stress, we could not demonstrate the superior effects of early enteral feeding with specialized enteral preparations over normal diets on colonic anastomoses when the bursting pressures were compared.