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PubMed1994

Determining the site and causes of colonic obstruction with sonography.

OBJECTIVE: We studied the value of sonography in determining the site and cause of colonic obstruction. MATERIALS AND METHODS: Sonographic findings in 26 patients with known (n = 21) or suspected (n = 5) colonic obstruction on the basis of clinical findings and abdominal radiographs were correlated with radiologic and surgical findings. Colonic obstruction was proved in all with findings from surgery (n = 18) or from barium enema and CT (n = 8). Causes of the obstructions included colorectal cancer (n = 13), ileocolic intussusception (n = 11), transverse colonic adhesion (n = 1), and sigmoid volvulus (n = 1). Sonographic criterion of obstruction was the demonstration of a continuous distension of colonic loop with an abrupt transition to an empty distal colon. The value of sonography in terms of indicating the level and cause of colonic obstruction was evaluated. RESULTS: The location of colonic obstruction was established by using sonography in 22 (85%) of 26 cases, and the cause of obstruction was identified in 21 (81%) cases. Sonography depicted a mass (n = 5) or a segmental wall thickening (n = 5) in cases of colon cancer, and a target or doughnut sign in cases of ileocecal intussusception (n = 11). Sonography failed to depict the cause of obstruction in three cases of colon cancer and one case each of adhesion and sigmoid volvulus. CONCLUSION: Our experience suggests that sonography is useful for examining patients with colonic obstruction to determine the level and cause of the obstruction.

Adenocarcinoma↗
PubMed1998

The effect of narasin on apparent nitrogen digestibility and large intestine volatile fatty acid concentrations in finishing swine.

The effect of narasin on apparent nitrogen and dry matter digestibilities and large intestine VFA concentrations in finishing swine was investigated. The study used 21 crossbred barrows averaging 72 kg. Seven blocks were formed on the basis of pretreatment dry matter digestibility, and barrows were randomly assigned to three treatments in each block. Treatments consisted of a control (C) and narasin (N15 and N30) applied at 15 and 30 ppm, respectively. Fecal and urine samples were collected. Upon the completion of the digestibility work, intestinal samples were taken from three locations, and VFA concentrations for each animal were measured. Weight gains for the N15 and N30 treatments were increased 3.0 and 6.0% (not significant), respectively, over control. Fecal nitrogen was decreased (P < .05) in the narasin-fed barrows, and apparent nitrogen digestibility was increased (P < .05). Neither nitrogen retention nor urinary nitrogen excretion was altered (P > .05) due to narasin. There were no increases (P > .05) in apparent dry matter digestibility due to narasin. Analysis of pooled colon samples showed an increase (P < .05) in the concentration of propionic acid in relation to acetic and butyric in the narasin-fed barrows. Butyric acid was reduced (P < .05) in the transverse colon of narasin-fed barrows. In summary, narasin administration to finishing barrows resulted in improved apparent nitrogen digestibility, thus decreasing fecal nitrogen, and increased relative concentrations of propionic acid in the large intestine.

Animals↗
PubMed2003

Effects of neurotrophins on gastrointestinal myoelectric activities of rats.

AIM: To observe the effects of mouse nerve growth factor (NGF), rat recombinant brain derived neurotrophic factor (rm-BDNF) and recombinant human neurotrophin-3 (rh-NT-3) on the gastrointestinal motility and the migrating myoelectric complex (MMC) in rat. METHODS: A randomized, double-blinded, placebo-controlled experiment was performed. 5-7 days after we chronically implanted four or five bipolar silver electrodes on the stomach, duodenum, jejunum and colon, 21 experimental rats were coded and divided into 3 groups and injected NGF, rm-BDNF, rh-NT-3 or placebo respectively via tail vein at a dose of 20 microg x kg(-1). The gastrointestinal myoelectrical activity was recorded 2 hours before and after the test substance infusions in these consciously fasting rats. RESULTS: The neurotrophins-induced pattern of activity was characterized by enhanced spiking activity of different amplitudes at all recording sites, especially in the colon. In the gastric antrum and intestine, only rh-NT-3 had increased effects on the demographic characteristics of electrical activities (P<0.05), but did not affect the intervals of MMCs. In the colon, all the three kinds of neurotrophins could significantly increase the frequency, amplitude and duration levels of spike bursts, and also rh-NT-3 could prolong the intervals of MMC in the transverse colon (25+/-11 min vs 19+/-6 min, P<0.05). In the distal colon rh-NT-3 could evoke phase III-like activity and disrupt the MMC pattern, which was replaced by a continuously long spike bursts (LSB) and irregular spike activity (ISA) for 48+/-6 min. CONCLUSION: Exogenous neurotrophic factors can stimulate gut myoelectric activities in rats.

Animals↗
PubMedDate not supplied

[The single-stage surgery of colorectal neoplastic occlusion. The experience of 133 cases].

BACKGROUND AND AIM: 133 cases of occluded colorectal neoplasms (14% of the entire series): 30 (23%) of the right colon, 103 (77%) of the left colon-rectum; 69 males (52%) and 64 females (48%); mean age 67.5 years old, range 33-91 years. pTNM: stage II, 28 cases (21%); stage III: 43 cases (32%); stage IV, 62 cases (47%). The aim of this study was to resolve the occlusive symptoms and to treat the neoplasm in a single operation. METHODS: In the 62 cases at stage IV, surgery was solely palliative: 49 (79%) derivations, 13 (21%) entero-enterostomies and 36 (58%) preternatural anus; 11 (18%) standard hemicolectomies, extended in two cases to hepatic resection, and 2 (3%) Hartmann's operations. In the 71 cases at stages II and III, surgery took the form of standard colic exeresis with primary ligature of the colonic vessels at source and at the outlet; 15 (21%) right colectomies, 50 (70%) left colectomies, extended in 6 cases (8%) to abdomino-perineal amputation; 6 segmentary colectomies, 3 (4%) of the transverse colon and 3 (4%) Hartmann's operations. The following aspects are essential in this single-stage surgery: urgency; massive dose antibiotic treatment limited to the pre- and perioperative stages; peritoneal cleansing using accurate, methodical, repeated and abundant lavage; perioperative colonic preparation using direct colotomic perioperative lavage or using a trans-buccoenteric access (using Grosz-Dennis tube); the peritonisation of the retroperitoneum with the omentum and the protection of the anastomosis using omental wrapping and active lavage and, for colorectal anastomosis, even using the 3-way tube, lavage and active aspiration, in a transanal trans- or sub-anastomotic position. Total parenteral feeding is useful for 6-7 days. RESULTS: In the 62 cases at stage IV, postoperative morbidity was 3 cases (6%): 3 suppurations of laparotomy, and mortality occurred in 10 cases (16%): one case of anastomotic disunion (pre-Gullino's tube), 3 cases of septic shock and 6 cardiorespiratory failures. Mean postoperative hospitalisation was 14 days. All these patients died owing to the spread of neoplasms within 1-40 months, mean 13 months. The worst results were obtained in entero-enterostomies: 1-9 months, mean 5 months. In the 71 cases at stages II and III, postoperative morbidity was 3 cases (4%): a small anastomotic filtration after right colectomy and 2 suppurations of the laparotomic incision; mortality amounted to 10 cases (14%): one case of septic shock, one of acute hepatitis, one intestinal infarction and one cardiac infarction, 3 pulmonary embolisms and 3 cardiorespiratory failures. Mean postoperative hospitalisation was 13 days, only 10 in cases of left colectomy with anastomosis protected by Gullino's tube. The long-term results were very good in these 71 patients: over 5-year survival of 50% (Kaplan-Meier). CONCLUSIONS: Using this courageous single-stage surgery, the results are optimal even at a distance, together with reduced surgical trauma and a shorter hospital stay.

Adult↗
PubMed2001

[A case of intra-peritoneal recurrence of colon carcinoma that responded remarkably to combined therapy of low-dose leucovorin and 5-fluorouracil].

We treated a patient with intra-peritoneal recurrent tumor from colon cancer who responded completely to chemotherapy of combined low-dose Leucovorin (LV) and 5-fluorouracil (5-FU). The patient was a 75-year-old man. He underwent resection of the transverse colon, sigmoid colon and distal stomach for colon and gastric cancers. Nine months after the operation, his CEA level increased to 39.5 ng/ml and a CT scan revealed an intra-peritoneal tumor measuring about 5 cm. He received chemotherapy of 30 mg/day of LV that was injected in a bolus and 500 mg/day of 5-FU that was given i.v. by continuous infusion for 10 days. At the end of 2 cycles of this regimen, CT scan demonstrated complete tumor remission and the patient's CEA level decreased to normal level. After an additional cycle of this regimen, he received modulated chemotherapy combined with l-Leucovorin and 5-FU as an outpatient. However, after 3 months of treatment, a recurrent tumor was detected in the same portion and the first regimen was re-started for 5 days. After 4 cycles of treatment the tumor disappeared completely from a CT scan. It is important to investigate effective regimens that do not reduce the quality of life of the patient. This clinical experience suggests that a low-dose LV/5-FU therapy may be beneficial to patients with recurrent colon cancer. Further investigation is necessary to establish an effective regimen that can be given for a long period without adverse effects on quality of life.

Aged↗
PubMed1991

Pyelotransverse pyelocolostomy: an alternative method for high urinary diversion in patients with extended bilateral ureter damage.

After previous radiation due to pelvic malignoma or after multiple operations, the ileal conduit as well as sigmoid conduit are associated with an increased rate of complications. In these patients, the middle and distal ureter often cannot be considered for reimplantation due to fibrosis. High anastomosis to a bowel segment which is undamaged proves favorable. The transverse colon, conveniently situated in the cranial abdomen, is close enough to the kidneys for such a high anastomosis and is mostly spared from irradiation. In cases where severely damaged ureters forbid connection to a normal transverse conduit, we performed a pyelotransverse pyelocolostomy with high anastomosis of the bowel to both renal pelves or ureteropelvic junctions. 7 patients have been treated in this way and the follow-up of these patients ranges between 14 and 24 months. Postoperatively increased renal function was found in 6 renal units, stable function in 6 renal units, and only 1 patient showed a functional ureteropelvic stenosis. 4 months after the operation 1 patient died of sepsis caused by recurrent urinary tract infections due to recurrent stone disease as a consequence of immobilization in myelomeningocele. In patients with nearly total loss of ureters the pyelotransverse conduit is an effective surgical solution and may prove more comfortable to the patient than bilateral percutaneous nephrostomies.

Adult↗
PubMed2004

Polypoid arteriovenous malformation of colon mimicking inflammatory fibroid polyp.

Arteriovenous malformation is a well-known cause of lower gastrointestinal bleeding in the elderly and usually appears as flat or elevated bright red lesions endoscopically. Here we present a 59-year-old woman with a large fungating polypoid mass in the transverse colon. Histologically, the larger vessels were located mainly in the submucosa, and smaller vessels were also observed within the mucosa. Verhoeff's elastic stain showed internal and external elastic lamina in the malformed vessels. We report an extremely rare case of a large, pedunculated, polypoid arterioveneous malformation with the first description of our complete pathological findings.

Arteriovenous Malformations↗
PubMed1994

[Colonic lymphoma simulating cryptogenetic colitis associated with common variable hypogammaglobulinemia].

We report the case of a 72 year-old woman with late-onset common variable immunoglobulin deficiency who was hospitalized for diarrhoea and fever. Colonoscopy showed aphtoïd and deep ulcerations in the rectum, the sigmoid and transverse colon, suggestive of Crohn's disease. Histologic and immunohistochemical study revealed a low grade B cell mucosa-associated lymphoid tissue (MALT) lymphoma. This is an unusual presentation for colonic lymphoma, and the second case of colonic lymphoma associated with late-onset common variable immunoglobulin deficiency.

Aged↗
PubMed1979

Hirschsprung's disease with skip area (segmental aganglionosis).

Hirschsprung's disease is characterized by a single aganglionic segment of colon extending distally to the anal margin. Well documented reports of segmental aganglionosis have been rare. We report a case of segmental aganglionosis in which there were two distinct aganglionic segments resected. The entire transverse colon between the two aganglionic segments was normally ganglionated, preserved, and utilized and functions in a normal fashion.

Colon↗
PubMed1993

Deoxycholate is an important releaser of peptide YY and enteroglucagon from the human colon.

Peptide YY (PYY) and enteroglucagon are hormonal peptides found in endocrine cells of the distal intestinal mucosa. Although it is known that plasma concentrations of both peptides increase in response to feeding, the mechanism by which ingested food causes release of colonic hormones is not understood. The release of PYY and enteroglucagon was measured in response to intraluminal stimuli in 176 patients having investigative colonoscopy. Introduction of air, saline (isotonic and hypertonic), glucose (isotonic and hypertonic), oleic acid (without bile salts), and casein hydrolysate all failed to release PYY but glucose caused a small but significant increase in enteroglucagon concentrations. In contrast with the lack of effect of nutrients, infusion of deoxycholic acid produced a rapid and marked dose responsive increase in plasma PYY concentrations when introduced into the sigmoid colon. PYY release was statistically significant at doses between 3.3 mM to 30 mM; for example 10 mM deoxycholate caused a sixfold increase in plasma PYY concentrations. Infusion of 10 mM deoxycholate into the transverse colon or caecum produced an increase of PYY that was similar to the responses in the sigmoid colon. There was also a significant release of enteroglucagon in response to infusion of this bile salt into the sigmoid colon at doses between 3.3 mM and 30 mM. The enteroglucagon response to 10 mM deoxycholate was similar in all three colonic regions. When oleic acid was added to deoxycholate as an emulsion, the release of PYY and enteroglucagon was similar to that seen with the bile salt alone. These findings suggest that bile salts may play an important part in the control of colonic endocrine function and may explain the increased circulating concentrations of colonic regulatory peptides that are seen in malabsorption states and after small bowel resection in humans.

Aged↗
PubMed2000

[The use of interposed colon for endothoracic anastomosis in esophageal surgery].

OBJECTIVE: To study the use of interposed colon for endothoracic anastomosis in esophageal surgery. METHODS: From May 1991 to December 1993, 28 cases were selected with carcinoma of the middle and/or lower segment of esophagus. After tumor resection, a segment of transverse colon with peduncle was anastomosed in its peristaltic direction to the two ends of the severed esophagus. The vagus nerve innervating esophagus and stomach was intact, the anastomical position of the esophagus-cardia hiatus and the stomach were preserved. RESULTS: No anastomosis leakage, reflux esophagitis or the symptoms caused by the endothoracic stomach occured in this group. The digestive function of the patients remained good. The 1-, 3-, 5-year survical rate was 96.6%, 92.8% and 71.4%, respectively. CONCLUSION: The interposed colon for endothoracic anastomosis is a comparatively ideal method for the reconstruction of esophagus following resection of cancer of mid and lower thind of the esophagus.

Adult↗
PubMed2006

A study of large-bowel volvulus in urban Australia.

BACKGROUND: Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001. METHODS: A retrospective chart study was carried out. RESULTS: Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum. CONCLUSIONS: Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized.

Aged↗
PubMed1993

Obstructive colonic cancer.

The records of 121 patients with obstructing cancer of the colon were reviewed. About one-third of the patients had metastatic disease at the time of operation. Primary resection and anastomosis of the intestine was performed for most cancers of the ascending or transverse colon. Hartmann's procedure was performed in most patients with cancer of the sigmoid colon and rectum. Wound infection occurred in 20 patients (16.5%) and anastomotic leakage in six (4.9%). The operative mortality rate was 14.9%. The 5-year survival rate was 13.5%. Acute colonic obstruction is associated with high morbidity and mortality. The high incidence of advanced disease, advanced age, delay in tumour excision and unprepared bowel are some of the factors resulting in the poor prognosis of these patients.

Acute Disease↗
PubMed1987

Spontaneous expulsion of lipoma per rectum occurring with colonic intussusception.

The spontaneous expulsion of lipoma per rectum is an extremely rare phenomenon. The present case report describes this event in a patient with lower abdominal pain and bleeding per rectum leading to exploratory laparotomy. At surgery, a large intussuscepting ulcerated submucosal lipoma remnant was identified in the transverse colon. This unusual presentation of colonic lipoma is discussed and the pertinent literature is reviewed.

Colonic Diseases↗
PubMed1995

Stercoral perforation of the colon.

An elderly man presented with abdominal pain and signs of peritonitis. Emergency laparotomy was performed and a stercoral perforation of the cecum was found with a large scybalum plugging the defect. The patient was treated with right colectomy and a stoma was formed from the terminal ileum and transverse colon. Stercoral perforation of the colon is extremely unusual and carries high morbidity and mortality. The etiology, diagnosis and treatment of the condition are briefly discussed.

Aged↗
PubMed1998

Laryngeal metastasis from a signet ring cell carcinoma of the colon. A case report and review of the literature.

Secondary involvement of the larynx and pharynx by malignant neoplasms arising in contiguous structures is well known, but metastases to the larynx from distant tumors are rare. In the present paper a case of signet ring cell carcinoma of the transverse colon metastatic to the left pyriform sinus is reported. A review of the literature identifies 7 other published cases of metastases to the larynx from a colon carcinoma.

Aged↗
PubMed1992

The adenoma-adenocarcinoma sequence in the large bowel: variations on a theme.

Most adenocarcinomas of the colorectum arise in a visible benign precursor lesion, the adenoma, which is a monoclonal proliferation of dysplastic nonmalignant epithelial cells. The resultant adenoma-adenocarcinoma sequence represents the predominant pathogenetic pathway, in contrast to de novo carcinoma. Therefore, the adenoma is a tempting endpoint for chemoprevention trials. The adenoma-adenocarcinoma sequence occurs in diverse clinical settings. In familial adenomatous polyposis (FAP) syndrome, autosomal dominant inheritance of the mutated APC (adenomatous polyposis coli) gene on chromosome 5q21 typically results in thousands of adenomas in the colorectum and in lesser numbers in the proximal small bowel. Adenocarcinoma usually develops in only a few of these adenomas, typically in the left colon and duodenum. In hereditary nonpolyposis colorectal cancer (HNPCC) syndrome, autosomal dominant inheritance of an unidentified gene appears to result in small numbers of adenomas which progress frequently to adenocarcinoma, predominantly in the right or transverse colon. In familial aggregation of colorectal cancer without a recognizable syndrome, cancer and/or adenomas occur in pedigree members. In "sporadic" cancers and adenomas, family history is absent and the tumors are mainly in the left colon. Colorectal adenomas have variable characteristics including size, shape (polypoid vs. flat), villous architecture, and dysplasia. A variety of oncogenes and tumor suppressor genes are altered during progression. Epigenetic factors are important as evidenced by the disappearance of adenomas in FAP patients after ileorectal anastomosis or treatment with the nonsteroidal antiinflammatory drug sulindac. Several variations on the theme of the adenoma-carcinoma sequence are evident. Identification of the inherited and acquired genetic alterations as well as the interacting environmental factors will provide a rational basis for chemoprevention.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2003

Xanthogranulomatous cholecystitis resembling carcinoma with extensive tumorous infiltration of the liver and colon.

BACKGROUND: Xanthogranulomatous cholecystitis is a macrophage-rich inflammatory condition of the gallbladder that occasionally presents with tumorlike appearance. CASE PRESENTATION: In the present case the inflammation involved all the layers of the gallbladder, the surrounding connective tissue, and part of the right lobe of the liver and right transverse colon. The clinical and radiological findings were suggestive of advanced carcinoma of the gallbladder. However, intraoperative frozen section investigation revealed xanthogranulomatous cholecystitis, for which simple cholecystectomy is the treatment of choice. CONCLUSIONS: The original cause of the condition is unclear in most cases. In the present case it is possible that rupture of the gallbladder in association with the patient's known history of trauma have initiated the process.

Cholecystitis↗