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PubMed1988

Role of opiate receptors in the regulation of colonic transit.

The effects of morphine and the opiate antagonist naloxone on human colonic transit were investigated. In a crossover, double-blind fashion, two groups of 6 normal volunteers were studied using colonic transit scintigraphy during the administration of a test drug or control. The test drugs were morphine (0.1 mg/kg every 6 h s.c.) or naloxone (0.8 mg every 6 h s.c.); control was saline (1 ml every 6 h s.c.). Morphine significantly delayed transit in the cecum and ascending colon (p less than 0.05), slowed the progression of the geometric center (p less than 0.01), and decreased the number of bowel movements per 48 h (p less than 0.005). Naloxone accelerated transit in the transverse colon and rectosigmoid colon (p less than 0.05) and accelerated the progression of the geometric center (p less than 0.05), but had no effect on the number of bowel movements per 48 h (p greater than 0.05). These results suggest that narcotic analgesics may cause constipation in part by slowing colonic transit in the proximal colon and by inhibiting defecation. Acceleration of transit by naloxone suggests that endogenous opiate peptides may play an inhibitory role in the regulation of human colonic transit.

Adult↗
PubMed1980

The plain abdominal radiograph in acute pancreatitis.

The radiographs of 100 patients with acute pancreatitis were reviewed and compared with 100 controls by two radiologists and a surgeon. Our aim was to assess the frequency and usefulness of the signs described in the literature. Calcification of the pancreas was seen in one case only. Abnormalities of the biliary tree (visible gallbaldder, biliary gas and gallstones) were seen in 10%. The left psoas shadow was more frequently absent in the pancreatitis series. Paucity of gastrointestinal gas although observed in 12 cases was ascribed to vomiting. A more important sign was the gaseous outline of an adynamic duodenal loop which was seen in half of the patients examined in the left lateral decubitus position. Dilated jejunum was seen in 31 cases, associated with sentinel loops in 10 and multiple fluid levels in 25 patients. Dilatation of thet ransverse colon was the most constant colonic sign (18%), but the colon 'cut-off' sign was not seen. It was concluded that the most prominent signs in order of importance are a gaseous distension of the duodenal loop, gas in the duodenal cap, a dilated transverse colon and the sentinel loop. The gasless abdomen is a striking but rare sign and in our series was always associated with severe pancreatitis.

Acute Disease↗
PubMed1981

Diffuse colitis cystica profunda. Report of a case.

A 20-year-old man had a 2-year history of ulcerative colitis with multiple exacerbations and failure of medical management. In addition to evidence of ulcerative colitis involving the descending colon and rectum, the remainder of the total proctocolectomy specimen demonstrated prominent, circumferential, polypoid elevations of mucosa and epithelial-lined, submucosal mucous cysts diagnostic of colitis cystica profunda. The involvement of the ascending and transverse colon was diffuse. Colitis cystica profunda is an uncommon condition, usually localized to the rectum and which can be misdiagnosed both clinically and pathologically as invasive carcinoma. Diffuse involvement of the proximal colon as noted in this case, is exceedingly rare.

Adult↗
PubMed1992

Comparison of fermentation reactions in different regions of the human colon.

Colonic contents were obtained from two human sudden-death victims within 3 h of death. One of the subjects (1) was methanogenic, the other (2) was a non-CH4 producer. Measurements of bacterial fermentation products showed that in both individuals short-chain fatty acids, lactate and ethanol concentrations were highest in the caecum and ascending colon. In contrast, products of protein fermentation, such as ammonia, branched chain fatty acids and phenolic compounds, progressively increased from the right to the left colon, as did the pH of gut contents. In Subject 1, cell population densities of methanogenic bacteria (MB) increased distally through the gut and methanogenic activity was lower in the right (0.78-1.18 mumol CH4 produced/h/g dry wt contents) than in the left colon (1.34 mumol CH4 produced/h/g dry wt contents). Methane production rates did not correlate with MB numbers. Sulphate-reducing bacteria (SRB) were not found and dissimilatory sulphate reduction was not detected in any region of the colon. Methanogenic bacteria did not occur in subject 2, but high numbers of SRB were present throughout the gut (ca 10(9)/g dry wt contents). Sulphate reduction rates were maximal in the ascending and transverse colons (0.24 and 0.22 mumol 35SO4(2-) reduced/h/g dry wt contents, respectively). Short-chain fatty acid production by caecal contents was up to eight-fold higher than contents from the sigmoid/rectum. These findings demonstrate significant differences in fermentation reactions in different regions of the large gut.

Adult↗
PubMed2001

Progressive gastrointestinal histoplasmosis leading to colonic obstruction two years after initial presentation.

A 37-yr-old man from Ecuador presented with abdominal pain, diarrhea, and weight loss. Endoscopy revealed duodenal histoplasmosis. The patient improved with antifungal therapy but was readmitted 2 yr later with diarrhea and fever. Colonoscopy revealed histoplasmosis lesions, including a constricting transverse colon lesion. The patient refused surgery and died of colonic perforation. We discuss the diagnosis and management of gastrointestinal histoplasmosis in this report.

Adult↗
PubMed2004

[Diagnostic problems associated with intestinal amoeboma: case report].

Amoeboma is an inflammatory mass of the colon. It is uncommon with most cases occurring in Latin America and South Africa. When amoeboma is the presenting symptom of amoebiasis, it poses the problem of differential diagnosis of colon cancer. This report describes the case of a 60-year-old patient who presented a painful mass in the left hypochondrium. Radiologic and endoscopic examinations depicted a ring-like stenosis of the transverse colon in association with a mesenteric reaction. The presumptive diagnosis was colon cancer and the patient was referred to the National Oncology Institute for surgical treatment. Histological examination of the surgical specimen after segmental colectomy confirmed diagnosis of intestinal amoeboma. The patient was treated medically using metronidazole. Since intestinal amoebiasis is common in our country, amoeboma must be considered as a rare but potential diagnosis in patients presenting masses of the colon. Differential diagnosis of carcinoma is necessary to avoid the risks associated with unnecessary surgery.

Amebiasis↗
PubMed2003

Carcinoma of the cystic duct remnant with direct colonic invasion.

Carcinoma of the cystic duct remnant is extremely rare, and only five cases have been reported previously in the English literature. We present another case of carcinoma of the cystic duct remnant and review the literature. A 62-yr-old woman was diagnosed as having hilar cholangiocarcinoma and transverse colon cancer. However, at laparotomy, the center of the tumor mass was in the cystic duct remnant with contiguous colonic invasion. The pathology of the surgical specimen confirmed carcinoma of the cystic duct remnant. The diagnosis of carcinoma of the cystic duct remnant was made using Ozden's new criteria.

Bile Duct Neoplasms↗
PubMed1993

[A case of multiple colon cancer appeared after thymectomy for thymoma with myasthenia gravis].

A 62-year-old woman was admitted to our hospital because of diarrhea and melena. Thymectomy for thymoma with myasthenia gravis was carried out on this patient four years ago. Barium enema revealed four tumor shadows in the ascending and transverse colon. Multiple colon cancer was diagnosed and extended right hemicolectomy was carried out. The postoperative course was uneventful and she has been free from any symptom. In this paper, we discussed the relationship between thymoma and the incidence of nonthymic malignancy.

Adenocarcinoma↗
PubMed1985

[The problem of recurrence in colonic cancer].

In this study the incidence of recurrence in radical procedure for carcinoma of colon is more than 37.4%. Of 100 patients undergoing second laparotomy because of recurrence 33% could be resected curatively. The rate of recurrence was independent on sex, negatively correlated with age and positively correlated with tumor stage of former operations. Curative operations located at the ascending colon and hepatic flexure had less recurrences than others. Second operations in curative aims were twice as successful in men than in woman and equally possible in all decades. Results of recurrences of splenic flexure and transverse colon were better than other locations. Tumors of early stages relapsed later. The probability of a radical procedure in recurrence related operations was better in those cases with a long recurrence-free interval. The resectability +/- rate and tumor stage of second-look operation were depending on tumor stage in the first operation. This means further history of tumor disease is determined closely by tumor stage in the first operation.

Adult↗
PubMed2002

An unusual perforation of the colon: report of two cases.

We herein present two cases of a colorectal perforation due to uncommon reasons. First, we treated a 45-year-old woman for a stercoral perforation of the sigmoid colon. The pathognomonic etiology was a barium fecaloma originating from an upper gastrointestinal series 9 months before admission. The second case was a 46-year-old woman who was admitted with a perforation of the transverse colon. She had experienced perforations of the sigmoid colon at 32 years of age and of the rectum at 44 years of age, respectively. The second and third conditions were diagnosed to be idiopathic, and were histologically proven by an abrupt obliteration and a thinness of the colonic wall with some infiltration of inflammatory cells. The first condition, however, was most likely a stercoral perforation. The postoperative course of these patients was uneventful, and both are doing well at this writing.

Colonic Diseases↗
PubMed2004

Metastatic breast adenocarcinoma masquerading as colonic primary. Report of two cases.

BACKGROUND: Common sites of metastasis for the breast cancer are bones, lungs, the central nervous system and liver. The colon is the rarest site of metastasis for the breast carcinoma. PATIENTS AND RESULTS: We report our recent experience of two female patients, 55 and 57 years old respectively, who presented breast metastasis at the proximal transverse colon. They were operated for breast carcinoma followed by chemotherapy and radiotherapy, four and ten years before the metastasis was diagnosed. The symptoms were anaemia and bowel obstruction. Diagnosis was made by double contrast barium enema and colonoscopy. Postoperatively, both patients received systemic chemotherapy. At the follow-up, two and three years after, there is no evidence of recurrence or metastasis. CONCLUSIONS: Patients with history of breast cancer presenting with anaemia and/or bowel obstruction should be examined for possible metastasis to colon and should be treated surgically followed by systemic chemotherapy.

Adenocarcinoma↗
PubMed1994

Epstein-Barr virus-associated natural killer-large granular lymphocyte leukemia.

We describe the first case of an Epstein-Barr virus (EBV)-associated natural killer-large granular lymphocyte (NK-LGL) leukemia in the United States to the best of our knowledge. A 29-year-old woman of Japanese descent developed EBV infection after a blood transfusion as indicated by a rise in serum antibody titers. Peripheral blood and bone marrow aspirate smears demonstrated increased LGLs. Flow cytometry showed that these cells expressed NK-associated surface antigens. Cytogenetic analysis of the bone marrow aspirate showed two distinct but related clones with multiple copies of a modified 7 marker chromosome. Death followed colonic perforation. Findings at necropsy included bone marrow lymphocytosis and erythrophagocytosis, a mononucleosis-like lymphadenitis, atypical hepatitis with a mixed, predominantly T-cell infiltrate, interstitial pneumonitis, and multiorgan system vasculitis with perforation of the transverse colon. Epstein-Barr virus transcripts were identified in lymphocytes infiltrating liver and peripheral nerve by in situ hybridization. In addition, Southern blot analyses showed monoclonal bands superimposed on oligoclonal ladders of EBV termini in liver and lymph node. The identical episomal form of EBV was found in the bone marrow, lymph node, and liver. No immunoglobulin (Ig), T-cell receptor beta, or T-cell receptor gamma chain gene rearrangements were identified. These studies support the hypothesis that the LGL population was a neoplastic EBV-related clonal proliferation of NK cells.

Adult↗
PubMed1997

Cocaine-induced ischemic colitis with small-vessel thrombosis of colon and gallbladder.

Ischemic colitis is a rare complication of cocaine abuse. To date, only 15 reports have linked the use of cocaine to ischemic events of the small bowel and colon. We report ischemic colitis in a 36-year-old woman who admitted using crack cocaine twice, 1 and 2 days before onset of symptoms. Patchy areas of necrosis were grossly present in the resected transverse colon. In addition, the gallbladder showed edema and congestion of the wall on gross examination. On microscopy, the gallbladder as well as the colon were noted to have multiple small-vessel thrombi. Colonic mucosa showed ischemic necrosis. Cocaine abuse should be considered in the differential diagnosis of ischemic colitis, especially in a young adult.

Adult↗
PubMed1990

Neuromuscular structures specific to the submucosal border of the human colonic circular muscle layer.

The circular muscle layer of the human caecum and ascending colon is clearly subdivided into two portions: an outer one which includes the bulk of the circular muscle layer, and an inner one made up of only six to eight rows of cells. In the right transverse colon no demarcation can be observed, but a difference exists between the innermost and the outermost cells, since those of the two innermost rows possess some peculiarities with regard to the sarcoplasmic reticulum, glycogen particles, caveolae, and intercellular junctions. In the left part of the colon, the circular muscle layer is also divided into two portions. In fact, the innermost smooth muscle cells still possess peculiar morphologies, progressively increase in number, and become separate from each other making up a superficial muscle network. A fibrous lamella, along and inside which a ganglionated nerve plexus runs, is strictly apposed to the submucosal border of the circular muscle layer of the entire colonic length. A second nerve plexus runs between the two portions of the circular muscle layer. Both these plexuses are accompanied by interstitial cells of Cajal in the right colon only. The peculiar organization of the entire submucosal border of the human colonic circular muscle layer distinguishes it from other parts of the gut and probably represents a structural basis for control of human colonic motility. The presence of putative pacemaker cells (interstitial cells and peculiar smooth muscle cells) indicates that the inner border of human colonic circular muscle layer possesses pacemaking activities. Moreover, the interstitial cell--smooth muscle cell ratio differs depending on the colonic level; two main regions can be identified: the right and the left colon. Consequently, we might expect regional variation in pacemaking.

Cecum↗
PubMed1997

Evaluation of human collagen biomaterials in the healing of colonic anastomoses in dogs.

OBJECTIVE: To investigate the ability of human collagen biomaterials to secure colonic anastomoses in dogs and to evaluate the biocompatibility of anastomotic protection patches (APP). DESIGN: Experimental open study. SETTING: Experimental research centre, France. MATERIAL: 21 mongrel dogs randomised into three groups of 7 each. INTERVENTION: Standard transverse colonic end-to-end anastomoses were secured with two-layer oxidised collagen I + III sponge covered with thin crosslinked collagen IV film (APP 1) glued around the suture (n = 7); two-layer oxidised collagen I + III sponge covered with thin non-crosslinked collagen I + III film patch (APP 2) (n = 7); or sealed by fibrin sealant (n = 7), which acted as a controls. MAIN OUTCOME MEASURES: Gross examination, radiological control (barium enemas), and microscopic examination on day 35 postoperatively. RESULTS: Gross clinical and radiological examinations on day 35 showed normal wound healing in all but one dog in which the anastomoses had occluded by day 16. There was significantly less stricturing with the APP 2 patch (p < 0.05 compared with the controls). Microscopic examination showed complete absorption of the APP 2 patches as well as quicker mucosal and extracellular matrix repair than controls. The APP 1 patch gave the best healing of the muscular layer but did not reduce anastomosis stricturing, and was not totally absorbed. CONCLUSIONS: Collagen supporting devices do not alter healing of the large bowel. Encircling patches do not increase the number of adhesions or the rate of anastomotic stricturing and a thin fibrillar collagen I + III dense layer may even improve it. The speed of absorption of the patch depends on the type of dense collagen film. These results argue for a prospective clinical evaluation in humans.

Analysis of Variance↗
PubMed1999

Influence of arginine dietary supplementation on healing colonic anastomosis in the rat.

INTRODUCTION: This study sought to determine whether dietary arginine influences colonic anastomotic healing in the rat model. METHODS: Three groups of 42 Sprague-Dawley rats were fed 0, 1, and 3 percent arginine diets for three preoperative and three postoperative days. Animals underwent transection of the transverse colon with hand-sewn anastomosis. Subgroups of 14 animals in each dietary group were killed on postoperative Days 6, 10, or 14, and bursting pressures, histologic inflammation, and collagen content were compared. RESULTS: Mean anastomotic bursting pressures on postoperative Day 6 were lower for the 0 percent arginine group than the 1 and 3 percent arginine groups (mean +/- standard error of the mean = 134+/-6 mm Hg, 164+/-7 mm Hg, and 166+/-7 mm Hg, respectively; P<0.0005). On Days 10 and 14, no significant differences in bursting pressures were noted between arginine diets. Mean bursting pressures on postoperative Day 6 (155+/-4 mm Hg) were significantly lower than on Days 10 (204+/-5 mm Hg) and 14 (217+/-6 mm Hg; P<0.001) for all arginine diets. Microscopic evaluation of the anastomoses did not show significant differences in inflammation or collagen content between arginine diets. Collagen content in all dietary groups peaked at Day 10. CONCLUSIONS: Perioperative arginine deficiency in the rat model is associated with impaired anastomotic healing during the first week, as reflected by lower bursting pressures. Arginine supplementation to 3 percent does not improve bursting pressures above those found in the usual 1 percent arginine diet at 6, 10, or 14 days. Bursting pressures plateau by Day 10 regardless of perioperative dietary arginine, whereas collagen content peaks at Day 10 after six-day perioperative arginine diet manipulation.

Anastomosis, Surgical↗
PubMed1982

Multiple primary carcinomas of the colon and associated extracolonic primary malignant tumors.

A review of 308 cases of colorectal carcinoma showed 12 cases (3.9%) of colorectal multiple primary malignant tumors and 14 cases (4.5%) of colorectal primary malignant tumor associated with extracolonic primary malignant tumor. A total of 60 tumors was involved: 14 each in the sigmoid and transverse colon; eight in the cecum; six in the rectum; one each in the ascending and descending colons; three each in the bladder and prostate; two each in the breast, cervix, and lung; and one each in the skin, nasopharynx, kidney, and endometrium. Three of the four patients with multifocal cancer were found to have in situ cancer, and 12.7% of concomitant adenomas had malignant changes. Seven patients had regional lymph node metastases. Of the six patients with rectocolonic multiple tumors who had adequate follow-up data, survival in three ranged from 19.5 to 60 months; three were alive and well 15 to 51 months after resection. Survival of patients with primary rectocolonic and extracolonic tumors was similar. From these data and the pathologic study of the resected specimens, we recommend for any patient with cancer of the rectocolon that the entire colon be searched for multiple primary malignant tumors, that extracolonic tumors be considered second primary tumors unless proved to be metastases, and that follow-up be long and include frequent rectocolonic examinations for a second primary tumor.

Adenocarcinoma↗