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PubMedDate not supplied

Endosonographic probe-guided endoscopic removal of colonic pedunculated leiomyoma.

We report a rare case of endoscopic removal of colonic pedunculated leiomyoma with an aid of endoscopic ultrasonography (EUS). A 46-year-old man was admitted to our hospital with complaints of lower abdominal pain and alternating constipation and diarrhea. Colonoscopy revealed a small pedunculated polyp in the transverse colon covered with almost normal mucosa. EUS showed a hypoechoic solid tumor with clear margins and smooth contour in the second to third layer. We considered this lesion as a submucosal tumor of the colon with no continuity to the muscularis propria. We performed endoscopic removal of this tumor successfully, and histological diagnosis was a leiomyoma. Endoscopic removal of colonic pedunculated leiomyoma is rare. Moreover, in our case, EUS showed typical findings of colonic leiomyoma and was useful to assess the location of the submucosal tumor. We describe herein our experience and discuss similar cases reported in the English literature.

Colonic Neoplasms↗
PubMedDate not supplied

Laparoscopic treatment of Morgagni-Larrey hernia.

This report describes the cases of two patients who underwent laparoscopic repair for treatment of Morgagni-Larrey hernia at United Hospital Center in Clarksburg. The first patient was a 40-year-old woman complaining of epigastric discomfort and tenderness. Her chest X-ray revealed an anterior cardiophrenic mass, and a CT scan showed a characteristic Morgagni hernia with incarcerated colon and omentum. After reduction of the incarcerated bowel and omentum, autosuture repair was carried out laparoscopically In the second case, a 22-year-old man with severe GERD was found to have a large Morgagni hernia with incarcerated transverse colon and omentum, which was discovered while he was undergoing an elective laparoscopic Nissen fundoplication. Laparoscopic repair of Morgagni hernia was carried out, in addition to Nissen fundoplication. Both patients did very well postoperatively. Minimally invasive laparoscopic repair can be successfully carried out, and mesh implantation is performed only in some cases. In order to avoid pleural injury, we prefer not to remove the hernia sac before a Morgagni hernia is repaired. Laparoscopic repair should be considered the standard and safest procedure for the treatment of a Morgagni hernia.

Adult↗
PubMed2002

Ogilvie's syndrome in a patient with multiple myeloma.

Ogilvie's syndrome is characterized by physical examination and radiologic findings indicative of mechanical obstruction but in which no physical obstructive process can be found. Many factors have been associated with this syndrome which include electrolyte imbalance, systemic infection, drugs, and occasionally, neurologic disease. A case of acute colonic pseudoobstruction is presented which developed in a patient with multiple myeloma. The patient presented with severe thoracic pain, persistent and increasing abdominal distention and lack of bowel sounds. Plain radiography and ultrasonography revealed massive dilatation of the right and transverse colon. Nasogastric aspiration was initiated and all analgesic drugs were withdrawn. Erythromycin was given for nine days as prokinetic and a rectal tube was inserted for one day. Abdominal distention gradually disappeared within one day of nasogastric and rectal tube insertion and with multiple myeloma management. Ogilvie's syndrome is a very rare complication of multiple myeloma. Only one case of Ogilvie's syndrome with multiple myeloma has been reported in the literature. This case report of Ogilvie's syndrome in a patient with multiple myeloma is the second case report in the literature.

Journal Article↗
PubMed1993

Oral [111In]DTPA scintigraphic assessment of colonic transit in constipated subjects.

Patterns of colonic transit were assessed by a simple radioisotopic technique using 3.7 MBq of orally administered [111In]DTPA in 16 control subjects and 37 patients with intractable constipation. Normal subjects showed rapid diffuse spread of isotope through the colon resulting in low activity in all regions of interest (ROI). Activity was lost to feces at 24 hr and was virtually complete by 72 hr (median 94%, range 71-100%). Five constipated patients showed normal transit. Those with colonic inertia (N = 26) showed a significantly slowed geometric center of isotope compared to controls (P < 0.001), falling below the normal range at 48 hr. Percentage activity curves showed the major site of isotope hold-up to be in the transverse colon and splenic flexure. Other constipated patients (N = 6) showed late delay of the geometric center of isotope and accumulation of activity in the descending and rectosigmoid colon, compared to controls, at 96 hr. Oral [111In]DTPA colonic scintigraphy is a useful clinical test in the investigation of constipation.

Administration, Oral↗
PubMedDate not supplied

Abdominal actinomycosis: a report of two cases.

Actinomyces spp. cause a chronic suppurative, granulomatous disease which is characterized clinically by extensive abscess formation, recurrent draining of sinuses and fistulae and histologically by the presence of the so-called "sulphur granules". Colonic actinomycosis is a relatively rare infection and its diagnosis is difficult. We report the case of a female patient who was operated on for ovarian cyst and the case of another female patient operated on for a mass in the transverse colon. In both cases the pathology of the excised tissues revealed actinomycosis. Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leucocytosis and intestinal wall thickness and/or abdominal mass.

Abdomen↗
PubMed2002

Graded compression sonography of the colon in the diagnosis of polyps in pediatric patients.

OBJECTIVE: We report seven cases of juvenile polyps detected by graded compression gray-scale and color Doppler sonography in five children with nonspecific symptoms. CONCLUSION: Intestinal polyps can be detected by graded compression gray-scale and color Doppler sonography without colonic preparation. On gray-scale sonography, polyps appeared as spherical or ovoid hypoechoic nodules in the colon lumen. Small cysts were identified inside the nodules. Four polyps had fewer and smaller cysts, whereas three others contained many cysts. A hyperechoic layer surrounding the polyp corresponded to the submucosa. In two patients, the polyp was visualized in the transverse colon and caused a colocolic intussusception, which reduced spontaneously during sonography. Color Doppler sonography showed four hypovascularized and three hypervascularized polyps.

Age Factors↗
PubMed1978

Localized giant pseudopolyposis of the colon.

Localized giant pseudopolyposis is a rare complication in patients with inflammatory diseases of the colon which produces a huge intraluminal polypoid mass. Examples are described in a child with chronic ulcerative colitis in whom the lesion filled the rectum and in an adult with recurrent granulomatous ileocolitis in whom the mass was present in the transverse colon adjacent to a stenotic anastomosis. The clinical presentation, radiologic features and pathologic findings of this unusual sequela to inflammation are reviewed.

Child↗
PubMed1996

Screening for colonic neoplastic lesions using flexible sigmoidoscopy in employees of a nuclear research center and members of collective settlements.

It has been shown that screening of average risk individuals reduces the incidence of colorectal cancer. The most effective method for screening has yet to be determined in terms of cost-effectiveness, but approximately two-thirds of colorectal neoplastic lesions are within the reach of the flexible sigmoidoscope. It has been estimated that a single such examination at the end of the sixth decade may reduce the colorectal cancer incidence by 60%. As part of a screening program for colon cancer, short colonoscopy was performed on 399 employees of a nuclear research center and 228 members of a collective settlement (kibbutz). The examinations were carried out on individuals aged > or = 40 years by two experienced endoscopists. The splenic flexure or transverse colon was reached in 95% of the procedures. Neoplastic lesions were found in 24 (6.0%) and 8 (3.5%) screenees (not significant) in the Nuclear Research Center and kibbutz populations respectively. Polyps <1 cm in diameter were significantly more common in the Nuclear Research Center population but larger polyps and cancers were not. In 47 Nuclear Research Center screenees with a family history positive in a first-degree relative, findings increased to 14.9% (P = 0.016). A family history of malignancy was found in 33.8% of kibbutz members but in only 11.8% of Nuclear Research Center employees. There was no evidence to suggest that working at the Nuclear Research Center increased the risk of colonic neoplasms. We conclude that flexible sigmoidoscopy is a valuable screening tool, especially for individuals with a first-degree relative with cancer. The yield of neoplastic lesions in the Israeli Nuclear Research Center and kibbutz populations is similar to that of the general population in the western world. Compliance rates are high in well-defined populations.

Adult↗
PubMed1991

Delayed presentation of intrapericardial diaphragmatic hernia, an unusual cause of colon obstruction.

The earliest symptoms of diaphragmatic hernia may not appear until viscera incarcerate in it years after the causal injury. The most unusual site for a diaphragmatic hernia to occur is through the central tendon of the diaphragm into the pericardium. We present the case of a 43-year-old man who suffered a bowel obstruction when the transverse colon and omentum became incarcerated in the intrapericardial diaphragmatic hernia. The defect presumably resulted from blunt chest and abdominal trauma received 15 years earlier. The delayed presentation of intrapericardial diaphragmatic hernia is reviewed, and recommendations for evaluation and treatment are made.

Adult↗
PubMed2003

Colonic perforation following intraoperative temporary pacemaker implantation.

This report describes the case of a 73-year-old man who was referred for consultation for increasing abdominal free air 1 week after he underwent surgery for aortic valve replacement and coronary artery bypass grafting with intraoperative pacemaker implantation. Laparoscopic exploration revealed that the pacemaker wires had passed through the left transverse colon. Although no previous reports of colonic perforation due to pacemaker lead placement was found, this experience suggests that physicians should suspect this complication in patients with increasing free intraabdominal air and peritoneal signs who have recently undergone placement of a temporary cardiac pacing system.

Aged↗
PubMed2003

Anthranoid self-medication causing rapid development of melanosis coli.

It is widely known that long-term use of anthranoid-containing laxatives is the cause of melanosis coli. We describe a case of melanosis coli, which occurred in a 39-year-old liver transplant patient who took an over-the-counter product containing aloe, rheum and frangula. The typical brownish pigmentation of the colonic mucosa developed in a period of ten months. The anthranoid medication was stopped and follow-up colonoscopy one year later showed normal looking mucosa once more. However, in contrast to previous examinations, a sessile polypoid lesion was found in the transverse colon. Histology showed tubulovillous adenoma with extensive low-grade dysplasia. Since there have been preliminary reports suggesting a possible role of anthranoid-containing laxatives in the development of colorectal adenomas and cancer, their use should be discouraged.

Adult↗
PubMed1991

[A case of cytomegalovirus infection that caused gastrointestinal perforation after surgery for cancer of the bladder].

A 78-year-old man visited our department for macroscopic hematuria in June, 1989. On the basis of the diagnosis of tumor of the bladder and right afunctional kidney, total right nephro-uretero-cystectomy and skin grafting of the left ureter were performed on August 2. The patient continued to have fever of unknown origin postoperatively. Repeat laparotomy, which was performed for rectal fistula on August 25, revealed that the abdominal wall, colon, small intestine and mesenterium adhered to one another, producing a mass and that two sites in the rectum were perforated. A part of the small intestine was excised, the perforated sites were sutured, and an artificial anus was created at the transverse colon. Since the patient had intermittent fever and continued to complain of abdominal pain after creation of the artificial anus, nosotropic therapy was continued. However, the patient died from cardiac insufficiency on October 10. Erosion and ulcer were histologically observed over a wide range in the excised small intestine. In addition there was a defect in one area of the small intestine, penetrating the tunca muscularis propria, in which many cytomegalovirus (CMV) inclusion bodies were observed. CMV inclusion bodies were also detected in the bladder with re-examination of specimens from the excised bladder. From these findings, it appears that endogenetic CMV may have been reactivated in the present case.

Aged↗
PubMed2004

Unusual pathology of colon: inclusion dermoid cyst.

Dermoid cysts are typically known to occur in the midline, near the lines of embryonic fusion, from trapped ectodermal tissue. They are very rare in the gastrointestinal tract, and only a few cases of dermoid cyst in the caecum and ileum have been reported in the literature. In our case, a dermoid cyst was found in the transverse colon, which has not been reported previously.

Aged↗
PubMed1977

Bypass enteritis or obstructive volvulus?

In a consecutive series of 40 Scott-type jejunoileal shunts for morbid obesity, only two patients had the bypassed bowel drained end-to-side into the midsigmoid colon. In both of these patients, typical "bypass enteritis" as described by Passaro developed, but they were found to have volvulus at the sigmoid anastomosis. Both were cured by take-down of the anastomosis and reimplantation of the bypassed bowel into the transverse colon. No antibiotic treatment was found necessary. We suspect that obstruction of a mechanical nature plays a basic role in most, if not all, cases of "bypassed enteritis."

Enteritis↗
PubMed1983

Penetration of the colon by a ventriculo-peritoneal drain resulting in an intra-cerebral abscess.

A male child was born with internal hydrocephalus due to aqueductal stenosis requiring a ventriculo-peritoneal shunt on the first postnatal day. Subsequently, the hydrocephalus did not subside but increased. Autopsy at the age of 15 months disclosed the peritoneal tip of the catheter located inside the transverse colon, the cerebral tip of the catheter within a huge abscess of the right cerebral hemisphere. Penetration of the intestine by a ventriculo-peritoneal catheter seems to be a rare event, occasionally resulting in early death due ascending infection.

Brain↗
PubMed1980

Site of pain from the irritable bowel.

The distribution of pain from the colon was examined in normal subjects and in patients with irritable bowel syndrome (IBS). Colonic pain was induced by inflating a balloon (introduced during colonoscopy) at several sites throughout the colon. The pain was felt predominantly in the central, lower, and left abdomen in nine patients presenting with rectal bleeding and no spontaneous pain. Pain was felt in any part of the abdomen in 48 patients with painful IBS. Distension of the ascending and transverse colon often produced right-sided or upper abdominal pain in patients with IBS and in 29 of the 48 the pain induced was the same in quality and site as their presenting complaint. In addition pain was referred to several, previously undescribed, extra-abdominal sites. Wider recognition of the distribution of colonic pain could prevent unnecessary investigations including laparotomy.

Abdomen↗
PubMedDate not supplied

[Carcinoma of the splenic flexure. Nosological and therapeutic contribution].

Twenty-one patients undergoing colectomy for carcinoma of the splenic flexure from November 1996 throughout October 1993 were studied retrospectively. Clinical and prognostic features were compared with those of other colon cancers treated in the same period at the same Institution. No differences in symptoms at onset and stage distribution were found in the two groups. The complex removal of the cancer tissue was achieved with the resection of the major part of the transverse colon, splenic flexure, descending colon and its mesocolon. The splenic flexure cancer did not show a worse prognosis than other colon cancers.

Adenocarcinoma↗
PubMed1997

[Ulcerative colitis and colonic angiodysplasia associated with a lower digestive hemorrhage. Their diagnosis by 99-technetium-labelled red blood cells].

We describe a case of a patient with previously diagnosed of ulcerative colitis, who was admitted to the hospital because of rectal bleeding and abdominal pain. A mild active colitis was reported by colonoscopy with biopsy. Rectal bleeding relapsed, and an arteriovenous malformation in the transverse colon compatible with angiodysplasia was located by early vascular scintigraphy with 99m-technetium-labeled red blood cells. This finding was confirmed by selective arteriography. Four months after hemicolectomy, the patient is free of rectal bleedings. Labeled red blood cell scintigraphy may be useful to differential diagnosis of lower digestive hemorrhage.

Aged↗