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PubMed1977

Cancer of the Colon: 32 years of experience in Bombay, India.

Incidence rate of colon cancer is low in India compared to the Western countries. The dietary habits may be the protective factor in our population. During a 32 year period (1941-1972), 555 cases of colonic cancer were recorded at the Tata Memorial Hospital, Bombay. Among the social groups utilizing this hospital, the Parsis (Zoroastrians) have the highest incidence of colonic cancer. The frequency of cancer of the caecum and sigmoid are almost equal. Cancer of splenic and hepatic flexures are predominantly seen in men. Of the resected cases 50% survived for 5 years and 40% for 10 years. When cancer was localised, the 5 year survival rate was 64%. The 5 year survival rat among transverse colon cancer patients was 70%. The skin was the commonest site of a second cancer among colon cancer patients; the possible etiological association of these two cancers appears very intriguing.

Adolescent↗
PubMed2001

[Diaphragm-like strictures of the colon from diclofenac].

BACKGROUND: Diaphragm-like strictures of the colon induced by nonsteroidal antiinflammatory drugs (NSAID) constitute a recently described uncommon clinical entity. CASE REPORT: An 86-year-old man consulted for abdominal pain and constipation. The physical examination revealed bloody stools and anemia in a patient on long-standing diclofenac therapy. Colonoscopy demonstrated two diaphragm-like strictures of the left and transverse colon with ulceration of the apex. Clinical outcome was favorable after discontinuing the NSAID. DISCUSSION: We compared this observation with 26 other case reports in the literature. The etiological mechanism appears to be related to systemic and local toxicity. Severe stenotic stricture may require surgical management. Endoscopic pneumatic dilatation may be an alternative to surgery.

Abdominal Pain↗
PubMedDate not supplied

[Idiopathic perforations of the caecum after caesarean section. A new case report (author's transl)].

The authors in this work report a further case of idiopathic dilatation of the colon which was complicated by perforation of the caecum following a Caesarean operation. The aetiology of this condition is uncertain, the diagnosis difficult and the prognosis poor. It is necessary to try to operate before the caecum perforates and to do this by decompression, which should for preference be carried out at a site in the transverse colon.

Adult↗
PubMed2000

[A case of colon cancer with tension pneumothorax and empyema as a consequence of colo-pleural fistula].

A 63-year-old man was admitted to our hospital with fever and chest pain. Chest radiography revealed left pleural effusion with left pneumothorax and small nodular shadows in the right lung field. On CT of the chest and abdomen, multiple nodules were seen in both lung fields, and masses appeared in the liver and spleen. Fiberoptic colonoscopy showed obstruction at the end of the transverse colon. Biopsy of this obstruction proved it to be cancer. In this patient, a colo-pleural fistula was also diagnosed using thoracoscopy under local anesthesia and from the inflow of contrast medium from the colon into the thoracic cavity seen in abdominal radiographs. This was a rare case of a colo-pleural fistula without diaphragmatic deficiencies. Medical thoracoscopy is useful for the diagnosis of complicated pleural effusions as was seen in this case.

Anesthesia, Local↗
PubMedDate not supplied

Effects of colon to antrum transposition on gastrin release and antral G-cell proliferation.

To investigate the effects of colonic mucosa on antral G-cell activity and proliferation, a colonic patch was transposed to the antrum. Thirty-nine rats were divided into 3 equal groups and underwent the following surgical procedures: Group 1: sham operation. Group 2: a standard portion (1 cm2) of the anterior surface of the antrum, including the pyloric sphincter, was removed and the defect was closed using a 10 mm segment of transverse colon shaped as a patch. Group 3 (control group): an identical procedure was carried out, closing the gastric defect with a gastro-duodenal suture. Three months after surgery, serum gastrin levels were determined by radioimmunoassay, both in fasting and freely fed animals. The antrum was then removed and examined for: counts of antral G-cell number by an immunoperoxidase method; evaluation of the cytoplasmic G-cell granule distribution (assumed as an index of gastrin turnover) by transmission electron microscopy investigation. The colon to antrum transposition significantly increased the antral G-cell density. By contrast, fasting serum gastrin levels and gastrin turnover were reduced after colon to antrum transposition, as compared with the relevant control procedure.

Animals↗
PubMedDate not supplied

K-ras mutation in Greek patients with poorly and moderately differenciated tumours of the lower intestinal tract.

The K-ras protooncogene is activated via mutations in approximately 40% of primary colorectal adenocarcinoma. This finding suggests that these genetic alterations are important events in the genesis of colon cancer and should be correlated with other parameters in order to infer some conclusions relevant to the etiology and the pathogenesis of this type of cancer. In our study we examined whether the incidence of K-ras mutations detected in 23 samples with colorectal adenocarcinomas, was related to different anatomical sites within the lower intestinal tract (transverse colon, descending colon and rectosigmoid region) and also the correlation between K-ras mutations and depth of invasion, level of tumour cell differentiation and metastasis to the regional lymph nodes. For this study the critical regions for the activation of the K-ras protooncogene were amplified by the PCR technique and the particular sequences analysed, after their membrane transfer, by differential hybridization with selected synthetic oligonucleotides. Our results demonstrated that 39% of the adenocarcinomas examined contained point mutations, and 66.6% of these were located in the second position of K-ras codon 12, whereas the other 33.3% were located in the second position of codon 13. 77.8% of the mutations were located at the rectosigmoid region and the relevance of the mutations was higher in poorly differenciated tumours. The depth of invasion was associated with the presence of a mutation whereas no correlation was found between the presence of a mutation anb the regional lymph node metastasis.

Adult↗
PubMed2006

Split transverse colostomy: an alternative method of defunctioning the distal colon.

Split transverse colostomy is a novel method of defunctioning the distal colon. Herein, we describe the method of this procedure and present early interim results showing that this procedure is safe, relatively complication free and feasible for many pathologies affecting the colon and pelvis, especially in alleviation of symptoms for palliation.

Colonic Diseases↗
PubMed2000

Biomechanical and morphological properties in rat large intestine.

Intestinal stress-strain distributions are important determinants of intestinal function and are determined by the mechanical properties of the intestinal wall, the physiological loading conditions and the zero-stress state of the intestine. In this study the distribution of morphometric measures, residual circumferential strains and stress-strain relationships along the rat large intestine were determined in vitro. Segments from four parts of the large intestine were excised, closed at both ends, and inflated with pressures up to 2kPa. The outer diameter and length were measured. The zero-stress state was obtained by cutting rings of large intestine radially. The geometric configuration at the zero-stress state is of fundamental importance because it is the basic state with respect to which the physical stresses and strains are defined. The outer and inner circumferences, wall thickness and opening angle were measured from digitised images. Subsequently, residual strain and stress-strain distributions were calculated. The wall thickness and wall thickness-to-circumference ratio increased in the distal direction. The opening angle varied between approximately 40 and approximately 125 degrees with the highest values in the beginning of proximal colon (F=1.739, P<0.05). The residual strain at the inner surface was negative indicating that the mucosa-submucosal layers of the large intestine in no-load state are in compression. The four segments showed stress-strain distributions that were exponential. All segments were stiffer in longitudinal direction than in the circumferential direction (P<0.05). The transverse colon seemed stiffest both in the circumferential and longitudinal directions. In conclusion, significant variations were found in morphometric and biomechanical properties along the large intestine. The circumferential residual strains and passive elastic properties must be taken into account in studies of physiological problems in which the stress and strain are important, e.g. large intestinal bolus transport function.

Animals↗
PubMed2001

Altered periodic rectal motor activity: a mechanism for slow transit constipation.

The pathophysiology of slow transit constipation is poorly understood. Both decreased and increased distal colonic motility have been reported. In healthy humans, a 3 cycles per minute (cpm), periodic rectal motor activity (PRMA) has been described. Our aim was to investigate the characteristics of PRMA and to assess its role in the pathogenesis of constipation. A six-sensor solid-state probe was placed with the tip sensor in the mid-transverse colon, without sedation, and prolonged colonic motility was recorded in nine patients with slow transit constipation (1M, 8F) and in 11 healthy subjects (3M, 8F). Subjects were free to ambulate. We examined the frequency, nocturnal vs. diurnal variation, and characteristics of PRMA, and its relationship to proximal colonic motility. All subjects showed PRMA. The rhythm was similar (2.5-4 cpm) in both groups. However, constipated patients exhibited a greater (P < 0.001) number of PRMA cycles than controls. The duration of each cycle and amplitude of pressure waves during PRMA were also greater (P < 0.05) at night in patients compared with controls. In patients, 40% of PRMA cycles were associated with a proximal colonic motor event compared with 81% in controls (P < 0.02). The area under the curve of all colonic pressure waves and incidence of specialized propagating pressure waves was lower (P < 0.05) in patients during daytime. When compared with controls, constipated patients exhibited reduced daytime colonic pressure waves and a higher frequency of PRMA. Most of the PRMA was unrelated to proximal colonic activity in constipated patients in contrast with findings in control patients. In addition to decreased colonic motility, this excessive and unco-ordinated phasic rectal activity may further impede stool transport and contribute to the pathogenesis of slow transit constipation.

Adult↗
PubMedDate not supplied

Gastrointestinal stromal tumour of the colon presenting with intestinal obstruction.

Gastrointestinal Stromal Tumours are the commonest mesenchymal tumors of the gastrointestinal tract, the stomach and small intestine being the favored sites. They rarely occur in the colon and rectum and esophagus. The diagnosis is difficult, especially in the rarer sites, since there are no pathognomic features to suggest GIST on preoperative clinical examination and investigations, and only a detailed histopathological analysis of the specimen reveals their true nature. The case of a young female patient who presented with intestinal obstruction due a GIST of the transverse colon is reported. The relevant literature is briefly reviewed.

Adolescent↗
PubMed2000

[Hepatic portal venous gas].

STUDY OBJECTIVE: Hepatic portal venous gas is a radiological symptom associated with a poor prognosis (75% to 90% mortality). The aim of this retrospective study was to report 7 cases observed over a 2-year period. PATIENTS AND METHOD: From June 1997 to November 1999, hepatic portal venous gas was diagnosed in 6 patients by CT scan and in one patient by echosonography. It was not detected in any case by plain abdominal X-rays. Three patients had small bowel obstruction with necrosis, three had extensive superior mesenteric infarction and one had preperforative necrosis of the colon. RESULTS: One patient with extensive intestinal infarction and a metastatic head and neck cancer was not operated. Two patients were operated, but the extensive mesenteric infarction was not amenable to surgical management. Three of the 7 patients died, while the other four patients survived after resection of the necrotic small intestine (n = 3) and left colectomy extended to the transverse colon (n = 1). CONCLUSION: Hepatic portal venous gas was associated with intestinal necrosis in the seven cases of this series. The severity of portal venous gas is only correlated with the severity of the disease causing portal venous gas.

Aged↗
PubMed2005

Increased microvascular blood content is an early event in colon carcinogenesis.

BACKGROUND: Increased premalignant epithelial microvascular blood content is a common theme in neoplastic transformation; however, demonstration of this phenomenon in colon carcinogenesis has been stymied by methodological limitations. Our group has recently developed a novel optics technology, four dimensional elastic light scattering fingerprinting (4D-ELF), which allows examination of the colonic mucosal architecture with unprecedented accuracy. In this study, we utilised 4D-ELF to probe the preneoplastic colonic microvasculature. METHODS: Colonic mucosal blood content was assessed by 4D-ELF at serial preneoplastic time points from azoxymethane (AOM) treated Fisher 344 rats and age matched control animals. We also examined the pretumorigenic intestinal mucosa of the MIN mouse, and compared with wild-type mice. Finally, in a pilot study, we examined superficial blood content from the endoscopically normal mid transverse colon in 37 patients undergoing screening colonoscopy. RESULTS: In the AOM treated rat model, augmentation of superficial mucosal and total mucosal/superficial submucosal blood supply preceded the appearance of aberrant crypt foci (ACF) and temporally and spatially correlated with future ACF occurrence. These findings were replicated in MIN mice. The 4D-ELF based results were corroborated with immunoblot analysis for haemoglobin on mucosal scrapings from AOM treated rats. Moreover, 4D-ELF analysis of normal human colonic mucosa indicated that there was a threefold increase in superficial blood in patients who harboured advanced adenomas. CONCLUSION: We report, for the first time, that blood content is increased in the colonic microvasculature at the earliest stages of colon carcinogenesis. These findings may provide novel insights into early biological events in colorectal carcinogenesis and have potential applicability for screening.

Adenoma↗
PubMed2004

[A case of Heyde's syndrome with abnormal von Willebrand factor].

A 68-year-old woman with known severe aortic stenosis was admitted to the hospital because of hematochezia and dizziness. She had received several blood transfusions over the preceding 3 years and undergone right hemicolectomy 2 years ago for severe lower gastrointestinal bleeding. Postoperative histology revealed angiodysplasia involving the ascending colon. After the hemicolectomy, she continued to have hematochezia and anemia and required additional blood transfusions for anemia. During this admission, platelet count, activated partial-thromboplastin time, von Willebrand factor antigen, and von Willebrand factor ristocetin cofactor were normal. She had a severe deficiency of high-molecular-weight multimers of von Willebrand factor. Colonoscopy showed angiodysplasia in the transverse colon at this time. Successful coagulation of the bleeding angiodysplasia was achieved by argon plasma coagulator. No additional bleeding was observed thereafter. We report a case of Heyde's syndrome with abnormal von Willebrand factor in a patient who presented with intestinal angiodysplasia and aortic stenosis.

Aged↗
PubMed1983

The remaining colon after radical surgery for colorectal cancer. The first three years of a prospective study.

This study investigates the possible gain and limitation by performing colonoscopy and double-contrast enema immediately after, and every six months after, radical surgery for colorectal cancer. It was possible to perform a complete colonoscopy within three months of surgery in 80 per cent of the 239 patients and at the follow-up time in 90 per cent. Incompleteness was related to insufficient bowel preparation, narrow anastomosis, and long transverse colon. Five patients had synchronous cancers, and 64 had adenomas at the time of surgery. The risk of recurrent adenomas in the latter was higher (17/64) than in those without adenomas (15/175). The adenomas were located above the rectum in 57 of 80 patients who had polypectomy. Four patients with metachronous cancer and one of five patients with local recurrence had another radical operation, while this was possible in none of 40 patients with recurrence diagnosed by other means than colonoscopy and enema. Radical colorectal surgery should be followed by colonoscopy and double-contrast enema, but how often and for how long remains to be established.

Adenoma↗
PubMed1997

Effect of the addition of Peptostreptococcus productus ATCC35244 on the gastro-intestinal microbiota and its activity, as simulated in an in vitro simulator of the human gastro-intestinal tract.

Peptostreptococcus productus ATCC35244, a reductive acetogenic strain, was added daily over 9 successive days to the fourth vessel (ascending colon) of the SHIME, a six-stage reactor system simulating the in vivo continuous culture conditions of the human gastro-intestinal tract. Final numbers of organisms (cfu)/ml reactor contents (c) were attained such that log10c = 6.9 +/- 0.1. The addition caused the CH4 production to decrease below the detection limit while total gas and CO2 production in the fifth (transverse colon) and sixth reactor (descending colon) were lowered and the acetic acid concentration was augmented. Ending the supplementation caused CH4 production to re-establish within 4 days, while CO2 production increased much more slowly. The concentration of acetic acid only started to decrease after 7 days. The results indicate that P. productus, upon regular administration, is able to compete with methanogens for H2 in the gastro-intestinal microbial ecosystem because of its reductive acetogenic character.

Acetic Acid↗
PubMed2006

Non-traumatic colon perforation in children: a 10-year review.

Colon perforation is an abdominal surgical emergency in the pediatric population, but is seldom reported when occurring from non-traumatic causes in children beyond the neonate. The goal of this study was to identify the clinical characteristics, management, and outcomes of non-traumatic colon perforation in children. Medical records for the 10-year period from September 1994 to September 2004 were reviewed for children beyond the neonate with non-traumatic colon perforation. Data gathered included age, gender, symptoms, duration of symptoms, physical findings, and length of postoperative hospital stay. Diagnostic information included laboratory data, radiographic imaging, and operative findings. Forty-four patients with non-traumatic colon perforation were recruited into this study. The mean age was 2.22 +/- 1.87 years; 91.4% of cases were younger than 5 years old. The most common presenting symptom was fever (97.7%); the most common sign was abdominal distention (93.1%). The mean duration of symptoms prior to admission was 6.19 days. Pneumoperitoneum was presented in 86.3% of patients by plain abdominal radiograph. Ascending and transverse colon were the most common perforation sites. Non-typhoid salmonella was the leading pathogen isolated, causing 20.4% of episodes. One case died due to Clostridium speticum infection. Non-traumatic colon perforation most commonly affects children younger than 5 years of age. It may be secondary to infection, especially non-typhoid salmonella. Plain abdominal radiograph can be an adjuvant tool for the high index of suspicion for colon perforation in children with abdominal distention and history of fever or diarrhea for more than 5 days.

Abdomen, Acute↗
PubMed1981

[Segmental colonic atresia - a contribution to the differential diagnosis of ileus in the newborn (author's transl)].

Segmental atresia of the colon is regarded as an urgent emergency in the neonatal period and quick diagnosis and surgical interference are necessary. In spite of the rarity of this condition it could be thought about in the differential diagnosis in infants with relevant symptoms and can be diagnosed by simple means. The author's own technique is described in relation to the case of atresia of the transverse colon. The aetiology, classification, clinical picture, diagnosis and treatment are discussed. The prognosis depends very much on early diagnosis.

Colon↗
PubMed2005

Effect of polyethylene glycol electrolyte balanced solution on patients with acute colonic pseudo obstruction after resolution of colonic dilation: a prospective, randomised, placebo controlled trial.

BACKGROUND AND AIMS: Conservative therapy for patients with acute colonic pseudo obstruction (Ogilvie's syndrome) may be successful initially but relapses are common. The aim of the present study was to evaluate the effect of polyethylene glycol (PEG) electrolyte balanced solution on the relapse rate of the syndrome after initial resolution with neostigmine or endoscopic decompression. PATIENTS AND METHODS: The study was performed on 30 consecutive patients who presented with abdominal distension and radiographic evidence of colonic dilation, with a caecal diameter > or = 10 cm, that resolved conservatively. Patients then were randomised to receive daily 29.5 g of PEG (n = 15) or similar placebo (n = 15). Patients were monitored daily for a seven day period for stool and flatus evacuations, and colonic diameter on abdominal radiographs. Administration of the test solutions and assessment of patient symptoms and x rays were performed in a blinded fashion. A caecal diameter > or = 8 cm with a concomitant > or =10% increase after initial successful therapeutic intervention was considered as a relapse and these patients, after a second therapeutic intervention, were eligible to receive open label PEG. RESULTS: Twenty five patients received neostigmine as the initial therapeutic intervention which resulted in resolution of colonic dilation in 88% of cases. Eight patients had successful endoscopic decompression. Five (33.3%) patients in the placebo group had recurrent caecal dilation compared with none in the PEG group (p = 0.04). Therapy with PEG resulted in a significant increase in stool and flatus evacuations (p = 0.001 and 0.032, respectively) as well as in a significant decrease in the diameter of caecum, ascending and transverse colon, and abdominal circumference (p = 0.017, 0.018, 0.014, and 0.008, respectively). CONCLUSIONS: Administration of PEG in patients with Ogilvie's syndrome after initial resolution of colonic dilation may increase the sustained response rate after initial therapeutic intervention.

Acute Disease↗