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PubMed1994

Mucinous adenocarcinoma of the colon metastatic to the intestinal mucosa.

Autometastasis of colon cancer to the intestinal mucosa is a condition that has not been previously described. The 70-year-old man presented in this case report was seen for routine surveillance colonoscopy 14 months after low anterior resection, without anastomosis, of a Dukes' stage C mucinous adenocarcinoma of the rectosigmoid. The patient had received adjuvant chemotherapy according to Southwest Oncology Group protocol 8899. The routine colonoscopy revealed many new polypoid lesions in the remaining left and transverse colon, and the patient underwent completion total abdominal colectomy. Examination of the specimen revealed more than 100 polyps; the histologic examination identified these polyps as metastatic signet ring mucinous adenocarcinoma.

Adenocarcinoma, Mucinous↗
PubMed1989

Ogilvie's syndrome in the postcesarean section patient.

Two cases of colonic pseudo-obstruction (the so-called Ogilvie's syndrome) are reported. Both patients were in the immediate postcesarean section puerperium. The importance of early diagnosis in these cases is stressed, because this complication has a high mortality rate, frequently in relation to delayed diagnosis and treatment. One patient was successfully treated with conservative measures because diagnosis was made early. A plain X-ray abdominal film which shows cecum dilatation, with or without ascending and transverse colon dilatation, and no distal air, makes the diagnosis. A cecum diameter of 9 cm or more is a surgical indication, because the possibility of wall perforation is high. Surgical techniques are: puncture decompression or cecostomy. When cecum diameter is less than 9 cm, non-surgical measures (nasogastric suction, correction of any fluid and electrolytic imbalance, and maybe a flatus tube) are indicated. Observation through repeated X-ray abdominal films shows when the surgical indication appears: (1) failure of the conservative treatment (cecal distension continues or increases); or (2) cecal perforation is documented.

Adult↗
PubMed1987

The role of the oncogene c-myc in sporadic large bowel cancer and familial polyposis coli.

The human myc gene is homologous to the v-myc gene, which was discovered in the avian oncogenic retrovirus MC29. Abnormally high expression of the cellular oncogenes is suspected to be involved in nonviral carcinogenesis. This article reviews the evidence that elevated expression of the human myc gene is involved in sporadic colon carcinoma and familial polyposis coli. The abundance of myc RNA and protein is frequently higher in colorectal cancer than in normal mucosa. The mechanism of this altered expression is obscure because the structure and quantity of myc DNA are very rarely disturbed. The COLO320 cell line is discussed as one unusual example of myc DNA rearrangement and amplification. There is a correlation between tumor-specific elevated myc RNA level and location in the bowel; tumors distal to the transverse colon are more likely to have elevated myc expression. The site distribution of unselected colorectal malignancies with an elevated myc RNA level is similar to the site distribution of familial polyposis coli tumors. With this observation it is suggested that elevated myc RNA may be a marker of a distinct type of colorectal cancer that involves the same genetic events as precede familial polyposis coli cancer.

Adenomatous Polyposis Coli↗
PubMed1975

[Problems of the one- or two-stage operations of carcinoma on the left part of the colon (author's transl)].

260 radically operations of carcinoma of the colon were carried out from 1963-1972; 163 of these operations have been done on the left part of the colon. The results of the one- and two-stage procedures were compared with the related literature. 46.5 per cent of the resected lymphnodes were affected by carcinoma. An expanded resection was done in 24 cases complicated with tumour perforation in adjacent organs. Among 147 one-stage left-side resections 20 insufficiencies of the anastomoses (13.5 per cent) were observed. To protect the anastomoses in 8 cases a coecal fistula and in 4 cases a fistula of the transverse colon were performed. There was no insufficiency of the anastomose. In 4 cases of two-stage precedures insufficiencies of the anastomose were found at the extraperitoneal replaced anus. The mortality was found to be 11.6 per cent. Peritonitis occurred in 18 cases: after 6 right sited and 12 left sited resections.

Adolescent↗
PubMed1997

Regional proliferative patterns in the colon of patients at risk for hereditary nonpolyposis colorectal cancer.

UNLABELLED: Patients from a hereditary nonpolyposis colorectal cancer (HNPCC) kindred (Lynch Type 1 and Type 2) have an increased risk of developing large-bowel cancer. Tumors occur at a young age and are characteristically right-sided. Colonic mucosal proliferation is known to be increased in several groups of patients at risk of colorectal cancer. PURPOSE: This study was performed to assess the pattern of mucosal proliferation at different sites in the colon of patients at risk of HNPCC and to determine whether this pattern differs from normal patients. METHODS: Mucosal biopsies were obtained at colonoscopy from 21 patients at risk for HNPCC (16 females; mean age, 42 years) and from 7 normal patients (4 females; mean age, 38 years), and mucosal proliferation was quantified using the whole crypt mitotic count (WCMC) technique. RESULTS: In patients from HNPCC families, WCMC and crypt area were significantly greater in the cecum than in the transverse colon and left colon (P < 0.001). Compared with normal patients, WCMC in HNPCC patients was significantly greater in the cecum only (P < 0.05). A significant right-to-left shift was also observed in normal patients, but the percentage increase from right to left was two-fold greater in HNPCC patients. CONCLUSIONS: These results confirm a proximal-to-distal proliferative gradient in the human colon and suggest that this may be exaggerated in HNPCC. This increased proximal proliferative rate may be a factor in the development of right-sided cancer in these patients.

Adult↗
PubMed2002

Colonoscopic detection of a malignant melanoma metastatic to a tubular adenoma of the colon: report of a case.

PURPOSE: Metastasis of a malignant neoplasm to a benign tumor is an infrequent event. Adenomatous polyps of the colon have only been reported on three occasions acting as host tumors. We report the first case where a malignant melanoma metastasizing to a tubular adenoma in the colon was detected during colonoscopy. METHODS: An 85-year-old male with dementia and right hemiparesis presented to the hospital with change of bowel habits, signs and symptoms of anal incontinence, and a perianal ulcer. On physical examination, multiple subcutaneous nodules over his chest and abdominal wall were detected, and laboratory data revealed iron deficiency anemia. A colonoscopy was performed. RESULTS: During colonoscopy, a pedunculated, greenish-brown-colored polyp measuring 2 cm in greatest dimension located in the transverse colon was identified and snared. Pathology of this polyp was consistent with a malignant melanoma infiltrating into a tubular adenoma. Subsequently, one of the subcutaneous lesions was biopsied and this revealed malignant melanoma cells metastatic in soft tissue. The primary site of the malignant melanoma could not be identified. CONCLUSION: Polyp-cancer sequence is well documented in colorectal cancer. The vast majority of malignant lesions found in adenomatous polyps in the colon are the consequences of malignant transformation from benign neoplastic colonic adenomatous tissue. The possibility that colonic adenomatous polyps could harbor metastatic tumors should also be entertained. This could change the treatment and may require an appropriate workup.

Adenocarcinoma↗
PubMed2006

Giant GIST of the mesocolon: report of a case.

UNLABELLED: Gastrointestinal stromal tumors are rare neoplasms arising from mesenchymal cells of the gastrointestinal tract, that strongly express a class III receptor tyrosine kinase, called KIT, due to some mutations in the KIT proto-oncogene. Two thirds of GISTs are found in the stomach, 20% to 50% in the small bowel (one third in the duodenum), and 5% to 15% in colon and rectum; GISTs, however, may rarely be found also in the oesophagus, omentum, mesentery or the retroperitoneum. Their treatment is strictly surgical, and only R0 resection can achieve good RESULTS: Treatment with Imatinib seems to be promising in case of unresectable or metastatic GIST, even if some trials are studying its effects after curative resection. GIST of the mesocolon are rare, and as in the other locations, require extensive surgery. The Autohrs report a case of giant malignant GIST arising from transverse mesocolon, treated by en-bloc resection of the tumor with a segment of transverse colon and great omentum.

Aged↗
PubMed1972

Characterization of the kinetics of the passive and active transport mechanisms for bile acid absorption in the small intestine and colon of the rat.

Bile acid uptake occurs via passive diffusion in all regions of the intestine and via active absorption in the ileum. Determination of the passive permeability coefficient for ionized monomers ((*)P(-)) demonstrated that permeability decreased by a factor of 3.4, 6.8, and 8.1 for the addition of a hydroxyl, glycine, or taurine group, respectively, to the steroid nucleus. Removal of the negative charge increased permeation by a factor of 4.4; however, permeability coefficients for the protonated monomers showed the same relative decrease with addition of a hydroxyl group. The calculated incremental free energies of solution (deltaDeltaF(W-->1)) associated with these additions equaled + 757 (hydroxyl), + 1178 (glycine), and + 1291 (taurine) cal/mole. Passive permeability coefficients for the transverse colon showed the same relative relationships among the various bile acids. After making appropriate corrections for passive permeability across the ileum, apparent values for the maximal transport velocity ((*)V(max)) and Michaelis constant ((*)K(m)) of the active transport system were measured. (*)V(max) depended upon the number of hydroxyl groups on the steroid nucleus; values for the trihydroxy bile acids were high (1543-1906 pmoles/min per cm) while those for the dihydroxy (114-512 pmoles/min per cm) and monohydroxy (45-57 pmoles/min per cm) acids were lower. In contrast, (*)K(m) values were related to whether the bile acid was conjugated; unconjugated bile acids had values ranging from 0.37 to 0.49 mM, while values for the conjugated bile acids were approximately half as high (0.12-0.23 mM).

Animals↗
PubMed1995

A peroperative comparison of Western and Oriental colonic anatomy and mesenteric attachments.

It has been suggested that the Oriental colon is easier to colonoscope than its Western counterpart. The aim of this study was to investigate possible differences in colonic anatomy between Western and Oriental patients that might explain this observation. Measurements of colonic length and mesenteric attachments were taken according to a set protocol from 115 Western (Caucasian) and 114 Oriental patients at laparotomy. Sigmoid adhesions were found more frequently in Western (17%) compared to Oriental (8%) patients, P = 0.047. A descending mesocolon of > or = 10 cm occurred in 10 (8%) Western patients but only 1 (0.9%) Oriental patient, P = 0.01. The splenic flexure was more frequently mobile in Western patients (20%) compared to Oriental (9%) patients, P = 0.016. In 29% - of Western patients the mid-transverse colon reached the symphysis pubis, or lower when pulled downwards in contrast to 10% of Oriental patients, P < 0.001. There was no significant difference in total colonic length comparing Western (median = 114 cm, range 68-159 cm) to Oriental (median = 111 cm, range 78-161 cm) patients. Western patients have a higher incidence of sigmoid colon adhesions and increased colonic mobility when compared to Orientals. These findings support the observation that colonoscopy is a more difficult procedure in Western patients.

Adult↗
PubMed1992

[Colorectal cancer before 45 years of age].

Colo-rectal cancer in young patients is a subject of interest for many reasons. Various studies are devoted to this subject but controversies regarding the stages, the evolution and the prognosis still remains. We present intermediate results, of an ongoing study, which is directed to those particular aspects of colon cancer of the patients less than 45 years of age in a region where the global incidence of the disease is one of the highest in the world. In the past five years, we have observed 602 patients with colon cancer. 23 of them (4%) were less than 45 years old. The age at diagnosis was 38 +/- 6 years. Two-thirds of the subjects were male. 13% had had predisposing conditions for colon cancer such as FAP, ulcerative colitis or Turcot syndrome; 50% had a positive familial history for cancer. Symptoms lasted for less than 3 months in two thirds of the patients. 15% had a right sided tumor, 38% were located in the sigmoid and 28.5% in the rectum. At diagnosis, the tumors were classified as follows: 32% Dukes B, 23% Dukes C and 40% were disseminated disease. Most of them were located in the rectum, but 43% of Dukes B lesions were located in ascending or transverse colon. Grading reveal moderately to poorly differentiated tumors in 3/4 of cases. 30% of patients received an adjuvant therapy. After two years, 70% of the patients were alive. None of them with Dukes A or B but one of the patients with Dukes C were dead.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

Perforated colonic carcinoma mimicking perforated peptic ulcer: an argument for full exploration of the stomach and duodenum.

Perforated peptic ulcer is one of the commonest types of hollow-viscus perforation. Because many of these ulcers are found at laparotomy to be sealed off, some authors believe it is unnecessary to dissect the surrounding tissue from the presumed site of perforation. A patient with a long history of peptic ulcer disease experienced the sudden onset of signs and symptoms of perforated peptic ulcer. On exploration, the omentum appeared to be densely adherent to the pylorus and duodenum. However, no perforation was found when the omentum was dissected free from the stomach and duodenum. Further exploration revealed a walled-off, perforated carcinoma of the transverse colon adjacent to the mesenteric border. As a result of this experience, the authors emphasize that when the findings at operation do not fit the clinical presentation in a patient with a presumed perforated peptic ulcer, a thorough exploration of the abdominal viscera is mandatory to identify the pathologic process.

Adenocarcinoma↗
PubMed2003

Laparoscopic versus open hemicolectomy.

AIM: In the last decade, laparoscopic procedures are applied to the treatment of almost all colonic diseases, including both benign and malignant lesions. Focusing our attention to the laparoscopic operative technique, we compare the perioperative results and the oncological outcomes of laparoscopic hemicolectomy with those after open conventional hemicolectomy. METHODS: This prospective non randomized study is based on a series of 469 consecutive patients (73.6% with malignant lesions) operated on by the same surgical team following the same type of surgical technique, for laparoscopic and open approach, to perform right (RH) and left (LH) hemicolectomy, respectively, excluding segmental resections, emergency operations as well as transverse colon, splenic flexure and recurrent carcinomas. The treatment modality was selected by the patients after reading the informed consent form. Conversion rate to open surgery (for the laparoscopic group) and causes were assessed. Statistical significance (p) for operative time, resumption of gastrointestinal functions, length of stay, complications, perioperative mortality, as well as length of specimen, number of lymph-nodes harvest, incidence of local recurrences and distant metastases, and survival probability analysis in malignant cases, was assessed between the 2 groups (laparoscopic and open). RESULTS: From March 1992 to February 2003, 166 patients underwent RH and 303 LH. In the RH group, 108 patients underwent laparoscopic approach and 58 underwent open surgery (26 vs 13 for benign lesions and 82 vs 45 for adenocarcinomas, respectively). LH was performed by laparoscopy in 202 patients and by laparotomy in 101 (55 vs 30 for benign lesions and 147 vs 71 for adenocarcinomas, respectively). There were no conversions to open surgery in laparoscopic RH, while 10 patients (4.9%) in the laparoscopic LH group required conversion: 3 of 34 performed for diverticular disease and 7 of 147 performed for malignancy. Mean operative time for laparoscopic surgery was longer than for open surgery (182 vs 140 min for RH and 222 vs 190 min for LH, respectively), but with increasing experience this decreased significantly. Mean hospital stay in patients who underwent laparoscopic procedures was significantly shorter both in RH and LH groups (9.2 vs 13.2 days and 9.9 vs 13.2 days, respectively). Similar major complication rates were observed between the 2 laparoscopic and open groups (1.8% vs 1.7% for RH and 4.1% vs 4.9% for LH, respectively). Follow-up time ranged between 12 and 109 months (mean, 57.3 months) in RH groups and between 12 and 111 months (mean, 57.5 months) in LH groups. The follow-up dropout was of only 3 patients after RH (in the laparoscopic group) and 5 after LH (3 in the laparoscopic group and 2 in the open group). The local recurrence rate was lower after laparoscopic surgery in both arms (7% vs 8.8% for RH and 3.3% vs 7% for LH, respectively), but the differences were not statistically significant. Two port site recurrences were observed in the laparoscopic groups, 1 after a Dukes D palliative RH and 1 after a Dukes C LH converted to open surgery (1.7% and 0.9%, respectively). Metachronous metastases rates were similar between the laparoscopic and open groups (20.9% vs 17.6% for RH and 4.4% vs 5.3% for LH, respectively). Cumulative survival probability (CSP) at 72 months after laparoscopic RH was 0.791 as compared to 0.765 after open surgery (p=0.326) and 0.956 after laparoscopic LH as compared to 0.877 after open surgery (p=0.115). CSP for Dukes stage A, B and C in the laparoscopic RH group was 0.875, 0.846, and 0.727 as compared to 0.9 (p=0.815), 0.889 (p=0.87), and 0.6 (p=0.183) after open surgery, respectively. CSP for Dukes stage A, B and C in the laparoscopic LH group was 0.1, 0.966, and 0.885 as compared to 0.1 (p=0.936), 0.944 (p=0.466), and 0.7 (p=0.072) after open surgery, respectively. CONCLUSION: These results suggest that laparoscopic hemicolectomy for both benign and malignant lesions can be performed safely. Oncological outcomes were comparable with those of open surgery.

Adolescent↗
PubMedDate not supplied

[Prevalence of adenomatous and hyperplastic polyps of the colon in the population of the General Hospital of Mexico. An autopsy study].

A prospective survey of 450 autopsies was conducted to determine the prevalence of colorectal dysplastic polyps in the population of the General Hospital of Mexico City. The colon and rectum were removed and examined for the presence of polypoid lesions; their size, location, and appearance were described. All of the lesions were examined and classified according to their microscopic diagnosis. Results revealed a single polypoid lesion in nine cases; four were classified as regenerative or inflammatory and five as dysplastic. Four of the latter were in females and one in a male; their mean age was 64 years. Macroscopically four were pedunculated and one sessil; all measured less than 0.6 cm; two were located in the transverse colon and three in the left colon. No hyperplastic polyps were found. After standardization for age, comparison with similar studies performed in other countries showed an extremely low prevalence rate for dysplastic colorectal polyps (2.7%) in our patient population, similar to one reported in Iran and higher than that found in the African Bantus, but it is one of the lowest when compared with European and US series.

Adolescent↗
PubMed2003

The role of the rectal branches of pelvic plexus in defecation and colonic motility in a canine model.

The parasympathetic nerves regulate colonic motility and defecation. The vagal nerve controls the right colon and the pelvic nerve permeates the left colon and rectum via the rectal branches of the pelvic plexus (RBPP). This investigation aimed to measure the functional changes of the colon and rectum after RBPP-transection for over six months. RBPP-transection was performed in 15 dogs. Five dogs each were sacrificed immediately, one month, and six months after RBPP-transection. The stool condition, colorectal transit, defecation reflex, colorectal response to electrical stimulation, and pathological degeneration was investigated prior to, one month after, and six months after RBPP-transection. Four of the 5 dogs observed had loose stool one month after RBPP-transection, and one of the 3 had recovered six months later. Half transit time (HTT) at transverse colon got longer in six of the 8 in one month. Six months later, HTT got shorter in three of the 4 than that of one month. Defecation reflex was not observed one month after RBPP-transection, but noted in two of the 5 six months later. These results may suggest that vagal nerve compensates for the oral site of the left colon after denervation of the pelvic nerve which is originally distributed.

Animals↗
PubMed2006

Colonic mucosal tears in collagenous colitis.

In general, the colonic mucosa is macroscopically normal in collagenous colitis, although minor, non-specific abnormalities may be found. Significant endoscopic abnormalities, "mucosal tears" representing longitudinal mucosal lacerations, have been reported in a few patients with collagenous colitis. We report the cases of three women with collagenous colitis and mucosal tears detected at the index colonoscopy in order to illustrate the endoscopic characteristics and review the literature. Including the present cases, a total of 12 patients with mucosal tears and collagenous colitis have been reported. In 10 patients, the mucosal lacerations involved the ascending or the transverse colon. Three of the 12 patients had a colonic perforation immediately after the colonoscopy. The colonoscopist should be aware that the risk of perforation is likely to be increased when mucosal tears are present.

Anti-Inflammatory Agents↗
PubMed2003

Colonic fistula complicating electric burns--a case report.

Intestinal fistula is an uncommon complication of electric burns. The authors report the case of an 11-year-old child who sustained accidental burns from a high-voltage electric current and was admitted to their hospital with full-thickness burns of both the upper limbs and deep burns of the anterior abdominal wall. Staged surgery was required, and the authors were involved in the management of the burn of the anterior abdominal wall. Laparotomy was done because omentum was found prolapsing out of the abdominal wound. Three scattered areas of subserosal burn of the small bowel were noticed, which required no intervention. The rest of the viscera all were normal. During the course of his stay, he had a fecal fistula on the 19th postburn day, which was found to be from the transverse colon. Conservative management of the fistula with total parenteral nutrition for 23 days resulted in complete healing.

Abdominal Injuries↗
PubMed1995

Intraoperative measurement of colonic anatomy and attachments with relevance to colonoscopy.

This study examined the variations in colonic length and mesenteric attachments in 118 patients undergoing laparotomy. Measurements were taken according to a set protocol with the bowel pulled medially, or towards the pubic symphysis or the xiphisternum, mimicking the possible displacements that may occur during colonoscopy. A free sigmoid loop was not present in 20 patients (17 percent) because of adhesions. A descending mesocolon of 10 cm or more in length was recorded in ten patients (8 percent) and an ascending mesocolon 10 cm or greater in 11 (9 percent). Some 24 patients (20 percent) had mobile splenic flexures and in 34 (29 percent) the mid-transverse colon reached the symphysis pubis or lower when pulled downwards. Mean (range) total colonic length was 114.1 (68-159) cm. This study helps define anatomical variations that may affect the facility, or otherwise, of colonoscopy.

Adult↗