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PubMed2001

Current trends in colorectal cancer: site, incidence, mortality and survival in England and Wales.

The objective was to examine trends in colorectal cancer (CRC) incidence and mortality in England and Wales over the last 30 years. Age-standardized incidence, mortality and survival rates for CRC, based on data from the National Cancer Intelligence Centre at the Office for National Statistics, were calculated and trends assessed. Between 1971 and 1997 the total number of cases of CRC increased by 42%, from 20,400 to 28,900. The site distribution of CRC between 1971 and 1994 was: rectum 38%, sigmoid 29%, caecum 15%, transverse colon and flexures 10%, ascending colon 5%, and descending colon 3%. Between 1971 and 1997 the direct age-standardized incidence increased by 20% in males and by 5% in females. The direct age-standardized mortality fell by 24% in males and by 37% in females. Age-standardized relative 5-year survival in adults improved from 22%-27% for patients diagnosed during 1971-1975 to over 40% for those diagnosed during the period 1991-1993. In conclusion, the incidence of CRC in England and Wales has been steadily rising. It is more common in males and has increased more rapidly in males than in females. The reasons for these trends remain unclear. Five-year survival has improved substantially, but rates are still below those in comparable countries elsewhere in Europe and in the USA.

Adolescent↗
PubMed2004

Laparoscopic-assisted approaches for the definitive surgery for Hirschsprung's disease.

The surgical management of Hirschsprung's disease has progressed from a two- or three-stage procedure to a primary operation over the last 25 years. More recently, definitive surgery for Hirschsprung's disease has been performed using minimally invasive techniques. The Swenson, Duhamel and Soave endorectal pull-through procedures have all been reported using minimally invasive approaches. The endorectal dissection has become the dominant minimal access procedure because of the ease and reliability in performing this technique and the excellent results obtained. Although a transanal endorectal pull-through can be performed without laparoscopy, the laparoscopic-assisted transanal endorectal pull-through is a much more versatile technique and allows early biopsies to determine the extent of aganglionic and dysfunctional bowel before ablation of the rectum and mesocolon. The authors use a laparoscopic-assisted transanal pull-through for aganglionosis of the left and transverse colon. Total colon aganglionosis or aganglionosis of the ascending colon is managed by a laparoscopic-assisted Duhamel procedure which provides a better reservoir in patients with a short or absent colon.

Child, Preschool↗
PubMed2000

A comparative histopathologic evaluation of the effects of three different solutions used for whole bowel irrigation: an experimental study.

PURPOSE: Although whole bowel irrigation (WBI) is a widely used method of bowel preparation in daily surgical practice, almost nothing is known about the histopathologic alterations caused by WBI and whether these differences have any detrimental effect on the outcome of gastrointestinal surgical procedures. Therefore, an experimental study has been conducted to evaluate and compare the effects of WBI with various solutions on the histology of gastrointestinal tract. METHODS: During the experimental procedures animals were divided into 4 groups consisting of 8 animals each as follows: group A, WBI performed by using isotonic saline solution; group B, WBI performed by using an isoosmolar solution containing polyethylene glycol (PEG); group C, WBI performed by using Lactated Ringer's solution; group D, Animals that were not irrigated but sham operations that were performed served as controls. Four hours after WBI the animals underwent laparotomy and a segment of transverse colon with intact vascular peduncle was prepared. After waiting for 30 minutes, specimens from duodenum, small intestine, large bowel, colonic segment, and liver were obtained from each animal. Histopathologically, all of the specimens were evaluated and graded by 3 parameters including congestion, edema, and inflammation. RESULTS: Although varying degrees of congestion, edema, and inflammation were encountered from all of the specimens of group A, B, and C, only slight congestion was noted in all specimens of group D. The difference between group D and other groups was statistically very significant (P < .001). When the sections from duodenums of groups were evaluated, the degree of congestion, edema, and inflammation were found to be moderate in group B, mild-moderate in group A, and mild in group C. Histopathologic examinations of specimens of the small, large bowel, and isolated colonic segment showed severe congestion, edema, and inflammation in group A, moderate-mild in group B, and mild in group C. The difference between A and B, A and C, and A and D was statistically significant (P < .01). Although severe congestion was encountered in liver specimens of group A, only mild congestion was encountered in groups B and C (P= .0001). The matched durations of irrigations and total volume of irrigation solutions were found to be not related with the difference in histopathologic findings. CONCLUSIONS: WBI has induced varying degrees of histopathologic alterations from mild to severe in the rat gastrointestinal tract. Lactated Ringer's solution and PEG solution have induced the least alterations. Therefore, WBI with Lactated Ringer's solution and PEG solution seem to be safe alternatives of mechanical bowel preparation before elective large bowel surgery. Because saline solution has caused detrimental alterations in distal gastrointestinal tract histology, WBI with saline solution seems to be unadvisable.

Animals↗
PubMed2000

Cancer incidences in the digestive tube: is cobalamin a small intestine cytoprotector?

Malignancies are common in the digestive tube, although with unequal distribution among segments. The aim of this paper was to compare available interpretations of the low cancer incidence in the small bowel and high in the large bowel. Supposed mechanisms include relatively small bacterial population, large secretion of liquid and rapid transit in the small bowel. Small bowel mucosa is the main absorptive part of the digestive tube with absorption rates for various nutrients so high that they can even be considered as clearances from the intestinal content. Consequently, these nutrients are not present in the large bowel. An alternative explanation is that an absorbable protective substance from the intraluminal content, might protect the mucosa from malignant transformations. It can be speculated that if there are any cytoprotective substances in the digested food their effect would be expressed mostly in the absorptive small intestine, leaving the large bowel mucosa unprotected. Vitamin B12 might be a possible candidate for this role. Cobalamin molecules are initially bound to haptocorrin (Hc) in the stomach, but in the small intestine B12 is transferred to intrinsic factor (IF) after the action of pancreatic trypsin on Hc. Cobalamin-IF complexes are absorbed in the terminal ileum leaving only a small fraction of B12 to enter the large bowel. We have tried to summarize available data regarding cancer incidences in digestive tube, segmental length and transit times of tube content. Cancer density is calculated as incidence per length and transit speed as length per transit time. Cancer incidences for seven intestinal segments were considered low if they were below one case per 100 000 inhabitants annually, while the low cancer density meant less than six cases per 100 000 inhabitants per metre. For instance, transverse colon was considered as a high cancer incidence place (2.15 cases), with low cancer density (4.3 cases/m). Transit speed more than 0.3 metre/hour was associated with low cancer incidences (accuracy 0.85) and low cancer density segments (accuracy 1.00). Cobalamin availability showed similar distribution, available in low incidence segments and unavailable in high incidence segments. Experimental studies are needed to quantify B12 availability in the large bowel and to determine whether small amounts of B12-IF or, perhaps, B12-haptocorrin complexes are absorbed by the small bowel mucosa. Without that, no cytoprotective effects of B12 in the digestive tube can be expected.

Anticarcinogenic Agents↗
PubMed1975

[Recurrent haemoptysis for a period of five years following aspiration of a gall stone].

The article deals with a case report of a 71-years-old female who suffered from hemoptysis over a period of five years. The first hemoptysis occurred postoperatively after a cholecystectomy in December 1966 and was thought to be caused by pulmonary embolism. Persisting episodes of more or less slight hemoptysis in the following years lead to repeated different diagnostic procedures. Radiologically there was an infiltration of the right lower lobe rather constant in size. Endoscopically no bronchial obstruction was visible. In July 1972 the patient suffered from a more severe hemoptoe. X-ray findings were nearly unchanged. With bronchoscopy the hemorrhage could be localized to the segmental bronchi 8 and 9. Right lower lobectomy was done in September 1972 without an exact preoperative diagnosis. The patient had an uneventful postoperative course despite of her age. Pathological examination of the specimen showed a foreign body looking like a gallstone. This diagnosis was confirmed by chemical analysis. To get an explanation we inquired into the circumstances of the cholecystectomy performed 5 years ago. These lead to the conclusion that the concrement must have been vomited and aspirated by the evidently not intubated patient. These suggestions were supported by the fact, that the former operation has been done because of a gangrenous gallbladder with a highly delated common duct and the duodenum, stomach and transverse colon being involved in an inflammatory infiltration. Dangers of asymptomic foreign body aspiration and diagnostic problems in non-opaque peripheral foreign bodies are discussed.

Aged↗
PubMed2000

Omental flap for mediastinitis after median sternotomy in asplenia syndrome and gut malrotation.

We describe a 12-year-old patient with asplenia syndrome and gut malrotation who, after an interim step before a modified Fontan operation, developed life-threatening mediastinitis. A flap of the omentum arising from the transverse colon, longitudinally located in the left of the abdomen, was created and transferred to the mediastinum after a division of the arterial arcade at its most caudal extent. Her postoperative course was uneventful, and 12 months later, the modified Fontan operation was successfully completed. Although visceral heterotaxy results in an omental deformation, it does not preclude the use of an omental flap.

Abnormalities, Multiple↗
PubMed2001

Endoscopic snare excision of large pedunculated colorectal polyps: a new, safe, and effective technique.

BACKGROUND AND STUDY AIMS: The endoscopic polypectomy of large pedunculated polyps can have serious complications, such as hemorrhage, which has an incidence of about 2 %. We describe here a new, safe, and effective technique of endoscopic polypectomy for the treatment of large pedunculated colorectal polyps using a standard detachable diathermic snare. PATIENTS AND METHODS: 35 patients (18 men, 12 women; mean age 67.3, range 35 - 82), with 43 pedunculated colorectal polyps, of benign appearance and of size 3 cm or larger (range 3 - 5 cm) on colonoscopy, were included in our study. The polypectomy was performed in two steps: a) we first placed a polypectomy snare round the middle of the stalk, as a prophylactic measure to prevent postpolypectomy bleeding, and we then took out the colonoscope without removing the snare after dismantling it and blocking with a clip; b) endoscopic polypectomy was done using a second polypectomy snare, and transecting the stalk of the polyps at 2 mm above the first snare. The first polypectomy snare was left in place, and the patients were discharged within 3 hours of endoscopic polypectomy. The first polypectomy snare sloughed off spontaneously and slipped down the anus, being evacuated within 4 days following the endoscopic polypectomy. RESULTS: The ensnared polyps were located in the rectosigmoid region (n = 27), and the descending (n = 13) and transverse colon (n = 3). Complete ensnarement of the head of the polyp with a single endoscopic treatment was obtained in all cases. In addition, no procedural or delayed bleeding was noted during a 6-month follow-up. CONCLUSIONS: Our technique allows us to overcome the risk of bleeding, since the use of a standard diathermic snare makes it easier to obtain optimal tightness. Moreover, this technique is cheaper than the use of the standard detachable snare currently available (the cost of the snares being $50.52 compared with $189.47).

Adult↗
PubMed2002

Superficial depressed-type cancer monitored by colonoscopy through the early phase of invasion.

Although previous retrospective reports have demonstrated the developmental course of several colorectal tumors, the natural history and progression of depressed carcinoma, especially in the early stage, remains obscure. We report a case of superficial depressed tumor in the transverse colon in a 71-year-old man, which did not change in size and gross configuration through prospective colonoscopic observation over a period of 19 months but which was finally diagnosed as early-stage submucosal invasive cancer. Most depressed cancers have been supposed to arise de novo and grow rapidly, showing aggressive behavior when 10 mm or less in size. However, this case report may suggest that even a depressed tumor may grow to approximately 10 mm within the mucosal layer over a few years and that the growth of colorectal tumors, whether they are polypoid or depressed in configuration, might be fairly slow.

Adenocarcinoma↗
PubMed2003

[Life-threatening complication of the Nuss-procedure for funnel chest. A case report].

This report is the first description of an additional major complication seen with the Nuss repair. In addition to the conventional Rehbein and Ravitch operations for funnel chest, the minimally invasive procedure developed by Nuss has recently been added to the therapeutic options. The present report describes the case of a 21-year-old man who underwent a Nuss repair with implantation of 2 pectus bars 4 months previously. During the primary operation the central tendon of the left diaphragm was unnoticed injured. We performed an emergency operation on the patient to repair an incarcerated diaphragmatic hernia. The thorax was found to contain not only the entire, twisted stomach, but also the transverse colon and the spleen. During induction of anaesthesia the patient suffered a cardiovascular collapse. After successful resuscitation, thoraco-abdominal surgery was performed and the diaphragm closed from the thoracic side. Other authors have also reported major life-threatening complications of the Nuss-procedure, such as perforation of the heart. A careful evaluation of this procedure and the establishment of clear indications taking the age of the patient, the thoracic deformity and connective tissue disease into account, are mandatory to avoid discredit of this method.

Adult↗
PubMed2004

Poor effect of glutamin and human-EGF on autologic-allotopic transplanted ileum mucosa.

INTRODUCTION: After establishing a new method of autologic-allotopic ileum mucosa transplantation as a therapy for short-bowel syndrome, the effects of glutamine and human epithelial growth factor (human EGF) on the transplanted ileum mucosa were evaluated. METHODS: Ileum mucosa was transplanted in 28 young beagle dogs in a demucosed vascularised transverse colon segment. The ileum mucosa was kept in place with silicone stents in all animals. Eight animals of the control group were irrigated with saline solution. In the second group with 10 animals, 100 mg/kg glutamine were administered daily in the lumen. The 10 animals of the third group were treated with 25 microg/kg human EGF per day subcutaneously and irrigated with saline solution. 4 weeks later, histological specimens were harvested from the colon coat-ileum mucosa complex, the normal ileum and normal colon. Lumen diameter, percentage ileum mucosa uptake as well as mucosa and colon muscle coat thickness were evaluated. RESULTS: In all groups, the diameter of the lumen was larger than 10 mm after fixation, due to the silicone stent. The group with glutamine irrigation showed the largest lumen diameter. A complete mucosa lining of the inner surface of the colon muscle coat was achieved in none of the animals. The highest percentage of ileum mucosa uptake was found in the group with glutamine irrigation. In most animals, the transplanted ileum mucosa was markedly thinner than normal ileum mucosa. Only in the group with glutamine irrigation did we find two animals with nearly normal mucosa thickness. The longitudinal muscle of the transplanted colon coat was thicker in all three groups compared to normal colon. There were no differences in thickness of the circular muscle in all animals compared to normal colon. CONCLUSIONS: Silicone stents maintain a lumen after autologic-allotopic ileum mucosa transplantation. However, additional irrigation with glutamine, as well as treatment with human EGF subcutaneously could not provide a complete lining of the colon muscle coat with transplanted ileum mucosa. A modification of the operative procedure is necessary to achieve a colon muscle coat that is completely lined with ileum mucosa before the absorptive capacity of the transplanted colon coat-ileum mucosa complex can be evaluated.

Animals↗
PubMed1982

Antibiotic-associated colitis: always pseudomembranous?

Among the 14 cases of antibiotic-induced colitis, endoscopic features were: in 9 cases typical pseudomembranes, in 4 cases petechiae or ecchymosis or suggillation-like redness with near-to-normal surrounding mucosa. In one case induced by Spiramycin, a macrolide that had never been previously indicated as being responsible for the disease, the endoscopic picture was 'atypical' and directed us towards a severe ulcerative colitis. These forms are very rare and usually limited to the right or transverse colon which suggests, if possible, a total colonoscopy. The nosographic picture of these cases is not quite clear, since they could represent both the most severe stages within 'non-pseudomembranous' antibiotic-induced colitis and autonomous forms whose evolution does not contribute in any way to the formation of pseudomembranes.

Adult↗
PubMed1999

[Abdominal actinomycosis after stomach surgery in a patient with long-term rheumatoid arthritis treated with methotrexate].

HISTORY AND ADMISSION FINDINGS: A 78-year-old woman had a 30-year history of rheumatoid arthritis, of late treated with prednisolone and methotrexate. A week before admission she had first noticed a mass about 3 cm in diameter, at the lower end of a scar from a Billroth II gastric resection for gastric ulcer, performed 4 months before. She reported to have lost 6.5 kg in weight. On admission a moderately mobile, hard mass was palpated on the abdomen. INVESTIGATIONS: Ultrasound and computed tomography revealed a superficial, inhomogenous space-occupying lesion with poorly circumscribed margins. TREATMENT AND COURSE: After two days the skin over the mass became reddened and a laparotomy was performed because an incarcerated herniation was suspected. An abscess and inflammatory adhesions were found in the area of the transverse colon, histologically shown to be a chronic purulent abscess with granular clusters of pathogens indicating actinomycosis. After 3 weeks' treatment with imipenem i.v. the patient became free of symptoms, oral doxycyclin was continued for a further 6 months. CONCLUSION: Actinomycosis should be considered in the differential diagnosis of a tumour of undetermined benignity in the region of the head, chest or abdomen in immunosuppressed patients. This bacterial infection should be thought of especially if the gastrointestinal mucosa has been penetrated by invasive procedures.

Abdominal Abscess↗
PubMed1996

[CT-guided percutaneous endoscopic gastrostomy: a successful method if transillumination is not possible].

BACKGROUND AND OBJECTIVE: If transillumination is not possible, percutaneous endoscopic gastrostomy (PEG) is contraindicated. In these cases the stomach had so far to be punctured directly during radiological monitoring. A new method is described which combines endoscopy and computed tomography (CT) for performing a percutaneous endoscopic gastrostomy. PATIENTS AND METHODS: Among 189 patients who were to have the procedure there were eleven (nine men, two women) in whom transillumination was not possible. After endoscopic insufflation of air PEG was done under CT guidance, using the common pull-through technique. RESULTS: The combined method was successful in ten of the eleven patients without complication. In one patient with hepatomegaly and interposition of the transverse colon PEG was not possible even with CT guidance. CONCLUSIONS: The combined endoscopic-radiological method is practicable and safe in cases in which transillumination is not possible. There are several advantages compared with direct puncturing: The common pull-through technique can be used; radiological exposure is low and other clinically relevant findings may be revealed by the endoscopy.

Adult↗
PubMed1996

[Disseminated pneumoperitoneum during the therapy of lymphoma with methotrexate and cytosine arabinoside].

HISTORY AND CLINICAL FINDINGS: A 58-year-old man was treated for abdominal and inguinal recurrence of a centroblastic non-Hodgkin lymphoma with high doses of methotrexate and cytosine arabinoside. A chest radiogram, taken on the 18th day of chemotherapy to exclude pulmonary infiltration, revealed pneumoperitoneum. The patients's complaints were merely of abdominal fullness and persisting diarrhoea. His general state was hardly impaired, the abdomen soft on palpation with active peristalsis. INVESTIGATIONS: There was aplastic anaemia (haemoglobin 9.9 g/dl, erythrocytes 3.4 x 10(6)/microliters, white cells 1000/microliters, platelets 20,000/microliters. Plain film of the abdomen and abdominal computed tomography confirmed pneumoperitoneum. Intraluminal air had caused wall dissection in the ascending and transverse colon (pneumatosis coli as cause of the pneumoperitoneum). TREATMENT AND COURSE: There was complete absorption of the free abdominal air by the 29th day of chemotherapy under parenteral nutrition and metronidazole (3 x 500 mg daily).

Anemia, Aplastic↗
PubMed1989

[Acute intestinal hemorrhage in a pancreatic pseudocyst-colic fistula].

Chronic pancreatitis with a pseudocyst may cause acute massive intestinal bleeding due to simultaneous erosion of the splenic artery and transverse colon. This is a potentially lethal complication, which requires instant diagnosis and treatment. The pathogenesis, diagnosis and treatment of this condition are illustrated by two patients. Exact localisation of the source of bleeding is achieved by selective angiography of the visceral arteries. In shocked and inoperable patients, selective embolisation of the bleeding artery is the treatment of choice.

Acute Disease↗
PubMed1984

[Primary duodenal carcinoma. Clinico-radiologic study].

Primary carcinoma of the duodenum represents about 0.35% of all gastrointestinal carcinomas and is thus a rare disease. The radiological diagnosis of a duodenal origin is made more difficult by the close proximity of the pancreas, biliary system, right kidney and transverse colon. Histologically, duodenal malignant tumours are usually adenocarcinomas. Between 1973 and 1983, eight patients with primary duodenal carcinomas were diagnosed at the University of Tübingen. Average age of the patients was 67 years. There was no sex difference. Average survival was 3.3 years.

Adenocarcinoma↗
PubMed1995

[MALT lymphoma of the ileum as the cause of an enterocolic invagination].

HISTORY AND FINDINGS: A 44-year-old woman who had moved to Germany from Kazakhstan 2 years previously developed right upper abdominal pain. A cylindrical mass was palpable in the area. There were strong intestinal sounds. INVESTIGATIONS: There was an iron-deficiency anaemia (haemoglobin 6.3 g/dl, serum iron 4 micrograms/dl) and occult blood was found in the stool. Coloscopy revealed a lumpy mass external to the transverse colon but fixed to it, partially obstructing the lumen. However, on contrast infusion the mass could be displaced in to the caecum, suggesting enterocolic invagination. TREATMENT AND COURSE: At operation the cause of the investigation was found to be a large jagged tumour of the terminal ileum. A right hemicolectomy and excision of the terminal ileum were performed. Histologically the tumour was a centroblastic non-Hodgkin lymphoma of the MALT type (mucosa-associated lymphatic tissue).

Adult↗
PubMed1989

[Rectal stenosis due to long-term therapy with ergotamine].

Two patients (a woman aged 39, a man aged 46 years) had developed severe distal rectal stenoses after 20 years of anti-migraine treatment with ergotamine-containing suppositories. The woman required several bougie and laser treatments. In the man a megacolon had developed due to increasing, finally complete, rectal stenosis and this required a double colostomy (transverse colon) as an emergency. Ergotamine-containing suppositories are widely used in the treatment of migraine, but they should not be administered for prolonged periods.

Adult↗