Complete Single Stage Management of Left Colon Cancer Obstruction with a New Devices

Intraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation and colonoscopy before resection of tumor was devised. PURPOSE: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction. METHODS: The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively. RESULTS: There were 53 patients (27 male, median age 64, range; 28~82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27) Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases. CONCLUSIONS: The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.

Pyoderma Gangrenosum in Ulcerative Colitis / 대한소화기내시경학회지

Ulcerative colitis is an inflammatory disorder that affects the rectum and extends proximally to affect a variable extent of the colon. The major symptoms of ulcerative colitis include diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. Ulcer-ative colitis also may be complicated by many local and systemic disorders as extrain-testinal manifestations. Pyoderma gangrenosum is the most severe dermatologic com-plication associated with ulcerative colitis. It is a painful , chronic, ulcerating skin disease of unknown cause. Diagnosis is clinical, there being no accepted histological diagnostic criteria. Conventional therapy is empirical, usually with high dose corticosteroids, but var-ious other agents have been tried with occasional success including topical antibiotics, cyclosporine, disodium cromoglycate, and dapsone. This patient was treated with high dose corticosteroid (prednisolone 1 mg/kg/day) and discharged with clinical improvement. So we report this case with a literature review.