Invaginación de colon causado por lipoma / Colon invagination caused by lipoma

Los lipomas del colon ocupan el tercer lugar en frecuencia de aparición de tumores benignos. Estos tumores están formados por tejido adiposo bien diferenciado con un estroma fibroso. La gran mayoría de estos lipomas es asintomática, algunos en raras ocasiones presentan complicaciones de urgencia. El fin de esta publicación es presentar un caso de obstrucción de colon por lipoma. (AU)

Benign colonic lesions are infrequent and account for a low percentage of all colonic tumors. Among the benign tumors, lipomas are third in frequency. They are composed of mature adipose tissue with fibrous stroma. Most of them are asymptomatic but in rare instances, they may present as surgical emergencies. We present one case of colonic obstruction caused by lipomas. (AU)

Application Analysis of through-the-scope stent for patients with proximal malignant colonic ob-struction / 临床外科杂志

Objective To investigate the clinical values of preoperative through-the-scope(TST) stent implementation by analyzing its effectiveness and reliability in patients with acute colonic obstruction caused by proximal colonic cancer.Methods From June 2008 to June 2014,36 patients with proximal colonic cancer accompanied by acute obstruction were analyzed.Obstructive sites consisted of ileocecal junction(n =4),ascending colon(n =20),and transverse colon near the hepatic flexure(n =12).A-chievement ratio of the colonic tumor resection,the incidence rate of complications,operation time,and hospitalization were evaluated.Results TTS was successfully placed in all patients.All patients showed relief of obstructive symptoms within 1 ~2 days.Surgical resection was performed after 5 ~7 days.A total of 34 patients got a radical colonic tumor resection,while the other two patients had liver and pelvic metas-tasis.All patients were welly recovered without complications of anastomotic leakage,intraperitoneal infec-tion and bleeding.Conclusion For patients with acute colonic obstruction caused by proximal colonic cancer,preoperative through-the-scope(TST)stent implementation is a cost-effective and safe method.It reduces trauma and pain,and enhances life quality for patients,which is worthy of being spread.

Experiencia del Instituto Nacional de Cancerología en el manejo de obstrucción del tracto de salida gástrico y del colon con prótesis metálicas autoexpandibles (PMAE) / Experience of the National Institute of Cancer Research in managing obtruccions of the gastric tract outlet and colon with self expanding metal stents (SEMS)

Objetivo: conocer la experiencia en el uso de prótesis metálicas autoexpandibles para el manejo de las obstrucciones malignas del tracto de salida gástrico o del colon, así como describir las características demográficas, clínicas y patológicas de los pacientes del Instituto Nacional de Cancerología (INC) durante el periodo comprendido entre enero 1 de 2010 y septiembre 30 de 212. Método: estudio observacional, descriptivo, retrospectivo de serie de casos, que incluyo pacientes con obstrucción del tracto de salida gástrico o colorrectal, donde se analizan las características clínicas y los factores involucrados en el éxito técnico y clínico de la inserción de PMAE, así como la influencia de dichas prótesis en la morbimortalidad. Resultados: se incluyeron 96 pacientes, 73 con PMAE duodenal y 23 con PMAE colorrectal, con edad promedio de 63,7 años. El éxito técnico para la inserción de PMAE duodenal fue del 97,2% y el éxito clínico fue de 93,1%. Para las PMAE colorrectales, el éxito técnico y clínico fueron de 91,3%. Se presentaron 8 complicaciones y 3 pacientes requirieron cirugía para solucionar una complicación. El promedio de vida después del procedimiento fue de 102 días para las PMAE duodenales y 159 días para los colorrectales. No se presento mortalidad secundaria al procedimiento. Conclusiones: la inserción de una PMAE es un procedimiento de mínima invasión que ha demostrado ser un tratamiento paliativo efectivo y una alternativa para reducir la formación de ostomías reduciendo costos y complicaciones.

Usefulness of Self-expandable Metallic Stents for Malignant Colon Obstruction

PURPOSE: Treatment for malignant colonic obstruction consists of a multiple-staged emergency operation. In recent years, some authors have reported low morbidity and mortality rates using self-expandable metallic stents. This study is designed to evaluate the usefulness of self-expandable metallic stents in patients with malignant colonic obstruction. METHODS: The records of 38 patients who had undergone surgery for malignant colonic obstruction at our institution between January 2004 and August 2006 were reviewed retrospectively. Seventeen patients were treated with elective surgery after stent insertion, bowel decompression, and bowel preparation (stent group), and 21 patients were treated with emergency surgery without stent insertion (control group). RESULTS: There were no significant differences in age, sex, tumor node metastasis (TNM) stage, or cancer position between the two groups (elective operation after stent insertion vs. emergency operation). Of the 17 patients who underwent elective operation after stent insertion, primary anastomosis was possible in 15 (88.2 vs. 57.1% in the control group), with a lower need for a colostomy (11.8 vs. 42.9% in the control group, P=0.036). Also, the number of patients with severe complications (17.6 vs. 47.6% in the control group, P=0.048) and the hospital stay (10.82 vs. 13.43 days in the control group, P=0.032) were significantly lower in the study group. CONCLUSION: Placement of a self-expandable metallic stent for malignant colonic obstruction is a safe and effective procedure. It can reduce the colostomy, mortality, and morbidity rates and the hospital fee for treatment.

Obstructive Colitis Proximal to Obstructive Lesion of the Colon Cancer / 대한소화기내시경학회지

Obstructive colitis is a rare inflammatory condition that occurs in a dilated segment of the colon proximal to an obstructing lesion. A 69-year-old patient presented with abdominal pain and distension. The colonoscopy findings revealed a near total obstruction from sigmoid colon cancer. The mucosa of the obstructive lesion was erythematous and hemorrhagic but normal mucosa was found immediately above the 3 cm long obstructive lesion. The proximal bowel of the normal mucosa showed colitis with hemorrhagic mucosal changes and yellowish exudative plaques. Surgery was performed as a segmental resection after placing a metallic stent to decompress the proximal colonic loop. In conclusion, obstructive colitis should be considered if an ulcero-inflammatory lesion with a colonic obstruction and a skip lesion in the proximal colon are detected.

A Case of Crohn's Disease Which is Diagnosed through Acute Sigmoid Colon Obstruction

Crohn's disease is an inflammatory bowel disease like ulcerative colitis. Distinct from ulcerative colitis, Crohn's disease may involve any portion of the alimentary tract from the mouth to the anus. Recently, the incidence of Crohn's disease has been increasing in Korea. The proportion of the colon type is smaller than that of the ileocecal type or the small-bowel type. In the colon, Crohn's disease affects mainly the right side. Relatively, the sigmoid colon is rarely involved. Small-bowel obstruction is the most common complication requiring surgery in Crohn's disease. On the contrary, an obstruction limited to the colon requiring surgery is less common in Crohn's disease. We experienced a case of a severe acute sigmoid colon obstruction with peritonitis. At first, we suspected colon cancer, but after an emergency laparotomy, we diagnosed it as Crohn's disease. Such a situation is rare in Korea, so we hope this case report may provide a good opportunity to reconsider Crohn's disease.

Cicatrização de anastomoses colônicas na vigência de obstrução intestinal: Estudo experimental em ratos

INTRODUCTION: The healing of intestinal anastomosis has been studied specially the suture technique and materials used in the preparation of anastomosis, and also to the better comprehension of the effects of several factors related to healing. A considerable number of complications after anastomosis of the colon and rectum can be noticed and the colonic obstruction has been as one of the main factors. OBJECTIVE: Study the anastomotic healing in the colon of rats after intestinal obstruction. METHODS: The animals (n=39) were divided in: Group I (submitted to intestinal obstruction induced four days before of the anastomoses, n=22) and Group II (Controls, n=22). The colonic anastomosis were made by a standardized technique and, seven days later, the segments which them were reviewed, resected and analyzed for a hydroxyproline dosage. RESULTS: The complications were more usual in the animals with obstruction (11 rats: 50%) than in the controls (3 rats: 17,7%), p 0,05. The median value of hydroxyproline was higher in the Group I (975,0 x 872,0), p>0,05. CONCLUSION: The anastomosis in the rat's colon with intestinal obstruction is related to more complications. This can be explained by the following factor's: more technical difficulty in the preparation of the anastomosis caused by different diameter of the bowel, higher undernourishment, proximal faecal retention, bacterial translocation and ischaemia. The statistical similarity between the groups regarding to the dosage of hydroxyproline suggests that the healing of the rats' colonic anastomosis with intestinal obstruction, in the absence of complications, follows the same process of collagen synthesis as the controls ones.

INTRODUÇÃO: A cicatrização de anastomoses intestinais vem sendo estudada com ênfase às técnicas de sutura e materiais empregados na confecção das anastomoses, bem como à melhor compreensão dos efeitos de diversos fatores sobre a cicatrização. Observa-se número não desprezível de complicações nas anastomoses de cirurgias colorretais e a obstrução colônica é referida como um dos fatores determinantes. OBJETIVO: Estudar a cicatrização de anastomoses no cólon de ratos na vigência de obstrução intestinal. MÉTODOS: Os animais (n=39) foram divididos em: Grupo I (Submetidos à obstrução intestinal induzida quatro dias antes da anastomose, n=22) e Grupo II (Controles, n=22). As anastomoses colônicas foram confeccionadas por técnica padronizada e, sete dias após, os segmentos que as continham foram analisados e ressecados para dosagem de hidroxiprolina. RESULTADOS: As complicações foram mais frequentes nos animais com obstrução (11 ratos=50%) que nos controles (3 ratos=17,7%), p 0,05. A média dos valores de hidroxiprolina foi maior no grupo I (975,0 x 872,0), p>0,05. DISCUSSÃO: A anastomose no cólon de rato com obstrução intestinal está associada a maior número de complicações que podem ser explicadas pela presença de fatores como: maior dificuldade técnica na confecção da anastomose pela desproporção entre bocas, maior desnutrição, impactação de fezes à montante, translocação bacteriana e isquemia. A semelhança estatística entre os grupos quanto à dosagem de hidroxiprolina sugere que a cicatrização das anastomoses colônicas dos ratos com obstrução intestinal, na ausência de complicações, segue o mesmo processo de síntese de colágeno que a dos controles.

Application of one stage resection to the treatment of acute distal colorectal cancer obstruction / 中国综合临床

Objective To explore the principle and methods of surgical management of acute distal colon obstruction caused by colorectal cancer.Methods The data of the cases who received one stage resection in our hospital were analyzed retrospectively,and their surgical management was evaluated comprehensively.Results 34 patients received one stage resection and anastomosis and 6 received delayed anastomosis.All the patients were cured,and no anastomosis fistula or other complications occurred except for 3 cases who were complicated with infection.Conclusion One stage resection and anastomosis was safe for the patients of colorectal cancer complicated with acute disatal colon obstruction as long as the indications were determined appropriately.Colonic irrigation during the operation is essential for one stage anastomosis.

Management for Obstructed Carcinoma of the Left Colon

The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.

The Colonic Obstruction Due to Actinomycosis

Abdominal actinomycosis is very rare infectious disease and seldom reported as a cause of abdominal mass. This disease is diagnosed by pathologic findings and culture result but it is very difficult to differentiate with other granulomatous illammatory disease, diverticular disease, malignancy, etc. The radiologic findings were non-specific and CT scan revealed the inflammatory mass with multiple small abscesses and fibrous change. The treatment of choice for actinomycosis is medical treatment with penicillin but surgical intervention may be needed when complication such as obstruction, fistula formation, abscess formation develop. We report a patient with abdominal actinomycosis that presented with transverse colonic obstruction and severe abdominal wall inflammation. This patient had no past operative history but got intrauterine contraceptive devices during last 10 years. We treated this patient by surgical resection and antibiotic therapy.