Organoaxial volvulus of descending colon: a case report

“Colonic volvulus” refers to the twisting of colon, which most commonly involves sigmoid colon causing obstruction, ischemia and gangrene. But very rarely segment of descending colon can be involved. This is a case of 42 year old male with vomiting, abdomen pain and distension since one day, showing organoaxial volvulus of descending colon loop with a twist of mesentery.

Female Sex and Right-Sided Tumor Location Are Poor Prognostic Factors for Patients With Stage III Colon Cancer After a Curative Resection

PURPOSE: Stage-IIIC colon cancer is an advanced disease; however, its oncologic outcomes and prognostic factors remain unclear. In this study, we aimed to determine the predictors of disease-free survival (DFS) in patients with stage-IIIC colon cancer. METHODS: From a multicenter database, we retrospectively enrolled 611 patients (355 men and 256 women) who had undergone a potentially curative resection for a stage-IIIC colon adenocarcinoma between 2003 and 2011. The primary end-point was the 5-year DFS. RESULTS: The median age was 62 years; 213 and 398 patients had right-sided colon cancer (RCC) and left-sided colon cancer (LCC), respectively. The 5-year DFS in all patients was 52.0%; median follow-up time was 35 months (range, 1–134 months). A multivariate Cox regression revealed that female sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.19–1.90; P < 0.01), right-sided tumor location (HR, 1.65; 95% CI, 1.29–2.11; P < 0.01), lymphatic invasion (HR, 1.52; 95% CI, 1.08–2.15; P < 0.01) and a high (≥0.4) metastatic lymph node ratio (HR, 3.72; 95% CI, 2.63–5.24; P < 0.01) were independent predictors of worse 5-year DFS. Female patients with RCC were 1.79 fold more likely to experience recurrence than male patients with LCC. CONCLUSION: Female sex and right-sided tumor location are associated with higher tumor recurrence rates in patients with stage-IIIC colon cancers. Aggressive treatment and close surveillance should be planned for patients in these groups.

Submucosal lipoma simulating a malignant tumor of the left colon: a case report / Lipoma submucoso simulando tumor maligno de cólon esquerdo: relato de caso

Intestinal lipomas can occur anywhere in the gastrointestinal tract, and these tumors are more frequent in the colon. By being largely asymptomatic, colonic lipomas are usually found incidentally, as findings in colonoscopy examinations, in association with biopsy. Endoscopic or surgical resection is the therapeutic option, depending on the size of the tumor, its location, and the presence or absence of symptoms. In this study, we present a case of a 59-year old woman, with a descending colon lipoma histologically diagnosed only after surgical resection of the lesion. The approach was adopted according to the patient's clinical picture (intestinal bleeding, vomiting and weight loss), in addition to the occlusion of 80% of the colonic lumen observed in a colonoscopy.

Os lipomas intestinais podem ocorrer em qualquer parte do trato gastrointestinal, sendo mais frequente no cólon. Por serem em grande parte assintomáticos, os lipomas colônicos são usualmente encontrados acidentalmente como achados de exame de colonoscopia associada à biópsia. Como opções de tratamento, há a ressecção endoscópica ou cirúrgica, a depender do tamanho do tumor, sua localização e presença (ou não) de sintomas. Nesse relato, é apresentado um caso de uma mulher de 59 anos com lipoma de cólon descendente, diagnosticado histologicamente apenas após ressecção cirúrgica da lesão. A conduta foi adotada pelo quadro clínico de enterorragia, vômitos e perda ponderal, além da oclusão de 80% da luz do cólon observada em exame de colonoscopia.

Right sided descending and sigmoid colon: its embryological basis and clinical implications / 대한해부학회지

Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.

A stercoral perforation of the descending colon / 대한외과학회지

This is a case report on a stercoral perforation of the descending colon that was not adequately treated in the first operation. Re-operation was required in order to revise the primary repair site and to remove the impacted fecaloma.

Short-term Outcomes of a Laparoscopic Left Hemicolectomy for Descending Colon Cancer: Retrospective Comparison with an Open Left Hemicolectomy

PURPOSE: Many randomized clinical trials have been performed to treat a colorectal neoplasm with the exclusion of descending colon cancer. The aim of the present study was to investigate the difference in surgical outcomes between a laparoscopic left hemicolectomy and a conventional open left hemicolectomy for descending colon cancer. METHODS: A retrospective study of ninety patients with descending colon cancer, who underwent a laparoscopic (LAP) or open left hemicolectomy (OS) between May 1998 and December 2009 at Kyungpook National University Hospital, was performed. Clinicopathological and surgical outcomes were compared between the LAP and the OS for descending colon cancer. RESULTS: The baseline characteristics, including age, gender, body mass index, history of prior abdominal surgical history and tumor location, were similar between the two groups. The mean operation time was 156.2 minutes for the LAP group and 223.2 minutes for the OS group (P < 0.001). Intraoperative blood loss was significantly greater in the OS group (37.5 mL vs. 80.4 mL; P = 0.039). The postoperative recovery in the LAP group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay. Pathological examinations showed the surgery to be equally radical in the two groups. The median follow-up was 21 months and there were 3 distant metastases (8.5%) during follow-up in the LAP group, but no port-site or local recurrence. CONCLUSION: A laparoscopic left hemicolectomy is a technically safe and feasible procedure for treating descending colon cancer. Prospective multi-center trials are necessary to establish the LAP as the standard treatment for descending colon cancer.

A case of sparganosis presenting as hematochezia / 대한내과학회지

Sparganosis is a parasite infection caused by a sparganum, which is a plerocercoid larva of cestodes in the genus Spirometra. Recently, we experienced an unusual case of sparganosis of the descending colon in a 68.year.old female who presented with acute abdominal pain and severe hematochezia. At colonoscopy, a large hematoma was seen in the descending colon. The biopsy specimen showed the degenerating sparganum of a parasitic worm. We report this with a brief review of literature.

A Case of Arteriovenous Malformation of the Descending Colon Presenting with Massive Bleeding / 대한소화기내시경학회지

Arteriovenous malformation is a rare cause of lower gastrointestinal bleeding in patients younger than 50 years of age and is characterized by recurrent, painless, massive bleeding and chronic anemia without a remarkable prior or family history. The most commonly sites involved are the ascending colon and small bowel. This condition rarely involves the stomach and descending colon. Until recently, there has been only one case report on arteriovenous malformation of the descending colon in Korea. We report a case of a 32 year old male patient who presented with massive lower gastrointestinal bleeding and had been diagnosed with arteriovenous malformation of the descending colon after undergoing colonoscopy and abdomen CT with contrast enhancement. The patient underwent left hemicolectomy because of persistent bleeding despite conservative management.

Quantitative Study of the Myenteric Plexus of the Descending Colon of Young Rats Subjected to Intense Protein Deficiency / Estudio Cuantitativo del Plexo Mientérico del Colon Descendente de Ratas Jóvenes Sometidas a Intensa Deficiencia Proteica

We studied the effects of a severely hypoproteic diet on the quantitative aspects of the myenteric plexus of the descending colon of young rats. Eighteen rats were divided into two groups, one of them being fed with a chow having 26% protein (control) and the other with a chow having 4% protein, balanced for minerals and vitamins, during 12 weeks. The whole-mounts of the descending colon had their myenteric neurons stained either with Giemsa or NADPH diaphorase. The rats from the experimental group had deficits of body weight (54.23%) and area of the descending colon (48.14%); additionally, we observed that there was no alteration in the total number of neurons of the colon, but a decrease in the number of NADPH-diaphorase positive neurons (37.80%). The implications of these results concerning the priority that some cellular types may have when nutrients are less available are discussed.

Estudiamos los efectos crónicos de una dieta severamente hipoproteica sobre los aspectos cuantitativos del plexo mientérico del colon descendente de ratones jóvenes. 18 ratones fueron divididos en dos grupos, a uno de estos grupos se le dió ración con contenido proteico del 26% (control) y al otro, ración con contenido proteico del 4%. Se mantuvo el balance vitamínico y mineral, durante 12 semanas. Elaboramos los preparados de membrana del colon descendente y marcamos las neuronas del plexo mientérico con Giemsa y NADPH-diaforasa. Los ratones del grupo experimental presentaron déficit de peso corporal (54,23%) y del área del colon descendente (48,14%); además, observamos que no hubo alteración en el número total de neuronas en todo el colon; sin embargo, hubo una disminución en la marcación de neuronas NADPH-diaforasa positivas (37,80%). Los resultados son discutidos, respecto a la prioridad que ciertos tipos celulares pudiesen tener, con la menor disponibilidad de nutrientes.

Localized form of colitis cystica profunda: a case of occurrence in the descending colon

An unusual localization of localized colitis cystica profunda in a 31-year-old man is described. The patient presented as anal bleeding and a protruding mass at the descending colon; the mass was polypoid and was made up of papillary epithelial hyperplasia with downward herniation of glands into the submucosa. Only one similar case involving a descending colon has been reported in the world literature.