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Abstract Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.
Resumen El trauma de las vísceras huecas representa una gran proporción de las lesiones asociadas al trauma penetrante. Actualmente, las lesiones aisladas de intestino delgado o colon se manejan a través de anastomosis primaria en pacientes sometidos a laparotomía definitiva o anastomosis diferida en pacientes que requieran cirugía de control de daños. El dogma quirúrgico tradicional de la ostomía se ha probado que es innecesario y en muchos casos puede aumentar la morbilidad. El objetivo de este artículo es describir la experiencia obtenida en el manejo de lesiones combinadas de vísceras huecas de pacientes con trauma penetrante. Se determinó que el manejo primario o diferido del intestino a través de anastomosis es el abordaje quirúrgico preferido en pacientes que presentan lesiones penetrantes combinadas de intestino delgado y colon. Se ha reportado que el 90% de lesiones combinadas penetrantes intestinales pueden ser manejadas a través de anastomosis primaria o diferida incluso en los casos más severos requieren la aplicación de los principios de control de daños. Aplicando esta estrategia, la tasa general para ostomía (primaria o diferida) puede ser reducida a menos del 10%.
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A 43 year old female presented to the emergency department for nausea, vomiting and abdominal pain secondary to a bowel obstruction subsequently revealed to be a poorly differentiated large cell neuroendocrine tumor of the colon. After a CT scan showed a mass in the ascending colon with possible metastasis to the right lobe of the liver, an exploratory laparotomy was performed. A hemicolectomy was performed with biopsy of the liver mass. Pathology was consistent with large cell neuroendocrine tumor in all specimens including the liver biopsy, ascending colon, and transverse colon. Although large cell neuroendocrine tumors of the colon are a rare malignancy, they are an important consideration in the workup of multiple colonic masses with metastases, especially in patients presenting with bowel obstruction. The literature on poorly differentiated large cell neuroendocrine cancer and treatment is reviewed. Poorly differentiated large cell neuroendocrine tumor is a rare pathology but should be included in the differential diagnosis in patients presenting with a colon mass and bowel obstruction.
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Abstracts: Background: To study the different modes of clinical presentation and study clinical outcome in various causes of large bowel obstruction in adults and to accomplish the operative management and to anticipate the postoperative complications and their management. Methodology: This is a prospective observational study of large bowel obstruction in adults and was carried out in 2012-2014. Results: A total 50 cases of large bowel obstruction were studied. Maximum patients11(44%) cases belonged to age group 51-60yrs. Obstipation is seen in50(100%), pain in 44(88%), distension in 50(100%), tenderness in 44(88%), constipation in 50(100%),rigidity in 14(28%). In present study, malignancy was the commonest (24 cases – 48%) cause of large bowel obstruction. There were 10 cases (20%) of stricture, 8 cases (16%) of volvulus, two case (4%) of endometriosis and two case (4%) of intussusception causing large bowel obstruction. Pseudo-obstruction comprised 4 cases.20 cases (43.5%)were operated for resection anastomosis of pathological part to relieve obstruction, while 18 cases (39.1%) were operated for temporary colostomy due to lack of definitive procedure either due to unresectable mass or gross contamination of bowel loop. Rest of the cases 8(17.3%) were operated for end colostomy or ilestomy. Wound infection was the commonest complication observed in 10 cases.6 patients died due to septicaemia.Pleural effusion was present in 4 patients.Skin excoriation around colostomy occurred in 6 cases. Mortality of the study was 6 (12%) cases. Conclusion : Old age (51-60) was the most common age group affected by large bowel obstruction.Colorectal carcinoma was the leading cause of large bowel obstruction . In our study. Distention and constipation were predominent symptoms.. Plain X-ray erect abdomen is the single most important diagnostic tool for diagnosing obstruction and its level of obstruction.CT SCAN abdomen confirmed the type and site of obstruction and spread of tumor in cases of large bowel malignancy.Early recognition and timely intervention is important to prevent the bowel from going for gangrenous changes.
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PURPOSE: Bacterial translocation is a major problem after ischemic bowel injuries such as mesenteric vessel obstruction or bowel strangulation. In this study, we investigated the differential character of bacterial translocation from the large and small bowel using Escherichia coli labeled with technetium 99m (99mTc-E.coli). METHOD: Male Sprague-Dawley rats weighing 200~300 g underwent laparotomy. The superior mesenteric artery and marginal arteries of the proximal jejunum and distal colon were occluded for 30 minutes and then re-perfused for 4 hours. A suspension containing 99mTc-E.coli was injected into the lumen of the proximal colon (group 1) and distal ileum (group 2). In the sham operation group (groups 3, 4), 99mTc-E.coli was also injected in the same manner without induction of ischemia and reperfusion injury. Two hours after E. coli injection, blood, mesenteric lymph nodes (MLN), liver, spleen, and lung were collected for quantitative analysis of radioactivity. Large and small bowel specimens were also harvested for microscopic examination. Student's t-test was used for statistical analysis. P< or =0.05 was considered statistically significant. RESULT: Compared with group 1, group 2 showed a significant increase in 99mTc-E.coli translocation from the lumen to all organs investigated, except with regard to MLN. The sham operation group (groups 3, 4) showed scanty bacterial translocation. The mucosal epithelial cell layers of both groups (groups 1, 2) were comparatively intact. CONCLUSION: The 99mTc-E.coli method was found to be suitable for studies of bacterial translocation from the small and large bowels. Bacterial translocation is much more likely to occur across the small bowel wall than across the large bowel wall.
Subject(s)
Humans , Male , Arteries , Bacterial Translocation , Colon , Epithelial Cells , Escherichia coli , Glycosaminoglycans , Ileum , Ischemia , Jejunum , Laparotomy , Liver , Lung , Lymph Nodes , Mesenteric Artery, Superior , Radioactivity , Rats, Sprague-Dawley , Reperfusion , Reperfusion Injury , Salicylamides , Spleen , TechnetiumABSTRACT
PURPOSE: The purpose of this study was to review our experience with the use of self-expandable metallic stents as the initial interventional management for acute malignant large-bowel obstruction. METHODS: The records of 35 patients who underwent placement of a colonic stent for acute malignant obstruction at our institution between January 2003 and December 2004 were reviewed. RESULTS: Stents were placed for palliation in 19 patients and as bridge to surgery in 16 patients. Technical success of stent placement was achieved in all patients (100%), but clinical failure occurred in two patients due to limited expansion of the metallic stent. One of them who had clinical failure underwent an emergency operation, and the other needed no further procedure because of his death. Complications occurred in 4 patients (12%), including one pelvic abscess associated with colon perforation, two minor bleedings, and one anal pain. All the patients in the bridge-to-surgery group underwent an elective colon resection without stoma. In the palliative group, stent reocclusion was observed in three patients during the follow-up (median: 65 days; range: 27~440 days), two of which were managed by reinsertion of a stent. In the remaining patients, the stent was patent until death or the last follow up date (median: 65 days). CONCLUSIONS: Placement of a self-expandable metallic stent is a safe and effective procedure for immediate decompression of acute malignant large-bowel obstruction. It provides a chance of elective surgery for patients with resectable disease, as well as relief of symptoms for those with unresectable disease.
Subject(s)
Humans , Abscess , Colon , Decompression , Emergencies , Follow-Up Studies , StentsABSTRACT
Objective To compare the real time diagnosis and treatment values of magnifying endoscopy and electronic colonoscopy Methods A total of 105 colorectal polyps for colonoscopic examination were included in this study A magnifying videoscope with zoom ranges from ?1 to ?100 magnification and a common electronic endoscopy combined with indigocarmine dye were employed to observe the pit patterns of colorectal polyps Pit patterns were analyzed according to Kudo's modified classification as follows: ①type Ⅰ: round pit; ②type Ⅱ: asteroid pit; ③type Ⅲs: tubular or round pit, which is smaller than a normal pit (type Ⅰ); ④type ⅢL: tubular or round pit, which is larger than a normal pit (type Ⅰ); ⑤type Ⅳ: dendritic or gyrus like pit; ⑥type Ⅴ: irregular or amorphous pit; and ⑦ mixed type Results Magnifying colonoscopy revealed that phenotypes of non neoplastic and neoplastic lesions were 78 57% and 21 43% in inflammatory and hyperplastic polyps, 3 33% and 96 67% in neoplastic polyps, and 100% non neoplastic phenotype in juvenile polyps, respectively Pit pattern analysis according to Kudo's modified classification showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 96 67% and 80%, and specificity was 86 57% and 94 73%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 89 52% Pit pattern by common electronic colonoscopy showed that the diagnostic sensitivity of neoplastic and non neoplastic lesions was 88 3% and 73 3%, and specificity was 81 5% and 82 5%, respectively The overall diagnostic accuracy in differentiating neoplastic from non neoplastic lesions was 82% Conclusion The pit pattern analysis of colorectal lesions by magnifying colonoscopy or electronic endoscopy combined with indigocarmine dye is a useful method for the identification of non neoplastic polyps, adenomas and invasive carcinomas in the large bowel Therefore, it may be possible to determine, at the time of colonoscopy, which lesions should be removed endoscopically and surgically
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2 cm) according to the size of lesions. Large wound sections were sutured with metal clips. Results Histopathologic investigation showed that among 54 lesions,there were 13 cases of adenoma,38 cases of adenoma with atypical hyperplasia (10 cases with mild dysplasia,23 with moderate dysplasia and 5 with severe dysplasia )and 3 cases of mucosal cancer. We followed forty cases,local recurrence was found in none of 29 cases after 6 months of EMR. However,the recurrence was found in 2 of 11 cases after 1 month of EPMR and 1 each after 3 and 6 month of EPMR. There was no recurrence after further endoscopic re-treatment. Among 3 cancer patients,2 patients shifted to surgery due to patient's preference and 1 patient was followed up for 6 months. All of them were found without local recurrence by endoscopic biopsies or surgical results. Conclusions Chromoscopy,magnifying colonoscopy and EUS have benefits in diagnosis of early large bowel tumors,and it is also helpful in selecting the proper treatment so as to reduce the complication and recurrence.
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This paper deals with an established method of preparing patients for elective surgery of the large bowel, including the anorectum. Preoperative operation, which includes general and local measures, and postoperative care was discussed
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PURPOSE: Paclitaxel is a chemotherapeutic agent with a potent microtubule stabilizing activity that arrests mitosis at G2-M phase of cell cycle which is the most radiosensitive period. Therefore paclitaxel is considered as a cell cycle-specific radiosensitizer. This study investigates the effect of paclitaxel on the radiation response of the normal large bowel mucosa of the rat. MATERIALS AND METHODS: The rats were divided into the three groups i.e., single intraperitoneal infusion of paclitaxel (10 mg/kg), a single fraction of irradiation (8 Gy, x-ray) to the whole abdomen, and a combination of irradiation (8 Gy, x-ray) given 24 hours after paclitaxel infusion. The histological changes as well as kinetics of mitotic arrest and apoptosis were evaluated on the large bowel mucosa at 6 hours, 1 day, 3 days and 5 days after treatment with paclitaxel alone, radiation alone and combination of paclitaxel and radiation. RESULTS: The incidence of the mitotic arrest was not increased by paclitaxel infusion. The apoptosis appeared in 24 hours after paclitaxel infusion, and the histopathologic changes such as vesiculation, atypia and reduction of the goblet cell of the mucosa of the large bowel were demonstrated during the period from 6 hours to 3 days after, and returned to normal in 5 days after paclitaxel infusion. In irradiated group, the apoptosis was increased in 6 and 24 hours after irradiation, and the histopathologic changes of the mucosa were appeared in 24 hours and markedly increased in 3 days and returned to normal in 5 days. In combined group of irradiation and paclitaxel infusion, the apoptosis was appeared in 3 days and the histopathologic changes appeared during the period from 6 hours to 3 days after infusion. On the basis of the incidence of apoptosis and the degree of the histopathologic changes of the large bowel mucosa, there seemed to be additive effect by paclitaxel on radiation rather than sensitizing effect. CONCLUSION: The histopathological changes of large bowel mucosa in combined group compared to radiation alone group suggested an additive effect of paclitaxel on radiation response in the large bowel of rat.
Subject(s)
Animals , Rats , Abdomen , Apoptosis , Cell Cycle , Goblet Cells , Incidence , Infusions, Parenteral , Kinetics , Microtubules , Mitosis , Mucous Membrane , PaclitaxelABSTRACT
Gastrointestinal ganglioneuromatosis is an extremely rare lesion which typically occurs with a significant systemic syndrome. It is known to be a major component of multiple endocrine neoplasia, type 2b. We presented a case of polypoid ganglioneuromatosis of the colon in a 3-year-old female with abdominal pain and diarrhea. She had no clinical evidence of the systemic syndrome or von Recklinghausen's neurofibromatosis, conditions in which intestinal ganglioneuromatosis can occur. Gross examination showed diffuse polypoid masses in ascending and transverse colons with normal-appearing mucosa. Microscopic examination revealed a proliferation of spindle-shaped neuronal cells containing multiple clusters of mature ganglion cells in the mucosa, submucosa and proper muscle. We describe a case of colonic ganglioneuromatosis without any component of multiple endocrine neoplasia or family history.
Subject(s)
Child , Child, Preschool , Female , Humans , Abdominal Pain , Colon , Colon, Transverse , Diarrhea , Ganglion Cysts , Mucous Membrane , Multiple Endocrine Neoplasia , Multiple Endocrine Neoplasia Type 2b , Neurofibromatoses , NeuronsABSTRACT
0.05). It's concluded that PCNA immunohistochemicai staining is valuable in early detection of malignant potential of adenomas, also it may be helpful in distinguishing the degree of adenomatous dysplasia.
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One hundred large bowel carcinomas were studied immunohistochemically with regard to expression of HLA-DR antigen (DR). One or two sections from each tumor including surrounding normal mucosa were examined by a semiquantitative counting system for tumor cells and mucosal and stromal infiltrates of lymphocytes and mononuclear cells (MNCs) with DR expression and the results were applied Chi-square test. The rate of presence of DR positive (DR+) lymphocytes in lymphoid nodules and DR+ lymphocytes/ MNC in the adjacent mucosa and stroma in DR+ carcinoma (50%) was higher (P < 0.01) than in DR- carcinoma (21.9%). Thirty-six carcinomas (36%) were DR+. Three (75%) out of 4 DR+ poorly differentiated carcinomas and six (20%) out of 30 DR+ moderately differentiated carcinomas showed homogeneously strong DR+ expression. There was tendency for poorly differentiated carcinoma to be more homogeneous DR+ expression. According to Dukes' stage, four (80%) out of 5 carcinomas in Dukes' stage D were DR-. An increased infiltration of lymphocytes/MNCs into adjacent mucosa and stroma in large bowel carcinomas is possibly related with DR expression by carcinoma. From the results of this study, we postulated as follows: 1) DR+ tumor cells may act as antigen-presenting cells, 2) They may have an inhibitory effect for distant metastasis, 3) Poorly differentiated carcinoma expressed more DR+ homogeneously.