Tubular colonic duplication in an adult patient with long-standing history of constipation and tenesmus

Background Intestinal duplications are rare congenital developmental anomalies with an incidence of 0.005-0.025% of births. They are usually identified before 2 years of age and commonly affect the foregut or mid-/hindgut. However, it is very uncommon for these anomalies, to arise in the colon or present during adulthood. Case presentation Herein, we present a case of a 28-year-old woman with a long-standing history of constipation, tenesmus, and rectal prolapse. Colonoscopy results were normal. An abdominal computed tomography (CT) revealed a diffusely mildly dilated redundant colon, which was prominently stool-filled. The gastrografin enema showed ahaustral mucosal appearance of the sigmoid and descending colon with findings suggestive of tricompartmental pelvic floor prolapse, moderate-size anterior rectocele, and grade 2 sigmoidocele. A laparoscopic exploration was performed, revealing a tubular duplicated colon at the sigmoid level. A sigmoid resection rectopexy was performed. Pathologic examination supported the diagnosis. At 1-month follow-up, the patient was doing well without constipation or rectal prolapse. Conclusions Tubular colonic duplications are very rare in adults but should be considered in the differential diagnosis of chronic constipation refractory to medical therapy. Due to the non-specific manifestations of this entity, it is rather challenging to make an accurate diagnosis pre-operatively. Surgery remains the mainstay of treatment. Some reports suggest that carcinomas are more prone to develop in colonic/rectal duplications than in other GI tract duplications.

Sodium alginate-guar gum and carbopol based methotrexate loaded mucoadhesive microparticles for colon delivery: An in vitro evaluation

Methotrexate (MTX) is famous for its therapeutic potential against different cancers including colorectal cancer. Goal of the present investigation was to formulate MTX loaded mucoadhesive microparticles for colon targeting. The optimized formulation (MTX-MS2) was composed of mucoadhesive polymers (sodium alginate, guar gum and carbopol 940) in an appropriate ratio. MTXMS2 was developed by ionic-gelation method. The suitable particle size and zeta potential were found to be 21.10 ± 0.18 µm and 3.01 ± 0.16 mV for MTX-MS2 respectively. The % yield (98.60 ± 2.12), % entrapment efficiency (97.98 ± 1.22) and % drug loading (1.04 ± 0.03) were estimated for MTXMS2. The swelling index (0.99 ± 0.04 θ) and mucoadhesion (97.29 ± 4.61%) were significantly (***P ˂ 0.01) achieved with MTX-MS2 as compared to other formulations. The optimum drug release (96.07 ± 4.52%) was significantly achieved with MTX-MS2 at simulated gastric fluid (pH 7.4) for 36 h in a sustained manner. This profile may be attributed towards excellent mucoadhesivness of the polymers used in the formulation. Therefore, the current investigation suggests that mucoadhesive carrier system could be promising approach for colon delivery. Thus, the proposed work would be helpful for the treatment of colorectal canc

Poliposis gigante de colon como forma de presentación de colitis ulcerativa ideopática. Reporte de caso / Giant polyposis of colon as a presentation form of the idiopathic ulcerative colitis. Case report

RESUMEN La poliposis gigante localizada es una complicación rara de la colitis ulcerativa ideopática de corta evolución. Esta lesión representa un acumulo localizado de pólipos que forman una masa colónica intraluminal de aspecto neoplásico que puede simular un cáncer de colon. Suele presentarse en los adultos jóvenes y es más común en los países desarrollados con una incidencia cada vez mayor. Se presentó un caso de pólipos inflamatorios gigantes (PIG) de recto sigmoides que ingresa como un probable tumor de recto cuyas manifestaciones clínicas fueron semejantes a la de cualquier enfermedad inflamatoria. El paciente desarrolló esta masa inflamatoria sobre una enfermedad inflamatoria intestinal de poco tiempo de evolución clínica, con buena respuesta al tratamiento medicamentoso (AU).

ABSTRACT The located giant polyposis is rare complication of idiopathic ulcerative colitis of short evolution. This lesion is a localized accumulation of polyps forming an intra luminal colon mass of neoplastic aspect that might simulate a colon cancer. It is usually found in young adults, and it is more common in developed countries with a higher and higher incidence. We presented a case of giant inflammatory polyps (PIG as acronym in Spanish) of sigmoid rectum that entered the hospital as a probably rectum tumour, the clinical manifestations of which were similar to others of any inflammatory disease. The patient developed an inflammatory mass on a, intestinal inflammatory disease of short time clinical evolution, with a good answer to the medicinal treatment (AU).

Encarceramento do intestino delgado em forame epiploico em equinos com hábito de aerofagia: relato de caso / Entrapment of the small intestine in the epiploic foramen in crib-biting horses: case report

São relatados quatro casos de encarceramento de forame epiploico (EFE), entre os casos: três machos e uma fêmea; dois da raça Quarto de Milha, um SRD e um Brasileiro de Hipismo; idade média de 11 anos; altura média de cernelha de 160,5cm; massa corporal média de 465kg. Todos os animais possuíam o hábito de aerofagia. A presença de refluxo enterogástrico e intestino delgado distendido à palpação transretal foi variável na dependência do segmento intestinal aprisionado. À laparotomia exploratória constataram-se: dois casos de aprisionamento jejunoileal; um de jejuno; e o outro de íleo. Todos os animais apresentaram EFE da esquerda para a direita, representando o sentido horário. Apenas o animal que apresentava o íleo aprisionado sobreviveu; os demais foram submetidos à eutanásia no período transoperatório devido à extensa isquemia intestinal e às lesões vasculares decorrentes da manobra de redução. A aerofagia é o fator de risco que apresenta maior correlação positiva com o EFE, fato corroborado pelos casos apresentados. Apesar de ser descrito um bom prognóstico para o EFE na literatura, foi obtido um desfecho ruim entre os casos atendidos, e salienta-se que a extensão da lesão e o sangramento da veia porta no transoperatório contribuíram para esse resultado.(AU)

Four cases of epiploic foramen entrapment (EFE) are reported. Among the cases, three males and one female, two Quarter Horses, one mixed breed and one Brazilian Equestrian, aged between 3 to 20 years, mean 11 years. The average height was 160.5cm and 465kg. All horses had a previous record of crib-biting habit. The presence of enterogastric reflux and small intestine distended loops in transrectal palpation was variable in dependence of the trapped segment. In surgical exploration were identified two cases of jejunum and ileum entrapped, one of the ileum and one of jejunum. All animals showed EFE from left to right. The horse that had trapped the ileum has survived. The others were euthanized due to the extent of injury or rupture of large vessels during surgical reduction. Although there are many notes of possible risk factors for EFE occurrence, cribbing is the risk factor that has the highest positive correlation with EFE. This appointment was confirmed by the cases presented. Despite being described a good prognosis for the EFE, a bad outcome was achieved among the cases, and stresses that the extent of the injury and bleeding from the portal vein contributed to this outcome.(AU)

Formulation development and evaluation of colon targeted delayed release methotrexate pellets for the treatment of colonic carcinoma

Colonic carcinoma is one of the most common internal malignancies and is the second leading cause of deaths in United States. Methotrexate (MTX) is a drug of choice in the treatment of colon cancer. The aim of the present research work was to develop and characterize colon targeted pellets of MTX for treatment of colonic carcinoma. The product and process parameters were optimized by screening methods. Pellets were prepared by extrusion spheronization using microcrystalline cellulose (MCC) as spheronizing aid and ethyl cellulose (EC) as release retardant in different ratio. Based on the physical appearance, sphericity and % in vitro drug release, batch P17 containing EC: MCC (3:7) was optimized for core pellets. The site specificity was obtained by screening the coating polymers and by coating the core pellets with EudragitS100. The 32 full factorial design was applied in which airflow rate (X1) and coating time (X2) were the independent parameters and physical appearance (Y1) and time taken for 100% drug release (Y2) were selected as the dependent variables. From the results obtained, 6min of coating time and 60cm3/min airflow rate was optimized. The batch B5 showed appropriate physical appearance and % in vitro drug release upto 17hr indicating sustained release property. The ex-vivo studies performed on rat colon indicated a significant relation with the in vitro drug release. The drug release followed Higuchi's model indicating the diffusion pattern of drug release from the matrix of pellets. Thus, the coated pellets can be a good candidate for site specific delivery of MTX to colon by decreasing the gastric irritation and thus to improve bioavailability.

Design and preparation of a novel colon-targeted tablet of hydrocortisone

ABSTRACT The objective of this research was to design a new colon-targeted drug delivery system based on chitosan. The properties of the films were studied to obtain useful information about the possible applications of composite films. The composite films were used in a bilayer system to investigate their feasibility as coating materials. Tensile strength, swelling degree, solubility, biodegradation degree, Fourier Transform Infrared Spectroscopy (FTIR), Differential Scanning Calorimetry (DSC), Scanning Electron Microscope (SEM) investigations showed that the composite film was formed when chitosan and gelatin were reacted jointly. The results showed that a 6:4 blend ratio was the optimal chitosan/gelatin blend ratio. In vitro drug release results indicated that the Eudragit- and chitosan/gelatin-bilayer coating system prevented drug release in simulated intestinal fluid (SIF) and simulated gastric fluid (SGF). However, the drug release from a bilayer-coated tablet in SCF increased over time, and the drug was almost completely released after 24h. Overall, colon-targeted drug delivery was achieved by using a chitosan/gelatin complex film and a multilayer coating system.

Síndrome de Chilaiditi: relato de caso / Chilaiditi's syndrome: a case report

Os autores apresentam um caso de síndrome de Chilaiditi em uma mulher de 56 anos de idade. Mesmo tratando-se de condição benigna com rara indicação cirúrgica, reveste-se de grande importância pela implicação de urgência operatória que representa o diagnóstico equivocado de pneumoperitônio nesses pacientes. É realizada revisão da literatura, com ênfase na fisiopatologia, propedêutica e tratamento desta entidade.

The authors report a case of Chilaiditi's syndrome in a 56-year-old woman. Although this is a benign condition with rare surgical indication, it has great importance for implying surgical emergency in cases where such condition is equivocally diagnosed as pneumoperitoneum. A literature review is performed with emphasis on pathophysiology, diagnostic work-up and treatment of this entity.

Factores predictivos de la colitis ulcerativa en pediatría y sus carácterísticas clínicas, endoscópicas e histológicas / Predictors of ulcerative colitis in children and their clinical, endoscopic and histological characteristics

Introducción:La colitis ulcerativa (CU), es un trastorno inflamatorio difuso que afecta el recto y se extiende en dirección proximal y continua. Objetivo:Identificar los factores predictivos de laCUen pacientes pediátricos y describir el grado de actividad clínica, endoscópica e histológica, y las manifestaciones extraintestinales más frecuentes. Materiales y métodos:Estudio de casos y controles. La muestra quedó constituida por 66 pacientes, menores de 19 años, 22 casos con diagnóstico de CU y 44 controles de igual sexo y edad. Se diseñó y aplicó un cuestionario para recoger información acerca de los posibles factores predictivos asociados a la CU y se aplicó análisis de regresión logística multivariada. Conclusiones:Los factores predict ivos de la CU y las manifestaciones extraintestinales encontradas en el estudio son consistentes con lo reportado en la literatura.

Objective:To identify the predictive factors of Ulcerative Colitis (UC) in children, and to describe the clinical, endoscopical and histological activity index, and the extraintestinal manifestations founded in this patients. Methods:Case–control study. Cases were UC patients aged 0 – 19 years (22) and 44 healthy age – and sex- matched, we designed and applied a questionnaire to collect the information about the possible predictive factors associated to the UC and we also applied a multi-variance logistic regression analysis.Conclusions: The predictive factors of the UC and the extraintestinal manifestations founded in this study were similar with the reported in the literature.

Genética del cáncer de colon / Genetics of colon cancer

Colon cancer (CC) is a prevalent disease, with 800,000 new cases annually worldwide. In Chile the mortality is 6.2 per 100,000 inhabitants, which has increased in recent years, being more common in developed countries. Although, CC are most sporadic forms (70 percent), there are patients with family history (30 percent) and 10 percent have a hereditary component, with a predisposition to the formation of tumors, including CC, the most studied syndrome are: Familial Adenomatous Polyposis (FAP), Peutz-Jeghers syndrome and hereditary non-polyposis colon cancer (HNPCC).The progresses made by the human genome sequencing have allowed to known mutations in oncogenes and tumor suppressor genes that occur in a cell of the normal intestinal mucosa and lead to carcinogenic transformation. This review is an update of the known genes related to the sporadic form of the CC, as well as the most common inherited forms of CC. It is important that health professionals, be aware of developments in this area, because they are who should promote in the community a timely screening for patients with increased risk factors for CC, with the aim of giving an accurate counseling for decrease the morbidity and mortality of this condition.

Novo método para tratamento da angiodisplasia de cólon / New method of treating colonic angiodysplasia

A utilização da colonoscopia como método de diagnóstico e tratamento possibilitou avanços na abordagem da angiodisplasia de cólon, anomalia vascular responsável por um terço das hemorragias gastrointestinais baixas. Trata-se de paciente com 65 anos, insuficiência renal crônica dialítica e coronariopata grave, apresentando episódios de hematoquezia volumosa ao iniciar uso de agregantes plaquetários, necessitando múltiplas hemotransfusões. Colonoscopia diagnosticou lesões vasculares no ceco, onde existe grande risco de perfuração durante intervenções terapêuticas. Há descrições na literatura do uso de agentes hemostáticos tais como plasma de Argônio e vasoconstrictores, aplicados separadamente. Foi realizado tratamento endoscópico das angiodisplasias com aplicação de Argônio, após elevação das lesões com soro fisiológico, e pela primeira vez descrita no Brasil, acrescentado vasoconstrictor à solução.

The utilization of colonoscopy as a diagnostic and treatment tool allowed for advances in the approach of colonic angiodysplasia. This entity is responsible for one third of the cases of lower gastrointestinal bleeding. We discuss a 65 year old patient who suffered from coronary heart disease and chronic renal insufficiency that required dialysis. This patient developed massive hematochezia after starting the use of platelet aggregation inhibitors and required multiple transfusions. The colonoscopy identified vascular lesions in the cecum, where exist a high risk of perforation during therapeutics interventions. There are descriptions in medical literature of the use of hemostatic agents such as argon plasma coagulation and vasoconstrictors used separately. The angiodysplasia was treated endoscopically by the application of argon plasma laser after elevating the lesions with saline and, described for the first time in Brazil, adding vasoconstrictor to the saline solution.

Síndrome de Chilaiditi / Chilaiditi´s syndrome

A interposição permanente ou temporária do cólon, intestino delgado ou estômago no espaço hepatodiafragmático é conhecido como sinal de Chilaiditi, sendo geralmente assintomático. É evidenciado normalmente em um exame radiológico de rotina. A sua incidência é de 0,025% nos exames radiológicos em todas as idades, aumentando levemente nos pacientes maiores de 60 anos, sendo mais comuns em homens do que em mulheres, com uma relação de 4:1. A associação do sinal de Chilaiditi com sintomas como dor abdominal, náuseas, volvo intestinal, dor retroesternal, sintomas respiratórios, vômitos, distensão abdominal, obstrução ou suboclusão intestinal caracteriza a síndrome de Chilaiditi. No presente estudo, apresentamos um novo caso do sinal de Chilaiditi observado ocasionalmente ao exame radiológico de abdome (AU)

The permanent or temporary interposition of the colon, small intestine or stomach in between the liver and the diaphragm is known as Chilaiditi's sign, usually being asymptomatic. The condition is usually diagnosed in routine X-rays. Its incidence is 0.025% in radiological scans in all age groups, with a slight increase in patients over 60. It is more common in males than females in a ratio of 4:1. The association of Chilaiditi's sign with symptoms of abdominal pain, nausea, intestinal volvus, retrosternal pain, respiratory symptoms, vomiting, abdominal distension, intestinal obstruction or sub-occlusion characterizes the Chilaiditi syndrome. Here we report the case of Chilaiditi's sign as detected in abdominal X-rays (AU)

Fraser-cryptophthalmos syndrome with colonic atresia.

Fraser cryptophthalmos syndrome is a severe genetic disorder comprising of cryptophthalmos, syndactyly and genitourinary abnormalities. Gastrointestinal malformations are also increasingly being described. We describe a neonate with this syndrome having colonic atresia leading to cecal rupture and pneumoperitoneum.

Corrección de prolapso rectal / correction rectal prolapse

Se presenta una panorámica de la operación de González Castellanos en el tratamiento de las pacientes con prolapso rectal. Nuestro estudio tiene dos objetivos: el primero, hacer una revisión de la literatura médica relacionada con esta patología y segundo, presentar nuestra experiencia en el tratamiento de pacientes con prolapso rectal.

Cecostomía percutanea en pediatría / Percutaneous cecostomy in cChildren

Propósito: Reportar nuestra experiencia con la Cecostomía Percutánea en el manejo de pacientes pediátricos con incontinencia fecal. Pacientes Método: Entre marzo 2002 y agosto 2005, se efectuaron 20 cecostomías percútáneas. La edad promedio fue de 8.9 años. Las causas de incontinencia fueron: malformación anorectal en 18 casos, mielomeningocele en 1 caso y constipación crónica en el restante. Todos los procedimientos se realizaron bajo anestesia general y control radioscópico. En todos los casos se utilicó un catéter Dawson Mueller de 8.5 F, que se reemplazó luego de 45 días, por un botón ad-hoc (trapdoor catheter). Resultados: Todos los procedimientos fueron satisfactorios. No se registraron complicaciones mayores. Conclusión: La Cecostomia Pecutánea es un procedimiento seguro y efizaz para el manejo de pacientes con incontinencia fecal de cualquier origen. El objetivo de este procedimiento es permitir el lavado anterógrado de todo el colon. Con ello se evita la necesidad de repetidos enemas evacuantes, lo que contribuye significtivamente a la mejor calidad de vida de estos pacientes.

Interposición de colon para atresia esofágica pura: reporte de un caso y revisión de la literatura / Colon interposition for pure esophageal atresia: case presentation and review

Se informa el primer paciente operado en el Hospital de especialidades del Instituto Hondureño de Seguridad Social con una interposición de colon como tratamiento en una paciente con atresia esofágica pura. La técnica consistió en una interposición de colon transverso retroesternal isoperistáltico con excelentes resultados. La atresia de esófago pura o aislada llamada también tipo I de la clasificación anatómica de Vogts, una malformación congénita rara que ocurre únicamente en el 7% de todos los tipos de atresia esofágica. El presente caso es el primero en ser operado e informado en la literatura médica hondureña...

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS): a case report in Thailand.

Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare congenital disease with high mortality rate. The authors report a case of a female term infant with massive abdominal distension at birth. Abdominal ultrasonography revealed a huge cystic mass resolved after urinary catheterization. Exploratory laparotomy was performed and intraoperative findings were an enlarged urinary bladder, microcolon, short bowel and malrotation of the small intestine. Ladd's procedure, ileostomy and vesicostomy were performed. Pathological findings of rectal biopsy revealed normal ganglion cells. Although prokinetic drugs were given for promoting bowel motility, enteral feedings were not tolerated. She died from septicemia at the age of 50 days.

Multiple tubular and cystic intestinal duplications.

Duodenal and colonic duplication presenting as mass in a neonate is rare. We report a 52-cm-long tubular, total colonic and 5-cm-long cystic duodenal duplication in a two-day-old neonate. Both the duplications could be excised without resection of the normal bowel.

Hirschsprung's disease complicating colonic atresia.

A case of colonic atresia associated with Hirschsprung's disease is described in a full term neonate presented with intestinal obstruction. Laparotomy revealed type III colonic atresia. Histopathological examination suggested total aganglionosis in the postatretic colonic segment. The child recovered satisfactorily following two stage Duhamel - Martin's pull through procedure. Authors present their experience with the present case and the pertinent literature.