Apendagitis epiploica en paciente con la COVID-19 / Epiploic appendagitis in a COVID-19 patient

Introducción: La apendagitis epiploica es un proceso inflamatorio producido por daño estructural debido a torsión que genera zonas hemorrágicas o isquémicas, o bien por una inflamación circundante que afecta los apéndices y genera infarto o necrosis grasa. Objetivo: Describir las características clínico-imagenológicas de un paciente con diagnóstico de apendangitis epiploica en el curso de su infección por COVID-19. Caso clínico: Paciente blanco, masculino de 48 años, con diagnóstico de COVID-19, que comenzó con cuadro de dolor abdominal difuso de 8 días de evolución, que se intensificó en las últimas 24 horas a nivel de la fosa iliaca derecha, acompañado de fiebre, estado nauseabundo y toma del estado general. Se le realiza rayos X de abdomen simple encontrándose íleo regional y tomografía axial computarizada con doble contraste, se halló el signo del halo hiperdenso compatible con apendangitis epiploica. Se decide tratamiento conservador. Se tiene en cuenta la comorbilidad con la COVID-19. Se le realizó seguimiento clínico-imagenológico con evolución favorable con la terapéutica impuesta. Desarrollo: La apendagitis epiploica es una causa de dolor abdominal infrecuente, que puede simular un cuadro de abdomen agudo. La evolución de esta enfermedad puede ser autolimitada por lo que se recomienda el manejo conservador. Conclusiones: Con la presente investigación se exponen los hallazgos clínicos-imagenológicos de la apendagitis epiploica, entidad poco conocida, que puede imitar un abdomen agudo quirúrgico y conllevar a una innecesaria intervención quirúrgica(AU)

Introduction: Epiploic appendagitis is an inflammatory process caused by structural damage due to torsion that generates hemorrhagic or ischemic areas, or by surrounding inflammation that affects the appendages and generates infarction or fat necrosis. Objective: describe the clinical-imaging characteristics of a patient diagnosed with epiploic appendangitis in the course of his COVID-19 infection. Clinical case report: We report the case of a white, 48-year-old male patient, diagnosed with COVID-19, who began with an 8-day history of diffuse abdominal pain, which intensified in the last 24 hours at the level of the right iliac fossa, accompanied by fever, nauseous state and taking of the general state. Simple abdominal X-rays were performed, finding regional ileus and computed tomography with double contrast, a hyperdense halo sign compatible with epiploic appendangitis was found. Conservative treatment is decided. Comorbidity with COVID-19 is taken into account. Clinical-imaging follow-up was carried out with favorable evolution with the imposed therapy. Development: Epiploic appendagitis is an infrequent cause of abdominal pain, which can simulate an acute abdomen. The evolution of this disease can be self-limited, so conservative management is recommended. Conclusions: This research disclosures the clinical-imaging findings of epiploic appendagitis, a little-known entity that can mimic an acute surgical abdomen and lead to unnecessary surgical intervention(AU)

Hemicolectomía derecha laparoscópica con abordaje suprapúbico: una técnica novedosa para el tratamiento del cáncer de colon / Suprapubic laparoscopic right hemicolectomy: a novel technique for the treatment of colon cancer

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología robótica o laparoscópica de incisión única ha sido recientemente informada. La utilización de la técnica estándar multipuerto en HDLS no se ha descripto previamente. Material y métodos: entre enero y agosto del año 2018 fueron intervenidos 4 pacientes, 3 mujeres y 1 hombre, con mediana de 64 años de edad y diagnóstico de adenocarcinoma de colon derecho. Resultados: el procedimiento se realizó exitosamente en todos los pacientes, con una mediana de tiempo operatorio de 210 minutos (r:170-240). Ningún paciente tuvo complicaciones y fueron dados de alta en una mediana de 4 días (r:3-5). Todas las piezas quirúrgicas tuvieron márgenes negativos y un recuento ganglionar > 12 ganglios. A 7, 5, 4 y 2 meses del seguimiento, los pacientes se hallan vivos y libres de enfermedad. Conclusión: la técnica de HDLS multipuerto es una alternativa sencilla, factible y segura para el tratamiento del cáncer de colon en pacientes seleccionados, con un resultado funcional, estético y oncológico favorable.

Background: The suprapubic approach for laparoscopic right hemicolectomy has been reported with robotic surgery or single incision laparoscopy. The use of the suprapubic approach for standard multiport laparoscopic right hemicolectomy has not been previously described. Material and methods: Between January and September 2018, four consecutive patients (three women and one man; median age: 64 years) with right-sided colon cancer underwent laparoscopic right hemicolectomy using the suprapubic multiport approach. Results: The procedure was successful in all the patients and mean operative time was 210 minutes (IQR: 170-240). There were no complications and were discharged on postoperative day 4 (IQR: 3-5). All the surgical specimens had negative margins and lymph node count was > 12 lymph nodes. All the patients are alive and free from disease at 7, 5, 4 and 2 months of follow-up. Conclusion: The suprapubic approach for standard multiport laparoscopic right hemicolectomy is an easy, feasible and safe alternative for the treatment of colon cancer in selected patients, with a favorable functional, esthetic and oncological result.

Apendagitis epiplóica primaria / Primary epiploic appendagitis

RESUMEN La apendagitis epiploica primaria es una rara causa de dolor abdominal que puede simular cualquier otro cuadro de abdomen agudo. Esto hace de su diagnóstico un verdadero desafío. Se presenta el caso de un paciente masculino de 22 años de edad, sin antecedentes de importancia que ingresó a la sala de emergencias con un cuadro de dolor abdominal de 36 horas de evolución. En la exploración física presentó dolor a la palpación en el flanco derecho. Se le realizó una tomografía axial de abdomen contrastada en la cual se observó una imagen redondeada con un halo hiperdenso con borramiento de planos grasos y cambios inflamatorios a su alrededor sin relación a otro órgano abdominal. Con estos hallazgos hicimos el diagnóstico de una apendagitis epiploica primaria. El paciente fue ingresado a la sala de internamiento para manejo del dolor y con mejoría clínica es egresado a las 48 horas asintomático. Si bien la apendagitis epiploica primaria es una causa infrecuente de dolor abdominal, consideramos que su conocimiento es relevante para evitar errores diagnósticos y terapéuticos que incrementan de forma innecesaria la morbilidad como el uso inadecuado de antibióticos y de recursos hospitalarios(AU)

ABSTRACT Primary epiploic appendagitis is a rare cause of abdominal pain that may mimic any other acute abdomen condition. This makes its diagnosis a real challenge for physicians. Here is a 22 years-old male patient, with no significant history of diseases, who were admitted to the emergency room because he had suffered abdominal pain for 36 hours. The physical exam revealed pain on palpating the right flank. He underwent a contrasted computed tomography of abdomen which showed a rounded image with hyperdense halo, fat plane effacement and inflammatory changes around, which was unrelated to another abdominal organ. These findings allowed diagnosing primary epiploic appendagitis. The patient was hospitalized for pain management and was discharged 48 hours later with clinical improvement and no symptoms. Primary epiploic appendagitis is infrequent cause of abdominal pain, however, we consider that it is important to know it so as to avoid diagnostic and therapeutic mistakes that might unnecessarily increase morbidity and the inadequate use of antibiotics and of hospital resources(AU)

Epidemiological aspects of endoscopic resections of colorectal polyps in patients at an endoscopy training center in the Santos region, Brasil / Aspectos epidemiológicos de las resecciones endoscópicas de los pólipos colo-rectales en un centro de entrenamiento de endoscopía en la región de Santos, Brasil

Introduction: Colorectal polyps are structures that project from the surface of the mucosal layer of the large intestine. They are classified as neoplastic or non-neoplastic. Early detection of pre-neoplastic lesions is important for preventing colorectal cancer. These can be resected so as to decrease the morbidity and mortality rates. Colonoscopy is the gold-standard procedure for diagnosing and resecting precursor lesions. Objective: To evaluate the epidemiological, endoscopic and histological aspects of endoscopic resection of lesions of the colon and rectum at a training center. Materials and method: A search was conducted in the database of our institution covering the period from January 2011 to July 2014. Cases that underwent endoscopic resection of polyps and/or colorectal lesions were selection. The following variables were defined: general data on the patients (age, gender and indication from the examination) and data on the polypoid lesion (number, histological type and topographic distribution). Results: 678 lesions were identified in 456 examinations. Regarding sex, 242 (53.1%) were female and 214 (46.9%) were male. The mean age was 64.54 years, with extremes of 5 and 94 years. The most frequent locations were the rectum (21%) and sigmoid (20%). Histologically, 34.7% were hyperplastic polyps and 58.9% were adenomatous polyps, of which 74.1% were tubular, 10.6% tubulovillous, 2% villous and 13% indeterminate; and 1.7% were adenocarcinomas. In 65.4% of the cases, the examination showed that only one polyps was present, while 34.6% had two or more lesions. Conclusion: In our clinic, with a mean of 250 examinations/month, the parameters evaluated were compatible with the results reported in the literature.

Introducción: Los pólipos colorrectales son estructuras que se proyectan en la superficie de la capa mucosa del intestino grueso. Son clasificados en neoplásicos y no neoplásicos. La detección precoz de lesiones preneoplásicas es relevante en la prevención del cáncer colorrectal. Pueden ser resecados y reducir los índices de morbimortalidad. La colonoscopia es el patrón de oro para el diagnóstico y resección de lesiones precursoras. Objetivo: Evaluar aspectos epidemiológicos, endoscópicos e histológicos relacionados a las resecciones endoscópicas de lesiones de colon y recto en un centro de entrenamiento. Matariales y métodos: Fue realizada una búsqueda en la base de datos de nuestra institución durante el período de enero de 2011 a julio de 2014. Se seleccionaron aquellos sometidos a las resecciones endoscópicas de pólipos y/o lesiones colorrectales. Las siguientes variables fueron definidas: datos generales de los pacientes (edad género e indicación del examen) y datos de la lesión polipoidea (número, tipo histológico, distribución topográfica). Resultados: Fueron identificadas 678 lesiones en 456 exámenes. Con relación al sexo, 242 (53,1 %) eran del género femenino y 214 (46,9 %) masculino. El promedio de edad fue de 64,54 años, con extremos de 5 y 94 años. La ubicación más frecuente fue en el recto (21 %) y sigmoide (20 %). Histológicamente, 34,7% eran pólipos hiperplásicos y 58,9% adenomatosos, siendo 74,1% tubulares, 10,6% tubulovellosos, 2% vellosos y 13% indeterminados y, 1,7% correspondieron a adenocarcinomas. En el 65,4% de los casos existía solamente un pólipo al hacer el examen, 34,6% presentaban dos o más lesiones. Conclusión: En nuestro trabajo, con un promedio de 250 exámenes/mes, los parámetros evaluados fueron compatibles a los resultados encontrados en la literatura.

Endoscopic ultrasound in the diagnosis of foreign bodies of the colon and rectum / Ultrassonografia endoscópica no diagnóstico de corpos estranhos no cólon e no reto

SUMMARY Although the ingestion of foreign bodies is a common clinical problem, severe complications such as perforation are rare and occur in less than 1% of cases. Different types of foreign bodies and the various affected regions within the gastrointestinal tract make foreign body ingestion a complex entity, with a wide range of presentation requiring different diagnostic modalities. We report two cases of patients who underwent endoscopic ultrasound for evaluation of sub-epithelial lesions consisting of foreign body granulomas in the colon and rectum. Colorectal foreign body granuloma is a rare complication after accidental ingestion. Endoscopic ultrasound can be a useful diagnostic tool and can avoid the need for more invasive procedures.

RESUMO Embora a ingestão de corpos estranhos seja uma condição clínica frequente, complicações graves como perfuração são raras e ocorrem em menos de 1% dos casos. Tipos diferentes de corpos estranhos e as diversas regiões afetadas do trato gastrointestinal fazem da ingestão de corpos estranhos uma entidade complexa, com uma variada gama de apresentações, demandando várias modalidades diagnósticas. Nós reportamos dois casos de pacientes que foram submetidos à ultrassonografia endoscópica para avaliação de lesões subepiteliais, consistindo em granulomas de corpo estranho no cólon e no reto. Granulomas de corpo estranho colorretais são uma complicação rara após ingestão acidental. Ultrassonografia endoscópica pode ser uma ferramenta diagnóstica útil e pode evitar procedimentos mais invasivos.

Manifestaciones imagenológicas y manométricas en pacientes con estreñimiento funcional / Imaging and manometric manifestations in patients with functional constipation

INTRODUCCIÓN: el estreñimiento es un síntoma o afección que puede comprometer la calidad de vida de los pacientes. Su prevalencia global varía entre 2 % y 28 %. OBJETIVO: evaluar la concordancia entre los resultados de los exámenes imagenológicos y la manometría anorrectal, en pacientes con sospecha de estreñimiento funcional. MÉTODOS: la muestra estuvo conformada por 37 pacientes, a los que se les realizó exámenes radiológicos de cecocolografía secuencial (o colon por ingestión), tiempo de tránsito colónico con marcadores radiopacos, defecografía y examen manométrico. Se calculó el índice de Kappa para determinar la concordancia. RESULTADOS: 62,2 % de los enfermos fueron del sexo femenino, la edad predominante estuvo entre 41 y 60 años (43,2 %), predominó el ciego móvil (54,2 %) como causa de estreñimiento. Se hicieron 14 estudios de tiempo de tránsito colónico con marcadores radiopacos, de ellos 28,6 % presentó un tiempo de tránsito lento. Se realizó defecografía a 4 pacientes y 3 presentaron disfunción del suelo pelviano. Se constató que 94,6 % de las pruebas imagenológicas y 78,4 % de las manometrías resultaron positivas (Kappa p= 0,006). CONCLUSIÓN: las técnicas imagenológicas que se investigaron son apropiadas para diagnosticar el estreñimiento funcional y la concordancia de dichas técnicas con la manometría anorrectal es adecuada.

INTRODUCTION: constipation is a symptom or condition that can compromise the quality of patient's life. Its global prevalence varies between 2 % and 28 %. OBJECTIVE: evaluate the correlation between the results of imaging tests and anorectal manometry in patients with suspected functional constipation. METHODS: the sample consisted of 37 patients, who underwent radiological examinations of sequential cecocolografía (colon or swallowed), colonic transit time with radiopaque markers, defecography and manometric examination. Kappa index was calculated to determine the correlation. RESULTS: 62.2 % of patients were female, the predominant age was between 41 and 60 years (43.2 %), mobile blind predominated (54.2 %) as a cause of constipation. 14 studies of colonic transit time with radiopaque markers, were made, 28.6 % of them presented a slow transit time. 4 patients underwent defecography and 3 had pelvic floor dysfunction. It was found that 94.6 % of imaging tests and 78.4 % of manometries were positive (Kappa p= 0.006). CONCLUSIONS: imaging techniques used in this study are suitable for diagnosing functional constipation and consistency of these techniques is suitable anorectal manometry.

Colonic Endometriosis / 대한소화기학회지

No abstract available.

CT Findings of Colonic Complications Associated with Colon Cancer

A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.

Follicular Dendritic Cell Sarcoma of the Abdomen: the Imaging Findings

Follicular dendritic cell sarcoma is a rare neoplasm that originates from follicular dendritic cells in lymphoid follicles. This disease usually involves the lymph nodes, and especially the head and neck area. Rarely, extranodal sites may be affected, including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. We report here on the imaging findings of follicular dendritic cell sarcoma of the abdomen that involved the retroperitoneal lymph nodes and colon. It shows as a well-defined, enhancing homogenous mass with internal necrosis and regional lymphadenopathy.

A Case Report with Lymphangiomatosis of the Colon

The incidence of lymphangiomas in the gastrointestinal tract is low, particularly in the colon and rectum, and most cases are solitary. Lymphangiomatosis of the colon are encountered infrequently with only one report in the English literature, and polypectomy was performed for the diagnosis in that case report. However, trends in the diagnosis of lymphangiomatosis of colon have been changing since the development of endoscopic ultrasonography (EUS), and this case is the first in that lymphangiomatosis of the colon was diagnosed without invasive procedures. Here we describe the case of 31-yr-old woman with lymphangiomatosis of the colon with numerous polyposis-like appearing lesions diagnosed by endoscopic ultrasonography and a colonoscopy.

Prospective, randomized comparison of castor oil and sodium phosphate preparation for barium enema.

OBJECTIVE: To compare castor oil and sodium phosphate preparation (Swiff) in patients' satisfaction, efficacy for colon cleanness, side effects, and prices. MATERIAL AND METHOD: One hundred patients referred for barium enema were randomized to receive castor oil (n = 50) and sodium phosphate preparation (n = 50). They graded their satisfaction using a 5-point scale (easy, acceptable, slightly difficult, extremely difficult, and unacceptable). The efficacy for colon cleanness was graded by two radiologists using a 5-point scale (excellent, easy for evaluation, acceptable, difficult for evaluation, and unacceptable). Side effects were evaluated by patients' vital signs, total number of bowel frequency, and 10 associated symptoms. RESULTS: Both preparations revealed no difference in patients' satisfaction (p = 0.882) and efficacy of colon cleanness (p = 0.130). Sodium phosphate preparation was more expensive (79 vs. 10 Baht) and caused higher number of bowel frequency (p < 0.001). CONCLUSION: With a cheaper price, castor oil was comparable with sodium phosphate preparation in patients' satisfaction and efficacy of colon cleanness.

Efficacy of Barium-Based Fecal Tagging for CT Colonography: a Comparison between the Use of High and Low Density Barium Suspensions in a Korean Population - a Preliminary Study

OBJECTIVE: This preliminarily study was designed to determine and to compare the efficacy of two commercially available barium-based fecal tagging agents for CT colonography (CTC) (high-density [40% w/v] and low-density [4.6% w/v] barium suspensions) in a population in Korea. MATERIALS AND METHODS: In a population with an identified with an average-risk for colorectal cancer, 15 adults were administered three doses of 20 ml 40% w/v barium for fecal tagging (group I) and 15 adults were administered three doses of 200 ml 4.6% w/v barium (group II) for fecal tagging. Excluding five patients in group I and one patient in group II that left the study, ten patients in group I and 14 patients in group II were finally included in the analysis. Two experienced readers evaluated the CTC images in consensus regarding the degree of tagging of stool pieces 6 mm or larger. Stool pieces were confirmed with the use of standardized CTC criteria or the absence of matched lesions as seen on colonoscopy. The rates of complete fecal tagging were analyzed on a per-lesion and a per-segment basis and were compared between the patients in the two groups. RESULTS: Per-lesion rates of complete fecal tagging were 52% (22 of 42; 95% CI, 37.7-66.6%) in group I and 78% (28 of 36; 95% CI, 61.7-88.5%) in group II. The difference between the two groups did not reach statistical significance (p = 0.285). The per-segment rates of complete tagging were 33% (6 of 18; 95% CI, 16.1%-56.4%) in group I and 60% (9 of 15; 95% CI, 35.7%-80.3%) in group II; again, the difference between the two groups did not reach statistical significance (p = 0.171). CONCLUSION: Barium-based fecal tagging using both the 40% w/v and the 4.6% w/v barium suspensions showed moderate tagging efficacy. The preliminary comparison did not demonstrate a statistically significant difference in the tagging efficacy between the use of the two tagging agents, despite the tendency toward better tagging with the use of the 4.6% w/v barium suspension.

A Case of Oral Ingestion of Elemental Mercury / 대한소화기학회지

No abstract available.

Colonoscopia virtual / Virtual colonoscopy

Since the first report in 1994 virtual colonoscopy or CT colonography has had an explosive development due to the improvement in hardware and software. The multidetector CT has allowed faster studies with better images due to better multiplanar reconstructions and its speed avoiding the artifact of the breathing or bowel peristalsis. The new software has allowed to obtain better 3D images and faster reconstruction with shorter interpretation. This development, the use of standarized protocol plus the experience of trained radiologists have obtained sensitivity and specificity over 85% and 95% in polyps smaller and larger than 10 mm respectively. These results and the lower price of virtual colonoscopy in the United States compared with fibrocolonoscopy has done this technique a real alternative for the screening of colorectal cancer side by side with fibrocolonoscopy.

Desde la primera publicación sobre colonoscopía virtual o colonografía por tomografía computada (TC) esta técnica ha tenido un explosivo crecimiento especialmente dado por el desarrollo en el hardware, específicamente por la introducción de la TC multicorte que ha permitido obtener mejores imágenes gracias a la mayor velocidad que ha obviado los artefactos dados por el movimiento respiratorio y el peristaltismo intestinal. Otro factor importante en su desarrollo ha sido el gran avance en los programas computacionales (software) que han automatizado la técnica obteniendo recons-trucciones 3D de mejor calidad y en menor tiempo. El notable desarrollo tecnológico sumado a la estandarización de la técnica y la mayor experiencia lograda en diferentes centros ha hecho que en la actualidad la sensibilidad y especificidad de la colonografía sobrepasen el 85 y 95% para los pólipos menores y mayores de 1 cm, respectivamente. Todo esto, sumado a la estandarización de la técnica ha llevado a posicionarla como una alternativa válida y en estrecha competencia con la fibrocolonoscopía en la pesquisa de los pólipos de colon.

Pneumatosis Intestinalis and Hepatic Portal Venous Gas Caused by Necrotizing Colitis / 대한소화기학회지

No abstract availble.

Pneumatosis Intestinalis and Hepatic Portal Venous Gas Caused by Necrotizing Colitis / 대한소화기학회지

No abstract availble.

Intraoperative contrast colonography as a method to assess colonic and colorectal anastomosis

Anastomotic leakage is a major problem in colorectal surgery, and previous studies have suggested that intraoperative identification of leaks allows repair at the time of surgery. This will decrease the incidence of postoperative leakage [Wheeler and Gilbert 1999]. It is important to prevent leakage after colonic and colorectal anastomoses because of the high incidence of leakage and high mortality associated with it. Some studies had high anastomotic leakage rate from 9.8% to 18% [Karanjia et al., 1994, Benoist et al., 1997, Law et al., 2000, Nesbakken et al., 2001, and Eckmann et al., 2004] while others had lower rate from 2.9% to 7.3% [Vignali et al., 1997, Luna-Perez et al., 1999, Isbister 2001, and Sutton et al., 2004]. Methods to detect leakage are all concerned for postoperative detection. Intraoperative methods to assess colonic anastomosis has been developed and used. These include doppler flowmetry [Boyle et al., 2000] and transanal injection of air [Vignali et al., 1997] or saline [Wheeler and Gilbert 1999]. In this study, we will assess the liability of leakage of colonic and colorectal anastomosis intraoperatively by using a new technique by transanal injection of radiological contrast material at the completion of the anastomosis and taking X-rays to ensure that there is no leakage of the anastomosis. Also, a coloring agent was added for direct visualization of any anastomotic defects. If leakage is present, it has to be secured intraoperatively before closure of the abdomen. This study included 10 patients who were subjected to intraoperative radiological contrast testing after colonic or colorectal anastomosis. The study was conducted in Al Jedani Group of Hospitals in Saudi Arabia between January 2001 and November 2004; There were 7 males and 3 females. Mean age was 49.3 years [range 23-65 years]. The anastomosis performed was either handsewn or stapled anastomosis. We used the non-ionic water-soluble contrast material lohexol [Omnipaque, Amersham Health Inc.] 350 mg1/ml. We used 50 ml lohexol + 50 ml Normal saline 0.9% + 5 ml Methylene blue as a coloring agent. After completion of the anastomosis, its integrity was tested intraoperatively. Transanal injection of the contrast using Foley's catheter No. 22 French. Injection using a manometer to a maximum distending pressure of 25-30 cm. of water. Using the screen to detect leaking anastomosis during injection. Visualization of the coloring agent [Methylene blue] at leaking anastomotic site. Any leaks were repaired and the anastomosis retested until it was free of leakage. Postoperative gastrografin enema was performed at 10th postoperative day. Comparison of data between intraoperative colonography, leaking coloring agent and postoperative study. Indication of resection and anastomosis included colorectal cancer [7 cases], diverticular disease [2 cases] and volvulous with gangrene of sigmoid colon [1 case]. Types and levels of anastomosis included right hemicolectomy [2 cases], left hemicolectomy [1 cases], sigmoidectomy [4 cases], and anterior resection of the rectum [3 cases]. Number of leakage of anastomosis detected by our technique was 3 cases [2 of stapled anastomosis and one of handsewn anastomosis]. These 3 cases were detected by leaking of contrast material under screen and visualization of coloring agent [Methylene blue] at the leaked suture line. There was one case after sigmoidectomy for volvulous with gangrene. The other two cases were after anterior resection for rectal and rectosigmoid carcinoma. There was only one postoperative leakage after anterior resection for cancer rectum. Comparison between in traoperalive colonography and 10th day postoperative study: There were 3 cases of anastomotic leakage detected by intraoperative colonography. The defects were repaired intraoperatively. All the 3 cases were not leaking by the 10th postoperative gastrografin enema. Only one case of postoperative leakage was detected by 10th postoperative gastrografin enema which was different from the 3 cases detected and corrected intraoperatively. A total of 2 complications occurred out of 10 patients [20%]. One case of anastomotic leak occurred after low stapling and one case of wound infection. There was no postoperative mortality. A high leak rate has been identified in patients with very low anastomoses. This high leak rate can be avoided by routine use of intraoperative contrast testing of colorectal anastomosis. This is the secret of having a low leak rate. This technique is simple, safe and effective. Although it has the disadvantage of inability to assess the blood supply of the colonic ends, it avoided potential leaks in 3 cases, detected anastomotic defects which can be repaired intraoperatively specially in low anastomosis which can not be directly visualized because of its depth in the pelvis. We recommend routine use of one of modalities for intraoperative assessment of colorectal anastomosis and intraoperative correction of defects detected. We recommend use of intraoperative colonography for larger number of cases to ensure validity of comparison between it and other modalities of intraoperative assessment

Adult-onset Still's Disease with Disseminated Intravascular Coagulation and Multiple Organ Dysfunctions Dramatically Treated with Cyclosporine A

Severe systemic manifestations of adult onset Still's disease (AOSD) are often fatal and occasionally related to hemophagocytic syndrome (HS). We describe the case of a 49-yr-old woman with AOSD presenting with non-remitting high fever, confusion, jaundice, hepatosplenomegaly, serositis, azotemia, pancytopenia, coagulopathy with disseminated intravascular coagulation (DIC), hyperferritinemia, acute acalculous cholecystitis and ileocolitis noted in computed tomographic images. The patient had a history of herpes zoster developed prior to the admission, but there is no history of diarrhea or abdominal pain. Although bone marrow examination was not performed due to hemorrhagic diathesis, we suspected AOSD-associated HS on the basis of clinical course without detectable infectious agents in cultures or serologic studies. Intravenous immunoglobulin, pulse methylprednisolone, oral cyclosporine A (CsA) and ceftriaxone brought about transient improvement of fever and confusion, but the disease progressed. After increasing CsA dose, all previously mentioned abnormalities disappeared rapidly. Accordingly, we believe that DIC and multiple organ dysfunctions might have been the complications of HS but not that of sepsis, and that CsA can be used as a first-line therapy in case of life-threatening situations.