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1.
Oncología (Guayaquil) ; 32(2): 180-193, 2 de Agosto del 2022.
Article in Spanish | LILACS | ID: biblio-1391900

ABSTRACT

Introducción: La cirugía laparoscópica es una alternativa segura para el tratamiento en el cáncer de colon y además permite todas las ventajas de un procedimiento de mínima invasión. El objetivo de la presente investigación fue medir el impacto en la morbilidad de la técnica quirúrgica abierta vs cerrada en cáncer de colon. Metodología: El estudio se realizó en el Hospital Solón Espinosa Ayala, en Quito-Ecuador, período marzo del 2012 hasta marzo del 2017, con una muestra no probabilística, se incluyeron pacientes mayores de edad, con cáncer de colon. Se incluyen variables socio-demográficas, histología, días de hospitalización, sangrado quirúrgico, tiempo quirúrgico, estancia hospitalaria, márgenes quirúrgicos, ganglios reseca-dos, inicio de dieta, % de conversión quirúrgica, complicación quirúrgica, recidiva, morbilidad quirúrgica, mortalidad quirúrgica. Se utiliza estadística descriptiva univariada y bivariada.Resultados: Se analizan 85casos, 52 casos se realizaron cirugía abierta y 33 casos se realizaron cirugía laparoscópica.La conversión quirúrgica fue 75% por adherencias y 25% por infiltración a duodeno. El tiempo quirúrgico similar 121 a 180 minutos 61%. Complicaciones laparoscópicas 2,3% y 9,4% abierta (colecciones pélvicas y fistulas intestinales 2.4% vs 1.7%). La desnutrición no presentó relación. Inicio de dieta 2 a4 días 83% laparoscópica y 67% abierta. Hospitalización de 4 a 8 días fue laparoscópica 87% y abierta 78%. Pérdida sanguínea menor a 100cc fue laparoscópicas 82%, y abiertas 60%. La resección de ganglios (+13) en laparoscopía 69.6% y abierta 68.1%. El margen proximal de pieza quirúrgica por laparoscopía 5.1 a 10cm (43.5%), por abierta (55.3%), la recaída tumoral del 56.2%y 52.3%. El estado vital por laparoscopía fue fallecido 12.5%, y abierta 28.8%, en relación a su enfermedad tumoral Conclusión: Las comorbilidades quirúrgicas y recuperación fueron menores por laparoscopía, pero la cirugía abierta mostro mejores resultados anatomopatológicos post quirúrgicos


Introduction:Laparoscopic surgery is a safe alternative for colon cancer treatment and allows all the advantages of a minimally invasive procedure. The objective of the present investigation was to measure the impact on morbidity of the open vs. closed surgical technique in colon cancer.Methodology: The study was carried out at the Solón Espinosa Ayala Hospital, in Quito-Ecuador, from March 2012 to March 2017, with a non-probabilistic sample, including elderly patients with colon cancer. Socio-demographic variables, histology, days of hospitalization, surgical bleeding, surgical time, hospital stay, surgical margins, resected lymph nodes, the start of the diet, % surgical conversion, surgical com-plication, recurrence, surgical morbidity, and surgical mortality are included. Univariate and bivariate de-scriptive statistics are used.Results: 85 cases are analyzed; 52 underwent open surgery, and 33 underwent laparoscopic surgery. The surgical conversion was 75% due to adhesions and 25% due to duodenal infiltration. The similar surgical time is 121 to 180 minutes 61%. Laparoscopic complications 2.3% and 9.4% open (pelvic col-lections and intestinal fistulas 2.4% vs 1.7%). Malnutrition was not related. Start of diet 2 to 4 days 83% laparoscopic and 67% open. Hospitalization from 4 to 8 days was laparoscopic 87% and open 78%. Blood loss less than 100cc was laparoscopic in 82% and opened in 60%. Lymph node resection (+13) in lapa-roscopy 69.6% and open 68.1%. The proximal margin of the surgical piece by laparoscopy is 5.1 to 10cm (43.5%), by open (55.3%), the tumor recurrenceof 56.2% and 52.3%. The mortality in laparoscopy surgery was 12.5%, and in open surgery was 28.8%.Conclusion: Laparoscopy's surgical comorbidities and recovery were lower, but open surgery showed better post-surgical pathological results


Subject(s)
Neoplasms , Laparoscopy , Colectomy , Colon , Colon, Ascending , Colon, Descending
2.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 579-584, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1357673

ABSTRACT

Introducción: el sarcoma fibromixoide de bajo grado (LGFMS) se considera un tumor de tejidos blandos raro, que tiene tendencia a surgir del tronco y de las extremidades inferiores, su localización en el área intraabdominal se considera poco común. Objetivo: describir un caso de LGFMS primario de colon transverso perforado con metástasis hepática. Caso clínico: describimos el caso de un paciente masculino de 57 años con dolor abdominal de inicio súbito; en la cirugía se encontró un tumor con absceso y perforación en el colon transverso que infiltraba hasta la raíz del mesenterio. Se realizó hemicolectomía izquierda extendida con colostomía de colon ascendente. Más tarde, en una exploración posoperatoria, se encontró que tenía enfermedad hepática metastásica. Conclusiones: este caso es único en términos de ubicación y presentación. Es un recordatorio del diagnóstico diferencial del dolor abdominal agudo. Hasta donde sabemos, es el primer caso de LGFMS del colon con metástasis hepática sincrónica.


Background: Low grade fibromyxoid sarcoma (LGFMS) is considered a rare soft tissue tumor and has a tendency to arise from deep soft tissue of the trunk and lower extremities, the intraabdominal area is considered a rare location. Objective: To describe the first case of a LGFMS arising from the transverse colon with liver metastasis Clinical case: We describe a 57-years-old male patient with abdominal pain of sudden onset; at surgery he was found to have an abscessed tumor in the transverse colon that infiltrated to mesentery root. An extended left hemicolectomy was performed with ascending colon colostomy. Later on, a postoperative scan he was found to have metastatic liver disease Conclusions: This case is unique in terms of the location and presentation. It's a reminder of differential diagnosis of acute abdominal pain. To our knowledge is the first case of a LGFMS of the colon with synchronous liver metastasis.


Subject(s)
Humans , Male , Female , Colonic Neoplasms , Intestinal Perforation , Neoplasm Metastasis , Sarcoma , Tertiary Healthcare , Colostomy , Abdominal Pain , Colectomy , Colon , Colon, Ascending , Liver Diseases
3.
Int. j. morphol ; 39(4): 1001-1005, ago. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1385430

ABSTRACT

SUMMARY: The normal morphology of the colon differs among mammal species.The ascending colon presents several types of cells, responsible for carrying different functions for this organ. Among them, the mucus-secreting cells ensure the integrity of the mucosa, local defense, protection against different external factors, inflammatory diseases, cancer, etc. The ascending colon from 5 adult male chinchillas were processed for paraffin embedding and stained with three methods: Goldner's trichrome, PAS reaction, and Alcian blue staining procedure. The results showed that the structure of the ascending colon is similar to the one described in other species, i.e. mucosa, submucosa, muscularis externa, and serosa. Regarding the mucus-secreting cells present in the deeper part of the mucosal crypts (deep crypt secretory or DCS cells) turned out to be different not only morphologically from the surface goblet cells but also regarding the type of mucus synthesized. DCS cells have a multivacuolated, faintly stained cytoplasm with moderately PAS-positive reaction and intensely positive reaction to Alcian blue stain. The mean surface of DCS cells was 521.6 μm2 as compared to 437.9 μm2 for goblet cells (p<0.05). In conclusion, our study describes for the first time in chinchilla (Chinchilla lanigera) the presence of formerly known non-goblet or vacuolated cells, and recently entitled DCS cells in the glandular epithelium of the colon. The understanding of morphological peculiarities in chinchilla may serve as a good basis to understand the pathophysiology of various conditions that may arise.


RESUMEN: La morfología normal del colon es diferente entre las especies de mamíferos. El colon ascendente presenta varios tipos de células, encargadas de llevar varias funciones a este órgano. Entre ellos, las células secretoras aseguran la integridad de la mucosa, defensa local, protección frente a diferentes factores externos, enfermedades inflamatorias, cáncer, etc. Se procesaron para su inclusión en parafina el colon ascendente de 5 chinchillas machos adultos y se tiñeron con tres métodos: tricrómico de Goldner, reacción PAS y Azul de Alcian. Los resultados mostraron que la estructura de del colon ascendente es similar a la descrita en otras especies, es decir, mucosa, submucosa, muscular externa y serosa. Las células secretoras de la mucosa presente en la parte más profunda de las criptas mucosas (células secretoras de la cripta profunda o células DCS) resultaron ser diferentes morfológicamente de las células caliciformes superficiales, con citoplasma levemente teñido con reacción PAS positiva moderada y reacción intensamente positiva a Azul de Alcian. La superficie media de las células DCS fue de 521,6 μm2 en comparación con 437,9 μm2 de las células caliciformes (p <0,05). En conclusión, nuestro estudio describe por primera vez en chinchilla (Chinchilla lanigera) la presencia de células no caliciformes o vacuoladas anteriormente conocidas, y recientemente denominadas células DCS en el epitelio glandular del colon. La comprensión de las peculiaridades morfológicas de la chinchilla puede servir como una buena base para comprender la fisiopatología de las diversas afecciones.


Subject(s)
Animals , Chinchilla/anatomy & histology , Colon, Ascending/cytology
4.
Rev. gastroenterol. Perú ; 40(4): 351-354, oct.-dic 2020. graf
Article in Spanish | LILACS | ID: biblio-1280415

ABSTRACT

RESUMEN Se presenta el caso de un paciente con cáncer de colon ascendente e infiltración de la pared abdominal con tumoración proliferativa sobre la piel. Se trata de un varón de 83 años que diez meses antes de su ingreso fue operado por un absceso intraabdominal y evoluciona con una fistula colocutánea. El paciente presentaba una tumoración en flanco y fosa iliaca derecha, de 10 cm de diámetro, proliferativa, multilobulada, no dolorosa; a la biopsia resultó adenocarcinoma. La colonoscopía reveló tumoración de 6 cm en colon ascendente, la biopsia reportó adenocarcinoma medianamente diferenciado. La tomografía mostró una lesión neoformativa en colon ascendente y región cecal con dimensiones de 52x46x44 mm con un trayecto tumoral colocutáneo de 62 mm que terminaba a nivel cutáneo en una lesión ovoide de 70 mm. Se realizó colectomía derecha con resección en bloque de la pared abdominal comprometida por la tumoración. Se postula la relación entre la infiltración cutánea, y el antecedente de drenaje quirúrgico laparoscópico de un absceso intraperitoneal aparentemente causado como una complicación del cáncer de colon ascendente casi un año antes del ingreso. El drenaje utilizado sirvió de ruta para la infiltración a la pared abdominal.


ABSTRACT The case of a patient with ascending colon cancer and infiltration of the abdominal wall with a proliferative tumor on the skin is presented. This is an 83-year-old man who underwent surgery for an intra-abdominal abscess ten months before admission and develops a colocutaneous fistula. The patient presented a 10 cm diameter proliferative, multilobed, non-painful tumor on the flank and right iliac fossa; the biopsy revealed an adenocarcinoma. The colonoscopy revealed a 6 cm tumor in the ascending colon, the biopsy reported moderately differentiated adenocarcinoma. The tomography showed a neoformative lesion in the ascending colon and cecal region with dimensions of 52x46x44 mm with a 62 mm colocutaneous tumor course that ended at the cutaneous level in a 70 mm ovoid lesion. A right colectomy was performed with en bloc resection of the abdominal wall compromised by the tumor. The relationship between skin infiltration and a history of laparoscopic surgical drainage of an intraperitoneal abscess apparently caused as a complication of ascending colon cancer almost one year before admission is postulated. The drain used served as a route for infiltration into the abdominal wall.


Subject(s)
Aged, 80 and over , Humans , Male , Colonic Neoplasms , Abdominal Wall , Colonoscopy , Colectomy , Colonic Neoplasms/surgery , Colonic Neoplasms/diagnosis , Abdominal Wall/surgery , Colon, Ascending/surgery
5.
Rev. gastroenterol. Perú ; 40(4): 361-365, oct.-dic 2020. graf
Article in Spanish | LILACS | ID: biblio-1280417

ABSTRACT

RESUMEN El cáncer colorrectal (CCR) es el tercer cáncer más frecuente en el mundo y la segunda causa de muerte de origen neoplásico. El sincronismo en CCR es de aproximadamente 3-6%. El tracto gastrointestinal es el lugar más frecuente de asiento de neoplasias neuroendocrinas (NNE), y de estos los carcinomas neuroendocrinos (CNE) son poco frecuentes. El tratamiento es un desafío, debido a la agresividad de la neoplasia y la falta de protocolos bien establecidos. Todo esto conlleva a la necesidad de un enfoque multidisciplinario, sin embargo, en la mayoría de casos el pronóstico resulta no ser el mejor. Presentamos el caso de un varón de 83 años que acude a emergencia con historia de 3 meses de diarrea, dolor perianal, pérdida ponderal y hematoquezia. El estudio endoscópico evidenció dos neoplasias y el estudio histológico confirmó la presencia de CNE de células pequeñas de recto y adenocarcinoma de colon ascendente, recibió quimioterapia sistémica sin embargo evolucionó desfavorablemente falleciendo a las 3 semanas.


ABSTRACT Colorectal cancer (CRC) is the third most frequent cancer in the world and the second cause of death of neoplastic origin. Synchronism in CCR is approximately 3-6%. The gastrointestinal tract is the most frequent place where neuroendocrine neoplasms (NNE) settle and a special type of these neuroendocrine carcinomas (CNE) are rare. Treatment is challenging, due to the aggressiveness of the malignancy and the lack of well-established protocols. Therefore a multidisciplinary approach is needed, however, in most cases the result is not the best. We present the case of an 83-year-old man who has an emergency with a 3-month history of diarrhea, perianal pain, weight loss, and hematochezia. The endoscopic study shows evidence of two malignancies and the histological study confirms the presence of CNE in small cells at the rectum and adenocarcinoma in the ascending colon. He underwent systematic chemotherapy, however, he evolved unfavorably, dying after 3 weeks.


Subject(s)
Aged, 80 and over , Humans , Male , Adenocarcinoma , Colonic Neoplasms , Carcinoma, Neuroendocrine , Rectum , Adenocarcinoma/diagnosis , Colonic Neoplasms/diagnosis , Carcinoma, Neuroendocrine/diagnosis , Colon, Ascending
6.
Rev. cuba. cir ; 59(2): e935, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126414

ABSTRACT

RESUMEN Introducción: El cáncer avanzado es aquel que crece fuera del órgano en el cual se originó. La resección quirúrgica es el método más eficaz para lograr la curación de cáncer colorrectal en 50 por ciento de los casos. Objetivo: Evaluar los resultados del tratamiento multidisciplinar, realizado a pacientes con diagnóstico de cáncer colorrectal avanzado. Método: Se realizó un estudio observacional, descriptivo, ambispectivo y de corte transversal en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre enero de 2013 y diciembre de 2018. La muestra fue de 219 casos. Resultados: El 34,2 por ciento de los pacientes tenían entre 70 y 79 años. Hubo predominio de localización en colon ascendente (37,4 por ciento), en 57,1 por ciento fue moderadamente diferenciado y en 34,2 por ciento en estadio IIIA. El 7,8 por ciento de los pacientes tuvo recaída con metástasis, de ellos, 70,5 por ciento en hígado. En 72,6 por ciento la vía de acceso fue laparoscópica. En 50,7 por ciento se realizó hemicolectomía derecha. Las complicaciones se observaron en 25 pacientes (35,2 por ciento). El 91,3 por ciento de los casos recibió terapia adyuvante. En 27,4 por ciento hubo recurrencia. En el análisis del tiempo libre de enfermedad y de la supervivencia se obtuvieron buenos resultados. Conclusiones: El tratamiento combinado, secuencial y multidisciplinario en enfermedad maligna colorrectal avanzada ha demostrado beneficios clínicos y mayor supervivencia. Con una morbilidad y mortalidad relacionada con el proceder quirúrgico aceptable independientemente la vía de acceso empleada(AU)


ABSTRACT Introduction: advanced cancer is cancer that has grown outside the organ in which it originated. Surgical resection is the most effective method to achieve colorectal cancer cure in 50 % of cases. Objectives: the objective was to evaluate the results of the multidisciplinary treatment, carried out on patients diagnosed with advanced colorectal cancer. Method: it is an observational, descriptive, ambispective and cross-sectional study at the "Hermanos Ameijeiras" Surgical Clinical Hospital between January 2013 and December 2018. The sample was 219 cases. Results: 34.2 percent of the patients were between 70 and 79 years old. 56.2 percent were women. There was a predominance of localization in the ascending colon (37.4 percent), in 57.1 percent it was moderately differentiated and in 34.2 percent in stage IIIA. 7.8 percent of the patients had a metastatic relapse, 70.5 percent of them in the liver. In 72.6 percent, the access route was laparoscopic. Right hemicolectomy was performed in 50.7 percent. Complications were observed in 25 patients (35.2 percent). 91.3 percent of the cases received adjuvant therapy. In 27.4 percent there was recurrence. Good results were obtained in the analysis of disease-free time and survival. Conclusion: we conclude that combined, sequential, and multidisciplinary treatment in advanced colorectal malignancy has demonstrated clinical benefits and increased survival. With an acceptable morbidity and mortality related to the surgical procedure regardless of the access route used. Multivisceral and / or en bloc resections and maximum resection manage to increase the free interval of disease progression and alleviate symptoms(AU)


Subject(s)
Humans , Male , Female , Aged , Colorectal Neoplasms/diagnosis , Colectomy/methods , Colon, Ascending/injuries , Neoplasm Metastasis/drug therapy , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
7.
Annals of Surgical Treatment and Research ; : 139-145, 2020.
Article in English | WPRIM | ID: wpr-811107

ABSTRACT

PURPOSE: Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection.METHODS: Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution.RESULTS: During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors.CONCLUSION: For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.


Subject(s)
Humans , Colon , Colon, Ascending , Colon, Transverse , Colonic Neoplasms , Follow-Up Studies , Hospitals, Teaching , Laparoscopy , Lymph Node Excision , Lymph Nodes , Multivariate Analysis , Odds Ratio , Pathology , Recurrence , Retrospective Studies , Risk Factors
8.
Clinical Endoscopy ; : 506-509, 2019.
Article in English | WPRIM | ID: wpr-763467

ABSTRACT

Colon cancer is very rarely accompanied by tumor thrombosis of the superior mesenteric vein (SMV). A 46-year-old patient had been diagnosed with SMV tumor thrombosis related to colon cancer without hepatic metastasis and underwent right hemicolectomy with SMV tumor thrombectomy. Tumor thrombosis was pathologically confirmed as metastatic colon cancer. There has been no recurrence for 12 months with 12 cycles of adjuvant-chemotherapy.


Subject(s)
Humans , Middle Aged , Colon, Ascending , Colonic Neoplasms , Mesenteric Veins , Neoplasm Metastasis , Recurrence , Thrombectomy , Thrombosis
9.
Clinical Endoscopy ; : 191-195, 2019.
Article in English | WPRIM | ID: wpr-763408

ABSTRACT

Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.


Subject(s)
Aged , Female , Humans , Middle Aged , Chemoradiotherapy , Colon , Colon, Ascending , Colon, Transverse , Colonic Neoplasms , Consensus , Fistula , Rectal Neoplasms
10.
Korean Journal of Gastroenterology ; : 163-167, 2019.
Article in English | WPRIM | ID: wpr-761544

ABSTRACT

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm³) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Subject(s)
Adult , Female , Humans , Abdominal Pain , Ascites , Biopsy , Colon, Ascending , Diagnosis , Diarrhea , Enteritis , Eosinophilia , Eosinophils , Food Hypersensitivity , Ileum , Influenza A virus , Influenza, Human , Leukocytes , Paracentesis , Steroids , Tomography, X-Ray Computed
11.
Korean Journal of Gastroenterology ; : 46-50, 2019.
Article in English | WPRIM | ID: wpr-761524

ABSTRACT

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Subject(s)
Aged , Female , Humans , Actinomycosis , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Flank Pain , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight Loss
12.
The Korean Journal of Gastroenterology ; : 163-167, 2019.
Article in English | WPRIM | ID: wpr-787192

ABSTRACT

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm³) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author's knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.


Subject(s)
Adult , Female , Humans , Abdominal Pain , Ascites , Biopsy , Colon, Ascending , Diagnosis , Diarrhea , Enteritis , Eosinophilia , Eosinophils , Food Hypersensitivity , Ileum , Influenza A virus , Influenza, Human , Leukocytes , Paracentesis , Steroids , Tomography, X-Ray Computed
13.
The Korean Journal of Gastroenterology ; : 46-50, 2019.
Article in English | WPRIM | ID: wpr-787172

ABSTRACT

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Subject(s)
Aged , Female , Humans , Actinomycosis , B-Lymphocytes , Biopsy , Colon , Colon, Ascending , Colonic Neoplasms , Colonoscopy , Diagnosis , Drug Therapy , Flank Pain , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Masks , Penicillin G , Sulfur , Tomography, X-Ray Computed , Weight Loss
14.
Korean Journal of Medicine ; : 511-518, 2019.
Article in Korean | WPRIM | ID: wpr-786305

ABSTRACT

BACKGROUND/AIMS: Previous studies have reported that endotoxemia is associated with pathogenesis and complications in cirrhosis. Endotoxin stimulates the secretion of inflammatory cytokines, which contributes to the development of complications. In addition, endotoxin easily invades the gut barrier system because of the increased intestinal permeability due to portal hypertensive enteropathy. In this report, we explored changes in cytokine levels and intestinal permeability and measured the thickness and elasticity of the bowel wall using ultrasonography in cirrhotic patients.METHODS: We enrolled 40 patients with cirrhosis classified as Child-Pugh B or C and 20 healthy volunteers. Abdominal ultrasonography examinations were used to evaluate bowel wall parameters in the ascending colon and terminal ileum. Intestinal permeability was measured using dual sugar absorption tests with lactulose and mannitol. Levels of tumor necrosis factor (TNF)-α and IL-10 were determined from blood samples. We compared these outcomes between cirrhotic patients and healthy controls and between Child-Pugh B and C patients. In addition, we explored the correlation between cytokine levels, intestinal permeability ratio, and bowel wall parameters in cirrhotic patients.RESULTS: In cirrhotic patients, the ascending colon wall elasticity decreased (20.4 vs. 10.9 kPa, p = 0.048) and the terminal ileum wall thickness increased (4.2 vs. 1.9 mm, p < 0.001). The intestinal permeability ratio and levels of the cytokines TNF-α and IL-10 increased (0.219 vs. 0.017, p < 0.001; 22.47 vs. 13.48 pg/mL, p < 0.001; and 14.91 vs. 8.57 pg/mL, p = 0.019, respectively) in cirrhotic patients. However, there were no significant differences between Child-Pugh classes and no significant correlations between bowel wall parameters and intestinal permeability or cytokine levels.CONCLUSIONS: Ultrasonography revealed bowel wall thickening and decreases in elasticity; in addition, intestinal permeability and cytokine levels increased in cirrhotic patients compared with healthy controls.


Subject(s)
Humans , Absorption , Ascites , Colon, Ascending , Cytokines , Elasticity , Endotoxemia , Fibrosis , Healthy Volunteers , Ileum , Interleukin-10 , Intestines , Lactulose , Liver Cirrhosis , Mannitol , Permeability , Tumor Necrosis Factor-alpha , Ultrasonography
15.
Clinical Endoscopy ; : 616-619, 2019.
Article in English | WPRIM | ID: wpr-785661

ABSTRACT

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.


Subject(s)
Aged , Female , Humans , Abdominal Pain , Bezoars , Colon , Colon, Ascending , Colonoscopy , Diet , Endoscopy, Digestive System , Gastric Bypass , Gastrostomy , Ileum , Intestine, Small , Pyloric Antrum , Surgical Instruments , Ulcer , Vomiting
16.
Chinese Journal of Gastrointestinal Surgery ; (12): 1105-1109, 2019.
Article in Chinese | WPRIM | ID: wpr-781758

ABSTRACT

Colon cancer is one of the most common malignancies of the alimentary tract, and one main metastatic route is lymph node metastasis. Thorough dissections of regional lymph nodes is one of the core surgical treatment of right colon cancer. D3 lymphadenectomy and complete mesocolic excision (CME) are generally accepted surgical methods for right colon cancer, which can improve the standardization of surgery, improve the quality of tumor resection, and provide more lymph nodes dissectal. Colon cancer of hepatic flexure is likely to have metastasis of the infrapyloric lymph nodes (No.206), which are not regional lymph nodes. Lymph node dissection of No.206 group belongs to extended right hemicolectomy, which involves many vascular variations and complicated peripheral anatomical structure. The theory of fascial surgery provides surgeons with anatomic basis and a clear understanding of the anatomical structure of the infrapyloric region, which is an important theoretical basis for the thorough dissection of lymph nodes in No.206 group, and can completely remove the mass, regional lymph nodes and adipose connective tissue, so as to achieve the goal of non-bleeding surgery. Lymph nodes in No.206 group were dissected, not just the visible lymph nodes, but the entire lymph nodes and lymphatic vessels in the region, including adipose tissue. Extended right hemicolectomy requires higher surgical techniques. The survival benefits of extended right hemicolectomy are not supported by high-level evidence. It is still controversial whether the infrapyloric lymph node dissection should become routine for colon cancer of hepatic flexure. In this article, the metastasis and dissection of infrapyloric lymph node in colon cancer of hepatic flexure is elucidated.


Subject(s)
Humans , Colectomy , Colon, Ascending , Pathology , General Surgery , Colonic Neoplasms , Pathology , General Surgery , Lymph Node Excision , Methods , Lymph Nodes , Pathology , General Surgery , Lymphatic Metastasis , Mesocolon , Pathology , General Surgery
17.
Rev. cuba. cir ; 57(4): e605, oct.-dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-991059

ABSTRACT

RESUMEN El síndrome de Waugh es una patología del neonato caracterizado por la asociación de una malrotación intestinal a una intususcepción. Existen pocos casos documentados en la literatura, lo que conlleva una baja incidencia. Presentamos el caso de un neonato femenino de 4 meses de edad quien fue llevada a tratamiento quirúrgico con oclusión intestinal y evolución posoperatoria favorable. El objetivo del trabajo es presentar el caso de un síndrome de Waugh en un lactante en cuyo cuadro se debe mantener una alta sospecha diagnostica, apoyándose con la toma de estudios de imagen complementarios ante un cuadro de dolor abdominal en pacientes lactantes cuya resolución diagnostica siempre resulta un reto para el médico. Si bien estas acciones podrán en un futuro reflejar un aumento en la incidencia de este síndrome, también es posible que el manejo de dicho síndrome se optimice. Paciente femenina de 4 meses de edad la cual fue sometida a tres intentos de desinvaginación hidrostática antes de pasar a laparotomía exploradora para corrección definitiva de su patología. La asociación de invaginación con mal rotación intestinal actualmente es subdiagnósticada, debido a la tendencia conservadora actual. Es importante realizar más estudios de imagen antes de iniciar con cualquier estrategia terapéutica, para no retrasar el manejo quirúrgico definitivo que este requiere. De esta manera se podrá ganar en la calidad de los pronósticos de los pacientes(AU)


ABSTRACT Waugh's syndrome is a neonatal pathology characterized by the association of intestinal malrotation and intussusception. There is a low number of cases documented in literature, which implies low incidence. Here is a 4 months-old female neonate who was surgically treated because of intestinal occlusion, and her postoperative recovery was favorable. The objective was to present a Waugh's syndrome case in a newborn in which high diagnostic suspicion is important, supported by complementary imaging studies when we face abdominal pain in neonates whose diagnostic resolution is always a challenge to the physician. These actions may show an increase in the incidence of this syndrome in the future; it is also possible that the management of this disease be optimized. Hydrostatic disinvagination was performed three times in this patient before undergoing exploratory laparotomy for final correction of her pathology. The association of invagination and intestinal malrotation is poorly diagnosed at present, due to current conservative tendencies. However, it is important to perform more imaging studies before adopting any therapeutic strategy to avoid delays in the definitive surgical management of this disease(AU)


Subject(s)
Humans , Female , Infant , Appendectomy/adverse effects , Colon, Ascending/abnormalities , Intussusception/diagnosis , Laparotomy/methods
18.
Journal of Neurogastroenterology and Motility ; : 614-627, 2018.
Article in English | WPRIM | ID: wpr-740758

ABSTRACT

BACKGROUND/AIMS: Although functional abdominal pain disorders (FAPDs) are common in children, the accurate pathogenesis of FAPDs is not known yet. Micro-inflammation, particularly tissue eosinophilia of gastrointestinal (GI) tract, has been suggested as the pathophysiology observed in several GI disorders. We aimed to evaluate eosinophilic infiltration throughout the entire GI tract in children with FAPDs, compared to those with inflammatory bowel diseases (IBD) and to normal reference values. METHODS: We included 56 children with FAPDs, 52 children with Crohn’s disease, and 23 children with ulcerative colitis. All subjects underwent esophagogastroduodenoscopic and colonoscopic examination with biopsies. Tissue eosinophil counts were assessed in 10 regions throughout the GI tract. RESULTS: Eosinophil counts of the gastric antrum, duodenum, terminal ileum, cecum, and ascending colon were significantly higher in children with FAPDs compared to normal reference values. Eosinophil counts of the stomach and the entire colon were observed to be significantly higher in children with IBD than in those with FAPDs. Even after selecting macroscopically uninvolved GI segments on endoscopy in children with IBD, eosinophil counts of the gastric body, cecum, descending colon, sigmoid colon, and the rectum were also significantly higher in children with IBD than those with FAPDs. CONCLUSIONS: Significantly high eosinophil counts of the stomach and colon were observed in the order of IBD, followed by FAPDs, and normal controls, regardless of endoscopically detected macroscopic IBD lesions in children. This suggests some contribution of GI tract eosinophils in the intrinsic pathogenesis of FAPDs in children.


Subject(s)
Child , Humans , Abdominal Pain , Biopsy , Cecum , Colitis, Ulcerative , Colon , Colon, Ascending , Colon, Descending , Colon, Sigmoid , Duodenum , Endoscopy , Eosinophilia , Eosinophils , Gastrointestinal Diseases , Gastrointestinal Tract , Ileum , Inflammatory Bowel Diseases , Pyloric Antrum , Rectum , Reference Values , Stomach
19.
Chinese Journal of Gastrointestinal Surgery ; (12): 691-695, 2018.
Article in Chinese | WPRIM | ID: wpr-691331

ABSTRACT

<p><b>OBJECTIVE</b>To compare the difference of the diameters of superior mesenteric vein (SMV) and gastrocolic trunk (GCT) between patients with cecum-ascending colon cancer and normal individuals, and to assess the diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer.</p><p><b>METHODS</b>Preoperative imaging data of 60 patients with primary cecum-ascending colon cancer confirmed by postoperative pathology at the First Affiliated Hospital of Sun Yat-sen University from June 2014 to December 2016 were retrospectively analyzed. The diameters of SMV and GCT were measured on preoperative CT images. SMV was measured at about 2 cm below the junction of SMV and splenic vein. GCT was measured at 1 cm near the proximal junction of right colon vein, right gastroepiploic vein and anterior pancreaticoduodenal vein. Another 60 people receiving pelvic CT examination without organ illness were collected as control. The diameter differences of SMV and GCT between cancer group and control group were compared. The diagnostic value of the diameters of SMV and GCT in cecum-ascending colon cancer was evaluated by receiver operating characteristic (ROC) curves.</p><p><b>RESULTS</b>Among 60 cases of cecum-ascending colon cancer, 36 were males and 24 were females with median age of 48 years (range 28-84); 13 were cecum cancer, 47 were ascending colon cancer; 11 had no lymph node and liver metastasis, 40 had lymph node metastasis, 9 had liver metastasis (all with lymph node metastasis). Compared to control group, the diameters of SMV and GCT in cancer group were significantly longer [SMV:(11.2±1.3) mm vs. (9.5±1.7) mm, t=6.04, P<0.001; GCT:(5.5±0.9) mm vs. (3.5±1.0) mm, t=11.51, P<0.001]. However, there were no statistically significant differences in diameters of SMV and GCT among hepatic metastasis, lymph node metastasis and no metastasis cancer groups (all P>0.05). The ROC curve analysis showed that the area under the curve of SMV diameter was 0.777, and the optimal cut-off point was 10.5 mm in the diagnosis of cecum-ascending colon cancer, with the sensitivity and specificity of 95.0%(57/60) and 46.7%(28/60) respectively. The area under the curve of GCT diameter was 0.923, and the optimal cut-off point was 4.5 mm in the diagnosis of cecum-ascending colon cancer, with sensitivity and specificity of 88.3%(53/60) and 85.0%(51/60) respectively.</p><p><b>CONCLUSION</b>The dilation of the SMV and GCT may be used as warning factors for cecum-ascending colon cancer, especially the diameter of GCT.</p>


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cecum , Colon, Ascending , Pathology , Colonic Neoplasms , Pathology , Mesenteric Veins , Retrospective Studies
20.
Annals of Coloproctology ; : 286-291, 2018.
Article in English | WPRIM | ID: wpr-718753

ABSTRACT

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.


Subject(s)
Female , Humans , Male , Adenocarcinoma , Colon , Colon, Ascending , Colon, Descending , Colonic Neoplasms , Disease-Free Survival , Follow-Up Studies , Lymph Nodes , Prognosis , Recurrence , Retrospective Studies
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