Chronic constipation leading to sigmoid colon volvulus in an adolescent

We report a case of one of the rare complications of constipation in an adolescent. The patient presented with acute abdominal symptoms and the radiographic images revealed a dilated twisted sigmoid colon. Rectal tube reduction was successful and subsequently, the patient underwent sigmoidectomy and uneventful recovery

Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon / 대한소화기학회지

Primary colorectal choriocarcinoma is a rare neoplasm. Only 19 cases have been reported worldwide, most of which involved adenocarcinomas. The prognosis is usually poor, and the standard therapy for this tumor has not been established. A 61-year-old woman presented with constipation and lower abdominal discomfort. She was diagnosed with primary adenocarcinoma with focal choriocarcinomatous differentiation in the sigmoid colon and liver metastasis. Because the serum beta-human chorionic gonadotropin level was not significantly elevated, and because only focal choriocarcinomatous differentiation was diagnosed, we selected the chemotherapy regimen that is used for the treatment of metastatic colorectal adenocarcinoma. The patient survived for 13 months after the initial diagnosis. This is the first case in Korea to assess the suppressive effects of the standard chemotherapy for colorectal adenocarcinoma against coexisting colorectal choriocarcinoma and adenocarcinoma.

Surgical technique of en bloc pelvic resection for advanced ovarian cancer / 부인종양

OBJECTIVE: The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus, pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients with widespread pelvic involvement. METHODS: The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacent pelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic disease within this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying the bladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vessels are divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon is divided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesentery is ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed and dissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to the left of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in a retrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosis was completed using stapling device. RESULTS: En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvic disease leaving no gross residual disease was possible using en bloc pelvic resection. CONCLUSION: En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic disease in advanced primary ovarian cancer patients with extensive pelvic organ involvement.

Length and caliber of the rectosigmoid colon among patients with Chagas disease and controls from areas at different altitudes

Introduction In this study, we investigated radiological changes in the sigmoid colon in chagasic patients by comparing their colon lengths and caliber with those of non-chagasic living in the same region and non-chagasic living at high altitudes. Methods A total of 317 individuals were evaluated using clinical, serological and radiological methods and divided into three groups: 1) one hundred and nine non-chagasic individuals from Uberaba, Brazil; 2) sixty-one non-chagasic from Puno, Peru; 3) one hundred forty-seven chagasics examined in Uberaba, being 62 without megacolon (3A), 72 with megacolon (3B) and 13 with doubtful diagnosis of megacolon (3C). Results In group 2, the sigmoid colon had a significantly larger caliber (p=0.001) and the rectosigmoid colon was longer (p<0.001) than group 1. In subgroup 3A, the sigmoid colon (p<0.001) and rectum (p<0.001) had a significantly larger caliber and the rectosigmoid was longer (p<0.001) than that of the non-chagasic individuals. In subgroup 3B, the rectosigmoid was longer in all patients, and the caliber of the sigmoid was significantly larger than that of subjects in subgroups 3A and 3C (p<0.001). Conclusions Morphometric analysis confirms that Chagas disease may increase the caliber and length of the rectosigmoid. Our results suggest that altitude, ethnicity and diet may have influenced the size and length of the rectosigmoid of andean patients. .

Divertículo sigmoideo gigante complicado en un paciente diabético / Complicated sigmoid giant diverticulum seen in a diabetic patient

La divertículosis colónica es una entidad frecuente en los países occidentales y representa una de las primeras enfermedades gastrointestinales con mayor repercusión en cuanto a costos de salud. La prevalencia de esta dolencia aumenta con la edad, aproximadamente hasta un 50 porciento de los adultos mayores de 60 años la padecen. Se señala que una de las razones de este incremento es el bajo consumo de fibras en la dieta y una interacción compleja entre la fibra dietética, la estructura de la pared colónica y la motilidad intestinal. El divertículo gigante de colon (mayor de 4 cm) es una entidad rara, hemos encontrado 156 publicados en la literatura. El presente caso es un paciente masculino de 47 años de edad con múltiples comorbilidades que hicieron su forma de presentación inusual y difícil su diagnóstico(AU)

Colonic diverticulosis is a frequent pathology in Western countries and represents one of the major gastrointestinal diseases with higher impact on health costs. Its prevalence increases with the age and is present in almost 50 percent of adults over 60 years old living in these countries. It has been said that among the reasons for this rise is the low dietary fiber consumption, and the complex interaction among the dietary fiber, the colon wall structure and the intestinal motility. Giant colonic diverticulum (over 4 cm long) is a rare entity; we have found just 156 cases reported in literature. This is the case of a 47 years-old male patient, who presented with multiple comorbidities that cause the unusual presentation of the diverticulum and create difficulties in diagnosing it(AU)

A Case of Congenital Infantile Fibrosarcoma of Sigmoid Colon Manifesting as Pneumoperitoneum in a Newborn

Congenital infantile fibrosarcoma (CIF) is a rare soft-tissue tumor in the pediatric age group and seldom involves the gastrointestinal tract. A 2-day-old boy was transferred to our hospital with a pneumpoperitoneum. After emergency operation, we could find a solid mass wrapping around a sigmoid colon and performed a segmental resection of sigmoid colon including a mass. Histopathologic examination showed an infantile fibrosarcoma origining from the muscular layer of colon. The baby was discharged on the 17th hospital day and followed for 1 yr without recurrence.

A Case of Crohn's Disease Having Normal Delivery after Infliximab Treatment during Early Pregnancy / 대한소화기학회지

Infliximab is a chimeric IgG1 monoclonal antibody to tumor necrosis factor (TNF)-alpha used in the treatment of steroid refractory or dependent Crohn's disease (CD). Patients with active CD are more likely to experience stillbirth, preterm labor, or small for gestational aged babies. The safety of administering infliximab in pregnant patients is not well documented. A 25-year-old woman, who was diagnosed with small bowel CD three years ago, was admitted to our hospital due to the aggravation of abdominal pain. She had been treated with mesalazine, azathioprine and intermittent steroid for three years. After admission, she did not respond to steroid therapy, we decided to try infliximab. After the administration of infliximab, epigastric pain was relived and Crohn's disease activity index score decreased significantly. However after the fourth infusion of infliximab, the patient became aware that she was ten gestational weeks old pregnancy state After then, infliximab was stopped and maintained by mesalazine. The patient gave birth to a healthy baby via normal vaginal delivery without the recurrence of CD. This case suggests that infliximab administration is safe during the early period of pregnancy. Thus, we report this case with a review of literature.

Clinical Outcomes in Ischemic Colitis: According to the Colonoscopic Extent and Feature / 대한소화기학회지

BACKGROUND/AIMS: Ischemic colitis (IC) usually occurs in the elderly population and has a various clinical presentations from mild to severe forms. The aim of this study was to investigate the clinical outcomes according to the involved sites and colonoscopic findings in IC. METHODS: We retrospectively analyzed the medical records of 77 patients who had diagnosed with IC between January 2000 and July 2010. The clinical outcomes were compared according to numbers of the involved segments, location and endoscopic findings. RESULTS: Mean age of the patients was 70+/-11 years and male to female ratio was 1:1.26. Hematochezia (67.5%) and abdominal pain (63.6%) were the most common associated symptoms. The colonoscopic examination was performed at mean 4.6+/-3.7 days after the symptom onset. The most common involved segment was the sigmoid colon (72.7%). Duration of fasting, antibiotics therapy, hospital stay and mortality were significantly increased in the patients group with more involved segments (p<0.001, p=0.004, p<0.001, p<0.001, respectively). Duration of antibiotics therapy and hospital stay were significantly longer in the right colon involvement group (p=0.038, p=0.002, respectively). The time taken until the alleviation of symptoms and the white blood cells count were significantly longer and higher in the ulcer or gangrenous group (p=0.001, p=0.022, respectively). CONCLUSIONS: Evaluating the involved sites, the degree and severity of mucosal damage by colonoscopy may be important in predicting the clinical course and prognosis of the patients with IC. Early detection, careful monitoring and prompt treatment are crucial especially in the patients with ulcer or necrosis in colonscopic findings.

Various surgical options for emergency management of sigmoid volvulus

The objective of this study was to compare the outcome of various surgical options for the emergency surgical management of sigmoid volvulus. This comparative study was conducted in emergency department of postgraduate medical institute Lady Reading Hospital, Peshawar over a period of one year from February 2007 to January 2008. Study comprised of hundred cases to have sigmoid volvulus on clinical and radiological grounds operated in casualty department with various surgical options and outcomes of these procedures were determined postoperatively. Out of 100 cases, 79% were males and 21% females. Majority 51% patients were in the age range of 41-60 years, 36% patients were in age group of 61-80 years. Resection and Hartman's procedure was performed in 52% cases, resection with primary anastomosis with covering colostomy in 18% cases, resection and primary anastomosis in 15% cases, and resection with double barrel colostomy [Paul Mikulicz] in 15% cases. Wound infection/ dehiscence occurred in 21% cases, intra-abdominal abscess in 9% cases, anastomosis leakage in 6% cases. Colostomy complications included bleeding in 7% cases, retraction in 7% patients, prolapse in 4% cases. Resection and Hartmann procedure was performed in majority of patients. Wound infection/dehiscence, intra-abdominal abscess, anastomosis leakage were common postoperative complications with various frequencies

Sigmoidoanal intussusception with exteriorization of sigmoid adenocarcinoma

The intestinal intussusception is a rare disease in adults, and is mostly caused by malignant neoplasm. Symptoms are usually nonspecific and chronic, and in most cases suggesting intestinal obstruction. Treatment consists of removing the malignant tumor. This article reports the case of a patient with hematochezia and apparent mass in the anus who underwent anterior rectosigmoidectomy and had the diagnosis of adenocarcinoma of the sigmoid confirmed. (AU)

A intussuscepção intestinal é uma doença rara em adultos, sendo na maior parte dos casos causada por neoplasia maligna. Os sintomas são geralmente inespecíficos e crônicos, na maioria das vezes sugerindo obstrução intestinal. O tratamento consiste na remoção oncológica do tumor. Este artigo relata o caso de uma paciente com quadro de hematoquezia e exteriorização de massa através do ânus que foi submetido à retossigmoidectomia anterior alta em bloco e confirmado o diagnóstico de adenocarcinoma de sigmoide. (AU)

Sigmoidovesical Fistula Caused by Diverticulitis Detected with Sigmoidoscopy / 대한소화기학회지

Enterovesical fistular is an abnormal communication between the intestine and the bladder. It represents a rare complication of intestinal diverticulitis, colorectal malignancy, bladder cancer, inflammatory bowel disease, radiotherapy, and trauma. The most common etiology is diverticular disease. A 70-year-old man came to our hospital due to frequent urinary tract infection, dysuria, pneumaturia and fecaluria. Sigmoidoscopy revealed a large diverticulum with impacted stool at the sigmoid colon. When the scope was inserted into the site, the patient complained of severe urgency and pneumaturia. CT scan was performed. 1.5 cm sized fistular tract between the sigmoid colon and bladder was noted. According to the endoscopy and CT finding, the diagnosis of colovesical fistula was made. The patient underwent surgical intervention. At laparotomy, there were multiple diverticula and fistular tract was noted.

Clinical Analysis of Stercoral Perforation of the Colon / 대한소화기학회지

BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.

A Case of Segmental Colitis Associated with Diverticular Disease / 대한소화기학회지

Segmental colitis associated with diverticular disease (SCAD) is a colonic inflammatory disorder with localized non-granulomatous inflammation at sigmoid colon, and associated with colonic diverticulosis. SCAD is an apparently uncommon disorder in Western. We experienced a rare case of SCAD in a 46-year-old woman who visited the hospital due to abdominal discomfort. Colonoscopic examination showed multiple sigmoid diverticula in association with a segment length colitis. Colonoscopic biopsies of the sigmoid colon demonstrated cryptitis and crypt abscess along with chronic inflammatory cells infiltration. The biopsies of the rectum was histologically normal. The patient was given the diagnosis of SCAD and treated with oral mesalamine. This is the first case of SCAD reported in Korea.

Increased Immunoendocrine Cells in Intestinal Mucosa of Postinfectious Irritable Bowel Syndrome Patients 3 Years after Acute Shigella Infection: An Observation in a Small Case Control Study

PURPOSE: Postinfectiously irritable bowel syndrome (PI-IBS) develops in 3-30% of individuals with bacterial gastroenteritis. Recent studies demonstrated increases in inflammatory components in gut mucosa of PI-IBS patients even after complete resolution of infection. We aimed to investigate histological changes in colon and rectum of PI-IBS subjects after long term period of infection. MATERIALS AND METHODS: We recruited PI-IBS subjects who had been diagnosed IBS after complete resolution of enteritis caused by shigellosis outbreak 3 years earlier. We compared unmatched four groups, PI-IBS (n = 4), non PI-IBS (n = 7), D-IBS (n = 7, diarrhea predominant type) and healthy controls (n = 10). All of them underwent colonoscopic biopsy at three areas, including descending colon (DC), sigmoid colon (SC) and rectum, which were assessed for 5-hydroxytryptamine (5-HT)/peptide YY (PYY)-containing enterochromaffin (EC) cell, intraepithelial (IEL) and lamina propria T lymphocyte (CD3), CD8 lymphocytes, mast cells and CD68/calprotectin+ macrophages. RESULTS: All subjects had no structural or gross abnormalities at colonoscopy. In PI-IBS, 5-HT containing EC cells, PYY containing EC cells, IELs, CD3 lymphocytes, CD8 lymphocytes, mast cells, and CD68 + macrophages were increased compared to control (p < 0.05). In D-IBS, PYY containing EC cells, IELs, and CD3 lymphocytes were increased compared to control (p < 0.05). In PI-IBS, 5-HT containing EC cells tended to increase and PYY containing EC cells, CD8 lymphocytes, mast cells, and CD68+ macrophages were increased compared to non PI-IBS (p < 0.05). Calprotectin + marcrophages were decreased in PI-IBS, non PI-IBS and IBS compared to control. CONCLUSION: The immunoendocrine cells were sporadically increased in PI-IBS, non PI-IBS and D-IBS compared with control. Our findings in a very small number of patients suggest that mucosal inflammation may play a role in long-term PI-IBS, and that other sub-groups of IBS and larger scale studies are needed to confirm this observation.

Percutaneous endoscopic colostomy: a new technique for the treatment of recurrent sigmoid volvulus

Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percuatneous endoscopic colostomy for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall

Management of sigmoid volvulus

The objective of this work paper is to report our experience in the management of the sigmoid volvulus. This retrospective study relates to 40 cases of sigmoid volvulus operated in Surgical Departments B of Rabta University Hospital, Tunis, from January 1999 to December 2008. It refers to 35 men and 5 women, of 55 years as average age. Twenty six patients have been subjected to cm volvulus removal through rectosigmondoscopy, which allowed an untwisting of the volvulus in 23 cases. Those patients have been subjected to a colorectal anastomosis within an average 9 day term. Among those patients, 5 subjects have undergone a sigmoidectomy assisted by laparoscopy. Urgent laparotomy has been performed in 17 patients following failure or complication of the endoscopy [3 cases], or straightaway laparotomy [14 cases] which showed a colic necrosis in 10 cases, of which 4 cases had stercoral peritonitis. One patient had a pre perfrorative lesions on right colon has been subjected to a total colectomy, followed by an ileorectal anastomosis. A sigmoidectomy has been performed in 16 patients, followed by a colorectal anastomosis [n=2]. An Hartman intervention [n = 4] and a double stomy [n = 10]. All those patients have had restoration of digestive continuity within an average 90 days term. Postoperative complications have consisted in 5 pneumopathy cases, 2 heart insufficiency cases, 3 urinary tract infection cases and on peristomial eventration case. No patient has showon an anastomotic loosening or a recurrence after elective surgery. The average follow-up duration was 110 days. Four deaths have occurred immediately after urgent laparotomy. This relates to a state of septic shock with multiple organ failure [n = 2], a lung embolus [n = 1] and a pneumapathy [n = 1] The best treatment for sigmoid volvulus consists to an endoscopic volvulus removal intervention followed by a sigmoidal resection during the same hospitalization period. Urgent laparotomy is indicated in case of signs of necrosis or failure of endoscopy. Sigmoidal resection without immediate restoration of digestive continuity is recommended in presence of risk factors of anastomotic loosening

[Epidemiological study, pathologic evaluation and prognostic factors of colorectal mucinous adenocarcinoma VS non mucinous [about a series of 196 patients]]

Colorectal carcinoma is one of the main causes of cancer death in the worldwide with a decrease survival rate in relationship with a later diagnosis of advanced disease. This study highlights the particular epidemiological, clinicopathological and immunohistochemical colorectal cancer profile. Indeed, our results differ markedly from that reported in the literature. We underwent a retro and prospective study interesting 196 patients with colorectal carcinoma diagnosed in the pathological and cytological laboratory of Mongi Slim Hospital [Tunisia]. Age at diagnosis, mode of presentation, sex, tumour location, macroscopic and histological features, TNM and Astler Coller stage were assessed and evaluated. we report here a particular epidemiological pattern which is characterised by younger age of the patients, equally distribution between men and women, predominant sporadic carcinomas and preponderance of rectosigmoid location. The poorer degree of differentiation and mucinous subtype are correlated with an advanced stage. It is also correlated with more frequent vascular embols, neural invasion and metastatic nodes. Furthermore, immunohistochemical analysis of galectin-3 showed a significant difference between mucinous and non mucinous adenocarcinoma. Based on the presented data, the epidemiological pattern and the anatomic distribution especially in the rectosigmoid region suggest diet and lifestyle to be primordial risk factors of colorectal tumorigenesis

A Case of Primary Sigmoid Colon Mucosa-associated Lymphoid Tissue Lymphoma / 대한소화기학회지

The gastrointestinal (GI) tract is the most frequently involved site of mucosa-associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the GI tract. However, MALT lymphoma of the large intestine is rare. A diagnosis is established by pathological examination of the surgical or endoscopic specimens. A 72-year-old man with low abdominal pain was diagnosed as a sigmoid MALT lymphoma, which was noted as an obstructing mass in a colonoscopic examination. A left hemicolectomy was performed, and the patient has had no recurrence postoperatively without any chemotherapy.

Enterocolic fistula in GI lymphoma: a case report

The following case describes a young patient with failure to thrive and new-onset diarrhea who underwent upper GI series. The findings on upper GI series revealed an enterocolic fistula. Laparatomy was performed and the persistent pathology was lymphoma

Gastrointestinal histoplasmosis presenting as colonic pseudotumour.

We report a case of gastrointestinal histoplasmosis in a 45-year-old HIV positive man who was misdiagnosed as a case of colonic cancer. The patient presented with low-grade fever, pain in lower abdomen, anorexia and weight loss of six months duration. On examination a lump in the left iliac fossa was detected. Colonoscopy revealed stricture and ulcerated growth in the sigmoid colon. Radiological investigations suggested malignant/inflammatory mass in the sigmoid colon with luminal compromise. Patient was operated and ulcerated tissue was sent for histopathological examination, which revealed numerous intracellular, 2-4 microm, oval, narrow-based budding yeast cells suggestive of Histoplasma capsulatum. Subsequently, the patient developed fluffy opacities on X-ray chest. Examination of sputum revealed presence of acid-fast bacilli and yeast forms of H. capsulatum. Patient was started on amphotericin B but died on the seventeenth postoperative day. The diagnosis of histoplasmosis was made retrospectively. Atypical presentation and rarity of the disease led to this diagnostic pitfall. To the best of our knowledge this is the first report of gastrointestinal histoplasmosis presenting as colonic pseudotumour from India.