ABSTRACT
Management of the malignant colonic polyp remains a subject for debate even after almost two decades of experience. Some researchers believe all patients should have a colonic resection; others argue that only certain cases call for laparotomy, while still others hold for a selective approach but with varying criteria. Therefore, a survey has been made of current practice and opinion from the time colonoscopic polypectomy was introduced in 1969 to the present. The authors have reviewed a sizable segment of their experience, dividing cases of malignant polyps into two broad categories: those in which complete polypectomy was followed by bowel resection; and those undergoing polypectomy alone. The determinants leading to one course or the other were analyzed, as were the results.
Subject(s)
Colectomy , Colonic Polyps/surgery , Colonic Polyps/pathology , Colonoscopy/methods , HumansSubject(s)
Endoscopy , Gastrointestinal Diseases/therapy , Adult , Aged , Biliary Tract Diseases/diagnosis , Biliary Tract Diseases/therapy , Cholangiopancreatography, Endoscopic Retrograde , Endoscopes , Endoscopy/history , Endoscopy/methods , Esophagoscopy , Foreign Bodies/therapy , Gastrointestinal Diseases/diagnosis , Gastrointestinal Neoplasms/therapy , History, 18th Century , History, 20th Century , Humans , Intestinal Obstruction/therapy , Intestinal Polyps/surgery , Intubation, Gastrointestinal/methods , Lasers , MaleABSTRACT
The use of the colonoscope to evaluate the cause of rectal bleeding in a series of 2200 patients has been reviewed. The most common cause of bleeding in this series was found to be neoplastic polyps, which were present in 723 patients (32 per cent). Colonic carcinoma was detected as the source of the bleeding in 425 cases (19 per cent). Although a large number of barium enema films were false negatives, the patients reviewed are a highly select group. It is still believed that barium enema studies and colonoscopy are complementary rather than competitive procedures. Their continued combined use greatly enhances diagnostic accuracy. Various other causes of colonic bleeding, including inflammatory bowel disease, arteriovenous malformations, endometriosis, ovarian carcinoma, ischemic colitis, and radiation colitis, have been discussed and their endoscopic appearance described. Of particular significance is the coexistence of internal hemorrhoids or diverticular disease and neoplastic colonic lesions. Barium enema films and sigmoidoscopy have been frequently described as the twin pillars of diagnosis in the detection of colonic pathology. Colonoscopy, as the third pillar of diagnosis, should be an integral part of the evaluation of patients with rectal bleeding.
Subject(s)
Colonoscopy , Gastrointestinal Hemorrhage/etiology , Colitis/complications , Diverticulitis/complications , Evaluation Studies as Topic , Hemorrhoids/complications , Humans , Intestinal Neoplasms/complications , Intestinal Polyps/complications , Proctitis/complications , RectumABSTRACT
Gastric carcinoma is a rare entity in twins at any age. A 31-year old black male presented with a nine-month history of epigastric pain and was found to have cancer of the stomach. His asymptomatic twin was therefore evaluated and also found to have gastric carcinoma. Both patients underwent gastric resection. Pathologically the cancers were similar, although the associated changes of the gastric mucosa showed some remarkable differences. The uniqueness of carcinoma in twins has resulted in extensive utilization of twin studies in an attempt to clarify genetic, environmental and immunological factors in the development of cancer. The results of these studies reported in the literature, however, are inconclusive. Gastric cancer is quite uncommon in the younger population but must be promptly excluded when symptoms doe not quickly respond to usual therapy.
