Anaphylactic shock induced by polyethylene glycol after bowel preparation for the colorectal cancer surgery: A case report.

BACKGROUND: Polyethylene glycol (PEG) is widely used as an additive because of its hydrophilic and chemically inert properties. However, there are been increasing reports of PEG allergies, including anaphylaxis, although they are still rare. This case report aims to raise awareness, that the commonly used bowel cleansing agent containing PEG can cause serious allergic reactions. CASE SUMMARY: Prior to surgery for sigmoid colon cancer, a 63-year-old man was prescribed a bowel cleansing agent containing PEG. Within 30 min of ingestion, he developed symptoms of anaphylactic shock and did not respond to initial intramuscular epinephrine injection. Under diagnosis of anaphylaxis to PEG, he was stabilized with fluid hydration and continuous norepinephrine infusion. CONCLUSION: While allergic reactions to PEG are rare, they can be life-threatening. Therefore, it is crucial for clinicians to be aware of this possibility and to diagnose and resuscitate patients immediately.

Comparing clinical characteristics and surgical outcomes of gastric and small bowel GIST: A single center experiences.

OBJECTIVE: Gastrointestinal stromal tumor (GIST) is a rare kind of neoplasm at the gastrointestinal tract. There are few studies regarding the comparison of gastric and small bowel GIST in Korea. We aimed to analyze clinical characteristics and outcomes between gastric and small bowel GIST after curative resection. METHODS: Between May 2005 and Dec 2017, 165 patients who underwent curative resection for gastric GIST (n = 115) and small bowel GIST (n = 50) were retrieved from a retrospective database. They were compared with respect to clinical, pathologic and oncological outcomes. RESULTS: The mean age at surgery in both two group was similar (58.8 vs. 58.6, p = 0.772). The rate of emergency admission and surgery was higher in small bowel GIST group (p < 0.005). The mitotic rate and risk category were not significantly different between the two groups. However, the T stage was higher in small bowel GIST compared to the T stage of gastric GIST (22.6% vs. 44.0%, p = 0.025). During the follow-up, 5-year disease free survival rate was worse in small bowel GIST (82.0%) compared gastric GIST (93.7%) (p = 0.032). 5-year survival rate was not significantly different between the two groups (100.0% vs. 97.7%, p = 0.578). The T stage, mitotic count, and risk category were independent prognostic factors for disease free survival of Gastric and small bowel GIST in Cox multivariate analysis. CONCLUSION: Small bowel GIST has more advanced T stage and higher rate of emergency surgery. Disease free survival rate was worse in small bowel GIST. Larger scaled prospective study of small bowel GIST is needed.

Ileocolic intussusception caused by giant submucosal colonic lipoma: A rare case report.

INTRODUCTION: An adult intussusception is associated with a pathological lesion involving a lead point, such as a benign polyp, enlarged mesenteric lymph node, lipoma, Meckel's diverticulum, lymphoma, gastrointestinal stromal tumor, primary, or metastatic adenocarcinoma. A lipoma is usually asymptomatic, however, lipomas >2 cm may cause intussusception by forming a lead point. PRESENTATION OF CASE: A 46-year-old South Korean man was admitted and presented with a two-week history of intermittent abdominal pain and discomfort. Abdominal pelvic computed tomography scan revealed that about 6.5 cm of fat attenuation mass is present in the ascending colonic loop with about 15 cm of ileal loop pulled into the ascending colonic loop through the ileocecal valve. Mechanical obstruction with ileocolic intussusception was found in distal ileum. The colonoscopy detected a huge mass in the mid-ascending colon blocking the passage of the colonoscope. The patient was diagnosed with an ileocolic intussusception which was suspected to be a huge lipoma. Laparoscopic assisted right hemicolectomy was performed and the follow-up pathologic examination showed that it is a submucosal lipoma. CONCLUSION: The present case report concerns a 46-year-old male with a long segment ileocolic intussusception due to a giant lipoma arising from the ascending colon and whose intussusception was surgically resected.

Surgery of intraabdominal giant dedifferentiated liposarcoma of ascending colon mesentery: A rare case report.

INTRODUCTION: Liposarcoma, a lipogenic tumor of large deep-seated connective tissue space, presents the most common type of soft tissue sarcoma arising in the retroperitoneum. Liposarcoma that arises from colonic mesentery is especially a very rare disease. The present case describes a surgery of giant dedifferentiated liposarcoma at ascending colon mesentery. PRESENTATION OF CASE: A 47-year-old South Korean man was admitted and presented with palpable abdominal mass. Abdominal pelvic computed tomography scan revealed a huge mass at his right sided abdomen (about 25 × 19 cm sized mass at right abdomen with encapsulation). After the surgery, the entire mass was completely excised en bloc with the ascending colon. The specimen consisted of multinodular, pinkish tanned, focally myxoid tissue, which measured up to 25.5 × 19 × 12.5 cm. Final pathological analysis reported dedifferentiated liposarcoma (high grade sarcoma) with MDM2 and CDK2 (+) in immunohistochemistry. CONCLUSION: The present case report concerns a 47-year-old male with giant dedifferentiated liposarcoma arising from colonic mesentery and achieved en-bloc resection of liposarcoma with right hemicolectomy.

Effect of transanal drainage tube on anastomotic leakage following low anterior resection for rectal cancer without a defunctioning stoma.

PURPOSE: Anastomotic leakage (AL) is one of the most serious complications of rectal cancer surgery. The aim of this study was to analyze the effectiveness and safety of transanal drainage tube (TDT) placement to prevent AL after low anterior resection (LAR) for rectal cancer. MATERIAL AND METHOD: In this retrospective study, the data of 556 patients with rectal cancer who underwent LAR using the double stapling technique between January 2001 and April 2016 were analyzed. The patients were divided two groups: the non-transanal drainage tube (NTDT) group comprised patients without a TDT (n = 341) and the transanal drainage tube (TDT) group, patients with a TDT (n = 215). RESULTS: The overall rate of AL was 4.1% (n = 23). The AL rate was significantly lower in the TDT group. The AL rate was 5.6% (n = 19) in the NTDT group and 1.9% (n = 4) in the TDT group (p = 0.032). The mean time of AL postoperatively was 6.0 days. Among AL patients, the re-operation rate for AL was 84.2% (16/19) for the NTDT group and 75.0% (3/4) for the TDT group. Sex, age, BMI, neoadjuvant chemoradiation therapy, tumor location, and double stapler diameter were not analysized to be risk factors for AL after LAR. Non-use of a TDT (odds ratio, 0.106; 95% confidence interval, 0.013-0.843; p = 0.034) was established as a risk factor for AL in the logistic analysis. CONCLUSION: Based on the present data, TDT placement can reduce the rate of AL following LAR using the double stapling technique for rectal cancer.

Potential benefit of superior to inferior dissection during laparoscopic extended right hemicolectomy.

Various approaches can be used for performing laparoscopic right hemicolectomy for right-sided colon cancer. However, laparoscopic complete mesocolic excision with central vessel ligation using these approaches may sometimes present with difficulties of various factors. This video article presents a laparoscopic extended right hemicolectomy using a superior-to-inferior approach. The superior approach has potential benefits in that it exposes the superior mesenteric vessels and gastrocolic trunk.

Prognostic impact of GPR56 in patients with colorectal cancer.

G protein-coupled receptor 56 (GPR56) belongs to the adhesion G protein-coupled receptor subfamily, which plays a role in cell progression and survival. The aim of this study was to investigate the role of the GPR56 gene in a cell line study and the impact of its protein expression on the prognosis of colorectal cancer (CRC) patients. The effect of GPR56 on tumor cell proliferation (WST-1 assay), invasion (Transwell assay), migration (Transwell assay, wound healing assay), and colony-forming ability (semisolid agar colony-forming assay) was explored. The expression levels of GPR56 in tissue samples of 109 CRC patients were evaluated by immunohistochemistry. The prognostic value of GRP56 was analyzed using univariate and multivariate analyses. The downregulation of GPR56 in the CRC cell line reduced cell proliferation as compared with that in a control sample (48 h; p=0.042, 72 h; p=0.001). Downregulation of the GPR56 expression reduced cell invasion and migration abilities and inhibited colony-forming abilities (p<0.005). The 5-year overall survival rate was worse in the high-expression group as compared with that in the low-expression group (51.6% vs. 74.4%, p=0.008). High GPR56 expression was a significant prognostic factor for overall survival of CRC patients in the univariate (p=0.001) and multivariate (p<0.001) analyses. The expression level of GPR56 plays an important role in tumor progression in CRC, and it may serve as a prognostic indicator in CRC patients.

Comparison of oncologic outcome of abdominoperineal resection versus sphincter saving resection for low lying rectal cancer.

Purpose: The present study compares the peri/postoperative and oncological outcomes of abdominoperineal resections (APR) and sphincter saving resection (SSR) for low lying rectal cancer. Methods: Between January 2001 and December 2014, 176 patients who underwent SSR (n=67) and APR (n=109) for low rectal cancer, without stage IV, were retrieved from a retrospective database. Results: With a median follow-up of 66.5 months. The mean total number of harvested lymph nodes was 16.7 (SSR) versus 17.1 (APR) (P=0.801). The advanced T stage was higher in the APR group (82.6%) versus the SSR group (55.2%) (P=0.006). The positive rate of lymph nodes after surgery was significantly higher in the APR group (45.9%) versus SSR group (25.4%) (P<0.05). The 5-year overall survival rates for SSR and APR were 87.3% and 67.6%, respectively (P<0.005). The 5-year disease-free survival rate (DFS) was 83.6% (SSR) versus 65.5% (APR) (P=0.002). The recurrence rate was higher in the APR group (34.9%) versus the SSR group (14.9%) (P=0.004). Local recurrence rate was not different between the two groups. However, distant recurrence rate was significantly higher in the APR group (26.6% vs. 11.9%, P=0.023). In multivariate analysis, node positive (N0 vs. N1-2) was an independent prognostic factor for DFS (P<0.005). Conclusion: Based on the present data, SSR achieved better 5-year oncological outcome than APR. The positive lymph node ratio in the N stage after surgery was higher in the APR group and this seems to have an effect on the oncological outcomes of the APR group.

Surgery of hereditary hemorrhagic telangiectasia with severe refractory gastrointestinal bleeding: A case report of a rare condition.

INTRODUCTION: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disease that affects the vasculature of numerous organs. HHT is characterized by the presence of multiple arteriovenous malformations that lack intervening capillaries and result in direct connections between arteries and veins. PRESENTATION OF CASE: A 58-year-old South Korean female was admitted presenting with severe anemia, dizziness, and intermittent hematochezia. The patient had experienced chronic severe refractory gastrointestinal bleeding for years. She had an intermittent spontaneous epistaxis, telangiectasias in the oral cavity (tongue), and hepatic arteriovenous malformations and gastrointestinal telangiectasia. She underwent a segmental resection of a segment of the ileum and cecum (about 77 cm). After surgery, the patient experienced no more drops in hemoglobin count or symptoms of anemia and melena. She is living a normal life. CONCLUSION: The present case report is a surgical case of undiagnosed HHT with chronic refractory gastrointestinal bleeding. Surgical treatment is rarely required for gastrointestinal bleeding unless nonsurgical methods such as endoscopy/colonoscopy and angiography have failed.

Clinical outcome for management of colonic diverticulitis: characteristics and surgical factor based on two institution data at South Korea.

PURPOSE: The aim of this study was to analyze clinical outcomes after surgical and/or conservative management of patients with colonic diverticulitis. MATERIAL AND METHODS: Between January 2001 and November 2018, data for 1175 patients (right (Rt.) side: n = 1037, left (Lt.) side: n = 138) who underwent conservative management (n = 987) and surgical management (n = 188) for colonic diverticulitis were retrieved from a retrospective database. The Rt. sided was defined up to the proximal two-thirds of the transverse colon and Lt. sided was defined from the distal one-third of the transverse colon. RESULTS: The overall incidence of colonic diverticulitis is gradually increasing. The mean age of all patients was 43.2 ± 17 and was significantly higher in patients with Lt.-sided (57.0 ± 15.7) than with Rt.-sided (41.4 ± 13.4) diverticulitis (p = 0.001). The most common lesion site was cecum (71.7%, n = 843). First-time attacks were the most common (91.0%, n = 1069). The surgical rate was 12.2% on the right. sided and 44.9% on the left sided (p < 0.005). The mean age, age distribution, BMI, open surgery rate, stoma formation rate, and Hinchey types III and IV rate were significantly higher in Lt. sided than in Rt. sided (p < 0.005). Older age, higher BMI (≥ 25), and Hinchey types III and IV were significantly associated with surgical risk factors of diverticulitis (p < 0.005). CONCLUSION: Base on present study, Lt.-sided colonic diverticulitis tends to be more severe than Rt. sided, and surgery is more often required. In addition, colonic diverticulitis that requires surgery seems to be older and more obese on Lt. sided.

The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution.

BACKGROUND/OBJECTIVE: Colonoscopy-induced colonic perforation often requires surgical management. The aim of this study was to analyze the outcomes after surgery for colonoscopic perforations (CPs). METHODS: This was a retrospective chart review study of 48 patients who underwent surgery for CPs between January 2002 and May 2017. The patients were divided into two groups: Group I (n = 25) had diagnostic CPs, and Group II (n = 23) had therapeutic CPs. RESULTS: The most common perforation sites in Group I were the sigmoid colon (n = 19; 76.0%), whereas in Group II were the transverse colon (n = 10, 43.5%) and sigmoid colon (n = 10, 43.5%; p = 0.013). The surgeries performed were primary closure (n = 16, [64.0%] Group I; n = 11 [47.8%] Group II) and bowel resection (n = 9 [36.0%] Group I; n = 11 [47.8%] Group II). The rate of temporary stomas was higher in Group II (n = 9, 26.1%) than Group I (n = 2, 8.0%; p = 0.030). The re-perforation rate after surgery was 8.0% (n = 2) in Group I and 8.7% (n = 2) in Group II (p = 0.568). These re-perforation patients all those who had a simple closure without a wedge resection. The conversion rate after laparoscopic surgery was 20.0% (n = 2 of 10) in Group I and 33.3% (n = 1 of 3) in Group II. CONCLUSIONS: Surgical management is one of the important therapies in the treatment of CP. Simple primary closure without a wedge resection should be used cautiously. Therapeutic CPs was associated with more temporary stoma formation. The type of surgery should be carefully selected, depending on the type of CP.

Surgery for intra-abdominal abscess due to intestinal perforation caused by toothpick ingestion: Two case reports.

RATIONALE: Failure to pass though the gastrointestinal tract can result in inflammatory response, reactive fibrosis, and intestinal perforation. Fish bones, chicken bones, and toothpicks are the most common types of foreign substances that produce intestinal perforation during ingestion. PATIENT CONCERNS: Case 1: A 49-year-old female was hospitalized with abdominal pain and a fever. The fever lasted for 5 days before hospitalization. Case 2: A 72-year-old male was hospitalized with abdominal pain and fever. The fever lasted for 4 days before hospitalization. DIAGNOSES: Case 1: An abdominal pelvic computed tomography (APCT) scan revealed a large inflammatory mass formation and linear high-density material within the inflammatory mass. The presence of foreign bodies, including acupuncture needles or intrauterine devices was ruled out. Case 2: An APCT scan revealed that there was a small abscess formation measuring about 2.5 cm abutting the abdominal wall and a parasitic infestation was ruled out. INTERVENTIONS: Case 1: An exploratory laparotomy was performed. After removal of the abscess pocket, the sigmoid colon was found to be perforated, and there was a firm, sharp foreign body in the abscess pocket that measured about 5 cm and resembled a toothpick. Case 2: Laparoscopic exploration was then performed. When the abscess was removed from the abdominal wall using a harmony scalpel, a 4 cm foreign body that resembled a toothpick appeared in the abscess pocket. OUTCOMES: The patients recovered well after surgery and were discharged. LESSONS: Two of the above case reports describe the cases in which the presence of toothpicks was suspected clinically, resulting in the surgery of intra-abdominal abscess caused by intestinal perforations.

Long-term oncologic outcomes of laparoscopic versus open resection following stent insertion for obstructing colon cancer: a multi-center retrospective study.

BACKGROUND: This study compared oncologic outcomes between open and laparoscopic surgery following self-expanding metallic stents insertion for obstructing colon cancer. METHODS: This retrospective study included 50 patients who underwent open surgery and 44 patients who underwent laparoscopic surgery for obstructing left-sided colon cancer at four tertiary referral hospitals between June 2005 and December 2013. RESULTS: The median follow-up periods were 48 months and 47 months in the open and laparoscopic groups, respectively. The median operative time, time to soft diet, and length of stay were comparable between the groups. Four cases converted to open surgery (9.1%) in the laparoscopic group. The morbidity within 30 days after surgery was comparable between the groups (OR 0.931; 95% CI 0.357-2.426; p = 0.884). The proximal and distal resection margins, the histologic grade of tumor, TNM stage, median tumor size, and presence of lymphovascular invasion did not differ significantly between the groups. The 5-year overall survival (OS) rates of the open and laparoscopic groups were 67.1% and 71.7% (HR 1.028, 95% CI 0.491-2.15, p = 0.942) and the 5-year disease-free survival (DFS) rates were 55.8% and 61.5% (HR 0.982; 95% CI 0.522-1.847; p = 0.955), respectively. The recurrence pattern did not differ between the groups. Multivariate analysis showed that sex (p = 0.027), nodal stage (p = 0.043), and the proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.002) were independent prognostic factors for OS. The proportion of patients receiving postoperative adjuvant chemotherapy (p = 0.017) was an independent prognostic factor for DFS. CONCLUSIONS: Laparoscopic resection following stent insertion for obstructing colon cancer can be performed safely, with long-term oncologic outcomes comparable with those of open surgery.

CORRIGENDUM: Correction of funding statement in ACKNOWLEDGEMENTS section: Epigenetic inactivation of RUNX3 in colorectal cancer.

[This corrects the article on p. 19 in vol. 94, PMID: 29333422.].

Epigenetic inactivation of RUNX3 in colorectal cancer.

PURPOSE: Emerging evidence indicates that runt-related transcription factor 3 (RUNX3) is an important tumor suppressor gene in several cancer types, including colorectal cancer (CRC). However, the clinical significance of RUNX3 inactivation in CRC remains unclear. The aim of this study was to examine the correlation between clinicopathologic factors and RUNX3 hypermethylation/expression in CRC. METHODS: Sixty-two CRC patients who were treated at the Soonchunhyang University College of Medicine were recruited in this study. The hypermethylation of CpG islands in the RUNX3 promoter and the expression of RUNX3 mRNA were identified by methylation-specific polymerase chain reaction (PCR) and reverse transcriptase-PCR, respectively. The expression of RUNX3 was determined by immunohistochemical staining. RESULTS: Of the 62 CRC tissue samples, 20 (32.3%) presented hypermethylated RUNX3 promoters. Aberrant RUNX3 hypermethylation was found to be associated with vascular (P = 0.006) and lymphatic (P = 0.002) invasion. Hypermethylation of RUNX3 was associated with poor survival outcomes (P = 0.038). However, expression of RUNX3 was not a prognostic factor (P = 0.363). CONCLUSION: Hypermethylation of RUNX3 may be a predictor of a poor prognosis in CRC.

Surgery of multiple lymphangioma in small bowel: a rare case report of chronic gastrointestinal bleeding.

Small bowel lymphangioma is a rare benign tumor of the lymphatic system, characterized by the presence of dilated lymphatic spaces and significant gastrointestinal bleeding. Small bowel lymphangiomas are rare in adults and case reports are few. Lymphangiomas in the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. The case reported herein is of an older patient (70-year-old male) with melena and chronic anemia (hemoglobin count < 5 g/dL) who had small-sized multiple lymphangiomas in his small bowel (jejunum). Surgical resection was performed after failure of treatment by gastroenteroscopy. Final pathological analysis revealed lymphangioma with thrombus and hemorrhage. After surgery, he no longer had decreased hemoglobin count, nor symptoms of anemia and melena. Also, at the last follow-up visit, the patient's hemoglobin count patient was normal and he returned to normal daily functions.

Comparison of oncological outcomes of right-sided colon cancer versus left-sided colon cancer after curative resection: Which side is better outcome?

PROPOSE: There are embryological origins, anatomical, histological, genetic, and immunological differences between right-sided colon cancer (RCC) and left-sided colon cancer (LCC). Many studies have sought to determine the survival and prognosis according to tumor location. This study aimed to analyze outcomes between RCC and LCC. MATERIAL AND METHOD: Between January 2000 and December 2012, data on 414 patients who underwent curative resection for RCC and LCC were retrieved from a retrospective database. Propensity score matching (1:1) was performed and RCC was identified in 207 and LCC in 207 patients. RESULTS: On average, RCC exhibited a more advanced N stage, increased tumor size, more frequently poorly differentiated tumors, more harvested lymph nodes, and more positivity of lymphovascular invasion than LCC. With a median follow-up of 66.7 months, the 5-year overall survival (OS) rates for RCC and LCC were 82.1% and 88.7%, respectively, (P < .05). The 5-year disease-free survival (DFS) rates were 81.4% (RCC) and 88.3% (LCC; P < .05). In stage III cancers, the DFS rates were 61.1% (RCC) and 81.9% (LCC; P < .05), while the OS rates were 65.6% (RCC) and 78.6% (LCC; P = .056). CONCLUSION: On the basis of present data, LCC exhibited better survival outcomes than RCC after curative resection. Especially in stage III, LCC showed better oncologic outcomes. Proper specialized treatment related to the location of colon cancer is needed.

Unusual case of rapid growing intraabdominal abscess caused by Stenotrophomonas maltophilia after laparoscopic appendectomy due to perforated appendicitis: A case report.

INTRODUCTION: An intraabdominal abscess due to Stenotrophomonas maltophilia (S maltophilia) infection is a very rare clinical manifestation. S maltophilia is a glucose nonfermentative, aerobic, gram-negative, mobile, and biofilm-forming bacterium. It is an opportunistic pathogen and uncommon cause of infection. Respiratory tract infections (pneumonia) and bloodstream infections (bacteremia) are the most common clinical manifestations of S maltophilia infection. CONCLUSIONS: This case report describes an unusual case of a rapidly growing, extremely large intraabdominal abscess (within 1 week during antibiotic therapy), which was detected 2 weeks after a laparoscopic appendectomy was performed for perforated appendicitis and was caused by multidrug-resistant S maltophilia infection.