Interposición hepatodiafragmática del colon / Hepatodiaphragmatic Interposition of the Colon

Hombre de 72 años con antecedentes de diabetes mellitus tipo 2 y sustitución protésica de cadera derecha hace dos años, que ingresó por dolor localizado en región posterolateral del miembro inferior derecho y dificultad para deambular. El examen físico mostró mucosas hipocoloreadas, abdomen depresible e indoloro con borramiento de la submatidez hepática normal e impotencia funcional con calor y dolor en la articulación coxofemoral. La radiografía del tórax (figura A) reveló un hemidiafragma derecho elevado y el colon transverso estaba interpuesto entre el hígado y el diafragma. Esta anormalidad anatómica es conocida como el signo de Chilaiditi y puede conducir a un diagnóstico falso positivo de neumoperitoneo (figura B de archivo). El signo de Chilaiditi se debe casi siempre a la interposición del colon transverso, aunque puede ser intestino delgado. Cuando se asocia al dolor abdominal, la entidad recibe el nombre de síndrome de Chilaiditi(AU)

Intracorporeal versus extracorporeal anastomosis in minimally invasive right colectomy: an updated systematic review and meta-analysis.

BACKGROUND: Minimally invasive colectomy has become the standard for treatment of colonic disease in many centers. Restoration of bowel continuity following resection can be achieved by intracorporeal (IC) or extracorporeal (EC) anastomosis. The aim of this systematic review was to assess the outcomes of IC compared to EC anastomosis in minimally invasive right colectomy. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic literature search for studies assessing the outcome of IC and EC anastomosis in laparoscopic and robot-assisted right colectomy was conducted. The primary outcome of this review was postoperative complications. Secondary outcomes included operative time, blood loss, length of stay, conversion to open surgery, and bowel recovery. RESULTS: Twenty-five studies including 4450 patients were evaluated. 47.7% of patients had IC anastomosis and 52.3% had EC anastomosis. The weighted mean length of extraction site incision in the IC group was shorter than the EC group. The EC group had significantly higher odds of conversion to open surgery (OR 1.87, 95% CI 1-3.45, p = 0.046), total complications (OR 1.54, 95% CI 1.05-2.11, p = 0.007), anastomotic leakage (AL) (OR 1.95, 95% CI 1.4-2.7, p = 0.003), surgical site infection (SSI) (OR 1.69, 95% CI 1.4-2.6, p = 0.002), and incisional hernia (OR 3.14, 95% CI 1.85-5.33, p < 0.001) compared to the IC group. Both groups had similar rates of ileus, small bowel obstruction, bleeding, and intra-abdominal infection. CONCLUSION: IC anastomosis was associated with significantly shorter extraction site incisions, earlier bowel recovery, fewer complications, and lower rates of conversion, AL, SSI, and incisional hernia than has the EC anastomosis.

Transverse colon duplication with chronic constipation in adult.

Gastrointestinal duplications are extremely rare congenital abnormalities having definite difficulties to be diagnosed preoperatively. Most of them are presented at the oesophagus and ileum and only involve colon from 4% to 18%. We illustrate a case report of an 18-year-old female patient with transverse colon duplication. There were symptom manifestations such as chronic constipation with flatulence accompanied with abdominal pain. We demonstrate this case report due to non-specific clinical presentation and some difficulties to form preoperative diagnosis. The patient underwent surgery. Tubular transverse colon duplication communicated with normal bowel in the proximal part was revealed. We performed transverse colon resection with duplication. The postoperative period was uneventful.

Evaluation of lymph flow patterns in splenic flexural colon cancers using laparoscopic real-time indocyanine green fluorescence imaging.

PURPOSE: The treatment of splenic flexural colon cancer is not standardized because the lymphatic drainage is variable. The aim of this study is to evaluate the lymph flow at the splenic flexure. METHODS: From July 2013 to January 2016, consecutive patients of the splenic flexural colon cancer with a preoperative diagnosis of N0 who underwent laparoscopic surgery were enrolled. Primary outcome is frequency of the direction of lymph flow from splenic flexure. We injected indocyanine green (2.5 mg) into the submucosal layer around the tumor and observed lymph flow using the laparoscopic near-infrared camera system in 30 min after injection. RESULTS: Thirty-one patients were enrolled in this study. The lymph flow was visualized in 31 patients (100 %) without any complications. No case exhibited lymph flow in both the left colic artery (LCA) and left branch of the middle colic artery (lt-MCA) areas. There were 19 cases (61.3 %) with lymph flow directed to the area of the root of the inferior mesenteric vein (IMV), regardless of the presence of the left accessory aberrant colic artery. Lymph node metastases were observed in six cases (19.4 %), and all of the involved lymph nodes existed in lymph flow areas determined by real-time indocyanine green fluorescence imaging. CONCLUSIONS: The findings of the lymph flow pattern of splenic flexure suggest that lymph node dissection at the root of the IMV area is important, and it may be not necessary to ligate both the lt-MCA and LCA, at least in cases without widespread lymph node metastases.

Transverse loop colostomy and colonic motility.

BACKGROUND: The motility of the defunctionalized colon, distal to transverse loop colostomy, has never been studied "in vivo." The aim of our study was to evaluate the influence of transverse loop colostomy on colonic motility. METHODS: Thirteen patients were examined before stoma closure by means of clinical evaluation and colonic manometry; we studied both the right and distal colon in both fasting and fed patients in order to detect motor activity. RESULTS: Quantitative and qualitative manometric analyses showed that the diverted colon had motor activity even if no regular colonic motor pattern was observed. The spreading of aboral propagated contractions (PCs) was sometimes recorded from the right colon to the distal colon. The response of the proximal and distal colon to a standard meal, when compared to fasting values, increased more than 40 and 35 %, respectively. Stool and gas ejections from the colostomy were never related to a particular type of colonic motility: Motor quiescence such as PCs was chaotically related to stool escape. CONCLUSIONS: In conclusion, motility of the defunctionalized colon is preserved in patients with transverse loop colostomy.

Substance P and vasoactive intestinal peptide are reduced in right transverse colon in pediatric slow-transit constipation.

BACKGROUND: Slow-transit constipation (STC) is recognized in children but the etiology is unknown. Abnormalities in substance P (SP), vasoactive intestinal peptide (VIP) and nitric oxide (NO) have been implicated. The density of nerve fibers in circular muscle containing these transmitters was examined in colon from children with STC and compared to other pediatric and adult samples. METHODS: Fluorescence immunohistochemistry using antibodies to NO synthase (NOS), VIP and SP was performed on colonic biopsies (transverse and sigmoid colon) from 33 adults with colorectal cancer, 11 children with normal colonic transit and anorectal retention (NAR) and 51 with chronic constipation and slow motility in the proximal colon (STC). The percentage area of nerve fibers in circular muscle containing each transmitter was quantified in confocal images. KEY RESULTS: In colon circular muscle, the percentage area of nerve fibers containing NOS > VIP > SP (6 : 2 : 1). Pediatric groups had a higher density of nerve fibers than adults. In pediatric samples, there were no regional differences in NOS and VIP, while SP nerve fiber density was higher in sigmoid than proximal colon. STC children had lower SP and VIP nerve fiber density in the proximal colon than NAR children. Twenty-three percent of STC children had low SP nerve fiber density. CONCLUSIONS & INFERENCES: There are age-related reductions in nerve fiber density in human colon circular muscle. NOS and VIP do not show regional variations, while SP nerve fiber density is higher in distal colon. 1/3 of pediatric STC patients have low SP or VIP nerve fiber density in proximal colon.

[Splenic flexure and irritable colon syndromes: conjugate conditions].

AIM: To investigate phenotypical and clinical characteristics in individuals with high fixation of the splenic angle (HFSA). MATERIAL AND METHODS: The study group included 82 patients with HFSA, the comparison group--76 patients with irritable colon syndrome (ICS), control group--19 patients without colon pathology. the results of the following examinations were analysed: the disease history, detailed intestinal investigation, rectal sensitivity, constitution, connective tissue weakness, vegetative dysfunction and regulation. RESULTS: HFSA is encountered mainly in persons with hyperstenic constitution. Some HFSA patients have pain on the left side--splenic flexure syndrome (SFS). The pain corresponds most to clinical criteria of irritable colon syndrome diagnosis and is accompanied with reduced threshold of pain sensitivity to balloon extension. Provoking factors of the symptoms are stress situations in childhood. CONCLUSION: SFS can be considered as a variant of ICS arising in HFSA. The treatment should be based on the principles of ICS treatment.

[Changes of the position and length of the transverse colon causing abdominal pain and chronic constipation during adolescence]. / Zmiany polozenia i dlugosci poprzecznicy powodujace bóle brzucha i przewlekle zaparcia w wieku dojrzewania.

In 12 patients aged 9 to 17 years (14.1 +/- 2.3 SD years) (11 girls, 1 boy) complaining of abdominal pain and chronic constipation, barium large bowel X-ray examination showed the following anatomical and positional abnormalities: ptosis of the transverse colon to the small pelvis was found in 11/12 patients, ptosis of the hepatic flexure of the transverse colon (2/12), ptosis of both the hepatic and lienal flexures (2/12), dolichocolon (2/12), and dolichosigma (2/12); 10 of 12 children had symptoms characteristic of irritable colon syndrome. It seems that clinical symptoms accompanying these abnormalities begin to manifest mainly in girls during adolescence because at that time the final length of the colon is established, the transit time reaches its maximal value, and the shape of the pelvis becomes characteristic for this gender. These abnormalities are rather constitutional than acquired since previously it has been reported that the vertical ptosis of the kidney(s) occurs also mainly in adolescent girls.