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12/31/1969 03:59 PM
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Abdominal Colectomy With Ileorectal Anastomosis
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colon; From 1980 to 1983, 20 patients had abdominal colectomy with primary ileorectal anastomosis. Fourteen operations were elective and six were emergency. Elective indications included familial polyposis (five), inflammatory bowel disease (four), colon cancer associated with multiple polyps (four), and colon cancer associated with diverticulosis and a history of massive hemorrhage (one). Emergency operations were performed for obstructing sigmoid or rectosigmoid cancer (three), massive lower gastrointestinal hemorrhage (two), and right colon cancer associated with obstructing diverticulitis (one). All patients survived the operation; in three patients complications developed in the immediate postoperative period for a morbidity of 15%. Our experience suggests that abdominal colectomy with primary ileorectal anastomosis can be safely performed in carefully selected cases.
(C) 1984 Southern Medical Association
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12/31/1969 03:59 PM
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Functional Result Following Abdominal Colectomy
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FUNCTIONAL RESULT FOLLOWING ABDOMINAL COLECTOMY. Department of General Surgery, Scott & White Hospital, and Texas A & M University College of Medicine, Temple, Texas.
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12/31/1969 03:59 PM
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En Bloc Pancreaticoduodenectomy and Colectomy for Duodenal Neoplasms
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colon; Duodenal malignancy is rare and generally considered to have both a low resectability rate and a poor prognosis. Historically, the involvement of the colon or its mesentery has been considered a criterion for unresectability by many surgeons because of the overall magnitude of surgery involved with an en bloc colectomy and pancreaticoduodenectomy. In the past few years, several reports have noted a decrease in morbidity and mortality rates for pancreaticoduodectomy. The current safety of the procedure suggests that the classical criteria for resectability can now be reevaluated for certain neoplasms. We report two cases of pancreaticoduodenectomy with en bloc colectomy done as attempted curative resections for primary duodenal malignancies. The procedure was well tolerated by both patients; there were no major complications, and it provided both prolonged survival and effective palliation.
(C) 1997 Southern Medical Association
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12/31/1969 03:59 PM
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Laparoscopic Total Abdominal Colectomy: A Prospective Trial
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LAPAROSCOPIC TOTAL ABDOMINAL COLECTOMY: A PROSPECTIVE TRIAL.
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12/31/1969 03:59 PM
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Endometriosis of the Colon: Report of 14 Patients Requiring Partial Colectomy
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Reviewed are the clinical, radiologie, operative and pathologic findings and the results in 14 women (ages 31 to 51 years) requiring partial colectomy for endometriosis. All had symptoms related to the lesion of the colon; eight had gynecologic symptoms. In only four instances did the physical examination reveal a palpable mass. Most important in making the preoperative diagnosis is radiographie examination of the colon (barium enema). In common localized endometrioma, features are those of an eccentric intramural, submucosal lesion with transverse ridging. More extensive endometriosis is more difficult to differentiate from carcinoma by radiographie means. Operative diagnosis, which was less accurate than radiologie diagnosis, should be suggested by uninvolved mucosa on examination of the unopened colon and frozen section diagnosis of endometriosis on an implant. When endometriosis of the colon is of a degree sufficient to cause symptoms, partial colectomy should be done; oophorectomy only, without resection, is not recommended.
(C) 1974 Southern Medical Association
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12/31/1969 03:59 PM
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Radiologic Study of the Anastomosis After Right Colectomy
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There are only a few reports in the literature describing the postoperative radiologic appearance of anastomoses after operation on the colon, and most of these describe the end-to-end anastomosis of a colocolostomy on the left colon. The purpose of this paper is to report the radiologic appearance of the anastomotic site after right colectomy. Sixty patients who had resections of the right colon were studied postoperatively by barium and air contrast enemas and, in some instances, by examinations of the small bowel. Eighteen patients had deformities in and about the anastomotic site which caused some difficulty in interpretation. This was particularly true when a blind pouch was present after a lateral or end-to-side anastomosis and the inverted and of the gut produced an irregular contour. Most of the deformities were recognized on follow-up examinations but one patient required operation to rule out a recurrent tumor. Two patients had recurrent carcinoma at the anastomotic site. Three patients had obstruction of the ileum due to adhesions. It is suggested that a postoperative barium and air contrast enema be done three months after operation to provide a base line, and thereafter annually. If there is any question as to recurrence of disease at the anastomotic site, surgical exploration should be considered. The significance of the investigation was to determine the radiologic appearance oft he anastomotic site in order to have some knowledge of the postoperative changes. If the surgical changes are recognized radiologically, some patients may be spared a needless operation.
(C) 1974 Southern Medical Association
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12/31/1969 03:59 PM
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One Stage Colectomy, Proctectomy and Ileostomy for Diffuse Ulcerative Colitis
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The surgical attack on ulcerative colitis has become more bold in recent years with antibiotics and a better understanding of fluid and electrolyte balance. The author proposes a one stage operation be used when the indications for surgery are present.
(C) 1960 Southern Medical Association
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12/31/1969 03:59 PM
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Total Abdominal Colectomy in the Surgical Management of Diverticular Disease Of the Colon: Twenty Years' Experience
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The authors consider the indications for subtotal colectomy in the treatment of diverticulosis and its complications. They show that ileorectal anastomosis leads to no greater morbidity than segmental resections and causes no inconvenience to the patient subsequently.
(C) 1972 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Therapy for Diffuse Granulomatous Colitis
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Of 16 patients with diffuse granulomatous colitis treated surgically, nine initially had total proctocolectomy and seven had abdominal colectomy with ileorectal anastomosis. There was no mortality in either group, and there was no anastomotic leak from ileorectal anastomosis. Disease recurred in 22% of patients after proctocolectomy and in 57% of patients with ileorectal anastomosis. A review of the literature on the surgical management of Crohn's colitis reveals a recurrence rate of 3% to 46% (average 20%) after proctocolectomy and a recurrence rate of 6.6% to 75% (average 46%) after ileorectal anastomosis. Colectomy with ileorectal anastomosis is the operation of choice for Crohn's colitis where feasible.
(C) 1980 Southern Medical Association
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12/31/1969 03:59 PM
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Colonic Atony in Association With Sigmoid Volvulus: Its Role in Recurrence of Obstructive Symptoms
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We reviewed a 30-year experience in management of 129 patients with 163 acute obstructions due to sigmoid volvulus. Recurrent obstruction of the colon was observed in 47 (or 45%) of 104 patients who survived their initial obstructive episode: 61% after rectal tube insertion, 45% after detorsion, 33% after sigmoid plication, and 21% despite sigmoid colectomy. Subsequent barium enema or surgical exploration showed true sigmoid volvulus to be the cause of recurrent obstruction in 36 of 47 patients, while atonic bowel, involving the sigmoid alone or more proximal colon as well, was responsible for the other 11 recurrent obstructions. Sigmoid excision was corrective only if bowel atony was limited to that portion of the colon. Only more extensive colectomy, so as to include all flaccid colon, consistently obviated recurrence. Failure to recognize functional obstruction accounted for five of the 25 total deaths.
(C) 1982 Southern Medical Association
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12/31/1969 03:59 PM
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Outpatient Bowel Preparation For Elective Colon Resection
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colon; To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary anastomosis. Patients who required protective proximal stoma were excluded. Patients requiring emergency surgery, colostomy closure, and restorative proctocolectomy were excluded. Patients were separated into two groups equally matched by age, sex, procedure done, and comorbidity: 145 had bowel preparation as outpatients and 174 as inpatients. Both groups had similar numbers of days hospitalized, days receiving nothing by mouth, and days requiring nasogastric intubation or gastrostomy tube, as well as similar postoperative complications. There was one wound infection, one anastomotic leak, and one death in each group. Cost of outpatient preparation was approximately $40. Cost of inpatient preparation, including a semiprivate room, was approximately $400. Outpatient preparation with polyethylene glycol-electrolyte lavage solution and oral antibiotics before elective colon resection can be done with equivalent safety and at a substantial cost savings.
(C) 1997 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Treatment of Ulcerative Colitis: Problems of the Ileostomy
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In many patients having ulcerative colitis there comes a time when surgical interference must be considered. The indications and methods of attack are presented by the authors. It appears much is to be said for a one-stage ileostomy and colectomy for acute exacerbation of ulcerative colitis
(C) 1957 Southern Medical Association
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12/31/1969 03:59 PM
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Problem of Cancer in Ulcerative Colitis
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There are differences of opinion in regard to "prophylactic colectomy" against cancer in instances of chronic ulcerative colitis. The authors consider the prognosis in regard to possible cancer and suggest a conservative attitude if follow-up care can be adequate.
(C) 1968 Southern Medical Association
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12/31/1969 03:59 PM
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Current Medical Therapy for Inflammatory Bowel Disease
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Traditional medical therapy for inflammatory bowel disease (IBD) includes corticosteroids and sulfasalazine. In recent years, several mesalamine derivatives of sulfasalazine have become available. These allow delivery of increased dosages of active medication with minimal side effects. Newer steroid preparations, all investigational at this point, likely will offer efficacy similar to that of prednisone but with an improved side effect profile. Immunosuppressive agents, including 6-mercaptopurine, azathioprine, and likely also methotrexate, are beneficial in treating refractory IBD, particularly in patients with chronic steroid dependence. Cyclosporine has been shown to be remarkably effective in delaying colectomy for severe ulcerative colitis, but its long-term role remains uncertain.
(C) 1996 Southern Medical Association
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12/31/1969 03:59 PM
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Familial Polyposis in Children: Early Detection and Preferred Treatment
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colon; Familial polyposis is a disease with high malignant potential. When the diagnosis is established, surgical removal of the premalignant tissue should be complete. Reports of early malignant expression of the disease have led us to recommend early surveillance and treatment of children from affected families. We describe four children who had total colectomy, rectal mucosectomy, and ileoanal anastomosis, and relate our reasons for preferring this modality of therapy for familial polyposis in young patients.
(C) 1984 Southern Medical Association
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12/31/1969 03:59 PM
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Vascular Malformations of the Intestine: An Important Cause of Obscure Gastrointestinal Hemorrhage*
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Case reports of five patients are presented who had obscure massive bleeding from various vascular malformations of the gastrointestinal tract. The small size and vascular nature of these lesions make the diagnosis by routine roentgenographic studies difficult or impossible. They are equally difficult to find even during exploratory laparotomy. Selective mesenteric angiography is probably the best diagnostic aid and may be carried out even if the patient is not actually bleeding at the time. Arteriovenous malformations are more frequent in the right colon. When such a lesion is suspected and all radiographic studies are negative, blind right colectomy is more apt to cure the patient than any other procedure.
(C) 1974 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Management of Colonic Inertia
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colon; Fourteen patients with chronic constipation due to colonic inertia were treated with total abdominal colectomy and ileorectal anastomosis at the Cleveland Clinic Foundation from 1981 to 1986. All patients were white women ranging in age from 28 to 64 years (mean 41 years). The duration of symptoms averaged 21 years (range six to 47 years) and the average time between bowel movements was ten days. The preoperative evaluation included barium enema in 12 patients and colonoscopy in five (some patients had both studies). Anorectal dysfunction was excluded by manometry in ten patients and by rectal biopsy in six. Colonic transit studies were accomplished in only two patients. The hospital stay averaged 13 days, and there was no operative mortality. Postoperative morbidity included one case of small bowel obstruction, necessitating operative correction on postoperative day 9. Follow-up ranged from three months to five years. At their last clinic visit, the patients averaged two bowel movements per day. All patients had excellent bowel control and were happy with the procedure.
(C) 1989 Southern Medical Association
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12/31/1969 03:59 PM
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Primary Colon Cancer Without Gross Mucosal Tumor: Unusual Presentation of a Common Malignancy
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colon; Colon cancer typically arises in the colonic lumen, allowing for endoscopic detection of cancerous and premalignant lesions. In the case presented, a 73-year-old man with iron deficiency anemia had two colonoscopies showing only diverticula and internal hemorrhoids. Three years later, when the patient complained of dull, intermittent lower abdominal pain, a third colonoscopy identified diverticula, three adenomatous polyps, and no other abnormality. Computed tomography (CT) of the abdomen revealed a 5 cm x 6 cm pericolic fluid collection, which was later found to communicate with the sigmoid colon. The surgical specimen from a partial colectomy contained a distal sigmoid perforation with a 2.5 cm moderately differentiated adenocarcinoma in the underlying submucosal tissue. There was no gross intraluminal tumor. Histopathology, including immunohistochemistry, was consistent with colonic adenocarcinoma. Primary colon cancer grossly sparing the mucosa is an unusual presentation for this common malignancy
(C) 1998 Southern Medical Association
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12/31/1969 03:59 PM
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Stimulation of Hematopoiesis as an Alternative to Transfusion
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colon; Optimal parenteral nutritional support, provided concomitantly with extraordinarily large replacement doses of intravenous iron dextran can be safe, effective, and life-saving for severely anemic patients who cannot or will not accept erythrocyte transfusion. Five patients who had sustained massive acute blood loss and two who had severe chronic anemia received as much as 140 ml of iron dextran intravenously. The average initial hemoglobin value in the patients with acute blood loss was 4.7 gm/dl (range 2.6 to 8.4 gm/dl), increasing to an average of 9.8 gm/dl (range 7.5 to 12.8) in 23.4 days (range 17 to 30 days), a 166% increase. The average initial hemoglobin value in the patients with chronic anemia was 3.7 gm/dl, increasing to 10.5 gm/dl over an average period of 121 days, a 182% increase. Total abdominal colectomy, pyloroplasty with truncal vagotomy, and highly selective vagotomy were accomplished without complications in four of the patients. There were no adverse reactions to the therapeutic regimen, and all patients were discharged in good condition.
(C) 1986 Southern Medical Association
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12/31/1969 03:59 PM
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Diverticulitis in a Young Man with Hyper-IgE Syndrome
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Autosomal dominant hyperimmunoglobulin E syndrome (HIES, or Job syndrome) is a rare primary immunodeficiency characterized by elevated immunoglobulin E (IgE), eosinophilia, recurrent skin and pulmonary infections, dermatitis, and connective tissue and skeletal abnormalities. A 26-year-old male with known HIES presented with abdominal pain and diarrhea. Imaging showed sigmoid diverticulitis without abscess or perforation. Conservative management with antibiotics failed, and he developed a peridiverticular abscess, which was percutaneously drained with plans for elective resection. He returned four days later with progression of his diverticulitis, requiring partial colectomy with primary anastomosis. To our knowledge, this is the first case of diverticulitis in HIES. Diverticulitis is rare in younger individuals, raising the possibility that the connective tissue abnormalities of HIES patients may predispose them to colonic diverticula. Although the majority of complications are sinopulmonary and skin infections, diverticulitis should be considered in the differential of intra-abdominal processes in HIES.
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12/31/1969 03:59 PM
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Multiple Endocrine Neoplasia Type 2 Syndrome Presenting With Bowel Obstruction Caused by Intestinal Neuroma: Case Report
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We present the case of a 23-year-old male with a history since early childhood of lip and tongue mucosal neuromas. At the age of 19, he was diagnosed with both medullary thyroid carcinoma and pheochromocytoma within 1 year. These findings, with his marfanoid habitus, led to the diagnosis of multiple endocrine neoplasia type 2 (MEN 2B) syndrome. This was confirmed by a positive RET proto-oncogene. On this admission, he presented with an intestinal obstruction. Abdominal exploration revealed an obstructing tumor mass requiring colectomy, which proved by biopsy to be an intestinal neuroma. This report presents a unique case of a colonic mucosal neuroma causing obstruction in MEN 2B syndrome after the diagnosis of medullary thyroid carcinoma.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Prolonged Sinus Pauses with Hydromorphone in the Absence of Cardiac Conduction Disease
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A 49-year-old male had open sigmoid colectomy with colorectal anastomosis for sigmoid diverticulitis. The patient was given patient-controlled analgesia (PCA) hydromorphone and subsequently developed bradycardia with prolonged sinus pauses up to 7.1 seconds. The pauses resolved shortly after the hydromorphone was discontinued. This is the first case report to our knowledge of reversible prolonged sinus pauses associated with the use of hydromorphone. Animal studies support a role for opioid signaling at the sinoatrial (SA) node. Hydromorphone is a potential cause of prolonged sinus pauses and should be taken into consideration when monitoring a patient on hydromorphone for pain control.
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12/31/1969 03:59 PM
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Massive Fecal Impaction Presenting with Megarectum and Perforation of a Stercoral Ulcer at the Rectosigmoid Junction
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A 25-year-old male with lifelong constipation presented to the emergency department with an acute abdomen. Initial resuscitation was performed, and the patient underwent urgent laparotomy. He was found to have feculent peritonitis with megabowel involving the rectum and sigmoid colon and a stercoral ulcer with full thickness erosion, and perforation was also identified on the anti-mesocolic surface at the rectosigmoid junction. Abdominal irrigation and subtotal colectomy with proximal fecal diversion was performed. This case illustrates that recognition of severe, chronic constipation should lead to interventions including disimpaction and aggressive medical management. When indicated, megabowel can be managed surgically in an elective setting based on anatomic findings and physiologic studies. Peritonitis is an ominous late finding in patients with severe constipation.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Perforated Stercoral Ulcer of the Sigmoid Colon
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Perforated Stercoral Ulcer of the Sigmoid Colon. Department of Surgery, Ohio State University College of the sigmoid colon. A sigmoid colectomy with colostomy was performed. Pathology showed transmural
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12/31/1969 03:59 PM
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The Water Jet Deformation Sign: A Novel Provocative Colonoscopic Maneuver to Help Diagnose an Inverted Colonic Diverticulum
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Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert an inverted diverticulum include probing it with a closed biopsy forceps or intraluminal air insufflation during colonoscopy. On colonoscopy, a 59-year-old female had two intraluminal colonic projections. Probing these projections and using air insufflation failed to indent or evert them. Spraying these lesions with a water jet, however, flattened or partly everted them. This novel maneuver provided conclusive evidence that these intraluminal projections represented inverted diverticula. The proposed pathophysiology is that water pressure causes an inverted diverticulum to indent or evert due to its thin wall. The currently reported maneuver may be easier and safer than probing an inverted diverticulum with biopsy forceps and may prove a more reliable diagnostic maneuver than air insufflation.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Cecoanal Intussusception in an Adult Caused by Cecal Polyp
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Cecoanal Intussusception in an Adult Caused by Cecal Polyp. Division of Gastroenterology, Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical School, Dallas, TX
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12/31/1969 03:59 PM
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Subphrenic Displacement of the Colon: From Sign to Syndrome
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Subphrenic Displacement of the Colon: From Sign to Syndrome. From the Radiology Department, Government Medical College and SSG Hospital, Baroda, Vadodara, Gujarat, India. 3. Chilaiditi D. Zur Frage der
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12/31/1969 03:59 PM
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Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor
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Synchronous Occurrence of Colorectal Adenocarcinoma and Colonic Gastrointestinal Stromal Tumor. Gastroenterology Department, Agios Savvas Cancer Hospital (Xinopoulos, Paraskevas)
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
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Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was attributed to UC, as hypercoagulable testing was negative. IBD is certainly a hypercoagulable state, and aggressive thromboembolism prevention should be considered for hospitalized patients with active disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Gastrointestinal Tract Bleeding in Intellectually Disabled Adults
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Background: Gastrointestinal (GI) tract bleeding in intellectually disabled (ID) individuals presents peculiar diagnostic and management difficulties. This study details the experience of a tertiary referral teaching hospital in Central Saudi Arabia in the management of GI bleeding necessitating admission in ID adults.
Patients and Methods: Prospective collection of data was taken on consecutive ID adults admitted for GI bleeding from January 2000 through December 2004. Demographic details, clinical presentation, diagnosis, associated physical and neurologic disabilities, etiology of bleeding and treatment outcome were analyzed.
Results: Thirty-nine ID adults accounted for 44 admissions during the period under review. Twenty-six (66.7%) patients were admitted with upper, and 13 (33.3%) for lower GI bleeding. Reflux esophagitis (57.7%) remained the most common cause of upper GI bleeding. Five out of 26 patients with upper and 6 of 13 with lower GI bleeding needed operative treatment. Various congenital anomalies or malformations were observed frequently associated with lower GI bleeding.
Conclusions: Bleeding GERD remained the most common etiology of upper GI bleeding necessitating admission. Endoscopy is the mainstay in diagnosis and initial management of ID patients. Continued surveillance endoscopy is recommended for early diagnosis of Barrett changes. Bleeding from developmental malformations may have association with intellectual disability.
(C) 2008 Southern Medical Association
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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Oncology in the Community Hospital: Can It Be Done Safely?
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Background: Many studies have documented the fact that outcomes and survival are improved when major surgical oncology cases are performed at high-volume centers. Consolidation of such cases in tertiary centers, however, is often not possible or practical, due to a number of factors.
Methods: A retrospective review was performed of the operative experience of a single surgical oncologist at a community hospital in Mississippi during a noncontinuous 36-month period. Data were obtained regarding all major inpatient cancer operations, as well as complication and death rates. This review was limited to major inpatient procedures and resections performed with intent to cure.
Results: A total of 171 major cancer cases were performed during the study period. This represented 23.7% of the total inpatient procedures performed and 47.5% of all major inpatient procedures. Distribution of surgical sites was as follows: liver-9; stomach-8; esophagus-3; pancreas-4; colon and rectum-76; breast-33; lung-13; intra-abdominal (sarcoma)-9; and thyroid-16. There were 5 complications within this group (2.9%); two of these resulted in death (1.2%).
Conclusions: In the hands of a single surgeon operating at a community institution, major resections for cancer and major surgical oncology cases could be done safely with acceptable complication rates and results. Whether or not such major cancer cases should be done at the community level, however, depends on a number of factors and requires further evaluation of both surgeon and hospital capabilities.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Repeated Stool Toxin Testing for Diagnosing Difficile Colitis Is Still Valid
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Repeated Stool Toxin Testing for Diagnosing Difficile Colitis Is Still Valid. From the Departments of Internal Medicine and Infectious Diseases, Henry Ford Hospital, Detroit, MI.
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12/31/1969 03:59 PM
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Gastrointestinal Metastases from Breast Cancer: A Case Report
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Gastrointestinal Metastases from Breast Cancer: A Case Report. This case report describes breast cancer that, 16 years later, metastasized to the gastrointestinal tract. The mucosa of the intestinal
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12/31/1969 03:59 PM
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Giant Ulcerated Lipoma of the Colon Causing Iron Deficiency Anemia Successfully Treated with Endoscopic Ultrasound-Assisted Resection
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Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Influence of pT3 Subgroups on Outcome of R0-Resected Colorectal Tumors
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Objective: Evaluate whether depth of infiltration within T3 colorectal tumors influences long-term oncologic outcome.
Patients and Methods: Patients with stage pT3 colon and rectal tumors were divided into four subgroups according to the depth of infiltration. The influence on overall and disease-free survival was tested for each subgroup and compared in univariate and multivariate analyses.
Results: A total of 368 patients were evaluated, with a median follow-up time of 92.5 months. In 181 patients with colon cancer 5- and 10-year overall survival rates were 82.7% and 65.0%, respectively, and 5- and 10-year disease-free survival rates were 80.9% and 64.4%, respectively. For 187 patients, rectal cancer 5- and 10-year overall survival rates were 69.0% and 50.5%, respectively, and disease-free survival rates were 61.3% and 47.5%, respectively. In either colon or rectal cancer, different pT3 categories showed neither a statistically significant influence on survival nor the occurrence of local or distant recurrence in univariate and multivariate analyses; however, higher pT3 subgroups had a significant influence on lymph node involvement and vessel invasion in patients with rectal cancer.
Conclusions: Subdivision of pT3 tumors in colon cancer based on depth of infiltration does not provide additional information about prognosis. In rectal cancer, T3 substages were associated with lymph node involvement; however, we could not demonstrate an impact on recurrence or survival.
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12/31/1969 03:59 PM
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Vogt-Koyanagi-Harada Syndrome and Ulcerative Colitis
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The Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon disorder characterized by uveitis and neurologic and cutaneous abnormalities, including tinnitus, vertigo, headache, meningoencephalitis, vitiligo, alopecia, and poliosis. The VKH syndrome has been reported to occur in association with other autoimmune disorders. We report a case of a patient with severe ulcerative colitis who developed VKH syndrome. We postulate that the patient's history of a traumatic brain injury might have been responsible for an abnormal "immunologic milieu" and the occurrence of ulcerative colitis, VKH syndrome, and severe reactive arthritis.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Pilot Study on Gastric Electrical Stimulation on Surgery-associated Gastroparesis: Long-term Outcome
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Objectives: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis.
Methods: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time.
Results: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying.
Conclusions: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Diffuse Malignant Peritoneal Mesothelioma Presenting as Intestinal Obstruction
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Diffuse malignant peritoneal mesothelioma (DMPM) represents 90% of all peritoneal forms of mesothelioma. It affects mainly patients 50-69 years old. In 50% of cases there is a history of asbestos exposure. The clinical presentation of the disease is not characteristic: nonspecific abdominal pain, weight loss, and abdominal distension are common. Ascites occurs in 90% of the patients. Bowel obstruction is a late manifestation. We present three patients with DMPM, without a history of asbestos exposure and without ascites, who presented with complete bowel obstruction. All patients underwent emergency operations, and palliative surgical procedures were performed. Each patient died within 3 to 6 months postoperatively.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Bloodstream Infection with Anaerobiospirillum succiniciproducens: A Potentially Lethal Infection
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Anaerobiospirillum succiniciproducens (A succiniciproducens), a spiral, Gram-negative anaerobic rod which is part of the normal intestinal flora of cats and dogs, has rarely been reported as a cause of bacteremia and diarrhea in humans, particularly in immunocompromised hosts. Although it can be associated with significant mortality, the full extent of its pathogenicity, clinical spectrum, and optimal therapy remain to be determined. We review the available literature on microbiology, clinical manifestations, and treatment options for Anaerobiospirillum infection.
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12/31/1969 03:59 PM
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Nephrolithiasis: Evaluation and Management
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Nephrolithiasis is a major cause of morbidity involving the urinary tract. The prevalence of this disease in the United States has increased from 3.8% in the 1970s to 5.2% in the 1990s. There were nearly two million physician-office visits for nephrolithiasis in the year 2000, with estimated annual costs totaling $2 billion. New information has become available on the clinical presentation, epidemiologic risk factors, evaluative approach, and outcome of various therapeutic strategies. In this report, we will review the epidemiology and mechanisms of kidney-stone formation and outline management aimed at preventing recurrences. Improved awareness and education in both the general population and among health-care providers about these modifiable risk factors has the potential to improve general health and decrease morbidity and mortality secondary to renal-stone disease.
Key Points
* Nephrolithiasis is a major cause of morbidity involving the urinary tract.
* Increasing daily fluid intake is very important in preventing recurrent stone disease.
* The cornerstone of the evaluation is 24-hour urine collection.
* The mostly commonly-used noninvasive procedure for smaller stones is lithotripsy.
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12/31/1969 03:59 PM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1 Multiple mucosal neuromas over the tongue and upper lip.
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2 Colonoscopy shows diffuse submucosal nodular abnormalities representing intestinal neuromas.
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1 Representative slice of computed tomography (CT) scan of the abdomen and pelvis. Initially, it showed microperforated localized sigmoid diverticulitis with no evidence of abscess formation or free air.
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2 Representative slice of computed tomography (CT) scan of the abdomen and pelvis. After the patient was asymptomatic for seven days, diverticulitis was complicated by abscess formation.
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12/31/1969 03:59 PM
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Fig. Maximum sinus p...
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Fig. Maximum sinus pause of 7.12 seconds while taking hydromorphone.
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12/31/1969 03:59 PM
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Fig. Operative view ...
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Fig. Operative view of massively distended rectum and sigmoid colon.
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