-
World Journal of Gastroenterology Jan 2020Obesity is a risk factor for colorectal cancer, yet metabolic distinctions between healthy right and left colon tissue, before cancer is diagnosed, remains largely...
BACKGROUND
Obesity is a risk factor for colorectal cancer, yet metabolic distinctions between healthy right and left colon tissue, before cancer is diagnosed, remains largely unknown. This study compared right-ascending and left-descending colon tissue metabolomes to identify differences from the stool metabolome in normal weight, overweight, and obese adults.
AIM
To examine right and left colon tissue metabolites according to body mass index that may serve as mechanistic targets for interventions and biomarkers for colon cancer risk.
METHODS
Global, non-targeted metabolomics was applied to assess right-ascending and left-descending colon tissue collected from healthy adults undergoing screening colonoscopies to test the hypothesis that BMI differentially impacts colon tissue metabolite profiles. The colon tissue and stool metabolome of healthy adults ( 24) was analyzed for metabolite signatures and metabolic pathway networks implicated in progression of colorectal cancer.
RESULTS
Ascending and descending colon contained 504 host, food, and microbiota-derived metabolites from normal weight, overweight and obese adults grouped according to body mass index. Amino acids, lipids, and nucleotides were among the chemical types that further differentiated from the stool metabolite profiles. Normal weight adults had 46 significantly different metabolites between ascending and descending colon tissue locations, whereas there were 37 metabolite differences in overweight and 28 metabolite differences for obese adults ( < 0.05). Obese adults had trimethylamine N-oxide, endocannabinoids and monoacylglycerols with different relative abundances identified between ascending and descending colon. Primary and secondary bile acids, vitamins, and fatty acids also showed marked relative abundance differences in colon tissue from overweight/obese adults.
CONCLUSION
There were metabolite profile differences between right-ascending and left-descending colon tissue in healthy adults. Colon lipids and other metabolites in obese and overweight adults were distinguished from normal weight participants and associated with gut inflammation, nutrient absorption, and products of microbiota metabolism.
Topics: Adult; Biomarkers, Tumor; Body Mass Index; Colon, Ascending; Colon, Descending; Colorectal Neoplasms; Feces; Female; Gastrointestinal Microbiome; Healthy Volunteers; Humans; Ideal Body Weight; Intestinal Absorption; Lipid Metabolism; Lipids; Male; Metabolome; Middle Aged; Obesity; Overweight; Risk Factors
PubMed: 31988593
DOI: 10.3748/wjg.v26.i3.335 -
Revista Do Colegio Brasileiro de... 2023colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to... (Clinical Trial)
Clinical Trial
INTRODUCTION
colonoscopy is the best method for detecting polyps, with a reduction in colorectal cancer mortality of 29% and reaching 47% for distal tumors. However, it fails to demonstrate a significant reduction in proximal colon cancer mortality, and is the most common segment with interval neoplasm. The present study aimed to evaluate the impact on detection of polyps of a second sequential evaluation of cecum and ascending colon, with or without the use of indigo carmine chromoendoscopy.
METHODS
prospective, non-randomized clinical trial. Patients were divided into two groups. The first (G1) underwent a routine colonoscopy, followed by a second endoscopy assessment of ascending colon and cecum. The second group (G2) underwent a routine colonoscopy, followed by a second assessment of the ascending colon and cecum with indigo carmine chromoendoscopy.
RESULTS
In total, 203 patients were analyzed, 101 in the G1 and 102 in the G2. Newer polyps were identified in both groups after the second assessment with a significantly higher number of polyps detected in the patients in the G2 (p=0.0001). The number of patients who had at least one polyp in the two endoscopic assessments was significantly higher in the G2 (53 or 52% vs 27 or 26.7%, p=0.0002). In the second endoscopic assessment, the number of polyps found was also significantly higher in the G2 (50 or 76.9%) compared to the G1 (15 or 23.1%), p<0.0001.
CONCLUSIONS
the second assessment with dye-based chromoendoscopy increases the detection of polyps in the ascending colon and cecum.
Topics: Humans; Colon, Ascending; Colonic Polyps; Indigo Carmine; Prospective Studies; Adenoma; Colonoscopy; Cecum
PubMed: 37851759
DOI: 10.1590/0100-6991e-20233562-en -
Surgical Case Reports Dec 2016Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we...
Anomalies of the appendix are extremely rare, and a horseshoe appendix is even rarer. A literature search has revealed only five reported cases. In this report, we present a case of a horseshoe appendix.A 78-year-old man was referred for further examination following a positive fecal occult blood test. A mass in his ascending colon was detected on colonoscopy, while computed tomography showed that it was connected to the appendix. Tumor invasion derived from the ascending colon or appendix was suspected. We diagnosed ascending colon cancer prior to laparoscopic ileocecal resection. Macroscopic findings showed that the appendix connected to the back side of the mass, while microscopic findings showed that the mucosa and submucosa were continuous from the appendiceal orifice in the cecum to the other orifice in the ascending colon, where a type 1 tumor was observed on the orifice. We eventually diagnosed the patient with tubulovillous adenoma and a horseshoe appendix.A horseshoe appendix communicates with the colon at both ends and is supplied by a single fan-shaped mesentery. Cases are classified by the disposal of the mesentery and the location of the orifice. Anatomical anomalies should be considered despite the rarity of horseshoe appendices.
PubMed: 27878571
DOI: 10.1186/s40792-016-0261-3 -
Medicine May 2022Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma...
RATIONALE
Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another.
PATIENT CONCERNS
A 59-year-old man visited our clinic with dizziness and anorexia.
DIAGNOSIS
Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas.
INTERVENTIONS
Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed.
OUTCOMES
The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells.
LESSONS
In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis.
Topics: Adenocarcinoma; Colon, Ascending; Colonic Neoplasms; Enteritis; Humans; Male; Middle Aged; Peritonitis, Tuberculous; Tuberculosis, Gastrointestinal; Tuberculosis, Lymph Node
PubMed: 35623078
DOI: 10.1097/MD.0000000000029430 -
Clinical Gastroenterology and... Dec 2019
Topics: Aged, 80 and over; Biliary Fistula; Cholecystectomy; Colectomy; Colon, Ascending; Colonic Diseases; Female; Gallbladder Diseases; Gallstones; Humans; Intestinal Fistula; Intestinal Obstruction; Sigmoid Diseases; Tomography, X-Ray Computed
PubMed: 30710703
DOI: 10.1016/j.cgh.2019.01.031 -
Nigerian Journal of Clinical Practice Aug 2020To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic...
AIMS
To describe the clinical characteristics, colonoscopic features, histological findings, dysplasia patterns, and clinical outcome of endoscopically detected colonic polyps in the Saudi population.
METHODS
This retrospective record review was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, on patients who underwent colonoscopy between 2005 and 2015. Patients with colorectal cancer were excluded. Data were analyzed using SPSS software.
RESULTS
Among 211 patients recruited, 66.8% were males and 66.2% were Saudi. Single polyps were detected in 45.5% of cases, while 29.9%, 18%, and 6.6% had 2, 3, and 4 polyps, respectively. Regarding the size, 81%, 17%, and 2% of the polyps were <1 cm, 1-2 cm, and >2 cm, respectively. The endoscopic examination revealed that 16.4% of the polyps were pedunculated, 82.6% were sessile, and 1% were sessile and pedunculated. About 45%, 30%, 21%, and 6.6% of the polyps were located at the rectum/sigmoid, left colon, right colon, and transverse/ascending colon, respectively. Histologically, 68.6% of polyps were adenomatous and 21.3% were non-adenomatous. Mild dysplasia was detected in almost half of the studied sample (42.3%) while moderate and severe grades of dysplasia were demonstrated in 19.2% and 38.5% of the examined polyps. Surgical intervention was required in 8.1% of cases.
CONCLUSION
Single small-sized sessile polyps of adenomatous type and mild dysplasia are the most common polyps in the Saudi population. Sigmoid/rectum is the most common site affected, and the outcome of polyps is generally favorable.
Topics: Adenoma; Adult; Age Distribution; Aged; Aged, 80 and over; Colon, Ascending; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Endoscopy; Female; Humans; Male; Middle Aged; Precancerous Conditions; Retrospective Studies; Saudi Arabia; Sex Distribution
PubMed: 32788480
DOI: 10.4103/njcp.njcp_490_19 -
Annals of the Royal College of Surgeons... Sep 2015Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic...
INTRODUCTION
Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility.
METHODS
The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson's membrane (a congenital peritoneal band of the right colon) was also documented.
RESULTS
The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson's membrane was present in 66% of the subjects.
CONCLUSIONS
This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson's membrane was identified in most colons.
Topics: Aged; Aged, 80 and over; Cadaver; Colon; Colon, Sigmoid; Female; Gastrointestinal Motility; Humans; Male; Mesentery; Middle Aged; Sex Characteristics
PubMed: 26274737
DOI: 10.1308/003588415X14181254790527 -
Medicine Mar 2023Colon carcinoma is the most common type of cancer, and a leading cause of cancer-related death. Clinically, the most common sites of metastases from colon carcinoma are... (Review)
Review
RATIONALE
Colon carcinoma is the most common type of cancer, and a leading cause of cancer-related death. Clinically, the most common sites of metastases from colon carcinoma are the liver, lungs, peritoneum, and lymph nodes, while the incidence of metastases to the prostate is low. There are few relevant studies on colon carcinoma, most of them being case reports.
PATIENT CONCERNS
A 76-year-old man treated with radical resection of right colon carcinoma due to primary poorly differentiated adenocarcinoma of the cecum. Postoperative pathological examination suggested that he had cancer at the junction of the ascending colon and the cecum. He had received adjuvant chemotherapy after surgery. One year later, he received transurethral plasma resection of the prostate due to urinary system discomfort. Postoperative pathological immunohistochemistry suggested prostate metastasis of colorectal carcinoma, and he received individualized treatment, but this produced no clear survival benefit.
DIAGNOSES
Ascending colon cecal junction carcinoma with prostate metastasis.
INTERVENTIONS
Radical resection, chemotherapy, anti-androgen therapy, surgery to relieve primary lesion obstruction symptoms, and local radiotherapy of the prostate.
OUTCOMES
At present, clinical cases of colon carcinoma with prostate metastasis are rare. By sharing a rare case of ascending colon cecal junction carcinoma with prostate metastasis and reviewing the relevant literature, this paper explores and optimizes the clinical treatment of colon carcinoma with prostate metastasis.
Topics: Male; Humans; Aged; Colon, Ascending; Prostate; Prostatic Neoplasms; Colonic Neoplasms; Carcinoma; Cecal Neoplasms
PubMed: 36930066
DOI: 10.1097/MD.0000000000033308 -
Cureus Oct 2022Persistent mesocolon is a rare embryological anomaly that occurs when the primitive dorsal mesocolon fails to fuse with the posterior lateral parietal peritoneum...
Persistent mesocolon is a rare embryological anomaly that occurs when the primitive dorsal mesocolon fails to fuse with the posterior lateral parietal peritoneum allowing for volvulus of the cecum and colon. In malrotation of the gut, the normal rotation of the embryonic gut is arrested or disturbed during in-utero development. To our knowledge, this is the first case of isolated colon gangrene with persistent ascending mesocolon to be reported, although earlier studies have documented cases of persistent mesocolon of both ascending and descending mesocolon. This case had signs of acute intestinal obstruction and peritonitis, and preoperative imaging was suggestive of sigmoid volvulus. Explorative laparotomy revealed a hugely dilated and gangrenous ascending colon; the fixed part of the small intestine was found in the subhepatic space, and the hepatic flexure was at a level below the transpyloric plane in the midclavicular line. Findings were suggestive of isolated colon gangrene with persistent ascending mesocolon and malrotation of the gut. Right hemicolectomy with terminal ileostomy was performed and postoperative follow-up showed no complications. For a young patient with no prior co-morbidities, a volvulus of ascending mesocolon diagnosis was deemed unlikely because ascending colon is a retroperitoneal organ. The medial position of ascending mesocolon and small bowel loops to the right side was a crucial intra-operative clue for diagnosis. Such cases are difficult to diagnose pre-operatively through imaging alone, hence explorative laparotomy becomes necessary. Intra-operative findings led to performing a right hemicolectomy and ileostomy to relieve the obstruction. Therefore, among other congenital reasons for intestinal obstruction, surgeons should consider persistent mesocolon and volvulus as differential diagnoses when evaluating young patients. Emergent surgery is the only approach to address this.
PubMed: 36381750
DOI: 10.7759/cureus.29978 -
Scandinavian Journal of Surgery : SJS :... Jun 2017There is a demand for a better understanding of the vascular structures around the right colonic area. Although right hemicolectomy with the recent concept of meticulous... (Comparative Study)
Comparative Study Review
BACKGROUND AND AIMS
There is a demand for a better understanding of the vascular structures around the right colonic area. Although right hemicolectomy with the recent concept of meticulous lymph node dissection is a standardized procedure for malignant diseases among most surgeons, variations in the actual anatomical vascular are not well understood. The aim of the present review was to present a detailed overview of the vascular variation pertinent to the surgery for right colon cancer.
MATERIALS AND METHODS
Medical literature was searched for the articles highlighting the vascular variation relevant to the right colon cancer surgery.
RESULTS
Recently, there have been many detailed studies on applied surgical vascular anatomy based on cadaveric dissections, as well as radiological and intraoperative examinations to overcome misconceptions concerning the arterial supply and venous drainage to the right colon. Ileocolic artery and middle colic artery are consistently present in all patients arising from the superior mesenteric artery. Even though the ileocolic artery passes posterior to the superior mesenteric vein in most of the cases, in some cases courses anterior to the superior mesenteric artery. The right colic artery is inconsistently present ranging from 63% to 10% across different studies. Ileocolic vein and middle colic vein is always present, while the right colic vein is absent in 50% of patients. The gastrocolic trunk of Henle is present in 46%-100% patients across many studies with variation in the tributaries ranging from bipodal to tetrapodal. Commonly, it is found that the right colonic veins, including the right colic vein, middle colic vein, and superior right colic vein, share the confluence forming the gastrocolic trunk of Henle in a highly variable frequency and different forms.
CONCLUSION
Understanding the incidence and variations of the vascular anatomy of right side colon is of crucial importance. Failure to recognize the variation during surgery can result in troublesome bleeding especially during minimal invasive surgery.
Topics: Anatomic Variation; Angiography; Cadaver; Cohort Studies; Colectomy; Colon, Ascending; Colonic Neoplasms; Female; Humans; Intraoperative Complications; Male; Mesenteric Arteries; Vascular Malformations
PubMed: 27215222
DOI: 10.1177/1457496916650999