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International Journal of Colorectal... Nov 2017Conflicting evidence exists regarding any association between diverticulosis and adenomatous polyps. We evaluated the prevalence of polyps and cancer in colonic regions...
PURPOSE
Conflicting evidence exists regarding any association between diverticulosis and adenomatous polyps. We evaluated the prevalence of polyps and cancer in colonic regions containing diverticula.
METHODS
Six hundred consecutive colonoscopy reports from a single endoscopist were reviewed to determine prevalence and location of diverticulosis and polyps. Additionally, pathology reports of 88 colon cancer resection specimens were reviewed for the presence of diverticulosis, and compared with expected prevalence of diverticulosis in that colonic region based on the collected colonoscopy data.
RESULTS
Overall, rates of detected polyps were comparable between patients with and without diverticulosis. However, analyzing the data by colonic segment containing diverticulosis, the prevalence of adenomatous polyps was reduced in regions of diverticulosis compared to the same colonic segment unaffected by diverticulosis (7 vs. 17% for rectosigmoid (p = 0.005); 5 vs. 18% for descending (p < 0.0001); and 17 vs. 27% for ascending colon (p = 0.0495)). Among colon cancer resection specimens, the prevalence of diverticulosis was significantly reduced in the rectosigmoid and ascending colon, compared with expected rates of diverticulosis in those regions. (13 vs. 42% in rectosigmoid (p = 0.0006); 3 vs. 17% in ascending colon (p = 0.043)).
CONCLUSION
Despite similar overall frequency of polyps in patients with and without diverticulosis, polyps were significantly less likely in the colonic segment affected by diverticulosis. Additionally, the frequency of diverticulosis in areas of cancer in the rectosigmoid and ascending colon was significantly lower than expected compared with the expected frequency of diverticulosis for those colonic regions. These observations suggest a true negative association between colonic neoplasia and diverticulosis.
Topics: Biopsy; Colon; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Diverticulum; Female; Humans; Male; Middle Aged; Statistics as Topic; United States
PubMed: 28884385
DOI: 10.1007/s00384-017-2895-4 -
Radiology Case Reports May 2024A rare case of an ascending colon injury and ileal perforation in a 34-year-old male patient due to blunt abdominal trauma caused by a road traffic accident is reported...
A rare case of an ascending colon injury and ileal perforation in a 34-year-old male patient due to blunt abdominal trauma caused by a road traffic accident is reported in this study. This paper reports the clinical and imaging findings of seat belt syndrome. The seat belt syndrome primarily involves soft tissue injury; however, lacerations of the colon, small intestine, and mesentery have rarely been reported in the literature. However intestinal injuries, including bowel perforation and mesenteric injuries due to seat belt syndrome, must not be underestimated because they usually require emergency laparotomy because of accompanying peritonitis and hemorrhaging, and can be lethal if left untreated. Therefore, when an ascending mesocolon hematoma and free gas in the peritoneal cavity are present, gastrointestinal perforation due to seat belt syndrome should be suspected. In this case, gastrointestinal perforation was suspected based on the computed tomography findings, and emergency surgery was performed; the patient's course was uneventful without any postoperative complications. Early diagnosis and management are essential to prevent associated morbidity and mortality.
PubMed: 38390424
DOI: 10.1016/j.radcr.2024.01.090 -
Gan To Kagaku Ryoho. Cancer &... Oct 2023A 78-year-old male was diagnosed with a primary gastric B-cell malignant lymphoma and metastatic lung tumor 10 years ago. He underwent chemotherapy at another hospital,...
A 78-year-old male was diagnosed with a primary gastric B-cell malignant lymphoma and metastatic lung tumor 10 years ago. He underwent chemotherapy at another hospital, achieved complete remission, and was actively undergoing follow- up. He presented to our hospital with a 1-month history of a bulge in his right lower abdomen. CT revealed thickening of the ascending colon and dilatation of the oral intestine. He was diagnosed with ascending colon cancer and underwent right hemicolectomy. The subsequent pathological examination revealed a collision tumor involving diffuse, large B-cell lymphoma and well-differentiated adenocarcinoma. He was discharged from our hospital and received chemotherapy at another institution. Unfortunately, the patient died of interstitial pneumonia 31 months postoperatively. This report describes the resection of a collision tumor involving ascending colon cancer and malignant lymphoma. Surgical treatment combined with postoperative chemotherapy improved this patient's long-term survival.
Topics: Male; Humans; Aged; Colon, Ascending; Colonic Neoplasms; Lymphoma, Large B-Cell, Diffuse; Adenocarcinoma
PubMed: 38035839
DOI: No ID Found -
Clinical and Translational... Jan 2020Primary sclerosing cholangitis (PSC) is a cholestatic liver disorder that is frequently associated with ulcerative colitis (UC). Patients with PSC and UC (PSC-UC) have a...
INTRODUCTION
Primary sclerosing cholangitis (PSC) is a cholestatic liver disorder that is frequently associated with ulcerative colitis (UC). Patients with PSC and UC (PSC-UC) have a higher risk of colorectal neoplasia compared with patients with UC. The oncogenic properties of microRNA-346 (miR-346) have been recently reported. We investigated the expression of miR-346 and its 2 target genes, the receptor of vitamin D (VDR), and the tumor necrosis factor-α (TNF-α), which are known to modulate carcinogenesis.
METHODS
Ascending and sigmoid colon biopsies were obtained from patients with PSC, PSC and UC (PSC-UC), UC, and healthy controls (n = 10 in each group). Expressions of VDR, TNF-α, 18S RNA, p27, miR-346, and reference microRNA, miR-191, were evaluated by real-time PCR using human TaqMan Gene Expression and TaqMan MicroRNA Assays. Functional studies with miR-346 mimic and inhibitor were conducted in HepG2 and Caco-2 cells. The effect of ursodeoxycholic acid on miR-346 expression was examined in Caco-2 cells.
RESULTS
An increased expression of miR-346 in the ascending colon of PSC-UC was observed (P < 0.001 vs all groups). In patients with UC, an exceptionally low colonic expression of miRNA-346 was accompanied by the extensive upregulation of VDR and TNF-α genes. A functional in vitro analysis demonstrated that inhibition of miR-346 resulted in the upregulation of VDR and TNF-α, whereas the induction of miR-346 activity suppressed VDR, TNF-α, and p27.
DISCUSSION
The upregulation of miRNA-346 in the colon of patients with PSC may be responsible for the disturbance of VDR and TNF-α signaling pathway, which could result in an inadequate suppression of neoplasia.
Topics: Adult; Caco-2 Cells; Case-Control Studies; Cholagogues and Choleretics; Cholangitis, Sclerosing; Colitis, Ulcerative; Colon; Colon, Ascending; Colon, Sigmoid; Colorectal Neoplasms; Cyclin-Dependent Kinase Inhibitor p27; Female; Gene Expression Regulation; Hep G2 Cells; Humans; Male; MicroRNAs; Middle Aged; RNA, Ribosomal, 18S; Receptors, Calcitriol; Tumor Necrosis Factor-alpha; Up-Regulation; Ursodeoxycholic Acid; Young Adult
PubMed: 31972611
DOI: 10.14309/ctg.0000000000000112 -
Medicine Dec 2022Gastric metastases (GMs) are rare and often accompanied with synchronous metastases of other organs. Synchronous isolated GMs from ascending colon carcinoma are uncommon...
BACKGROUND
Gastric metastases (GMs) are rare and often accompanied with synchronous metastases of other organs. Synchronous isolated GMs from ascending colon carcinoma are uncommon and rarely studied. GMs may be confused with primary gastric tumors.
METHODS
A 45-year-old man presented to our hospital with abdominal distensionand anal pendant expansion. The abdominal physical examination was negative. The positive fecal occult blood test and the negative tumor marker were obtained. Colonoscopy and gastroduodenoscopy revealed a polypoidal lesion in the ascending colon and a polypoid mass in the gastric body, respectively. CT showed the thickened wall of ascending colon and polypoid mass in the gastric body with homogenous enhancement. Additionally, synchronous gastric metastases from the ascending colon carcinoma were confirmed by pathology after laparoscopic right hemicolectomy and partial gastrectomy. After 13 individual doses of fluorouracil (2.8 g/time), calcium leucovorin (0.8 g/time), and oxaliplatin (85 mg/time), the patient was discharged without any discomfort, without any additional metastases detected during the following 18 months.1.
RESULTS
A rare case of synchronous isolated gastric metastasis from ascending colon carcinoma was confirmed by computed tomography (CT) and pathological diagnosis.
CONCLUSION
GM may appear as a polypoid lesion. Surgery combined with chemotherapy may improve the prognosis in patients with synchronous isolated GM.
Topics: Male; Humans; Middle Aged; Colon, Ascending; Antineoplastic Combined Chemotherapy Protocols; Colonic Neoplasms; Stomach; Carcinoma
PubMed: 36595810
DOI: 10.1097/MD.0000000000032476 -
Digestive Diseases and Sciences Jul 2016Low adenoma detection rate (ADR) predicts development of interval cancers, found mainly in the right (cecum-ascending) colon, where poor bowel preparation is an...
BACKGROUND
Low adenoma detection rate (ADR) predicts development of interval cancers, found mainly in the right (cecum-ascending) colon, where poor bowel preparation is an associated factor. Single-site studies reported increased detection of adenomas in the proximal colon segments by water exchange (WE). Data about colon cleansing revealed that WE had the greatest impact in the right colon.
AIMS
To test the hypothesis that WE had the greatest impact on ADR in colon segments with the most favorable bowel cleanliness scores, namely the right colon.
METHODS
We pooled right colon and overall ADR data of three similarly designed colonoscopy trials that compared WE, water immersion (WI) and insufflation of air or carbon dioxide (AICD) in a mixed gender European population.
RESULTS
In this study, 1200 (704 males) subjects and were included. 288 were screening cases. Demographic and procedural data were comparable. Water exchange achieved significantly higher right colon <10 mm ADR (11.9 %, vs WI 6.9 %, p = 0.016; vs AICD 7.2 %, p = 0.025). Water exchange achieved the lowest proportions of poor bowel preparation and the highest right colon and overall Boston bowel preparation scale scores (p range 0.003, <0.0005). In patients with right colon excellent bowel cleanliness, water exchange was the only method significantly associated with right colon adenoma detection. One of the limitations is unblinded colonoscopists.
CONCLUSIONS
In a mixed gender European population, water exchange is confirmed to be a superior insertion technique showing a significant increase in <10 mm right colon adenoma detection, achieving the cleanest colon and lowest proportions of poor bowel preparation requiring repeat procedures. CLINICALTRIALS.
GOV NO
NCT01781650, 01954862, 01780818.
Topics: Adenoma; Aged; Colon, Ascending; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Middle Aged
PubMed: 26846118
DOI: 10.1007/s10620-016-4053-1 -
Gastrointestinal Endoscopy Sep 2021Now that the debate about the safety and effectiveness of laparoscopic versus open surgery is over, attention has turned to innovations that can verify whether...
Propensity score-matched comparison between totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction and conventional laparoscopic surgery with mini-laparotomy in the treatment of ascending colon cancer (with video).
BACKGROUND AND AIMS
Now that the debate about the safety and effectiveness of laparoscopic versus open surgery is over, attention has turned to innovations that can verify whether minimizing the impact of laparoscopy on the abdominal wall can further reduce pain, improve patient comfort, lead to superior cosmesis, and reduce morbidity. The aim of this study was to further explore the application value of totally laparoscopic right hemicolectomy with transcolonic natural orifice specimen extraction (NOSE) and to evaluate the short-term efficacy of transcolonic NOSE surgery for resecting specimens of ascending colon cancer.
METHODS
From January 2016 to May 2017, a retrospective study was conducted in Guangxi. Propensity score matching was used to minimize the bias from nonrandomized treatment assignment. Patients were followed up through May 2020.
RESULTS
Forty-nine patients underwent totally laparoscopic right hemicolectomy with transcolonic NOSE and 116 patients laparoscopic right hemicolectomy with mini-laparotomy (ML) procedures at our institution. After propensity score matching, each group included 45 patients, and all covariate imbalances were alleviated. The transcolonic NOSE group and the ML group did not differ significantly in terms of baseline clinical characteristics. The transcolonic NOSE group was associated with a shorter time to first flatus (NOSE vs ML: 1.8 ± .5 vs 3.2 ± .8, P = .032), a shorter length of hospital stay (11.3 ± 2.5 days vs 13.0 ± 3.1 days, P = .034), a shorter time to first liquid intake (2.6 ± .8 vs 3.8 ± .9, P = .068), less pain (1.8 ± .8 vs 4.2 ± .7, P = .013), less analgesia requirement (6 [13.3%] vs 21 [46.7%], P = .001), and lower C-reactive protein levels on postoperative day 1 (3.6 ± 1.7 vs 8.2 ± 2.2, P = .001) and postoperative day 3 (NOSE 2.4 ± 1.4 vs M: 4.6 ± 1.7 [P = .013]) than the ML group. The median follow-up was 28.4 months (interquartile range, 18.0-36.0). The 3-year overall survival rates were similar between the transcolonic NOSE group and the ML group.
CONCLUSIONS
In total, laparoscopic right hemicolectomy with transcolonic specimen extraction appears to be safe for selected patients with ascending colon cancer as a minimally invasive surgery.
Topics: China; Colectomy; Colon, Ascending; Colonic Neoplasms; Humans; Laparoscopy; Laparotomy; Length of Stay; Propensity Score; Retrospective Studies; Treatment Outcome
PubMed: 33798538
DOI: 10.1016/j.gie.2021.03.028 -
Techniques in Coloproctology Dec 2017Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular... (Review)
Review
BACKGROUND
Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular tie and adherence to embryonic planes during dissection, supported by preoperative scanning to accurately define the tumour lymphovascular supply and drainage. The authors support and recommend precision oncosurgery based on these principles, with an emphasis on the importance of understanding the vascular anatomy. However, the anatomical variability of the right colic artery (RCA) has resulted in significant discord in the literature regarding its precise arrangement.
METHODS
We systematically reviewed the literature on the incidence of the different origins of the RCA in cadaveric studies. An electronic search was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations up to October 2016 using the MESH terms 'right colic artery' and 'anatomy' (PROSPERO registration number CRD42016041578).
RESULTS
Ten studies involving 1073 cadavers were identified as suitable for analysis from 211 articles retrieved. The weighted mean incidence with which the right colic artery arose from other parent vessels was calculated at 36.8% for the superior mesenteric artery, 31.9% for the ileocolic artery, 27.7% for the root of the middle colic artery and 2.5% for the right branch of the middle colic artery. In 1.1% of individuals the RCA shared a trunk with the middle colic and ileocolic arteries. The weighted mean incidence of 2 RCAs was 7.0%, and in 8.9% of cadavers the RCA was absent.
CONCLUSIONS
This anatomical information will add to the technical nuances of precision oncosurgery in right-sided colon resections.
Topics: Arteries; Cadaver; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Humans
PubMed: 29196959
DOI: 10.1007/s10151-017-1717-6 -
Medical Archives (Sarajevo, Bosnia and... Dec 2019Colorectal cancer is the third most common cancer in the male and female population. Surgical treatment of colorectal cancer is based on tumor resection and removal of...
INTRODUCTION
Colorectal cancer is the third most common cancer in the male and female population. Surgical treatment of colorectal cancer is based on tumor resection and removal of associated lymph glands.
AIM
The aim of the paper is to present data from a five-year retrospective study of the surgical treatment of colorectal cancer at the Clinic for General and Abdominal Surgery at the Clinical Center of the University of Sarajevo.
METHODS
This is a retrospective five-year clinical trial (2014-2018) of patients with and surgically treated for colorectal cancer at the Clinic for General and Abdominal Surgery at the Clinical Center of Sarajevo University.
RESULTS
In the 2014-2018 period, n = 11 172 patients were hospitalized at the Clinic, of which n = 732 were surgically treated for colorectal cancer. 69.80% were operated in an elective program. 30.20% were made as emergencies. 51.09% were male patients and 48.36% were female patients. 97.20% were made by open technique. 2.10% operated by minimally invasive procedure. the most common type of colon tumor is Adenocarcinomas are the most common with 79%.
CONCLUSIONS
Better prevention and early detection are required to reduce the incidence of patients, which ultimately leads to more effective treatment and longer survival of colon cancer patients. Operative surgical principles must be adapted to modern trends, minimally invasive procedures (laparoscopic surgery, robotic surgery).
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Bosnia and Herzegovina; Colon, Ascending; Colorectal Neoplasms; Conversion to Open Surgery; Elective Surgical Procedures; Emergencies; Female; Humans; Laparoscopy; Laparotomy; Length of Stay; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Grading; Neoplasm Staging; Rectal Neoplasms; Retrospective Studies; Sigmoid Neoplasms
PubMed: 32082011
DOI: 10.5455/medarh.2019.73.412-414 -
Gut Jul 2019To determine if human colonic neuromuscular functions decline with increasing age.
OBJECTIVE
To determine if human colonic neuromuscular functions decline with increasing age.
DESIGN
Looking for non-specific changes in neuromuscular function, a standard burst of electrical field stimulation (EFS) was used to evoke neuronally mediated (cholinergic/nitrergic) contractions/relaxations in muscle strips of human ascending and descending colon, aged 35-91 years (macroscopically normal tissue; 239 patients undergoing cancer resection). Then, to understand mechanisms of change, numbers and phenotype of myenteric neurons (30 306 neurons stained with different markers), densities of intramuscular nerve fibres (51 patients in total) and pathways involved in functional changes were systematically investigated (by immunohistochemistry and use of pharmacological tools) in elderly (≥70 years) and adult (35-60 years) groups.
RESULTS
With increasing age, EFS was more likely to evoke muscle relaxation in ascending colon instead of contraction (linear regression: n=109, slope 0.49%±0.21%/year, 95% CI), generally uninfluenced by comorbidity or use of medications. Similar changes were absent in descending colon. In the elderly, overall numbers of myenteric and neuronal nitric oxide synthase-immunoreactive neurons and intramuscular nerve densities were unchanged in ascending and descending colon, compared with adults. In elderly ascending, not descending, colon numbers of cell bodies exhibiting choline acetyltransferase immunoreactivity increased compared with adults (5.0±0.6 vs 2.4±0.3 neurons/mm myenteric plexus, p=0.04). Cholinergically mediated contractions were smaller in elderly ascending colon compared with adults (2.1±0.4 and 4.1±1.1 g-tension/g-tissue during EFS; n=25/14; p=0.04); there were no changes in nitrergic function or in ability of the muscle to contract/relax. Similar changes were absent in descending colon.
CONCLUSION
In ascending not descending colon, ageing impairs cholinergic function.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Colon, Ascending; Colon, Descending; Electric Stimulation; Female; Humans; Male; Middle Aged; Muscle Contraction; Nerve Fibers; Neural Pathways; Neuromuscular Junction; Tissue Culture Techniques
PubMed: 30228216
DOI: 10.1136/gutjnl-2018-316279