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Case Reports in Gastroenterology 2019Here, we report a very rare case of melanocytic nevus of the colon. A 54-year-old woman with an unremarkable medical history visited our hospital for screening...
Here, we report a very rare case of melanocytic nevus of the colon. A 54-year-old woman with an unremarkable medical history visited our hospital for screening colonoscopy. Colonoscopy revealed a pigmented flat lesion in the ascending colon. Histological evaluation of a biopsy specimen revealed proliferation of pigmented cells in the lamina muscularis propria. On immunohistochemical analysis, pigmented cells were positive for S-100 protein and Melan-A expression, and a diagnosis of colonic melanocytic nevus was made. Although the pathogenesis underlying colonic melanocytic nevi remains unclear, we speculate that colonic melanocytic nevi develop via abnormal migration or differentiation of neural crest cells during embryogenesis.
PubMed: 31341458
DOI: 10.1159/000501196 -
International Journal of Surgery Case... Jun 2022We experienced a rare case of right-sided large bowl obstruction (LBO) of the colon caused by chronic diverticulitis, which was challenging to diagnose.
INTRODUCTION
We experienced a rare case of right-sided large bowl obstruction (LBO) of the colon caused by chronic diverticulitis, which was challenging to diagnose.
PRESENTATION OF CASE
A young male was admitted to our department with a fever, diarrhea, and right-sided lateral abdominal pain for several days. CT showed a thickened ascending colon wall with stenosis and adjacent retroperitoneal inflammation without marked diverticula. The next day, he developed severe abdominal pain, and perforation was suspected. We chose the "interval definitive surgery"; at that time, intestinal decompression and laparoscopic drainage. Colonoscopy showed an edematous membrane, but no cancerous lesions or diverticula. Hemi-colectomy was performed after 10 days' nutritional therapy. No postoperative complication occurred. The histopathology showed that the pathogenesis was chronic diverticulitis.
DISCUSSION
There have been few reported cases of right-sided LBO caused by diverticulitis, but it is important to be aware that benign disease, such as chronic diverticulitis, can cause LBO. Initial conservative therapy and nutritional therapy produced a correct diagnosis and good outcomes.
CONCLUSION
Performing "interval surgery" allowed us to make an accurate diagnosis and may help to prevent surgical complications in rare cases of right-sided LBO due to diverticulitis.
PubMed: 35576753
DOI: 10.1016/j.ijscr.2022.107184 -
Pediatric Gastroenterology, Hepatology... Mar 2021Although ultrasonography is the gold standard of diagnosing intussusception, plain abdomen radiograph (AXR) is often used to make differential diagnosis for pediatric...
PURPOSE
Although ultrasonography is the gold standard of diagnosing intussusception, plain abdomen radiograph (AXR) is often used to make differential diagnosis for pediatric patients with abdominal pain. In intussusception patients, we aimed to analyze the AXR and clinical data to determine the characteristics of early AXR findings associated with diagnosis of intussusception and recurrence after reduction.
METHODS
Between January 2011 and June 2018, 446 patients diagnosed with intussusception based on International Classification of Diseases-10 code of K56.1 were admitted. We retrospectively reviewed medical records of 398 patients who received air reduction; 51 of them have recurred after initial reduction. We evaluated six AXR features including absent ascending colon gas, absent transverse colon gas, target sign, meniscus sign, mass, and ileus. Clinical data and AXR features were compared between single episode and recurrence groups.
RESULTS
Two groups did not show significant differences regarding clinical data. Mean time to recurrence from air reduction was 3.4±3.2 days. Absent ascending colon gas (63.9%) was the most common feature in intussusception, followed by mass (29.1%). All of six AXR features were observed more frequently in the recurrence group. Absent transverse colon gas was the most closely associated AXR finding for recurrence (odds ratio, 2.964; 95% confidence interval, 1.327-6.618; =0.008).
CONCLUSION
In our study, absence of ascending colon gas was the most frequently seen AXR factor in intussusception patients. Extended and careful observation after reduction may be beneficial if such finding on AXR is found in intussusception patients.
PubMed: 33833969
DOI: 10.5223/pghn.2021.24.2.135 -
ACG Case Reports Journal Mar 2019Esophageal cancer is an aggressive and highly lethal malignancy that has a high death-to-incidence ratio approaching 0.90. We present a 60-year-old man with a history of...
Esophageal cancer is an aggressive and highly lethal malignancy that has a high death-to-incidence ratio approaching 0.90. We present a 60-year-old man with a history of Barrett's esophagus, presented with dysphagia. An upper endoscopy with biopsy confirmed invasive esophageal adenocarcinoma (EAC). Workup, including positron emission tomography scan, showed no evidence of metastasis. A preoperative colonoscopy showed a nodule in the ascending colon that was proven later to be a metastatic lesion from the esophageal primary tumor. Esophageal adenocarcinoma with an isolated colonic metastasis is an extremely rare presentation of esophageal metastasis. These metastatic lesions may not be detected by the positron emission tomography scan.
PubMed: 31620502
DOI: 10.14309/crj.0000000000000043 -
Journal of Surgical Case Reports Sep 2020Herniation through the foramen of Winslow is rare, with a non-specific clinical presentation and his diagnosis may be difficult. A 44-year-old female was admitted with...
Herniation through the foramen of Winslow is rare, with a non-specific clinical presentation and his diagnosis may be difficult. A 44-year-old female was admitted with an acute epigastric abdominal pain. A computed tomography showed an internal hernia of the colon in the lesser sac. Laparoscopic reduction of the herniated contents and the fixation of the ascending colon with several non-absorbable sutures were performed. Twenty months after surgery, the patient has not experienced any recurrence. Computed tomography helps practitioners to the preoperative diagnosis of herniation through the foramen of Winslow, to the viability of the herniated contents and presence of occlusion. In case of herniation through the foramen of Winslow favored by a mobile ascending colon with a misapposition of the right Told fascia, the fixation of the colon with a non-absorbable suture was safe and may prevent the risk of recurrent internal hernia and colonic volvulus.
PubMed: 32922726
DOI: 10.1093/jscr/rjaa283 -
Daru : Journal of Faculty of Pharmacy,... Jun 2022Sofosbuvir, a nucleotide antiviral drug, is a Biopharmaceutics Classification System (BCS) class III prodrug suffering from limited intestinal absorption due to its high...
PURPOSE
Sofosbuvir, a nucleotide antiviral drug, is a Biopharmaceutics Classification System (BCS) class III prodrug suffering from limited intestinal absorption due to its high hydrophilicity and low intestinal permeability. This research aims to investigate the luminal stability of Sofosbuvir, the influence of anatomical site on its intestinal absorption and the effects of verapamil on such absorption.
METHOD
The study utilized in situ rabbit intestinal perfusion technique to examine absorption of Sofosbuvir from duodenum, jejunum, ileum and ascending colon. This was conducted both with and without verapamil.
RESULTS
The luminal stability study showed that Sofosbuvir was subjected to premature degradation with varying fractions degraded from the different intestinal segments. The in situ perfusion data showed incomplete absorption of Sofosbuvir from small and large intestinal segments. The recorded values of the absorptive clearance per unit length (Pe.A/L) of Sofosbuvir were 0.026, 0.0075, 0.0026, & 0.054 ml/min.cm for duodenum, jejunum, ileum, and ascending colon, respectively. The Pe.A/L values were ordered as colon > duodenum > jejunum > ileum. This is the opposite rank of P-gp content in the different intestinal segments. The recorded values of the length required for complete Sofosbuvir absorption (L95%) were 29.58, 128.47, 949.2 and, 13.63 cm for duodenum, jejunum, ileum, and ascending colon, respectively. Co-perfusion with verapamil significantly increased Pe.A/L and reduced the L95% of Sofosbuvir from both jejunum and ileum (P-value < 0.05).
CONCLUSION
The results indicated that the absorptive clearance of Sofosbuvir was site dependent and associated with the content of P-glycoprotein, in addition to the expected drug interactions that can occur in polymedicated hepatitis C virus (HCV) infected patients.
Topics: Animals; Humans; Intestinal Absorption; Intestines; Jejunum; Rabbits; Sofosbuvir; Verapamil
PubMed: 35023081
DOI: 10.1007/s40199-021-00429-1 -
Veterinary Radiology & Ultrasound : the... 2015Objectives of this prospective study were to describe effects of varying technical components that may contribute to an optimal protocol for computed tomographic...
Objectives of this prospective study were to describe effects of varying technical components that may contribute to an optimal protocol for computed tomographic pneumocolonography (CTP) in dogs, and to develop a standardized methodology for CTP as a future potential diagnostic tool in canine clinical patients with large bowel disease. Eight purpose-bred intact male hound cross-research dogs were enrolled and randomized to groups based on variables of pressure/body position (n = 4) and insufflation time (n = 4). For each segment of large bowel (rectum, colorectal junction, descending colon, transverse colon, ascending colon), the adequacy of bowel preparation, % of bowel lumen filled with fecal material, and bowel tortuosity or folding were assessed. Measurements of bowel wall thickness (cm), cross-sectional bowel lumen diameter (cm), and cross-sectional bowel luminal area (cm(2) ) were obtained at standardized locations within the large bowel. False discovery rates (FDR) were calculated to adjust for multiple testing. Values of FDR < 0.05 were considered significant. Differences in mean cross-sectional area and diameter and bowel wall thickness under increasing pressure were not significant after adjusting for multiple testing; some had raw p values <0.05. Ascending colon diameter and ascending colon area significantly increased with insufflation time (FDR < 0.05). No other response variables showed a significant change with insufflation time. The optimal insufflation pressure for maintaining pneumocolon in this study was determined to be 20 mmHg. CTP is a feasible technique to provide consistent distension for imaging of the large bowel and further study on application of CTP in clinical patients is warranted.
Topics: Animals; Colon; Colonography, Computed Tomographic; Cross-Over Studies; Dogs; Insufflation; Male; Prospective Studies; Random Allocation; Ultrasonography
PubMed: 25545308
DOI: 10.1111/vru.12235 -
Surgical Case Reports Feb 2019Non-occlusive mesenteric ischemia (NOMI) is a rare and severe pathological condition that can cause intestinal necrosis without mechanical obstruction of the mesenteric...
BACKGROUND
Non-occlusive mesenteric ischemia (NOMI) is a rare and severe pathological condition that can cause intestinal necrosis without mechanical obstruction of the mesenteric artery. NOMI often develops during the treatment of severe disease in elderly patients and mostly occurs in the intestine supplied by the superior mesenteric artery (SMA). We experienced a 12-year-old patient with NOMI that was segmentally localized in the ascending colon and rectum during encephalitis treatment.
CASE PRESENTATION
A 12-year-old boy was hospitalized with limbic encephalitis. On day 41 after admission, he abruptly developed hypotension following diarrhea and fever, and presented abdominal distension. A computed tomography scan revealed pneumatosis intestinalis localized in the ascending colon and rectum coexisting with portal venous gas. The presence of peritoneal signs required an emergency laparotomy. Intraoperatively, skip ischemic lesions were found in the ascending colon and the rectum without bowel perforation. SMA and superior rectal arterial pulsation were present, and the patient was diagnosed with NOMI. The remaining colon, from the transverse to the sigmoid colon, appeared intact. We performed a distal ileostomy without bowel resection. Postoperative colonoscopies were carried out and revealed rectal and ascending colon stenosis with ulceration but demonstrated the patency of the two lesions. We confirmed the improvement of the transient bowel strictures; therefore, the ileal stoma was closed 14 months after the previous laparotomy.
CONCLUSION
NOMI can be present in childhood during encephalitis treatment and can be segmentally localized in the ascending colon and the rectum. Although NOMI is most often seen in elderly patients, we should also consider the possibility of NOMI when pediatric patients with severe illness manifest abdominal symptoms.
PubMed: 30771025
DOI: 10.1186/s40792-019-0592-y -
International Cancer Conference Journal Jul 2020A 75-year-old woman was diagnosed with anemia during hospitalization for the treatment of right superior ophthalmic arteriovenous fistula. Colonoscopy revealed an entire...
A 75-year-old woman was diagnosed with anemia during hospitalization for the treatment of right superior ophthalmic arteriovenous fistula. Colonoscopy revealed an entire circumference of type 2 tumor in the ascending colon. Computed tomography showed ascending colon wall thickening, a tumor with a maximum diameter of 32 mm on the right external iliac artery and multiple low-density nodules in the spleen. We performed right hemicolectomy with D3 lymph node dissection, splenectomy and right external iliac lymph node dissection. Histopathological finding revealed moderately-differentiated adenocarcinoma in ascending colon and right external iliac lymph node. The lesion of spleen was diagnosed as splenic lymphangioma. The patient was discharged on postoperative day 18. Additional treatments, including chemotherapy, were not performed, and no recurrences were seen up to 66 months after surgery. We herein report an uncommon event of ascending colon cancer with synchronous right external iliac lymph node metastasis, which was successfully treated by surgical resection, made feasible when the distant lymph node metastasis is localized.
PubMed: 32582524
DOI: 10.1007/s13691-020-00419-1 -
PloS One 2024Recent magnetic resonance imaging (MRI) studies showed that colonic volumes in children are different between health and functional constipation. The length of the colon...
Recent magnetic resonance imaging (MRI) studies showed that colonic volumes in children are different between health and functional constipation. The length of the colon has however been rarely measured and principally using unphysiological colon preparations or cadaver studies. The main objective of this study was to measure the length of the undisturbed colon in children with functional constipation (FC) and healthy controls. Here, the colon of 19 healthy controls (10-18 years old) and 16 children with FC (7-18 years old) was imaged using MRI. Different regions of the colon (ascending, transverse, descending, and sigmoid-rectum) were first segmented manually on the MRI images. Three-dimensional skeletonization image analysis methods were then used to reduce the regions of interest to a central, measurable line. Total colon length (corrected for body surface area) in healthy controls was 56±2 cm/m2 (mean±SEM). Total colon length was significantly longer in children with FC 69±3 cm/m2 compared to controls (p = 0.0037). The colon regions showing the largest differences between groups were the ascending colon (p = 0.0479) and the sigmoid-rectum (p = 0.0003). In a linear regression model, there was a positive significant correlation between total colon length and age (R = 0.45, p = 0.0064), height (R = 0.49, p = 0.0031), weight (R = 0.46, p = 0.0059) and colon volume (R = 0.4543, p = 0.0061). Our findings showed significant differences in colon lengths between healthy controls and children with constipation. A new objective diagnostic imaging endpoint such as colon length may help to improve knowledge of colon morphology and function and, in turn, understanding of colon functional pathology.
Topics: Humans; Child; Adolescent; Colon; Constipation; Colon, Sigmoid; Rectum; Magnetic Resonance Imaging
PubMed: 38165858
DOI: 10.1371/journal.pone.0296311