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World Journal of Clinical Cases Jun 2022A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery. Here, we...
BACKGROUND
A right-sided sigmoid colon is an extremely rare anatomic variation that should be considered as a possibility by surgeons and radiologists before surgery. Here, we report the first clinical case of a carcinoma in a right-sided sigmoid colon revealed by a preoperative computed tomography (CT).
CASE SUMMARY
A 56-year-old Chinese man was admitted to the hospital with abdominal pain. CT revealed a redundant sigmoid colon with a mass on the right side of the cecum and ascending colon. Laparoscopy confirmed an abnormal course in the descending colon and sigmoid colon. Subsequently, hemicolectomy was performed in an open manner after laparoscopic exploration. Pathological examination revealed an infiltrative mucinous adenocarcinoma with two lymph node metastases. The patient was discharged without any complications after a week. There were no signs of recurrence or metastasis during the 3-month follow-up period.
CONCLUSION
We report a rare anomaly of a right-sided sigmoid colon with carcinoma, which should be differentiated from ascending colon cancer and pericecal hernia to prevent errors and other surgical complications.
PubMed: 35949839
DOI: 10.12998/wjcc.v10.i18.6136 -
Clinical Experience of Diagnosis and Surgical Treatment of 6 Cases of Acute Subhepatic Appendicitis.Journal of Healthcare Engineering 2022To summarize the experience of diagnosis and surgical treatment of 6 cases of acute subhepatic appendicitis. The clinical data of 6 patients with subacute appendicitis...
To summarize the experience of diagnosis and surgical treatment of 6 cases of acute subhepatic appendicitis. The clinical data of 6 patients with subacute appendicitis in Zhejiang Provincial People's Hospital from July 2018 to December 2019 were analyzed retrospectively. . There were 5 males and 1 female. All 6 cases were diagnosed as appendicitis by abdominal CT before operation. All patients underwent laparoscopic appendectomy without conversion to laparotomy. One case of ectopic appendix was located under the liver with absence of ascending colon, one case of ectopic appendix was located under the liver with ectopic ascending colon of transverse colon, one case of appendix head was located in the liver cyst, and the resection of liver cyst was performed at the same time, and three cases of retrocolonic appendix head were located under the liver. Postoperative pathology confirmed appendicitis. For patients with right upper abdominal pain and tenderness, the possibility of subhepatic appendicitis should be considered before operation. Emergency abdominal CT has more advantages than ultrasound. Laparoscopy can not only make a definite diagnosis but also perform appendectomy at the same time.
Topics: Abdominal Pain; Appendectomy; Appendicitis; Cysts; Female; Humans; Laparoscopy; Male; Retrospective Studies
PubMed: 35469233
DOI: 10.1155/2022/4969774 -
Journal of the Formosan Medical... Mar 2018Interval colorectal cancer (CRC) is an emerging issue in CRC screening and surveillance. The frequency of interval CRC and its associated factors have not been well...
BACKGROUND/PURPOSE
Interval colorectal cancer (CRC) is an emerging issue in CRC screening and surveillance. The frequency of interval CRC and its associated factors have not been well studied in Eastern Asia. We aim to clarify the factors associated with interval CRC.
METHODS
CRC patients who had negative colonoscopy results 6-36 months prior to cancer diagnosis were defined as cases of interval CRC. Patient characteristics, past history, colon preparation, colonoscopy findings, and pathology were retrospectively evaluated. A total of 670 patients with colorectal adenocarcinoma by pathology who also underwent colonoscopy before diagnosis from January 2005 to November 2014 were recruited.
RESULTS
Twenty-two (3.28%) patients (65.7 ± 9.2 years old; 9 male) were diagnosed with interval CRC. The interval CRCs were predominantly located at the rectum and cecum, and presented as earlier stage cancers (Stage I and Stage II: 86.4%, Stage III and Stage IV: 13.6%). Factors associated with interval cancer include end-stage renal disease (ESRD) (hazard ratio: 10.494, 95% confidence interval: 2.131-51.681) and shorter ascending colon withdrawal time (interval cancer: noninterval cancer 2.00±0.82: 4.91±3.74 minutes; hazard ratio: 0.561, 95% confidence interval: 0.345-0.913). Prior polypectomy and tumor size also tended to be related to interval CRC.
CONCLUSION
The prevalence of interval CRC in the present study is 3.28%. Comorbidity with ESRD and shorter ascending colon withdrawal time could be factors associated with interval CRC. Good colon preparation for the patients with ESRD and more ascending colon withdrawal time could reduce the interval CRC.
Topics: Adenocarcinoma; Aged; Colorectal Neoplasms; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Neoplasm Staging; Retrospective Studies; Taiwan
PubMed: 28420554
DOI: 10.1016/j.jfma.2017.03.012 -
CEN Case Reports Feb 2021Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis,...
Peritoneal dialysis (PD)-related peritonitis is a common complication of PD. Nonocclusive mesenteric ischemia (NOMI) is a rare complication of PD-related peritonitis, has a high mortality rate, and therefore should be detected early once it occurs. We describe a case of a 70-year-old woman on PD presented with moderate abdominal pain and low blood pressure, which contributed to the early diagnosis of PD-related peritonitis complicated with NOMI. Increased white cell count of 7150/μL (neutrophil, 84%) in dialysate effluent was diagnostic of PD-related peritonitis, which was later found to be caused by Pseudomonas putida. Computed tomography with contrast performed after administering crystalloids revealed hepatic portal venous gas, pneumatosis intestinalis in the ascending colon, and normal enhancement of the bowel wall and mesenteric arteries, which suggested a reperfusion of the previously ischemic ascending colon. Colonoscopy on hospital day seventeen revealed mucosal hemorrhage and ulcers in the entire right colon and the terminal ileum while the remaining colon was normal. These findings are compatible with the consequence of NOMI. Increased peak systolic velocity of the superior mesenteric artery (SMA) implied its stenosis. Past studies show that ischemia of the colon in patients with chronic kidney disease commonly occurs in the right colon. Arteriosclerosis of the SMA due to the long history of chronic kidney disease and diabetes might have caused its vulnerability to low blood pressure. Abdominal complications including NOMI should be screened for when a patient presents with low blood pressure and strong abdominal pain. This is the first case report that shows colonoscopy images of the colonic ulcers post-NOMI and PD-related peritonitis.
Topics: Abdominal Pain; Administration, Intravenous; Aged; Anti-Bacterial Agents; Colon, Ascending; Colonoscopy; Constriction, Pathologic; Diabetic Nephropathies; Early Diagnosis; Female; Hemorrhage; Humans; Hypotension; Intestinal Mucosa; Ischemia; Kidney Failure, Chronic; Mesenteric Arteries; Mesenteric Artery, Superior; Mesenteric Ischemia; Peritoneal Dialysis; Peritonitis; Pseudomonas putida; Tomography, X-Ray Computed; Treatment Outcome; Ulcer
PubMed: 32865709
DOI: 10.1007/s13730-020-00522-5 -
Neurogastroenterology and Motility Oct 2022Gastrointestinal symptoms in functional gut disorders occur without any discernible structural gut abnormality. Preliminary observations on enteric MRI suggest possible...
BACKGROUND
Gastrointestinal symptoms in functional gut disorders occur without any discernible structural gut abnormality. Preliminary observations on enteric MRI suggest possible abnormal content and motility of the terminal ileum (TI) in constipation-predominant IBS (IBS-C) with severe bloating, and in functional bloating and distension (FABD) patients. We investigated whether MRI can quantify differences in small bowel (SB) content and motility between patients and healthy controls (HCs).
METHODS
11 IBS-C (mean age 40 [21-52] years; 10 women) and 7 FABD (36 [21-56]; all women) patients with bloating and 20 HCs (28 [22-48]; 6 women) underwent enteric MRI, including dynamic motility and anatomical sequences. Three texture analysis (TA) parameters assessed the homogeneity of the luminal content, with ratios calculated between the TI and (1) the SB and (2) the ascending colon. Four TI motility metrics were derived. Ascending colon diameter (ACD) was measured. A comparison between HCs and patients was performed independently for: (1) three TA parameters, (2) four TI motility metrics, and (3) ACD.
KEY RESULTS
Compared with HCs, patients had TI:colon ratios higher for TA contrast (p < 0.001), decreased TI motility (lower mean motility [p = 0.04], spatial motility variation [p = 0.03], and area of motile TI [p = 0.03]), and increased ACD (p = 0.001).
CONCLUSIONS AND INFERENCES
IBS-C and FABD patients show reduced TI motility and differences in luminal content compared with HCs. This potentially indicates reflux of colonic contents or delayed clearance of the TI, which alongside increased ACD may contribute to symptoms of constipation and bloating.
Topics: Adult; Constipation; Female; Flatulence; Gastrointestinal Diseases; Humans; Intestine, Small; Irritable Bowel Syndrome; Magnetic Resonance Imaging
PubMed: 35438218
DOI: 10.1111/nmo.14381 -
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 -
International Journal of Surgery Case... Jul 2023Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine...
INTRODUCTION AND IMPORTANCE
Intussusception is described as invagination of a segment of the bowel into the lumen of an adjacent segment. Although it is the most frequent cause of intestine obstruction during childhood, it is unusual in adulthood, where intussusception represents 1% of all intestine obstructions and 5 % of all intussusceptions.
CASE PRESENTATION
A 64-year-old female presented with a history of weight loss, intermittent diarrhea, and occasional transrectal bleeding. An abdominal computed tomography (CT scan) was performed showing a neoproliferative appearance and associated intussusception of the ascending colon. Colonoscopy revealed an ileocecal intussusception and a tumor on the ascending colon. Right hemicolectomy was performed. Histopathological findings were consistent with colon adenocarcinoma.
CLINICAL DISCUSSION
Adults have an organic lesion within the intussusception in up to 70 % of cases. The clinical presentation of intussusception can vary significantly between children and adults, who will often exhibit chronic nonspecific symptoms including nausea, changes in bowel habits, and gastrointestinal bleeding. The imaging diagnosis of intussusception is a difficult subject, the basis for the diagnosis is a high index of clinical suspicion and noninvasive techniques.
CONCLUSION
Intussusception is an extremely rare condition in adults, in this age group, the malignant entity is one of the main etiologies. Intussusception continues to be a rare entity and should be considered as a differential diagnosis of chronic abdominal pain and intestinal motility disorders; the treatment of choice continues to be surgical.
PubMed: 37413757
DOI: 10.1016/j.ijscr.2023.108439 -
International Medical Case Reports... 2023Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type...
INTRODUCTION
Intestinal knotting syndromes are rare causes of mechanical bowel obstruction, ileo-sigmoid knotting being the most common type. Ileocecal knotting is the rarest type among knot syndromes and there are few case reports across the world.
CASE PRESENTATION
We present a case of ileocecal knotting in a postpartum patient with abdominal distention, vomiting and failure to pass feces and flatus. Plain abdominal radiograph revealed dilated small bowel loops with multiple air fluid levels. Exploratory laparotomy was performed with intra-operative finding of ileocecal knotting with viable bowel, mobile cecum and ascending colon and gangrenous tip of appendix. We untied the knot and performed an appendectomy. Due to intra-operative instability of the patient's vital signs, right hemicolectomy was differed and cecum as well as ascending colon were fixed to right posterolateral abdominal wall.
CLINICAL DISCUSSION
Ileocecal knotting is a very rare finding, and few case reports have been published. The intra-operative findings of the mobile cecum and ascending colon are consistent with previous reports and it is a predisposing factor for knot besides low BMI and young age of our patient. Surgical management is dictated by intra-operative conditions such as viability of the bowel, intra-operative stability of the patient, extent of resection and length of the remaining bowel. Surgical options include en bloc resection of knot with gangrenous bowel and end to end anastomosis or end ileostomy with closure of distal end.
CONCLUSION
Ileocecal knotting should be considered as a differential diagnosis for patients presenting with intestinal obstruction with unusual radiographic findings. Early diagnosis and prompt surgical intervention prevents bowel infarction and enhance the prognosis. Preoperative abdominal CT scan is helpful in such cases with unusual radiographic findings.
PubMed: 38146343
DOI: 10.2147/IMCRJ.S448334 -
Clinical Gastroenterology and... Jul 2016Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for...
BACKGROUND & AIMS
Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for symptomatic and costly diverticular disease. We aimed to assess the number, location, and characteristics of colonic diverticula in a large US screening population.
METHODS
We analyzed data from a prospective study of 624 patients (mean age, 54 years) undergoing screening colonoscopy at the University of North Carolina Hospital from 2013 through 2015. The examination included a detailed assessment of colonic diverticula. To assess the association between participant characteristics and diverticula, we used logistic regression to estimate odds ratios and 95% confidence intervals.
RESULTS
Of our population, 260 patients (42%) had 1 or more diverticula (mean number, 14; range, 1-158). Participants with diverticula were more likely to be older, male, and have a higher body mass index than those without diverticula. The distribution of diverticula differed significantly by race. Among white persons, 75% of diverticula were in the sigmoid colon, 11% in the descending splenic flexure, 6% in the transverse colon, and 8% were in the ascending colon or hepatic flexure. In black persons 64% of diverticula were in the sigmoid colon, 8% in the descending colon or splenic flexure, 7% in the transverse colon, and 20% in the ascending colon or hepatic flexure (P = .0008). The proportion of patients with diverticula increased with age: 35% were 50 years or younger, 40% were 51-60 years, and 58% were older than 60 years. The proportion of patients with more than 10 diverticula increased with age: 8% were 50 years or younger, 15% were 51-60 years, and 30% were older than 60 years.
CONCLUSIONS
Older individuals not only have a higher prevalence of diverticula than younger individuals, but also a greater density, indicating that this is a progressive disease. Black persons have a greater percentage of their diverticula in the proximal colon and fewer in the distal colon compared with white persons. Understanding the distribution and determinants of diverticula is the first step in preventing diverticulosis and its complications.
Topics: Adult; Aged; Aged, 80 and over; Colonoscopy; Demography; Diverticulum, Colon; Early Detection of Cancer; Ethnicity; Female; Humans; Male; Middle Aged; North Carolina; Prevalence; Prospective Studies
PubMed: 26872402
DOI: 10.1016/j.cgh.2016.01.020 -
Surgical Case Reports Dec 2017Lymph node metastasis to the iliac or inguinal region of colon cancer is extremely rare. We experienced a case of ascending colon cancer with synchronous isolated right...
Ascending colon cancer with synchronous external iliac and inguinal lymph node metastases but without regional lymph node metastasis: a case report and brief literature review.
Lymph node metastasis to the iliac or inguinal region of colon cancer is extremely rare. We experienced a case of ascending colon cancer with synchronous isolated right external iliac and inguinal lymph node metastases but without any regional lymph node metastasis. An 83-year-old woman was admitted to our hospital due to anemia. Colonoscopy and computed tomography revealed an ascending colon cancer and also right external iliac and inguinal lymph node swelling. Further examination by F-deoxyglucose positron emission tomography strongly suggested that these lymph nodes were metastatic. Right hemicolectomy with lymph node dissection along the superior mesenteric artery, and right external iliac and inguinal lymph node dissection were performed. Histological examination revealed that both lymph nodes were metastasized from colon cancer, and there was no evidence of regional lymph node metastasis. The patient has shown no sign of recurrence at 27 months after surgery.
PubMed: 28220469
DOI: 10.1186/s40792-017-0309-z