-
Langenbeck's Archives of Surgery Jan 2024Persistent descending mesocolon (PDM) increases the difficulty and colonic ischemia in the surgery of colorectal cancer, but the preoperative diagnostic criteria have...
PURPOSE
Persistent descending mesocolon (PDM) increases the difficulty and colonic ischemia in the surgery of colorectal cancer, but the preoperative diagnostic criteria have not yet been clearly demonstrated. This study explored the MR imaging features and diagnostic criteria of PDM to improve the preoperative diagnostic rate.
METHODS
The clinical data of 54 patients with PDM and 270 patients without PDM who underwent rectal surgery at the Department of Colorectal Surgery, Fujian Medical University Union Hospital, from March 2018 to December 2022 were analyzed, retrospectively. The radiological parameters of PDM from MRI were analyzed.
RESULTS
On MRI T2WI axial image, the left edge of the abdominal aorta was defined as the reference line. The shortest vertical distance between the right edge of the descending colon and this line (dN) and the maximum transverse diameter of the peritoneal cavity (dA) at the same level and the maximum vertical distance between the right edge of the descending colon and this line (dW) were measured. There were significant statistical differences in dN, dW, dN/dW, and dN/dA between the PDM group and the non-PDM group. dN, dN/dW, and dN/dA have high diagnostic performance for the PDM. dN < 4.16 cm, dN/dW < 0.52, and dN/dA < 0.15 can all be used as clues to diagnose PDM.
CONCLUSIONS
We propose a feasible set of diagnostic criteria for PDM based on abdominal MRI, which can quickly and accurately diagnose PDM, and provide some reference for preoperative planning and surgical decision-making.
Topics: Humans; Mesocolon; Retrospective Studies; Laparoscopy; Rectal Neoplasms; Peritoneal Cavity
PubMed: 38233600
DOI: 10.1007/s00423-024-03235-w -
Chirurgie (Heidelberg, Germany) Nov 2023Epiploic appendagitis (AE) is a rare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis...
BACKGROUND
Epiploic appendagitis (AE) is a rare cause of acute abdomen and is often misdiagnosed as other common causes of acute abdomen, such as acute appendicitis, cholecystitis or diverticulitis due to its low incidence and its nonspecific clinical picture. This study presents the clinical course of AE and typical radiological features for an early and correct diagnosis in order to emphasize the importance of an early and correct diagnosis of AE.
METHODS
This is a retrospective review of 43 patients diagnosed with AE between June 2010 and September 2022 at the Charité - University Hospital Berlin, Campus Benjamin Franklin. The medical records were reviewed regarding clinical und radiological features, anatomical location of the AE und treatment methods.
RESULTS
A total of 43 patients (29 male, 11 female) were diagnosed with AE and almost all patients presented with abdominal pain, except in 8 cases (18.6%). Specific findings in computer tomography (CT) with a typical picture of AE were found in 33 patients (76.7%). AE was mostly localized in the left colon: 12 were found in the sigmoid colon (27.9%), 16 in the descending colon (37.2%) and 5 at the junction of the descending colon and the sigmoid colon (11.6%). Of the patients 28 (65.1%) were admitted for conservative treatment and the rest of the patients were treated as outpatients. No patient underwent surgery, all were treated with analgesics (NSAID) and 17 patients received antibiotics in addition.
CONCLUSION
AE is a self-limiting disease and a common mimic of other serious causes of abdominal pain. Due to the emergence of the widespread use of imaging modalities, an early diagnosis of AE and a conservative approach as first choice of treatment in patients with AE could be established.
Topics: Humans; Male; Female; Abdomen, Acute; Tomography, X-Ray Computed; Abdominal Pain; Colitis, Ischemic; Connective Tissue Diseases
PubMed: 37698617
DOI: 10.1007/s00104-023-01960-4 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Apr 2024Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the... (Review)
Review
Following extended colon resections, it may not always be possible to perform colorectal anastomosis. The Deloyers procedure, which involves the transposition of the right colon, has been identified as a viable solution. This report aims to discuss the circumstances under which the Deloyers procedure was performed, as well as to evaluate the early and late postoperative outcomes, by reviewing cases conducted between 2010 and 2023. In a 22-year-old female patient who suffered major organ and tissue loss (with injuries to the sigmoid colon, descending colon, transverse colon, and mesentery) due to a firearm injury, the Deloyers procedure was applied during restorative surgery following initial damage control surgery. The procedure involved mobilizing the cecum and right colon, performing a cranio-caudal rotation over the ileocolic artery pedicle, followed by an appendectomy, and creating a colorectal anastomosis using circular staplers. There were no complications during the postoperative follow-ups. By the 14th postoperative day, the patient was discharged and experienced bowel movements four times a day, managed with 2.5 mg of diphenoxylate hydrochloride and 0.025 mg of atropine sulfate. At the 6-month follow-up, the frequency of bowel movements had decreased to twice daily without the need for medical treatment. Given the functional outcomes in patients after extended left colectomies, the Deloyers procedure, with its low associated morbidity, stands out as a viable option.
Topics: Female; Humans; Young Adult; Adult; Firearms; Wounds, Gunshot; Anastomosis, Surgical; Colorectal Neoplasms
PubMed: 38634843
DOI: 10.14744/tjtes.2024.20813 -
The American Journal of Clinical... Mar 2024Folic acid supplementation during the periconceptional period reduces the risk of neural tube defects in infants, but concern over chronic folic acid exposure remains.... (Randomized Controlled Trial)
Randomized Controlled Trial
Low-dose daily folic acid (400 μg) supplementation does not affect regulation of folate transporters found present throughout the terminal ileum and colon of humans: a randomized clinical trial.
BACKGROUND
Folic acid supplementation during the periconceptional period reduces the risk of neural tube defects in infants, but concern over chronic folic acid exposure remains. An improved understanding of folate absorption may clarify potential risks. Folate transporters have been characterized in the small intestine, but less so in the colon of healthy, free-living humans. The impact of folic acid fortification or supplementation on regulation of these transporters along the intestinal tract is unknown.
OBJECTIVE
The objective was to characterize expression of folate transporters/receptor (FT/R) and folate hydrolase, glutamate carboxypeptidase II (GCPII), from the terminal ileum and throughout the colon of adults and assess the impact of supplemental folic acid.
METHODS
In this 16-wk open-labeled randomized clinical trial, adults consumed a low folic acid-containing diet, a folate-free multivitamin, and either a 400 μg folic acid supplement or no folic acid supplement. Dietary intakes and blood were assessed at baseline, 8 wk, and 16 wk (time of colonoscopy). Messenger RNA (mRNA) expression and protein expression of FT/R and GCPII were assessed in the terminal ileum, cecum, and ascending and descending colon.
RESULTS
Among 24 randomly assigned subjects, no differences in dietary folate intake or blood folate were observed at baseline. Mean ± SD red blood cell folate at 16 wk was 1765 ± 426 and 911 ± 242 nmol/L in the 400 and 0 μg folic acid group, respectively (P < 0.0001). Reduced folate carrier, proton-coupled folate transporter, and folate-receptor alpha expression were detected in the terminal ileum and colon, as were efflux transporters of breast cancer resistance protein and multidrug resistance protein-3. Other than a higher mRNA expression of FR-alpha and GCPII in the 400 μg supplement group in the ascending colon, no treatment differences were observed (P < 0.02).
CONCLUSIONS
Folate transporters are present throughout the terminal ileum and colon; there is little evidence that a low dose of folic acid supplementation affects colonic absorption. This trial was registered at clinicaltrials.gov as NCT03421483.
Topics: Adult; Humans; Folic Acid; ATP Binding Cassette Transporter, Subfamily G, Member 2; Neoplasm Proteins; Dietary Supplements; Folic Acid Transporters; Ileum; RNA, Messenger; Colon
PubMed: 38157986
DOI: 10.1016/j.ajcnut.2023.12.018 -
Minerva Medica Sep 2023
PubMed: 37733232
DOI: 10.23736/S0026-4806.23.08783-9 -
Journal of Taibah University Medical... Aug 2023Colorectal cancer is a common cause of cancer-related mortality in KSA with a rising incidence. Although adenomatous polyps are well-recognized as precursors of...
OBJECTIVES
Colorectal cancer is a common cause of cancer-related mortality in KSA with a rising incidence. Although adenomatous polyps are well-recognized as precursors of colorectal cancer, local data are scarce. Therefore, in this study, we aimed to evaluate the characteristics of adenomatous colon polyps in the Saudi population.
METHODS
We retrospectively reviewed the electronic databases of all patients who underwent colonoscopy for any indication between January 2015 and December 2019 at a tertiary care hospital. This study included adult patients who were found to have colorectal polyps with identified histopathology reports. We collected clinical and pathological data, including patient age, sex, and histopathological polyp characteristics. A p-value <0.05 was considered significant for descriptive and analytical statistics.
RESULTS
A total of 184 patients with colorectal polyps with identified histopathology reports were included in the analysis. Of these, 130 (70.6%) patients were aged 50 years or older, and 135 (73.3%) were male. Among all polyps, 127 (69%) were adenomatous, 31 (16.8%) were hyperplastic, and 24 (13%) were inflammatory. For adenomatous polyps, 31 (24.4%) were observed in patients younger than 50 years, and high-grade dysplasia was observed in 23 (18%) polyps. Among patients with adenomatous polyps, the anatomical location was as follows: 27 (23%) in the cecum/ascending colon, 12 (9%) in the transverse colon, 45 (35%) in the descending/sigmoid colon, 25 (19%) in the rectum, and 18 (14%) at multiple sites. Age >50 years was significantly associated with adenomatous polyps (P = 0.03).
CONCLUSION
Approximately one-third of adenomatous polyps were detected proximal to the splenic flexure. Although adenomatous polyps were significantly associated with increasing age, 24% were observed in patients younger than 50 years of age. This finding supports the current recommendation to start screening at the age of 45.
PubMed: 36852232
DOI: 10.1016/j.jtumed.2022.12.018 -
Cureus Oct 2023Foreign body ingestion is a common reason for emergency department (ED) visits, with rare complications necessitating immediate surgical intervention. This case report...
Foreign body ingestion is a common reason for emergency department (ED) visits, with rare complications necessitating immediate surgical intervention. This case report discusses diagnosis and treatment, emphasizing the importance of prompt intervention. A 45-year-old male with dentures presented with acute left abdominal pain. Diagnostic tests identified a foreign body in the descending colon, leading to laparoscopic surgery. Early laparoscopy offers a safe and reliable alternative to exploratory laparotomy. This case underscores the significance of swift diagnosis, preventing severe complications like peritonitis, obstruction, and hemorrhage. In conclusion, while foreign body ingestion is common, intestinal perforation remains extremely rare. Physicians should consider it in their differential diagnosis, with computed tomography (CT) and rapid surgical intervention as crucial components of proper management.
PubMed: 38022202
DOI: 10.7759/cureus.47479 -
Journal of the American Veterinary... Mar 2024To describe a case of caudal duplication successfully operated with long-term follow-up.
OBJECTIVE
To describe a case of caudal duplication successfully operated with long-term follow-up.
ANIMAL
A 12-week-old female Chihuahua mix.
CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES
The dog of this report presented for evaluation of duplicate external organs, including 2 anuses, 2 vulvas, and 2 tails. The dog was clinically normal except for signs of cystitis. Contrast CT identified complete urogenital and anorectal duplication, characterized by duplication of the cecum, descending colon/rectum, urinary bladder, urethra, uterus, and ovaries, with left-sided rectovestibular fistula.
TREATMENT AND OUTCOME
Exploratory laparotomy was performed to remove the left cecum and colon, the left ureter was transected and implanted into the right urinary bladder, the left bladder and urethra were removed, and bilateral ovariohysterectomy removed 4 ovaries and 2 uteruses. Following abdominal closure, the left anus and vulva with remaining portions of distal rectum and urethra, respectively, were removed en bloc with both tails. Long-term follow-up at 5 years showed the dog to be clinically normal.
CLINICAL RELEVANCE
Caudal duplication is extremely rare in veterinary medicine, and this report details successful surgical correction with good long-term follow-up.
Topics: Dogs; Female; Animals; Abnormalities, Multiple; Urinary Bladder; Urethra; Rectum; Colon; Dog Diseases
PubMed: 38056075
DOI: 10.2460/javma.23.09.0525 -
Clinical and Experimental Medicine Dec 2023Worldwide more than 550,000 new patients suffering from malignant tumors are associated with human papillomaviruses (HPV) infection. However, only a small portion of...
Worldwide more than 550,000 new patients suffering from malignant tumors are associated with human papillomaviruses (HPV) infection. However, only a small portion of patients infected progress to cancer, suggesting that other factors other than HPV may play a role. Some studies have investigated HPV infection in colorectal cancer (CRC) with discordant results; moreover, the role of HPV in CRC development is still unknown. We investigated HPV infection in 50 CRC from different regions, excluding the anal one, by immunohistochemistry (IHC), real-time PCR and RNA-seq. For each patient, we studied the tumor microenvironment in neoplastic and matched non-neoplastic samples, and we compared the tumor-infiltrating immune cell phenotypes among HPV-positive and negative samples. Finally, we compared the CRC-associated microbiota in HPV-positive and negative neoplastic samples by 16S rRNA sequencing. HPV infection was identified in 20% of CRC from the right side (caecum, ascending and transverse colon) and in 40% from the left side (descending colon and rectum). In all HPV-positive CRCs we found no expression of p53 and RB, thus suggesting HPV involvement in tumorigenesis. As far as the tumor microenvironment is concerned, in HPV-related cancers we observed a neoplastic environment with a reduced immune surveillance but an enhanced cytotoxic response by lymphocytes. HPV-positive and -negative CRC showed a different microbiota with lack of species normally found in CRC in the HPV-positive ones. Our results support the carcinogenic significance of HPV in CRC, suggesting a role of HPV in modulating the tumor immune microenvironment.
Topics: Humans; Colorectal Neoplasms; Papillomavirus Infections; RNA, Ribosomal, 16S; Tumor Microenvironment
PubMed: 37612430
DOI: 10.1007/s10238-023-01165-3 -
International Journal of Biological... Jun 2024Sourdough bread enriched with soluble fiber (by in-situ exopolysaccharides production) and insoluble fiber (by gazpacho by-products addition) showed prebiotic effects an...
Sourdough bread enriched with soluble fiber (by in-situ exopolysaccharides production) and insoluble fiber (by gazpacho by-products addition) showed prebiotic effects an in vitro dynamic colonic fermentation performance with obese volunteer's microbiota. Bifidobacterium population was maintained whereas Lactobacillus increased throughout the colonic sections. Conversely, Enterobacteriaceae and Clostridium groups clearly decreased. Specific bacteria associated with beneficial effects increased in the ascending colon (Lactobacillus fermentum, Lactobacillus paracasei, Bifidobacterium longum and Bifidobacterium adolescentis) whereas Eubacterium eligens, Alistipes senegalensis, Prevotella copri and Eubacterium desmolans increased in the transversal and descending colon. Additionally, Blautia faecis and Ruminococcus albus increased in the transversal colon, and Bifidobacterium longum, Roseburia faecis and Victivallis vadensis in the descending colon. Bifidobacterium and Lactobacillus fermented the in-situ exopolysaccharides and released pectins from gazpacho by-products, as well as cellulosic degraded bacteria. This increased the short and medium chain fatty acids. Acetic acid, as well as butyric acid, increased throughout the colonic tract, which showed greater increases only in the transversal and descending colonic segments. Conversely, propionic acid was slightly affected by the colonic fermentation. These results show that sourdough bread is a useful food matrix for the enrichment of vegetable by-products (or other fibers) in order to formulate products with microbiota modulatory capacities.
Topics: Bread; Humans; Dysbiosis; Fermentation; Gastrointestinal Microbiome; Dietary Fiber; Polysaccharides, Bacterial; Colon; Bifidobacterium; Male; Lactobacillus
PubMed: 38851991
DOI: 10.1016/j.ijbiomac.2024.132906