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DEN Open Apr 2024A 69-year-old woman, a long-term survivor of subtotal stomach-preserving pancreatoduodenectomy with the splenic vein resection for pancreatic cancer, visited our...
A 69-year-old woman, a long-term survivor of subtotal stomach-preserving pancreatoduodenectomy with the splenic vein resection for pancreatic cancer, visited our hospital with a chief complaint of bloody stools. Previously, she was diagnosed with varices in the ascending colon due to left-sided portal hypertension after pancreatoduodenectomy by computed tomography and colonoscopy. After emergency hospitalization, she went into shock, and blood tests showed acute progression of severe anemia. Computed tomography showed a mosaic-like fluid accumulation from the ascending colon to the rectum. She was diagnosed with ruptured varices in the ascending colon. Emergency colonoscopy was performed, and treatment with endoscopic injection sclerotherapy using -butyl-2-cyanoacrylate was successful. Ectopic varices occur at any location other than the esophagus and stomach, and colonic varices are rare among them. They are mostly caused by portal hypertension due to liver cirrhosis. However, with the trend of improving the prognosis for patients with pancreatic cancer, we should occasionally pay attention to the development of ectopic varices including colonic varices in patients who have undergone pancreatoduodenectomy with superior mesenteric and splenic veins resection. Treatment methods for colonic varices varied from case to case, including conservative therapy, interventional radiology, and endoscopic procedure. In this case, endoscopic injection sclerotherapy was successfully performed without any complications. To the best of our knowledge, this is the first study to report successful treatment with endoscopic injection sclerotherapy for varices in the ascending colon caused by left-sided portal hypertension after pancreatoduodenectomy. Colonic varices should be considered in patients with obscure gastrointestinal bleeding after pancreatoduodenectomy.
PubMed: 37441155
DOI: 10.1002/deo2.255 -
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 -
International Journal of Molecular... Nov 2023This study aimed to determine the effects of Zn sources, used with potato fiber (PF) or lignocellulose (LC), on electrolyte concentration and the mucus layer in the...
Comparison between Organic and Inorganic Zinc Forms and Their Combinations with Various Dietary Fibers in Respect of the Effects on Electrolyte Concentrations and Mucosa in the Large Intestine of Pigs.
This study aimed to determine the effects of Zn sources, used with potato fiber (PF) or lignocellulose (LC), on electrolyte concentration and the mucus layer in the large intestine of pigs. The experiment involved 24 barrows with an initial body weight of 10.8 ± 0.82 kg, divided into four groups fed the following diets: LC and ZnSO, LC and Zn glycinate (ZnGly), PF and ZnSO, or PF and ZnGly. Fiber supplements provided 10 g crude fiber/kg diet, while Zn additives introduced 120 mg Zn/kg diet. After four weeks of feeding, the pigs were sacrificed and digesta and tissue samples were taken from the cecum and colon. PF increased the water content and decreased the phosphorus concentration in the large intestine in comparison with LC. PF also increased calcium, iron, and chloride concentrations in the descending colon. Mucus layer thickness and histological parameters of the large intestine were not affected. ZnGly diets increased expression in the cecum as compared to the LC-ZnSO group. In the ascending colon, the PF-ZnGly diet increased expression, while both PF groups had greater expression in comparison with the LC-ZnSO group. In the transverse colon, the LC-ZnGly group and both PF groups had higher expression in comparison with the LC-ZnSO group, and both ZnGly groups had higher expression than ZnSO groups. PF and ZnGly increased and expression in the descending colon. PF and ZnGly may exert a beneficial effect on colon health in pigs by upregulating the expression of the and genes and are more effective than LC and ZnSO.
Topics: Swine; Animals; Zinc; Zinc Sulfate; Dietary Fiber; Dietary Supplements; Diet; Intestine, Large; Electrolytes; Mucous Membrane; Animal Feed
PubMed: 38069066
DOI: 10.3390/ijms242316743 -
Revista Medica Del Instituto Mexicano... Sep 2023The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic... (Observational Study)
Observational Study
BACKGROUND
The colon has two different embryological origins, which is why it can be divided into right and left with different characteristics each one; therefore, neoplastic lesions have a different clinical picture and are also associated with different pathologies.
OBJECTIVE
To describe the clinical and histopathological characteristics of malignant colon tumors acording to their location.
MATERIAL AND METHODS
Descriptive, retrospective study with 94 patients diagnosed with colon cancer. Descriptive statistics were performed with the calculation of frequencies and percentages, and chi-squared tests were calculated.
RESULTS
Mean age was 61.3 years, 49 (52.1%) were women; 53 (56.4%) were left-sided and 41 (43.6%) right-sided. The main symptom was hematochezia in 32 (60.4%), in patients with left cancer; and diarrhea in 20 (48.8%), in patients with right-sided colon cancer. The presentation of stage I tumors and polyps, p = 0.044 and p = 0.043, respectively, was more frequent on the right side compared to the left side; in the left, hematochezia (p = 0.001), narrow stools(p = 0.05), and a history of type 2 diabetes mellitus (T2DM) (p= 0.036) were more frequent compared to the opposite site.
CONCLUSIONS
Stage I and the presence of polyps were more frequent in right-sided cancer compared to left-sided cancer; T2DM, as well as hematochezia and narrow stools were more associated with the left side compared to the right side.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Diabetes Mellitus, Type 2; Colonic Neoplasms; Gastrointestinal Hemorrhage; Neoplasm Staging; Prognosis
PubMed: 37769029
DOI: 10.5281/zenodo.8316446 -
Annals of Medicine and Surgery (2012) May 2024Tuberculosis (TB) has been one of the most devastating diseases to humanity in recent decades; although pulmonary infection is the most common, infection of any other...
INTRODUCTION AND IMPORTANCE
Tuberculosis (TB) has been one of the most devastating diseases to humanity in recent decades; although pulmonary infection is the most common, infection of any other organ is familiar as well. Colon cancer is another disease affecting the gastrointestinal (GI) system and mostly targets people over 50. Only a few studies mentioned the co-existence of cancer and TB occurring at the same place and time. Hence, the authors report a rare case of concurrent ascending colon adenocarcinoma and colonic TB.
CASE PRESENTATION
A 49 -year-old man presented to our clinic with constipation and abdominal pain. Two colonoscopies were performed, and two biopsies were taken; the first one showed granulomatous inflammation consistent with TB, and the second one showed low-grade adenocarcinoma. Computed tomography showed annular thickening of the ascending colon with infiltrates around the lesions. A right hemicolectomy was performed, and the final pathology confirmed adenocarcinoma grade II and extensive TB granulomas involving the colon into the serosa and the lymph nodes. Anti-TB medications were administered after surgery.
CLINICAL DISCUSSION
Due to appropriate diagnostic methods, TB and cancer were detected at an early stage. In our treatment protocol, no adjuvant chemotherapy was applied after surgery due to the possibility of drug interaction with anti-TB medications.
CONCLUSION
The two diseases may co-exist; thus, diagnosing them may not be the easiest, not to mention the lack of a clear treatment protocol in case of their accompany.
PubMed: 38694366
DOI: 10.1097/MS9.0000000000001927 -
European Journal of Surgical Oncology :... Jul 2023We aimed to investigate manual subtraction computed tomography angiography (MS-CTA) to further confirm the distribution and classification of LCA (left colic artery)...
Verification of blood flow path reconstruction mechanism in distal sigmoid colon and rectal cancer after high IMA ligation through preoperative and postoperative comparison by manual subtraction CTA.
INTRODUCTION
We aimed to investigate manual subtraction computed tomography angiography (MS-CTA) to further confirm the distribution and classification of LCA (left colic artery) ascending/descending branches, then observe the postoperative blood flow path to illustrate how the above branches evolved to postoperative blood path.
MATERIAL AND METHODS
89 patients with distal sigmoid and rectal cancer were referred in our observation and underwent MS-CTA between June 2020 and March 2022. We classified the distribution of LCA and confirmed whether there exists AMCA (accessory middle colic artery). Then we planned blood flow path based on the classification of LCA branches before operation. High ligation was applied in regular radical surgery. During operation, we carefully protect the bifurcation of ascending and descending LCA. Then we compared the planned blood flow path with the actual postoperative blood flow path to verify the mechanism we proposed previously.
RESULTS
Of 89 patients, 82 cases met our criteria, we summarized 6 distribution pattens of LCA ascending and descending branches. These preoperative pattens are consistent with the inspection during operation. The postoperative blood flow path of 6 pattens is evolved from the above adjacent anastomotic branches and is consistent with the planned blood flow path. We also found 2 cases with IMA stenosis and 1 case with SMA stenosis under pathological condition, and their compensatory blood flow path is in accordance with our theory. The rate of the anastomotic leakage in our study group is relatively low (7.3%).
CONCLUSION
MS-CTA could confirm the distribution of LCA and AMCA, display accurate postoperative blood reconstruction path after IMA high ligation, and it further verified the mechanism we proposed previously, which is the proximal anastomotic branches forming new blood flow path from high-pressure area to the low-pressure area. This mechanism might be helpful for performing accurate laparoscopic sigmoid and rectal cancer surgery.
Topics: Humans; Colon, Sigmoid; Constriction, Pathologic; Tranexamic Acid; Rectal Neoplasms; Rectum; Ligation; Mesenteric Artery, Inferior; Laparoscopy; Lymph Node Excision
PubMed: 36658053
DOI: 10.1016/j.ejso.2023.01.012 -
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 Surgery... Oct 2023Oral antibiotics (OA) combined with mechanical bowel preparation (MBP) significantly decrease the rate of surgical site infections (SSIs). However, the prophylactic... (Randomized Controlled Trial)
Randomized Controlled Trial
Region-specific protection effect of preoperative oral antibiotics combined with mechanical bowel preparation before laparoscopic colorectal resection: a prospective randomized controlled trial.
BACKGROUND
Oral antibiotics (OA) combined with mechanical bowel preparation (MBP) significantly decrease the rate of surgical site infections (SSIs). However, the prophylactic effects in region-specific colorectal surgery have not been assessed.
MATERIALS AND METHODS
A single-centre, single-blind, randomized controlled trial was conducted from 2019 to 2022. Patients were eligible if they were diagnosed with nonmetastatic colorectal malignancy, and laparoscopic colorectal surgery was indicated. Participants were randomly assigned (1:1) to the experimental (OA+MBP preparation) or control group (MBP preparation). The randomization was further stratified by resected region. The primary outcome was the incidence of SSIs. Patients were followed up for 1 month postoperatively, and all complications were recorded.
RESULT
Between 2019 and 2022, 157 and 152 patients were assigned to the experimental and control groups, respectively, after 51 patients were excluded. The incidence of SSIs in the control group (27/152) was significantly higher than that in the experimental group (13/157; P =0.013), as was the incidence of superficial SSIs (5/157 vs. 14/152, P =0.027) and deep SSIs (7/157 vs. 16/152, P =0.042). After redistribution according to the resected region, the incidence of SSIs was significantly higher in the control group with left-sided colorectal resection (descending, sigmoid colon, and rectum) (9/115 vs. 20/111, P =0.022) but was similar between the groups with right-sided colon resection (ascending colon) (3/37 vs. 7/36, P =0.286). No differences were noted between the groups in terms of other perioperative complications.
CONCLUSION
OA+MBP before colorectal surgery significantly reduced the incidence of SSIs. Such a prophylactic effect was particularly significant for left-sided resection. This preparation mode should be routinely adopted before elective left-region colorectal surgeries.
Topics: Humans; Anti-Bacterial Agents; Colon, Sigmoid; Single-Blind Method; Prospective Studies; Colorectal Neoplasms; Surgical Wound Infection; Antibiotic Prophylaxis; Laparoscopy; Preoperative Care; Elective Surgical Procedures; Administration, Oral
PubMed: 37702427
DOI: 10.1097/JS9.0000000000000569 -
Cureus Apr 2024Primary liposarcoma of the colon is extremely rare in the literature. We present a case of a 51-year-old male patient with recurrent ascending colon liposarcoma, which...
Primary liposarcoma of the colon is extremely rare in the literature. We present a case of a 51-year-old male patient with recurrent ascending colon liposarcoma, which caused obstructive ileus, just a few days prior to his scheduled elective operation and led us to expedite his surgery. The procedure was scheduled to be a robotic right colectomy. After finishing the operation and extracting the specimen, the tumour could not be detected; hence, an exploratory laparotomy was performed. Findings were a large tumour in the sigmoid colon, causing complete obstruction. Sigmoidectomy was performed, in order to remove the tumour. To our knowledge, this is the first case published in the literature, reporting a colonic tumour detachment, displacement and causing distal bowel occlusion. This event highlights the importance of careful intraoperative inspection in patients with known intraluminal bowel malignancies that present with signs and symptoms of obstruction and emphasises the need for further research on the risk factors for tumour detachment and subsequent bowel occlusion.
PubMed: 38738041
DOI: 10.7759/cureus.58065