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Life (Basel, Switzerland) Nov 2023Collision tumors, although rare, characterized by two distinctive (morphological, as well immunohistochemical) and spatially independent tumor components at the same...
Collision tumors, although rare, characterized by two distinctive (morphological, as well immunohistochemical) and spatially independent tumor components at the same location, are always puzzling for clinicians, pathologists, and patients because they do not fit into the usual approaches, being neither diagnostic nor therapeutic. Reviewing the specialized literature, to date, collision tumors have been reported in multiple locations such as the skin, esophagus, stomach, intestine, liver, kidney, bladder, adrenal gland, or thyroid. We report a case of coexistence at the same site of a malignant tumor of the ascending colon and a benign tumor emerging from the peritoneal lining, initially thought by the surgeon to be right-sided serosal carcinomatosis. But histopathological examination reveals that those multiple serosal nodules were benign granular cell tumors that have collided with highly aggressive transparietal signet-ring colon carcinoma. These results put the patient's prognosis and therapeutic strategy in a different light than the clinical and intraoperative evaluation.
PubMed: 38137864
DOI: 10.3390/life13122263 -
Scientific Reports Jan 2024Recognizing anatomical sections during colonoscopy is crucial for diagnosing colonic diseases and generating accurate reports. While recent studies have endeavored to...
Recognizing anatomical sections during colonoscopy is crucial for diagnosing colonic diseases and generating accurate reports. While recent studies have endeavored to identify anatomical regions of the colon using deep learning, the deformable anatomical characteristics of the colon pose challenges for establishing a reliable localization system. This study presents a system utilizing 100 colonoscopy videos, combining density clustering and deep learning. Cascaded CNN models are employed to estimate the appendix orifice (AO), flexures, and "outside of the body," sequentially. Subsequently, DBSCAN algorithm is applied to identify anatomical sections. Clustering-based analysis integrates clinical knowledge and context based on the anatomical section within the model. We address challenges posed by colonoscopy images through non-informative removal preprocessing. The image data is labeled by clinicians, and the system deduces section correspondence stochastically. The model categorizes the colon into three sections: right (cecum and ascending colon), middle (transverse colon), and left (descending colon, sigmoid colon, rectum). We estimated the appearance time of anatomical boundaries with an average error of 6.31 s for AO, 9.79 s for HF, 27.69 s for SF, and 3.26 s for outside of the body. The proposed method can facilitate future advancements towards AI-based automatic reporting, offering time-saving efficacy and standardization.
Topics: Humans; Deep Learning; Colonoscopy; Colonic Diseases; Algorithms; Cluster Analysis
PubMed: 38195632
DOI: 10.1038/s41598-023-51056-6 -
Annals of Gastroenterological Surgery Nov 2023The lymph node metastasis rate in right-sided colon cancer is unknown, and the optimal central vascular ligation level remains controversial. We aimed to determine the...
BACKGROUND
The lymph node metastasis rate in right-sided colon cancer is unknown, and the optimal central vascular ligation level remains controversial. We aimed to determine the lymph node metastasis rate and short-term results of radical surgery with extended lymph node dissection in right-sided colon cancer.
METHODS
This prospective multicenter observational study included patients with stage II/III right-sided colon cancer from five cancer hospitals. The metastasis rate of each node station was analyzed according to tumor location and main feeding artery.
RESULTS
Between April 2018 and August 2021, 208 patients underwent dissection around the superior mesenteric artery (SMA) and vein (SMV). In transverse colon cancer, 7.5% and 2.5% of metastases occurred around the SMV and SMA at the root of the middle colic artery (MCA), respectively; 6.7% and 6.7% at the root of the right colic artery. In caecal cancer, 1.9% of metastases occurred around the SMV and 1.9% around the SMA. In ascending colon cancer, the rate was 1.1% around the SMV. Of the tumors, 17% fed mainly by the ileocolic artery had node metastases along the middle or right colic artery, as did 66.7% fed mainly by the right colic artery and 41.2% fed by the MCA ( = 0.01). Postoperative complications occurred in 42 patients (20.2%).
CONCLUSION
Routine prophylactic extended lymphadenectomy around the SMA might not be necessary in caecum and ascending colon cancer. Dissection around the SMA may be necessary in cases of transverse colon cancer or when the feeding artery is the MCA.
PubMed: 37927926
DOI: 10.1002/ags3.12703 -
BMC Gastroenterology Dec 2023Anal fistula is a common benign anorectal disease that often requires surgical intervention for effective treatment. In recent years, preoperative colonoscopy as a...
BACKGROUND
Anal fistula is a common benign anorectal disease that often requires surgical intervention for effective treatment. In recent years, preoperative colonoscopy as a diagnostic tool in patients with anal fistula has garnered increasing attention due to its potential clinical application value. By investigating underlying inflammatory bowel disease (IBD), polyps, and other abnormalities, preoperative colonoscopy can offer insights to refine surgical strategies and improve patient outcomes.
METHODS
This retrospective study focused on 1796 patients with various benign anorectal diseases who underwent preoperative intestinal endoscopy and met surgical criteria within the preceding three years at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine. Among these patients, 949 diagnosed with anal fistula comprised group A, while 847 patients without anal fistula were assigned to group B for comparison. The investigation encompassed an analysis of general patient information, endoscopic findings, polyp histopathology, distribution of bowel inflammation sites, and results of inflammatory bowel disease assessments between the two patient cohorts. A subgroup analysis was also conducted on 2275 anal fistula patients with no surgical contraindications. This subgroup was categorized into Group A (949 patients who underwent preoperative intestinal endoscopy) and Group C (1326 patients who did not undergo preoperative colonoscopy). The study compared the rates of detecting endoscopic lesions and IBD-related findings between the two subgroups.
RESULTS
The study initially confirmed the comparability of general patient information between groups A and B. Notably, the abnormal detection rate in group A was significantly higher than in group B (P < 0.01). In terms of endoscopic findings, the anal fistula group (group A) exhibited higher rates of detecting bowel inflammation, inflammatory bowel disease, and polyps compared to the non-anal fistula group (group B) (P < 0.05). The distribution of inflammation locations indicated higher detection rates in the terminal ileum, ileocecal region, and ascending colon for group A compared to group B (P < 0.05). Although the incidence of IBD in group A was higher than in group B, this difference did not reach statistical significance (P > 0.05). Subsequently, the analysis of the subgroup (groups A and C) revealed a significant disparity in intestinal endoscopic detection rates (P < 0.01) and statistically significant differences in detecting IBD (P < 0.05) and Crohn's disease (P < 0.05) between the two anal fistula subgroups.
CONCLUSIONS
The findings of this study underscore the substantial clinical value of preoperative colonoscopy in the comprehensive evaluation of patients with anal fistula. Preoperative colonoscopy aids in ruling out localized perianal lesions caused by underlying inflammatory bowel disease, thereby mitigating the likelihood of missed diagnoses and enhancing treatment outcomes. This research highlights the importance of incorporating preoperative colonoscopy as a valuable diagnostic tool in managing anal fistula patients.
Topics: Humans; Retrospective Studies; Colonoscopy; Rectal Fistula; Inflammatory Bowel Diseases; Inflammation
PubMed: 38102560
DOI: 10.1186/s12876-023-03066-x -
International Journal of Surgery Case... Jul 2024Cecal volvulus is a rare cause of obstruction in pregnancy. It accounts for ∼1.5 % of all intestinal obstructions. The diagnosis is challenging and causes increased...
INTRODUCTION AND IMPORTANCE
Cecal volvulus is a rare cause of obstruction in pregnancy. It accounts for ∼1.5 % of all intestinal obstructions. The diagnosis is challenging and causes increased morbidity and mortality to the mother and fetus. This case report will highlight the life-threatening nature of this condition and emphasize the critical importance of early diagnosis and intervention.
CASE PRESENTATION
A 30-year-old gravida-3 para-2 patient presented with colicky abdominal pain of 24 h duration. She had associated abdominal distension, vomiting and fever. She had amenorrhea of 05-months. The past medical and surgical histories were negative. Her vital signs were deranged and had tenderness all over the abdomen. Ultrasound showed gaseous abdomen and viable fetus in the uterus. Laparotomy has revealed gangrenous cecal volvulus. A right hemicolectomy and end-to-side ileo-transverse colon anastomosis were performed. She expelled a dead fetus after 12 h. She was discharged in good clinical status.
DISCUSSION
Cecal volvulus involves axial rotation of the ascending colon, cecum, and terminal ileum about associated mesentery. Pregnancy is among the pre-disposing factor for cecal volvulus. The diagnosis is often challenging because of non-specific presentations. Radiologic procedures are helpful in the diagnosis. The primary treatment is surgical intervention.
CONCLUSION
Cecal volvulus is a rare life-threatening cause of obstruction in pregnancy. It is an emergency situation, and early diagnosis and intervention are crucial to decreasing morbidity and mortality. The most effective treatment is surgical resection.
PubMed: 38796939
DOI: 10.1016/j.ijscr.2024.109803 -
Cirugia Pediatrica : Organo Oficial de... Oct 2023Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly...
INTRODUCTION
Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd's procedure). Dr. Abu-Elmagd recently described a new technique that was applied in one of our patients.
CLINICAL CASE
12-year-old boy who had undergone Ladd's procedure as a result of intestinal volvulus secondary to malrotation when he was 2 days old. He had subocclusion and eventually obstruction, with intestinal volvulus compatible imaging. Intraoperative findings: duodenal subocclusion, volvulus and lymphangiectasias. Kareem's procedure: bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixation of the cecum, the ascending colon, and the mesenteric root. The patient was discharged on postoperative day 6 and remains asymptomatic after 1 year of follow-up.
DISCUSSION
Kareem's procedure is a safe and effective malrotation repair technique. It can replace Ladd's procedure as it reduces the risk of re-volvulation and improves digestive symptoms.
Topics: Male; Humans; Child; Intestinal Volvulus; Intestines; Digestive System Surgical Procedures; Laparoscopy
PubMed: 37818902
DOI: 10.54847/cp.2023.04.16 -
Revista Espanola de Enfermedades... Dec 2023We report the case of a 48-year-old male who presented with right lower abdominal pain and a mass for 2 weeks and got constipation for 5 days. An abdominal CT scan...
We report the case of a 48-year-old male who presented with right lower abdominal pain and a mass for 2 weeks and got constipation for 5 days. An abdominal CT scan conducted before admission at other hospitals revealed an obstruction in the blind ascending colon, which was suspected to be a malignant tumor. Proctoscopy revealed peritoneal implantation metastasis and multiple pelvic lymph nodes. Physical examination was unremarkable except for multiple lymph node enlargements in the inguinal area, without pain. A whole-body contrast-enhanced FDG-PET/CT revealed lymphoma involvement in the ascending colon, peritoneum, bone marrow, and lymph nodes in multiple regions of the body, with DLBCL as a suspected diagnosis. Pathological findings from the colonoscopy revealed atypical lymphocyte infiltration and Immunostaining indicated the presence of atypical lymphocytes with Ki-67 (90%) and tested positive for CD20, CD19, CD10, and BCL-6. Based on the above findings, stage IV DLBCL was diagnosed. Furthermore, EBV-DNA amplification was positive. The patient received R-CHOP treatment for 2 days before experiencing symptoms of fevers, chills, and abdominal pain. He underwent emergency surgery due to intestinal perforation, and preoperative blood tests revealed HIV-positive. The prognosis for the patient is poor due to sepsis.
PubMed: 38095193
DOI: 10.17235/reed.2023.10124/2023 -
Medicine Feb 2024Intestinal nontuberculous mycobacteriosis due to nontuberculous mycobacteria infection has clinical manifestations similar to intestinal tuberculosis and inflammatory...
BACKGROUND
Intestinal nontuberculous mycobacteriosis due to nontuberculous mycobacteria infection has clinical manifestations similar to intestinal tuberculosis and inflammatory bowel disease, causing difficulties in clinical diagnosis.
CASE PRESENTATION
A 42-year-old male patient was admitted to the Sino-Japanese Friendship Hospital of Jilin University in June 2021 for diarrhea and intermittent hematochezia since April 2021. He was diagnosed with inflammatory intestinal disease by colonoscopy and midtransverse colon biopsy. However, the symptoms did not relieve after 2 months of mesalazine treatment. In August 2021, the patient was admitted to the outpatient department for suspected "intestinal tuberculosis." A diagnosis of intestinal nontuberculous mycobacteriosis was confirmed based on pathology and nucleotide-based matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS). After 2 weeks of antimycobacterial therapy, the patient's diarrhea was relieved, and hematochezia no longer appeared. In November 2021, recolonoscopy revealed scattered erosions and ulcers in ileocecal valve and ascending colon, while both nucleotide-based MALDI-TOF MS and next-generation sequencing could still detect Mycobacterium intracellulare.
CONCLUSION
This study reported a patient with an intestinal nontuberculous mycobacteriosis diagnosed by colonoscopy biopsy and nucleotide-based MALDI-TOF MS, and symptoms were relieved after antimycobacterial treatment.
Topics: Male; Humans; Adult; Nontuberculous Mycobacteria; Mycobacterium Infections, Nontuberculous; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tuberculosis, Lymph Node; Diarrhea; Gastrointestinal Hemorrhage; Nucleotides
PubMed: 38363897
DOI: 10.1097/MD.0000000000036954 -
Medicine May 2024This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort... (Observational Study)
Observational Study
This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort of 25 patients, focusing on demographic characteristics, clinical presentation, location and size of the lipoma, concomitant pathologies, and treatment methods. The average age of the patients was 67.3 years, with 36% being male and 64% female. The majority of lipomas were located in the ascending colon (52%), and their median size was 2 cm. The predominant presenting symptom was constipation, affecting 83.3% of the symptomatic patients. Surgical resection was undertaken in only 1 patient due to obstruction. Statistically significant differences were observed between symptomatic and asymptomatic patients regarding various parameters, including the size of the lipoma (P = .033). Colon lipomas are generally benign and frequently asymptomatic but may necessitate different treatment approaches depending on their size, location, and the presence of symptoms. Further studies are imperative to refine treatment strategies and enhance patient care outcomes.
Topics: Humans; Lipoma; Male; Female; Retrospective Studies; Aged; Colonic Neoplasms; Middle Aged; Aged, 80 and over; Constipation; Adult
PubMed: 38787996
DOI: 10.1097/MD.0000000000038287 -
Inflammatory Bowel Diseases Aug 2023There is currently no consensus on the definition of an abnormal intestinal ultrasound (IUS) for children with ulcerative colitis (UC). This cross-sectional study aimed...
BACKGROUND
There is currently no consensus on the definition of an abnormal intestinal ultrasound (IUS) for children with ulcerative colitis (UC). This cross-sectional study aimed to externally validate and compare 2 existing IUS indices in children with UC.
METHODS
Children undergoing colonoscopy for UC assessment underwent IUS the day before colonoscopy, assessed with the Mayo endoscopic subscore. The UC-IUS index and the Civitelli index were compared with the Mayo endoscopic score in the ascending, transverse, and descending colon. The area under the receiver-operating characteristic curve for detecting a Mayo endoscopic score ≥2 of both scores was compared and sensitivity and specificity were calculated.
RESULTS
A total of 35 UC patients were included (median age 15 years, 39% female). The area under the receiver-operating characteristic curve was higher for the UC-IUS index in the ascending colon (0.82 [95% confidence interval (CI), 0.67-0.97] vs 0.76 [95% CI, 0.59-0.93]; P = .046) and transverse colon (0.88 [95% CI, 0.76-1.00] vs 0.77 [95% CI, 0.60-0.93]; P = .01). In the descending colon, there was no difference (0.84 [95% CI, 0.70-0.99] vs 0.84 [95% CI, 0.70-0.98]). The optimal cutoff for the UC-IUS was <1 point to rule out a Mayo endoscopic score ≥2 (sensitivity: 88%, 100%, and 90% in the ascending, transverse, and descending colon, respectively) and a Mayo endoscopic score ≥2 could be detected using a cutoff of >1 (specificity: 84%, 83%, and 87%, respectively). For the Civitelli index, in our cohort, the optimal cutoff was <1 to rule out a Mayo endoscopic score ≥2 (sensitivity 75%, 65%, and 80%, respectively) and a cutoff >1 to detect a Mayo endoscopic score ≥2 (specificity 89%, 89%, and 93%, respectively).
CONCLUSIONS
In this cohort, the UC-IUS index performed better than the Civitelli index. The UC-IUS index had both a high sensitivity and specificity in this cohort, when using 1 point as cutoff for a Mayo endoscopic score ≥2.
Topics: Humans; Female; Child; Adolescent; Male; Colitis, Ulcerative; Cross-Sectional Studies; Intestinal Mucosa; Colonoscopy; Intestines; Severity of Illness Index
PubMed: 36149272
DOI: 10.1093/ibd/izac197