-
Annals of the Royal College of Surgeons... Sep 2015Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic...
INTRODUCTION
Locoregional variation in the human colon is important in surgical practice; the length and mobility of different colonic regions impacts on laparoscopic and endoscopic colorectal procedures. The aim of this study was to refine anatomical understanding of the colon in terms of segmental length and mobility.
METHODS
The colons of 35 cadavers were examined to determine lengths of caecum as well as ascending, transverse, descending and rectosigmoid colon, and to characterise colonic mobility at each location in terms of the mesenteric attachments. The presence of Jackson's membrane (a congenital peritoneal band of the right colon) was also documented.
RESULTS
The mean total colonic length was 131.2cm (standard deviation [SD]: 13.4cm). There was no correlation with height, age or sex; the best predictor of total colonic length was the length of the rectosigmoid segment. The mean height of the transverse mesocolon was 7.4cm (SD: 3.6cm) and that of the sigmoid mesocolon was 6.3cm (SD: 2.6cm). Two-thirds of the subjects had a mobile portion of the ascending colon and nearly one-third had a mobile descending colon. A mobile ascending colon was significantly more common in females. Jackson's membrane was present in 66% of the subjects.
CONCLUSIONS
This cadaveric study suggests that rectosigmoid length accounts for most of the variability in total colonic length. The significant proportion of colons with mobility of the ascending and descending segments prompts revision of the traditional anatomical teaching of these segments as fixed and retroperitoneal. Mobility of the ascending colon may account for the anecdotal finding that colonoscopy is more challenging in female patients. Jackson's membrane was identified in most colons.
Topics: Aged; Aged, 80 and over; Cadaver; Colon; Colon, Sigmoid; Female; Gastrointestinal Motility; Humans; Male; Mesentery; Middle Aged; Sex Characteristics
PubMed: 26274737
DOI: 10.1308/003588415X14181254790527 -
Acta Medica Okayama Aug 2021A 67-year-old woman underwent polypectomy for a tumor at the descending colon. Pathologically, the tumor was diagnosed as adenocarcinoma with an invasion of 2000 μm....
A 67-year-old woman underwent polypectomy for a tumor at the descending colon. Pathologically, the tumor was diagnosed as adenocarcinoma with an invasion of 2000 μm. Computed tomography showed a swollen paracolic lymph node and a mass lesion in the presacral space. Magnetic resonance imaging revealed a multio-cular cystic lesion. On diagnosis of descending colon cancer and tailgut cyst, she underwent synchronous lapa-roscopic resection. Histopathologically, the colon cancer was diagnosed as pT1bN1M0, pStage IIIa. The pre-sacral cystic lesion was diagnosed as a nonmalignant tailgut cyst with negative surgical margin. The patient is currently doing well without recurrence at 28 months.
Topics: Adenocarcinoma; Aged; Colon, Descending; Colorectal Neoplasms; Cysts; Female; Humans
PubMed: 34511622
DOI: 10.18926/AMO/62407 -
Frontiers in Surgery 2022In patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the...
BACKGROUND
In patients with Hirschsprung's disease (HD), persistent obstructive symptoms may develop after surgery. The causes of mechanical obstruction may be a retraction of the pulled-through bowel due to insufficient mobilization of the mesentery or impaired blood supply in the area of the coloanal anastomosis in the case of excessive ligation of the supplying vessels. Leakage and stenosis are formidable complications and require repeated surgical intervention.
OBJECTIVE
The purpose of this study is to describe our experience and short-term results of the developed method: mobilization of the descending colon for its pull-through during the surgical treatment of the children with HD, which allows ensuring good mobility to the descending colon and maintaining blood supply at the same time.
METHODS
The medical records of 20 patients with rectosigmoid HD, who underwent parietal mobilization of the descending colon with preservation of the marginal artery, sigmoid arteries, and ligation of the left colon artery, were reviewed. This method is aimed at increasing the mobility of the brought-down bowel and maintaining the blood supply to the distal part of the brought-down bowel not only from the superior mesenteric artery but also from the lower one.The SPSS Statistics 26.0 package was used for statistical analysis. To describe the analyzed data with a normal distribution, the mean values and the error of the mean were used. To determine the differences, Student's -test was used, and the differences were considered significant at a significance level of < 0.05.
RESULTS
In all patients, the postoperative period was uneventful, without complications. The patients were discharged for outpatient treatment on average on the seventh day after the surgery. In all cases, there were no signs of anastomotic leakage or stricture on follow-up after 6-12 months.
CONCLUSION
The method of mobilization of the colon in the rectosigmoid form of HD, parietal mobilization of the descending part of the colon preserving the marginal artery, sigmoid arteries, and ligating the left colon artery, can reduce the risk of complications by eliminating the tension of the descending colon.
PubMed: 35865043
DOI: 10.3389/fsurg.2022.921789 -
Automatic anatomical classification of colonoscopic images using deep convolutional neural networks.Gastroenterology Report Jun 2021A colonoscopy can detect colorectal diseases, including cancers, polyps, and inflammatory bowel diseases. A computer-aided diagnosis (CAD) system using deep...
BACKGROUND
A colonoscopy can detect colorectal diseases, including cancers, polyps, and inflammatory bowel diseases. A computer-aided diagnosis (CAD) system using deep convolutional neural networks (CNNs) that can recognize anatomical locations during a colonoscopy could efficiently assist practitioners. We aimed to construct a CAD system using a CNN to distinguish colorectal images from parts of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum.
METHOD
We constructed a CNN by training of 9,995 colonoscopy images and tested its performance by 5,121 independent colonoscopy images that were categorized according to seven anatomical locations: the terminal ileum, the cecum, ascending colon to transverse colon, descending colon to sigmoid colon, the rectum, the anus, and indistinguishable parts. We examined images taken during total colonoscopy performed between January 2017 and November 2017 at a single center. We evaluated the concordance between the diagnosis by endoscopists and those by the CNN. The main outcomes of the study were the sensitivity and specificity of the CNN for the anatomical categorization of colonoscopy images.
RESULTS
The constructed CNN recognized anatomical locations of colonoscopy images with the following areas under the curves: 0.979 for the terminal ileum; 0.940 for the cecum; 0.875 for ascending colon to transverse colon; 0.846 for descending colon to sigmoid colon; 0.835 for the rectum; and 0.992 for the anus. During the test process, the CNN system correctly recognized 66.6% of images.
CONCLUSION
We constructed the new CNN system with clinically relevant performance for recognizing anatomical locations of colonoscopy images, which is the first step in constructing a CAD system that will support us during colonoscopy and provide an assurance of the quality of the colonoscopy procedure.
PubMed: 34316372
DOI: 10.1093/gastro/goaa078 -
Iranian Journal of Veterinary Research 2023Abstract.
UNLABELLED
Abstract.
BACKGROUND
Colonic diverticulum is one of the rare findings in dogs characterized by an out-pouching of mucosal and submucosal layers through the defect in muscularis layer of the colon.
CASE DESCRIPTION
A five years old intact female Labrador was presented with an anamnesis of dyschezia and tenesmus.
FINDINGS/TREATMENT AND OUTCOME
Rectal examination was normal, and the survey radiograph showed an almost crescent shaped abnormal dilatation (10.52 cm × 6.21 cm) with gas and increased radiopaque material, dorsal to the urinary bladder and ventral to the descending colon suggesting fecal stasis. Ultrasonographic examination revealed gas-filled out-pouching with hyperechoic colon wall and acoustic shadowing. Exploratory celiotomy confirmed the diagnosis of colonic diverticulum, and diverticulectomy was performed. All four layers of the colonic wall were detected histopathologically in the biopsy sample and excluded neoplasia. The dog recovered uneventfully with no post-operative complications.
CONCLUSION
This surgery produced an excellent resolution of clinical signs. To our knowledge, this is one of the few cases of colonic diverticulum reported in dogs.
PubMed: 37790114
DOI: 10.22099/IJVR.2023.46410.6663 -
Surgical Case Reports Jan 2020The term "mesenteric inflammatory veno-occlusive disease (MIVOD)" is used to describe an ischemic injury resulting from phlebitis or venulitis that affects the bowel or...
BACKGROUND
The term "mesenteric inflammatory veno-occlusive disease (MIVOD)" is used to describe an ischemic injury resulting from phlebitis or venulitis that affects the bowel or mesentery in the absence of arteritis. MIVOD is difficult to diagnose because of its rarity and frequent confusion with other diseases. The incidence and etiology of MIVOD remain unclear; only a few cases have been reported. We describe a case of the successful surgical management of a patient with MIVOD with characteristic images.
CASE PRESENTATION
A 65-year-old Japanese man visited a hospital with the chief complaint of abdominal pain in January 2018. CT showed edema and thickening of the intestinal wall from the descending colon to the rectum. The patient was admitted to the hospital. Suspected diagnoses were enteritis, ulcerative colitis, amyloidosis, vasculitis, malignant lymphoma, and venous thrombus, but no definitive diagnosis was obtained. The patient was transferred to our hospital for the treatment of stenosis (located from the descending colon to the rectum) and bowel obstruction. An emergency transverse colostomy was performed. The sigmoid colon and mesentery were too rigid and edematous to resect. Colonic hemorrhage occurred 2 weeks after the surgery. With radiology intervention, coiling for the arteriovenous fistula in the descending colon was performed, and hemostasis was obtained. A colonoscopy at 6 months post-surgery showed neither ulceration nor stenosis in the rectum, indicating that the rectum could be preserved in the next surgery. However, severe stenosis in the descending and sigmoid colon remained unchanged. Ten months after the transverse colostomy, we performed a subtotal colectomy and ileorectal anastomosis, and an ileostomy was created. The sigmoid colon and mesentery were not so rigid compared to the first surgery's findings, and we were able to resect intestine and mesentery. Histopathology revealed phlebitis and venulitis, fibrinoid necrosis, and normal arteries, meeting the diagnostic criteria for MIVOD. Postoperatively, the patient showed no recurrence for 8 months.
CONCLUSION
Clinicians should consider MIVOD when examining a patient with intestinal ischemia. When MIVOD is suspected, the patient is indicated for surgery based on an accurate diagnosis and good prognosis.
PubMed: 31965458
DOI: 10.1186/s40792-020-0796-1 -
Journal of Nuclear Medicine Technology Sep 2021Intestinal F-FDG uptake is variable in whole-body PET/CT. In cancer patients, particularly those suspected of relapse or metastasis, F-FDG absorption might interfere... (Randomized Controlled Trial)
Randomized Controlled Trial
Intestinal F-FDG uptake is variable in whole-body PET/CT. In cancer patients, particularly those suspected of relapse or metastasis, F-FDG absorption might interfere with scan interpretation. This study evaluated the effect of diet on intestinal F-FDG absorption. In total, 214 patients referring for oncologic F-FDG PET/CT participated. They were randomly divided into 2 groups and asked to follow either a routine diet (RD) or a low-carbohydrate, high-fat diet (LCHFD) for 24 h before the study. The small bowel and different parts of the colon (the cecum; the ascending, transverse, and descending segments; and the hepatic and splenic flexures) were evaluated and visually interpreted by nuclear medicine experts. Bowel uptake was graded through comparison with that in the liver as absent, mild, moderate, or severe. Significantly higher F-FDG uptake in the descending colon ( = 0.001) and small intestine ( = 0.01) was observed in the RD group than in the LCHFD group. After patients with bowel cancer were omitted from the statistical analysis, no significant differences in the final results were seen. An LCHFD for 24 h before F-FDG PET imaging resulted in lower F-FDG uptake in the descending colon and small bowel than did an RD, assisting the interpreting physician by reducing the intestinal activity interference for more accurate diagnostic interpretation.
Topics: Diet; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 34244224
DOI: 10.2967/jnmt.120.257857 -
Journal of Surgical Case Reports Mar 2022Situs inversus totalis (SIT) is a congenital disorder of anatomical position, and the operation of patients with total visceral inversion often brings great challenges...
Situs inversus totalis (SIT) is a congenital disorder of anatomical position, and the operation of patients with total visceral inversion often brings great challenges to surgeons. Although there have been previously documented on patients with SIT and colonic cancer, this is the first case report of descending colon cancer in patient with SIT. The current report presents a case of a 67-year-old female patient with descending colon cancer and SIT. After preoperative preparation and discussion, open left hemicolectomy was performed for the patient. The postoperative recovery of the patient was smooth; however, there was a mild lymphatic leakage in the patient, which was cured by conservative treatment for 5 days. The patient was discharged on postoperative Day 10. There was no tumor recurrence or other discomfort in 1 year follow-up period.
PubMed: 35355573
DOI: 10.1093/jscr/rjab568 -
BJR Case Reports Feb 2019Splenic torsion is an uncommon condition becoming clinically apparent when the spleen twists or rotates around the organ's vascular pedicle. In the case of a wandering...
Splenic torsion is an uncommon condition becoming clinically apparent when the spleen twists or rotates around the organ's vascular pedicle. In the case of a wandering spleen the organ is only attached to an elongated vascular pedicle while the peritoneal attachments are absent. However, splenic torsion could also occur in patients with abnormal laxity of the splenic peritoneal attachments. We report a case of a splenic torsion due to absence of splenic ligaments with pancreatic volvulus and partial involvement of descending colon in a 9-year-old boy.
PubMed: 31131126
DOI: 10.1259/bjrcr.20180051