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Ziani H, Nasri S, Kamaoui I, Skiker I. An unusual case of diastatic perforation of the transverse colon: Case report and literature review. Radiol Case Rep 2024; 19:2434-2437. [PMID: 38585400 PMCID: PMC10997867 DOI: 10.1016/j.radcr.2024.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/24/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Diastatic perforation corresponds to a bursting of the cecal wall caused by excessive distension resulting from a remote obstruction of the low large bowel. This perforation could be explained by Laplace's physical law, and by the particular vascular anatomy of the cecal wall. We report the case of a 75-year-old man admitted for peritonitis with an abdominal CT scan highly suggestive of a diastatic perforation of the cecum complicating colonic distension upstream of a stenosing tumor of the rectosigmoid junction. To our surprise, surgical exploration revealed the defect to be in the transverse colon and not in the cecum. Diastatic perforation of the transverse colon is exceptional, and would require other pathophysiological explanations than those for classical cecal perforation.
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Affiliation(s)
- Hamid Ziani
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, Oujda, Morocco
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Niwa T, Watahiki M, Kosugi T, Kusama D, Tamakoshi H, Takinami M, Kaneko J, Takahashi Y, Nishino M, Yamada T. Endoscopic ultrasound-guided fine needle biopsy diagnosis of circumferentially extraluminal mucosa-associated lymphoid tissue lymphoma in the transverse colon: a case report. Clin J Gastroenterol 2024:10.1007/s12328-024-01945-8. [PMID: 38607542 DOI: 10.1007/s12328-024-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/05/2024] [Indexed: 04/13/2024]
Abstract
A 61-year-old man present to us with continued abdominal pain without abdominal tenderness for 1 month. Blood testing showed elevated biliary enzymes and inflammation. Contrast-enhanced computed tomography (CT) revealed thickening of the transverse colon with relatively strong enhancement but no bile duct dilatation. Colonoscopy revealed localized edema and granular mucosa in the transverse colon. Fluoroscopic endoscopy exhibited the absence of haustra. Multiple biopsies were performed, but differentiation between mild inflammation and mucosa-associated lymphoid tissue (MALT) lymphoma was inconclusive. To establish a definitive diagnosis, transgastric endoscopic ultrasound-guided fine needle biopsy of the hypoechoic mass was performed. Histopathological analysis exhibited the proliferation of small-sized lymphocytes. Fluorescence in situ hybridization revealed the characteristic API2-MALT1 translocation of MALT lymphoma. We performed liver biopsy to investigate biliary enzyme elevation. Histopathology confirmed lymphocytic infiltration within Glisson's capsule. Immunohistochemistry showed positive for CD20 and negative for CD3 and CD5, signifying the infiltration of MALT lymphoma in the liver. Based on these findings, we diagnosed MALT lymphoma, Lugano classification Stage IV. We performed bendamustine-rituximab (BR)-combined therapy. After six courses of BR-combined therapy, colonoscopy revealed improvement in the lead pipe sign and CT revealed disappearance of the mass.
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Affiliation(s)
- Tomoyuki Niwa
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Moeka Watahiki
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Toshikatsu Kosugi
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Daisuke Kusama
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Hiroki Tamakoshi
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Masaki Takinami
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Junichi Kaneko
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Yurimi Takahashi
- Department of Hepatology, Iwata City Hospital, Iwata, 43-8550, Japan
| | - Masafumi Nishino
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan
| | - Takanori Yamada
- Department of Gastroenterology, Iwata City Hospital, Iwata, 438-8550, Japan.
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Ekhaiyeme P, Olagunju N, Ajagbe O, Bello O, Yatu P, Afuwape O, Irabor D. A RARE METACHRONOUS COLONIC VOLVULUS. Ann Ib Postgrad Med 2023; 21:81-83. [PMID: 38298341 PMCID: PMC10811709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/30/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Colonic volvulus is a common cause of large bowel obstruction with the sigmoid colon most commonly affected. Volvulus of the transverse colon is an uncommon occurrence. Rarer still is a transverse colon volvulus developing after surgery for a sigmoid colon volvulus. Early diagnosis is critical as delay in detection and intervention is associated with the risk of complications - perforation, peritonitis, and death. Case presentation We report the case of an 86-year-old man who presented with features of large bowel obstruction 14 months following a sigmoid colectomy for a sigmoid colon volvulus. Conclusion A metachronous transverse colonic volvulus is uncommon. Preoperative diagnosis is challenging as there are no defining radiographic features compared to the volvulus of the sigmoid colon with the classical omega sign. Most cases are diagnosed intra-operatively. Bowel resection and anastomosis in a single stage is a safe option.
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Affiliation(s)
- P.A. Ekhaiyeme
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - N.A. Olagunju
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O.A. Ajagbe
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O.J. Bello
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - P.H. Yatu
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O. Afuwape
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - D.O. Irabor
- Department of Surgery, University College Hospital, Ibadan, Oyo State, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Iguchi K, Numata M, Shiozawa M, Kazama K, Sawazaki S, Katayama Y, Numata K, Higuchi A, Godai T, Sugano N, Mushiake H, Rino Y. Analysis of surgical outcomes of laparoscopic versus open surgery for locally advanced mid- transverse colon cancer. Langenbecks Arch Surg 2023; 408:222. [PMID: 37266706 DOI: 10.1007/s00423-023-02963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE This study compared the surgical outcomes between laparoscopic colectomy (LC) and open colectomy (OC) for mid-transverse colon cancer (MTC). METHODS This multicenter retrospective study compared the short- and long-term surgical outcomes for patients with advanced MTC (T3 and T4 with or without nodal involvement) who underwent LC or OC between January 2008 and December 2019 using a propensity score-matched analysis. RESULTS A total of 177 patients with advanced MTC were enrolled. After matching, 58 cases for the OC and LC groups were selected. No significant differences in age, sex, tumor progression, or procedure type (extended resection or segmental resection) existed between groups. The LC group had significantly less blood loss (20 mL vs. 50 mL, p=0.048) and a shorter postoperative hospital stay (8 days vs. 12 days, p<0.001) than the OC group. Postoperative complications (Clavien-Dindo grade ≥ 2) occurred in 27.6% and 25.9% of the OC and LC groups respectively (p=1). Three patients (5.2%) and one patient (1.7%) of the OC and LC groups respectively developed anastomotic leakage (p=0.62). Re-operation was required in five patients (8.6%) in the OC group and one patient (1.7%) in the LC group (p=0.21). No surgery-related deaths occurred in either group. The 3-year overall survival rates (stage II: LC 100% vs. OC 92.8%, p=0.15; stage III: 88.9% vs. 84.3%, p=0.88, respectively) were similar between the two groups. CONCLUSION LC is a minimally invasive technique with lesser blood loss, shorter postoperative hospital stays, and oncologic equivalence to OC. Hence, LC is useful for MTC treatment. TRIAL REGISTRATION UMIN000042676.
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Affiliation(s)
- Kenta Iguchi
- Department of Colorectal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-8515, Japan.
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Colorectal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, 241-8515, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Sho Sawazaki
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yusuke Katayama
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Koji Numata
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akio Higuchi
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Teni Godai
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Mushiake
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Ogi Y, Egi H, Ishimaru K, Koga S, Yoshida M, Kikuchi S, Akita S, Sugishita H, Matsumoto H, Shimokawa T, Takeuchi A, Watanabe Y. Cadaveric and CT angiography study of vessels around the transverse colon mesentery. World J Surg Oncol 2023; 21:36. [PMID: 36747176 PMCID: PMC9901106 DOI: 10.1186/s12957-023-02919-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. METHODS This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. RESULTS The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). CONCLUSIONS This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.
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Affiliation(s)
- Yusuke Ogi
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hiroyuki Egi
- Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime, 454 Shitsukawa791-0295, Japan.
| | - Kei Ishimaru
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Shigehiro Koga
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Motohira Yoshida
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Satoshi Kikuchi
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Satoshi Akita
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hiroki Sugishita
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Hironori Matsumoto
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
| | - Tetsuya Shimokawa
- grid.255464.40000 0001 1011 3808Division of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, 454 Shitsukawa, Toon City, Ehime 795-0295 Japan
| | - Akihide Takeuchi
- grid.255464.40000 0001 1011 3808Division of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, 454 Shitsukawa, Toon City, Ehime 795-0295 Japan
| | - Yuji Watanabe
- grid.452478.80000 0004 0621 7227Division of Gastrointestinal Surgery and Surgical Oncology, Ehime University Hospital, Toon City, Ehime 454 Shitsukawa791-0295 Japan
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Popović M, Knežević A, Dolinaj Škopelja J, Đolai M. JUVENILE POLYP IN ADULTS. Acta Clin Croat 2022; 61:354-358. [PMID: 36818922 PMCID: PMC9934046 DOI: 10.20471/acc.2022.61.02.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/10/2019] [Indexed: 02/10/2023] Open
Abstract
Colorectal juvenile polyp as a pathologic entity was first described by Verse. These non-neoplastic lesions are most commonly found in children and infants, while in older children after the age of 14 and adults are a rare phenomenon. A 75-year-old female underwent colonoscopy. There was a pedunculated polyp in the transverse colon. Complete endoscopic electroresection of this polyp was performed and the polyp was sent for histopathologic analysis. Macroscopically, the polyp was described as a fragment of irregular round shape, size of about 2.5x2x1 cm, with fine-grained, reddish surface, showing dark red color on serial sections. Histologic examination of the polyp showed some irregularly distributed glands, some of which were cystically dilated. All glandular formations were coated with normal intestinal epithelium. The surface of the polyp was partially eroded and replaced by non-specific cellular granulation tissue. There were some signs of hemorrhagic infarction in the stroma of the polyp. Histopathologic examination indicated that histopathologic characteristics of this polyp corresponded to juvenile polyp. Juvenile polyps are very rarely found in adults. Therefore, we describe a case of this patient in her eighties with juvenile polyp localized in the transverse colon.
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Affiliation(s)
- Milan Popović
- University of Novi Sad, Faculty of Medicine, Department of Histology and Embryology, Novi Sad, Serbia;,Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| | | | | | - Matilda Đolai
- University of Novi Sad, Faculty of Medicine, Department of Histology and Embryology, Novi Sad, Serbia;,Center for Pathology and Histology, University Clinical Centre of Vojvodina, Novi Sad, Serbia
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Nakao T, Shimada M, Yoshikawa K, Tokunaga T, Nishi M, Kashihara H, Takasu C, Wada Y, Yoshimoto T, Yamashita S, Iwakawa Y. Vascular variations encountered during laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer: a retrospective cohort study. BMC Surg 2022; 22:170. [PMID: 35538458 PMCID: PMC9092770 DOI: 10.1186/s12893-022-01603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. METHODS This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. RESULTS Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. CONCLUSION Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.
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Affiliation(s)
- Toshihiro Nakao
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan.
| | - Mitsuo Shimada
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Kozo Yoshikawa
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Takuya Tokunaga
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Masaaki Nishi
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Hideya Kashihara
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Chie Takasu
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Yuma Wada
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Toshiaki Yoshimoto
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Syoko Yamashita
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Yosuke Iwakawa
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
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Iguchi K, Numata M, Shiozawa M, Kazama K, Sawazaki S, Katayama Y, Numata K, Sato S, Higuchi A, Sugano N, Mushiake H, Rino Y. Laparoscopic extended right hemicolectomy versus laparoscopic transverse colectomy for mid- transverse colon cancer: a multicenter retrospective study from Kanagawa Yokohama Colorectal Cancer (KYCC) study group. Int J Colorectal Dis 2022; 37:1011-9. [PMID: 35384494 DOI: 10.1007/s00384-022-04128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The laparoscopic surgery approach for mid-transverse colon cancer (MTC) varies depending on tumor characteristics and the guidelines implemented by each surgeon; the optimal surgical procedure for MTC has not been established. This study aimed to compare the surgical outcomes of laparoscopic extended right hemicolectomy (Lap-ERHC) and laparoscopic transverse colectomy (Lap-TC) for MTC. METHODS This was a multicenter, retrospective study. We surveyed eight hospitals, by questionnaire, on MTC surgery policies and retrospectively compared the short- and long-term surgical outcomes for patients with MTC who underwent Lap-ERHC or Lap-TC between January 2008 and December 2019. RESULTS A total of 129 patients were enrolled, of whom 35 underwent Lap-ERHC and 94 underwent Lap-TC. There were no significant differences in tumor progression between the two groups. Operation time was significantly longer (202 min vs. 185 min, p = 0.026). We observed a higher complication rate (≥ grade 3) in the Lap-ERHC group than in the Lap-TC group (11.4% vs. 3.2%, p = 0.086). Three patients (8.6%) who underwent Lap-ERHC developed anastomotic leakage; none of the patients who underwent Lap-TC had this complication (p = 0.018). The 3-year overall survival rates (stage I: 100% vs. 91.9%, p = 0.64; stage II: 100% vs. 95.5%, p = 0.46; stage III: 100% vs. 88.2%, p = 0.91, respectively) were similar between the two groups. CONCLUSION Lap-ERHC for MTC has the same long-term outcomes as Lap-TC. However, Lap-ERHC for MTC has a higher complication rate. Therefore, Lap-TC may be recommended for patients with MTC. TRIAL REGISTRATION UMIN000042674.
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9
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Piozzi GN, Rusli SM, Choo JM, Kim JS, Kim SH. Laparoscopic transverse colectomy with extended complete mesocolic excision for mid- transverse colon cancer. Tech Coloproctol 2022; 26:497-498. [PMID: 35129734 DOI: 10.1007/s10151-021-02567-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022]
Affiliation(s)
- G N Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S M Rusli
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Department of Surgery, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - J M Choo
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - J S Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - S H Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
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Piozzi GN, Rusli SM, Baek SJ, Kwak JM, Kim J, Kim SH. Infrapyloric and gastroepiploic node dissection for hepatic flexure and transverse colon cancer: A systematic review. Eur J Surg Oncol 2021; 48:718-726. [PMID: 34893366 DOI: 10.1016/j.ejso.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/08/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated the oncological relevance of metastatic infrapyloric and gastroepiploic lymph nodes (IGLN) from hepatic flexure and transverse colon tumors. This study aimed to evaluate the incidence and risk factors for IGLN metastases, and the indications, surgical morbidities, and oncological outcome following extended lymphadenectomy. MATERIALS AND METHODS According to the PRISMA statement, a systematic review on IGLN lymphadenectomy for colon cancer was conducted into PubMed, Embase, and Cochrane databases. A critical appraisal of study was performed according to the Joanna Briggs Institute Tools. RESULTS Nine studies were included. IGLN metastases incidence ranged 0.7-22%. IGLN positivity for patients with metastatic mesocolic lymph nodes ranged 1.7-33.3%. Postoperative complication rate ranged 8.5-36.9%, mostly low grade according to Clavien-Dindo's classification. Postoperative mortality rate ranged 0-5.4% at 30-days. IGLN metastases were associated with advanced disease with a 5-year progression-free survival rate up to 33.9%. Two authors reported perineural invasion and N stage as risk factors, while another reported endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage to be risk factors for IGLN involvement. Apart from one study, all other studies were of moderate/high quality. CONCLUSIONS Metastatic IGLNs are not uncommon and should be highly considered. IGLN metastases could be potentially associated with an aggressive disease. IGLN dissection is not associated with higher morbidity and mortality than standard CME. Preoperative risk factors of IGLN involvement could guide surgical indication for extended lymphadenectomy.
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Affiliation(s)
- Guglielmo Niccolò Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Siti Mayuha Rusli
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Se-Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seon Hahn Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Song I, Park JW, Lim HK, Kim MJ, Kim MJ, Park SC, Oh JH, Oh HK, Kim DW, Kang SB, Ryoo SB, Jeong SY, Park KJ. The oncologic safety of left colectomy with modified complete mesocolic excision for distal transverse colon cancer: Comparison with descending colon cancer. Eur J Surg Oncol 2021; 47:2857-2864. [PMID: 34119379 DOI: 10.1016/j.ejso.2021.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. MATERIAL AND METHODS This study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. RESULTS Baseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786-3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530-2.952, p = 0.609). CONCLUSION The oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.
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Affiliation(s)
- Inho Song
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Han-Kin Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Jo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Bouali M, Yaqine K, Elbakouri A, Bensardi F, Elhattabi K, Fadil A. Ischemic volvulus of the transverse colon caused by intestinal malrotation: A case report. Int J Surg Case Rep 2021; 83:105971. [PMID: 34023547 PMCID: PMC8163956 DOI: 10.1016/j.ijscr.2021.105971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/29/2021] [Accepted: 05/08/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Congenital Intestinal malrotation is a complex disorder caused by incomplete or abnormal rotation of the intestine during fetal development. Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of acute abdomen in adults. It has a high risk of mortality, hence the need for an urgent diagnosis and surgical intervention. Case report We report an unusual case of volvulus of the transverse colon caused by intestinal malrotation. A 21-year-old women presented abdominal pain with nausea and vomiting. On clinical examination, the abdomen was tympanic to percussion with peritoneal sensitivity. The abdominal X-ray revealed a massive obstruction of the distended large intestine with a “U-shaped” loop. He underwent an exploratory laparotomy that revealed the diagnosis of transverse colon volvulus with intestinal malrotation. His condition was treated surgically by transverse colectomy with colostomy. The patient died on the second day following a hemodynamic instability. Conclusion Transverse colonic volvulus is a rare entity with a high mortality, so it requires urgent diagnosis and surgical intervention. Volvulus of the transverse colon secondary to intestinal malrotation is a rare cause of an acute abdomen in adults. Volvulus of the transverse colon has a high risk of mortality, so it requires urgent diagnosis and surgical intervention. The diagnosis of the volvulus of the transverse colon before surgery is rarely observed, it's most often made intraoperatively. The choice of a procedure depends on the general condition of the patient.
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Affiliation(s)
- Mounir Bouali
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Karim Yaqine
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - Abdelilah Elbakouri
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Fatimazahra Bensardi
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Khalid Elhattabi
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - Abdelaziz Fadil
- Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco; Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco
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Zhao J, Zhu J, Sun R, Huang C, Yuan R, Zhu Z. Primary tumor resection improves prognosis of unresectable carcinomas of the transverse colon including flexures with liver metastasis: a preliminary population-based analysis. BMC Cancer 2021; 21:503. [PMID: 33957871 PMCID: PMC8101189 DOI: 10.1186/s12885-021-08157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Studies on unresectable colorectal cancer liver metastasis(CRLM) rarely analyze the prognosis of the patients from the point of colonic subsites. We aimed to evaluate the effect of primary tumor resection (PTR) and different scope of colectomy on the prognosis of patients with unresectable transverse colon cancer liver metastasis (UTCLM), hepatic flexure cancer liver metastasis (UHFLM), and splenic flexure cancer liver metastasis (USFLM). Patients and methods The patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cause-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of PTR on survival. Results In total, this study included a cohort of 1960 patients: 556 cases of UHFLM, 1008 cases of UTCLM, and 396 cases of USFLM. The median survival time of whole patients was 11.0 months, ranging from 7.0 months for UHFLM patients to 15.0 months for USFLM patients. USFLM patients had the best OS and CSS, followed by UTCLM patients. UHFLM patients had the worst OS and CSS (All P < 0.001). PTR could improve the OS and CSS of UTCLM, UHFLM, and USFLM (All P < 0.001). Subgroups analysis revealed that USFLM patients with tumor size≤5 cm and negative CEA had not demonstrated an improved OS and CSS after PTR. Multivariate analysis showed that PTR and perioperative chemotherapy were common independent prognostic factors for UHFLM, UTCLM, and USFLM patients. There was no difference between segmental colon resection and larger colon resection on CSS of UHFLM, UTCLM, and USFLM patients. Conclusions We confirmed the different survival of patients with UTCLM, UHFLM, and USFLM, and for the first time, we proved that PTR could provide survival benefits for patients with unresectable CRLM from the perspective of colonic subsites of transverse colon, hepatic flexure, and splenic flexure. Besides, PTR may not improve the prognosis of USFLM patients with CEA- negative or tumor size≤5 cm. For oncologic outcomes, we concluded that segmental colon resection seemed an effective surgical procedure for UTCLM, UHFLM, and USFLM.
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Affiliation(s)
- Jiefeng Zhao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Jinfeng Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Rui Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Chao Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China
| | - Rongfa Yuan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China.
| | - Zhengming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, Jiangxi, 330006, People's Republic of China.
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Pamathy G, Jayarajah U, Gamlaksha DS, Constantine R, Banagala ASK. Abdominal actinomycosis mimicking a transverse colon malignancy: a case report and review of the literature. J Med Case Rep 2021; 15:224. [PMID: 33934716 PMCID: PMC8091771 DOI: 10.1186/s13256-021-02812-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy. Case presentation A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy. Conclusions Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.
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Affiliation(s)
- Gnanaselvam Pamathy
- Department of Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
| | - Umesh Jayarajah
- Department of Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
| | | | | | - Anura S K Banagala
- Department of Surgery, National Hospital of Sri Lanka, Colombo 10, Sri Lanka
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15
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Yamauchi A, Chinen Y, Chihara T, Ueda M, Ikenaga M, Yamada T, Hirota S. A case of planar-type gastrointestinal stromal tumor of the transverse colon with perforation. Clin J Gastroenterol 2021; 14:1157-62. [PMID: 33728873 DOI: 10.1007/s12328-021-01385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the human gastrointestinal tract. They usually develop in the stomach and small intestine, but extremely rarely in the colon. Although most GISTs form a mass, some cases showing a flatly proliferating lesion called planar-type GIST have been reported in the sigmoid colon and small intestine. Those are often associated with diverticular lesion and/or perforation. We present here a case of planar-type GIST of the transverse colon with perforation. A 49-year-old Japanese woman abruptly complained of abdominal pain, and was clinically diagnosed as perforation of the transverse colon. Partial resection of the transverse colon including the perforated site was done, and no apparent mass lesion was present. Histology showed that spindle cells flatly proliferated around the perforated area and replaced the layers from submucosa to subserosa. Immunohistochemistry revealed that the spindle cells were KIT-, DOG1- and CD34-positive. Codons 557 and 558 of exon 11 of the c-kit gene were heterozygously deleted at the lesional tissue but not at the normal mucosal tissue. Planar-type GIST of the transverse colon has not been reported yet, and the literature search for the similar cases was done.
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16
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Elbakouri A, Lafkih O, Abbad El Andaloussi Z, Bouali M, Elhattabi K, Bensardi F, Fadil A. Sub-acute transverse colon volvulus an exceptional cause of large bowel obstruction: Case report. Ann Med Surg (Lond) 2021; 63:102154. [PMID: 33659057 PMCID: PMC7890129 DOI: 10.1016/j.amsu.2021.01.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/01/2022] Open
Abstract
Introduction The sub-acute form of transverse colon volvulus manifests with signs and symptoms of large bowel obstruction. The diagnosis is most often done intraoperatively. We report a rare case of transverse colon volvulus in a 65-year-old female patient with no particular pathological or surgical history. Case presentation Sub-acute transverse colon volvulus in an elderly woman with no pathological or surgical history. Manifested with signs and symptoms of colonic obstruction. Surgically treated by a two-stage procedure with good postoperative outcomes. Discussion The transverse colon volvulus represents only 2-4% of all colonic volvulus. We discuss the diagnostic and therapeutic approach of our case of transverse colon volvulus through a literature review. Conclusion Transverse colon volvulus should be considered as a differential diagnosis in the face of large bowel obstruction. Early diagnosis and treatment improve the prognosis.
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Affiliation(s)
- Abdelilah Elbakouri
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Oussama Lafkih
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Zineb Abbad El Andaloussi
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of Radiology, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Mounir Bouali
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Khalid Elhattabi
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Fatimazahra Bensardi
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
| | - Abdelaziz Fadil
- Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.,Department of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco
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Manasewitsch NT, Lee MT, Khuu AN. Synchronous Volvulus of the Transverse Colon and Cecum Associated with Scleroderma and Lupus. Radiol Case Rep 2021; 16:273-7. [PMID: 33299508 DOI: 10.1016/j.radcr.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/11/2020] [Indexed: 12/28/2022] Open
Abstract
Colonic volvulus may infrequently occur in the transverse colon, and synchronous double volvulus is a rarely reported phenomenon in the literature. Additionally, intestinal volvulus is a rare but serious complication that has been reported in scleroderma and systemic lupus erythematosus (SLE) patients. We report a 26-year-old patient with a history of scleroderma-SLE overlap syndrome who presented with an acute abdomen. CT imaging revealed a transverse colon volvulus and a cecal bascule (cecal volvulus). To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. Additionally, this is the second reported case of transverse colon volvulus occurring in a patient with scleroderma and the first case in a patient with scleroderma-SLE overlap syndrome.
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Huang S, Wang X, Deng Y, Jiang W, Huang Y, Chi P. Gastrocolic Ligament Lymph Node Dissection for Transverse Colon and Hepatic Flexure Colon Cancer: Risk of Nodal Metastases and Complications in a Large-Volume Center. J Gastrointest Surg 2020; 24:2658-2660. [PMID: 32666497 DOI: 10.1007/s11605-020-04705-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Shenghui Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
- Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
- Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yu Deng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China
- Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.
- Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, 350001, Fujian Province, People's Republic of China.
- Training center of minimally invasive surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Al-Doud MA, Al-Omari MA, Dboush HG, Alabbadi AS, Al-Rahamneh IE. Large bowel obstruction as a consequence of transverse colon volvulus: A case report. Int J Surg Case Rep 2020; 76:534-538. [PMID: 33207426 PMCID: PMC7599370 DOI: 10.1016/j.ijscr.2020.10.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Transverse colon volvulus incidence is comparatively rare when compared to cecal and sigmoid volvulus. Its diagnosis is still challenging for the surgeon. Delay in the diagnosis of this condition carries high morbidity and mortality rates. AIM To report a rare case of transverse colon volvulus in a young adult male that presented as large bowel obstruction and was operated upon in the General Surgery department in the Jordanian Royal Medical Services (JRMS), Amman, Jordan. PRESENTATION OF CASE An 18-year-old male presented with severe generalized abdominal pain of 12-h-duration, associated with significant abdominal distention and constipation of one-day duration. His abdominal examination revealed a massively distended, tender abdomen; however, there were no signs of peritonitis. Abdominal radiographs showed a massively dilated large bowel. He underwent exploratory laparotomy that revealed the diagnosis of transverse colon volvulus. His condition was managed operatively with transverse colectomy with a primary anastomosis. The patient had a satisfactory postoperative recovery. DISCUSSION Only 3-5% of all cases of intestinal obstruction are caused by colonic volvulus. Transverse colon is involved in 2-4% of them. The diagnosis of transverse colon volvulus can be delayed and difficult because it does not have the same classically recognizable radiographic features as cecal and sigmoid volvulus. CONCLUSION Transverse colon volvulus is a rare entity. A swift suspicion of diagnosis is key to preventing severe outcomes. It can result in bowel perforation and fecal peritonitis. The definitive diagnosis is frequently made intraoperatively. Early surgical intervention is essential for better outcome and avoiding complications.
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Affiliation(s)
- Mohammad A Al-Doud
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
| | - Malek A Al-Omari
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
| | - Heba G Dboush
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
| | - Ahmad S Alabbadi
- Department of General Surgery, Jordanian Royal Medical Services (JRMS), Amman, Jordan.
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Yano M, Okazaki S, Kawamura I, Ito S, Nozu S, Ashitomi Y, Suzuki T, Kamio Y, Hachiya O. A three-dimensional computed tomography angiography study of the anatomy of the accessory middle colic artery and implications for colorectal cancer surgery. Surg Radiol Anat 2020; 42:1509-15. [PMID: 32500228 DOI: 10.1007/s00276-020-02511-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
Abstract
Purpose In the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns. Methods We included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery. Results Accessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases. Conclusion 3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.
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Kwak HD, Ju JK, Yeom SS, Lee SY, Kim CH, Kim YJ, Kim HR. Is radical surgery for clinical stage I right-sided colon cancer relevant? A retrospective review. Ann Surg Treat Res 2020; 98:139-145. [PMID: 32158734 PMCID: PMC7052394 DOI: 10.4174/astr.2020.98.3.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/19/2019] [Accepted: 02/07/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Radical lymph node dissection for right-sided colon cancer is technically challenging. No clear guideline is available for surgical resection of clinical stage I right-sided colon cancer. This study was designed to review the pathologic stage of clinical stage I right-sided colon cancer and determine the relevant extent of surgical resection. Methods Patients were treated for clinical stage I right-sided colon cancers (cecal, ascending, hepatic flexure, and proximal transverse colon) between July 2006 and December 2014 at a tertiary teaching hospital. Open surgery was not included because laparoscopic surgery is an initial major procedure in the institution. Results During the study period, 80 patients diagnosed with clinical stage I right-sided colon cancer were classified into 2 groups according to the pathology: stage 0/I and II/III. Tumor sizes were larger in the stage II/III group (P = 0.003). The stage II/III group had higher rates of vascular (P = 0.023) and lymphatic invasion (P = 0.023) and lower rates of well differentiation (P = 0.022). During follow-up, 1 case of local and 4 cases of systemic recurrences were found. Multivariate analysis to confirm odds ratios affecting change from clinical stage I to pathological stage II/III showed that tumor size (P = 0.010) and the number of retrieved lymph nodes (P = 0.046) were risk factors. Conclusion For right-sided colon cancer, even with clinical stage I included, radical lymph node dissection should be performed for exact staging with sufficient number of lymph nodes. This will help determine appropriate adjuvant treatment, especially in large tumor sizes.
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Affiliation(s)
- Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyun Ju
- Department of Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Seung-Seop Yeom
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Young Jin Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
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22
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Ito R, Mori K, Minamimura K, Hirata T, Kobayashi T, Kawasaki S. Displacement of the transverse colon is a highly specific computed tomography finding for the preoperative diagnosis of a transomental hernia. Jpn J Radiol 2019; 37:605-11. [PMID: 31256316 DOI: 10.1007/s11604-019-00851-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE A transomental hernia (TOH) is a rare type of internal hernia and is associated with a high strangulation rate and high mortality rate. Displacement of the transverse colon on computed tomography (CT) may be specific to a TOH and may facilitate an early diagnosis. The aim of this study was to verify the effectiveness of a novel approach assessing displacement of the transverse colon for the preoperative diagnosis of a TOH. MATERIALS AND METHODS We retrospectively reviewed the CT and operative data of 113 patients who underwent surgery for small bowel obstruction (SBO) between 2011 and 2018. The proportion of transverse colon loops posterior to dilated intestinal loops (PTPI) was calculated. RESULTS The patients were divided into a TOH group (n = 7) and other SBO group (n = 106). The median PTPI was significantly higher in the TOH group than in the other SBO group (67% [0-97%] vs. 0% [0-100%], Wilcoxon's test, p = 0.03). A receiver operating characteristic curve showed that when the PTPI was ≥ 57%, its sensitivity and specificity for a TOH were 71% and 94%, respectively. CONCLUSION The PTPI is a reliable quantitative measure to distinguish a TOH from other types of SBOs.
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Hasnaoui H, Laytimi F, Elfellah Y, Mouaqit O, Benjelloun EB, Ousadden A, Taleb KA, El Bouhaddouti H. Transverse colon volvulus presenting as bowel obstruction: a case report. J Med Case Rep 2019; 13:156. [PMID: 31126322 PMCID: PMC6534884 DOI: 10.1186/s13256-019-2080-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco. CASE PRESENTATION We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a "U-shaped" loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies. CONCLUSION This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.
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Affiliation(s)
- Hamza Hasnaoui
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco. .,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco.
| | - Faouzi Laytimi
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Yusuf Elfellah
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Ouadii Mouaqit
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - El Bachir Benjelloun
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Abdelmalek Ousadden
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Khalid Ait Taleb
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
| | - Hicham El Bouhaddouti
- Visceral Surgery Department A, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco
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Bakopoulos A, Tsilimigras DI, Syriga M, Koliakos N, Ntomi V, Moris D, Bistarakis D, Schizas D. Diverticulitis of the transverse colon manifesting as colocutaneous fistula. Ann R Coll Surg Engl 2018; 100:e1-e3. [PMID: 30112933 PMCID: PMC6204519 DOI: 10.1308/rcsann.2018.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 12/25/2022] Open
Abstract
The transverse colon is a particularly rare site for a diverticulum to develop, with only few reports of solitary diverticula described in the literature. Among the reported complications, colocutaneous fistulas appear relatively infrequently. We describe the case of an 80-year-old woman with a solitary diverticulum of the transverse colon presenting as acute diverticulitis with abscess formation in the epigastric region. A fistulous tract was found between the inflamed colon and the skin. A wedge resection of the inflamed colon together with the fistula and the solitary diverticulum was performed followed by primary suturing of the healthy colonic tissue. Despite the sufficient treatment and thorough clearance of the area, the patient died ten days later from ventilator associated pneumonia. Although rare, in patients presenting with a subcutaneous abscess in the abdominal region, there should be a high level of suspicion for active intraperitoneal inflammation derived from complicated diverticular disease given the continuously elevated prevalence of the condition in Western societies. The decision regarding proper management of this clinical state should be based on thorough clinical examination and imaging.
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Affiliation(s)
- A Bakopoulos
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - DI Tsilimigras
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - M Syriga
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - N Koliakos
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Ntomi
- Third Department of Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - D Moris
- Department of Surgery, Duke University Medical Center, Duke University, Durham, NC, USA
| | - D Bistarakis
- Department of Surgery, Hygeia Hospital, Athens, Greece
| | - D Schizas
- First Department of Surgery, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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25
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Yared RA, Badran HA, Kamareddine MH, Ghosn Y, Bou Khalil R, El Ajamy K, Chouairy C, Farhat SG. Colonic Malakoplakia: A Rare Finding in a Healthy Male. Case Rep Gastroenterol 2018; 12:453-456. [PMID: 30186099 PMCID: PMC6120369 DOI: 10.1159/000492208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Abstract
Malakoplakia is a rare chronic granulomatous disease that may affect many organs, including the lung, brain, adrenal glands, pancreas, bone, and the genitourinary tract. The gastrointestinal tract is the most common site of involvement outside of the urinary tract. Herein, we present a case of a 65-year-old male who presented with abdominal pain and unintentional weight loss. Physical examination findings were unremarkable, but colonoscopy revealed an isolated large, flat, soft, and pale lesion in the transverse colon. Histopathological examination of the lesion showed expansion of the lamina propria due to numerous lymphocytes, plasma cells, neutrophils, and polygonal cells. Von Kossa stain showed small intracytoplasmic basophilic granular inclusions, and these histiocyte cells showed numerous Michaelis-Gutmann bodies, findings considered as diagnostic features of colonic malakoplakia. This is a rare case of isolated malakoplakia of the transverse colon diagnosed on endoscopic specimens. The majority of reported cases have shown an association between systemic diseases and colorectal adenocarcinoma. In addition, most reported cases of colonic involvement have been in the rectum, sigmoid, and right colon.
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Affiliation(s)
- Rawad A. Yared
- Department of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Hussein A. Badran
- Department of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Mohammed Hussein Kamareddine
- Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Youssef Ghosn
- Saint George Hospital University Medical Center, Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Roula Bou Khalil
- Department of Endocrinology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Khaled El Ajamy
- Department of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Camil Chouairy
- Department of Pathology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Said G. Farhat
- Department of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
- *Assist. Prof. Said G. Farhat, MD, Department of Gastroenterology, Saint George Hospital University Medical Center, University of Balamand, PO Box 166378, Achrafieh, Beirut (Lebanon), E-Mail
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Harpain F, Gasché C, Prager G, Silberhumer GR. A siphon-like retrogastric transverse colon: A case report. Int J Surg Case Rep 2018; 44:110-113. [PMID: 29499513 PMCID: PMC5910513 DOI: 10.1016/j.ijscr.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/26/2017] [Accepted: 01/18/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Intestinal interposition is a term that describes rare anatomic variations where parts of the colon deviate from their normal intraabdominal position, attaching between two organs. Most patients with colonic interpositions are asymptomatic and diagnosed incidentally by computed tomography or ultrasound. Here we present a case of a symptomatic restrogastric colon, interposing kinked between stomach and pancreas. PRESENTATION OF CASE A 66-year old female patient presented with an eight-year history of intermittent spastic bowel movements, epigastralgia and nausea. Consecutively, the patient lost 12 kg. Physical examination was unremarkable and routine blood tests were within normal limits. Subsequently performed colonoscopy and cross-sectional imaging diagnosed a retrogastric colon. Finally, the patient underwent surgical treatment. The intraoperative findings were consistent with the computed tomography images and showed a kinked retrogastric protrusion of the transverse colon into the lesser sac, adhering to both, the posterior wall of the stomach, and the anterior surface of the pancreas. After adhesiolysis and mobilization, the transverse colon slipped back to the normal position within the abdominal cavity. The patient recovered well after surgery and was discharged on the sixth postoperative day. Six-month follow-up revealed cured bowel function, weight regain and no signs of recurrence. DISCUSSION & CONCLUSION These rare cases of intestinal interpositions are very often difficult to diagnose, as symptoms are misleading. In case of diagnosis adequate surgical treatment strategies should be considered.
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Affiliation(s)
- Felix Harpain
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Christoph Gasché
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Gerhard Prager
- Department of Surgery, Division of Visceral Surgery, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
| | - Gerd R Silberhumer
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria.
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Yakura T, Hayashi S, Terayama H, Miyaki T, Nakano T, Naito M. A case of a cystic artery arising from the superior mesenteric artery with abnormal branching of the celiac trunk. BMC Res Notes 2017; 10:526. [PMID: 29084586 PMCID: PMC5661926 DOI: 10.1186/s13104-017-2858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
Objective The celiac trunk normally has three branches; i.e. the left gastric, splenic, and common hepatic artery. It is known that the right hepatic artery occasionally branches from the superior mesenteric artery, while the cystic artery arising from the superior mesenteric artery is extremely rare. A deeper understanding of cystic arterial variations is necessary for all physicians performing examinations and surgical procedures of the hepatobiliary system. Results The cystic artery arising from the superior mesenteric artery was found in the cadaver of an 86-year-old woman during an anatomy dissection class at Aichi Medical University in 2015. In this case, the cystic artery ran along the dorsal side of the portal vein through Calot’s triangle to the gallbladder. The celiac trunk had four abnormal branches, one each to the left gastric, right hepatic, splenic, and left hepatic artery. The middle colic artery was absent and the left colic artery branching from the inferior mesenteric artery was distributed along the whole length of the transverse colon. In all cases of the cystic artery arising from the superior mesenteric artery, the vessel ran along the dorsal side of the portal vein; in addition, the right hepatic artery arose from the superior mesenteric artery.
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Affiliation(s)
- Tomiko Yakura
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Shogo Hayashi
- Department of Anatomy, Tokyo Medical University, Tokyo, Japan
| | - Hayato Terayama
- Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takayoshi Miyaki
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Kim MK, Lee IK, Kang WK, Cho HM, Kye BH, Jalloun HE, Kim JG. Long-term oncologic outcomes of laparoscopic surgery for splenic flexure colon cancer are comparable to conventional open surgery. Ann Surg Treat Res 2017; 93:35-42. [PMID: 28706889 PMCID: PMC5507789 DOI: 10.4174/astr.2017.93.1.35] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/21/2017] [Accepted: 02/01/2017] [Indexed: 01/31/2023] Open
Abstract
Purpose Few studies about laparoscopic surgery for splenic flexure colon cancer have been published. This study aims to compare the short- and long-term outcomes of laparoscopic surgery for splenic flexure colon cancer with those of conventional open surgery. Methods From January 2004 to December 2010, 51 consecutive patients who underwent curative resection for stages I–III splenic flexure colon cancer were enrolled. Thirty-three patients underwent laparoscopy-assisted colectomy, while 18 patients underwent conventional open colectomy. Short- and long-term outcomes of the 2 groups were compared. Results There were no differences in baseline characteristics, intra- and postoperative complications. The laparoscopy group showed longer operation time (median [interquartile range, IQR]: 295.0 [255.0–362.5] minutes vs. 180.0 [168.8–206.3] minutes, P < 0.001). In the laparoscopy group, return of bowel function was faster (median [IQR]: 3 [2–4] vs. 4 [3–5], P = 0.007) and postoperative hospital stay was shorter (median [IQR]: 9 [8–11] vs. 10.5 [9–19], P = 0.026). There were no statistically significant differences in overall survival rate (84.3% vs. 76.0%, P = 0.560) or disease-free survival rate (93.8% vs. 74.5%, P = 0.078) between the 2 groups. Conclusion Laparoscopic surgery for splenic flexure colon cancer has better short-term outcomes than open surgery, as well as acceptable long-term outcomes. Laparoscopic surgery can be a safe and feasible alternative to conventional open surgery for splenic flexure colon cancer.
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Affiliation(s)
- Min Ki Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Won-Kyung Kang
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Heba Essam Jalloun
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Gi Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Desmoplastic small round cell tumor (DSRCT) is an extremely rare, highly aggressive, malignant tumor of undetermined histogenesis. Adolescent males are primarily affected with a typically abdominal or pelvic mass. Diagnosis is based on histologic analysis of biopsy and cytogenetic studies. Owing to the rarity of the tumor and the unusually aggressive presentation, treatment is challenging and has not been standardized. DSRCT has a very poor prognosis, with a median survival range of 17 to 25 months. In this work, we report a case of DSRCT in the transverse colon, which has never before been reported in the literature. Our case study is of a 30-year-old Chinese female who presented with a history of 6 months abdominal discomfort and fatigue. A palpable, hardly mobile mass was detected in the right lower quadrant abdomen by physical examination. Abdominal and pelvic magnetic resonance imaging revealed an 8.0 × 10.5 × 11.1-cm mass with no pulmonary and hepatic metastasis. The patient underwent exploratory laparotomy and transverse colectomy, which revealed a mass in the transverse colon and no metastasis in the peritoneum, greater omentum, or mesentery. Immunohistochemistry findings revealed positive staining for epithelial, mesenchymal, and neural markers, which confirmed the presentation of DSRCT. A 6-month postoperative follow-up failed to find any recurrence. DSRCT is a highly aggressive, malignant, mesenchymal tumor with a very poor prognosis. No consensus has been reached for the treatment protocol of DSRCT. However, debulking surgery with postoperative chemotherapy or radiotherapy might promise more optimistic results on survival.
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30
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Jung KU, Park Y, Lee KY, Sohn SK. Robotic transverse colectomy for mid- transverse colon cancer: surgical techniques and oncologic outcomes. J Robot Surg 2015; 9:131-6. [PMID: 26531113 DOI: 10.1007/s11701-015-0502-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/08/2015] [Indexed: 12/13/2022]
Abstract
Robot-assisted surgery for colon cancer has been reported in many studies, most of which worked on right and/or sigmoid colectomy. The aim of this study was to report our experience of robotic transverse colectomy with an intracorporeal anastomosis, provide details of the surgical technique, and present the theoretical benefits of the procedure. This is a retrospective review of prospectively collected data of robotic surgery for colorectal cancer performed by a single surgeon between May 2007 and February 2011. Out of 162 consecutive cases, we identified three robotic transverse colectomies, using a hand-sewn intracorporeal anastomosis. Two males and one female underwent transverse colectomies for malignant or premalignant disease. The mean docking time, time spent using the robot, and total operative time were 5, 268, and 307 min, respectively. There were no conversions to open or conventional laparoscopic technique. The mean length of specimen and number of lymph nodes retrieved were 14.1 cm and 6.7, respectively. One patient suffered from a wound seroma and recovered with conservative management. The mean hospital stay was 8.7 days. After a median follow-up of 72 months, there were no local or systemic recurrences. Robotic transverse colectomy seems to be a safe and feasible technique. It may minimize the necessity of mobilizing both colonic flexures, with facilitated intracorporeal hand-sewn anastomosis. However, further prospective studies with a larger number of patients are required to draw firm conclusions.
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Affiliation(s)
- Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoonah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
| | - Kang Young Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kook Sohn
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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31
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Solak A, Solak I, Genç B, Sahin N, Yalaz S. Transverse colon diverticulitis with calcified fecalith. Eurasian J Med 2015; 45:68-70. [PMID: 25610254 DOI: 10.5152/eajm.2013.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/29/2012] [Indexed: 12/14/2022] Open
Abstract
Left colonic diverticula are common in Western populations, whereas right colonic diverticulosis primarily occurs in Oriental populations. Diverticulitis of the transverse colon is very rare, with very few cases reported in the literature. Herein, we report a case of transverse colon diverticulitis caused by a calcified stone in a 69-year-old female. This was a solitary diverticulum. The signs and symptoms of the disease are similar to acute pancreatitis. To the best of our knowledge, this is the first report describing the MRI findings of a patient with trans-verse colon diverticulitis caused by a calcified stone.
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Affiliation(s)
- Aynur Solak
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Ilhami Solak
- Department of General Surgery, Scool of Medicine Ege University, Izmir, Turkey
| | - Berhan Genç
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Neslin Sahin
- Department of Radiology, Sifa Hospital, Izmir, Turkey
| | - Seyhan Yalaz
- Department of General Surgery, Sifa Hospital, Izmir, Turkey
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Lee SY, Kwon JN, Kim KY. Acute peritonitis caused by a fibrosarcoma of the transverse colon in an adult. Ann Coloproctol 2015; 30:280-4. [PMID: 25580415 PMCID: PMC4286775 DOI: 10.3393/ac.2014.30.6.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 11/19/2014] [Indexed: 11/18/2022] Open
Abstract
A fibrosarcoma is a malignant mesenchymal tumor derived from fibrous connective tissue. It usually develops in the deep soft tissues of the extremities, as well as the trunk, head, and neck. In extremely rare cases, a fibrosarcoma may occur in the gastrointestinal tract. Most cases of fibrosarcoma in the gastrointestinal tract have been observed in the pediatric age group while only a few cases have been reported in adults. A 61-year-old male presented with pain in the entire abdominal region. Chest radiography showed free air in the subphrenic space. After an emergency operation, we found a solid mass around the transverse colon and performed a segmental resection with a lymphatic dissection of the transverse colon, including the mass. A pathologic examination showed a fibrosarcoma with a perforation. There was no perioperative complication. The patient was discharged on postoperative day 11 and had follow-ups for 1 year without any recurrence.
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Affiliation(s)
- Seok Youn Lee
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Jung Nam Kwon
- Department of Surgery, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
| | - Keun Young Kim
- Department of Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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Shetty P, Nayak SB. Absence of transverse colon, persistent descending mesocolon, displaced small and large bowels: a rare congenital anomaly with a high risk of volvulus formation. Anat Cell Biol 2014; 47:279-81. [PMID: 25548728 PMCID: PMC4276904 DOI: 10.5115/acb.2014.47.4.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 11/25/2014] [Accepted: 12/01/2014] [Indexed: 11/27/2022] Open
Abstract
Congenital anomalies such as positional anomalies of the right half of the colon are more common when compared to its left half. We report a rare case of congenital anomaly where the transverse colon was totally absent. Ascending colon continued as descending colon at the right colic flexure. Ascending and descending colons formed an inverted U shaped loop which was situated in the right half of the abdomen. The sigmoid colon began from the descending colon, on the right side of the midline and coursed to the left iliac fossa. The terminal part of ascending colon and entire descending colon had a persistent mesocolon. The jejunum and ileum were situated in the upper left part of the abdominal cavity. This anomaly can cause volvulus of the colon at any stage of life. Furthermore, the knowledge of this anomaly is very useful for radiologists, gastroenterologists and surgeons.
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Affiliation(s)
- Prakashchandra Shetty
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, India
| | - Satheesha B Nayak
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, India
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Abstract
We report a case of spontaneous transverse colon volvulus in a young healthy woman. It constitutes an unusual case since it occurred in a young healthy woman with a subacute onset and no aetiological factor has been found. Its diagnosis is still challenging. Prompt recognition with emergency intervention constitutes the key to successful outcome.
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Affiliation(s)
- Landolsi Sana
- Department of general surgery, Jendouba's Hospital, Tunisia
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Alfa-Wali M, Leuratti L, Efthimiou E. Diaphragmatic Richter's type of hernia involving the transverse colon after laparoscopic gastric bypass: an unusual complication. Surg Obes Relat Dis 2013; 9:e60-2. [PMID: 23433754 DOI: 10.1016/j.soard.2013.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 01/08/2013] [Accepted: 01/10/2012] [Indexed: 11/21/2022]
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Dey N, Sharma L, Sharma B, Chandra KS, Singh KG, Meitei AJ. Idiopathic neonatal colonic perforation- a case report. Indian J Surg 2011; 73:214-6. [PMID: 22654335 DOI: 10.1007/s12262-010-0209-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 03/07/2009] [Indexed: 01/19/2023] Open
Abstract
Perforation of the transverse colon in neonate is a rare finding in clinical practice. We report a case of Idiopathic neonatal colonic perforation in a twenty-one days old, healthy, female neonate without any demonstrable cause. She presented with abdominal distention and constipation. Abdominal radiograph showed massive pneumoperitoneum. On exploration, transverse colonic perforation was found near splenic flexure area. The perforation was closed primarily. Other than inflammatory fibrin flakes the rest of the large intestine and small bowel appeared normal. Hirschsprung's diseases, necrotizing enterocolitis, small left colon syndrome, atresia, imperforate anus, cystic fibrosis are some causes of colonic perforation in neonates. However none of the clinical features or intra-operative finding of the above conditions could be found in our case. At follow-up, the baby showed normal weight gain without any symptoms.
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Affiliation(s)
- Nilottpal Dey
- Regional Institute of Medical Sciences, Imphal, Manipur India
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Xia CF, Li Q, Li YF, Pan DG, Zhao JQ. Deep muscular lipoma of the transverse colon misdiagnosed as malignant stromal tumor: a report of one case. Shijie Huaren Xiaohua Zazhi 2010; 18:2392-2393. [DOI: 10.11569/wcjd.v18.i22.2392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A lipoma is a benign tumor of adipose tissue and usually arises in adipose-rich regions. Lipoma occurring in the deep muscular layer of the colon is a very rare clinical entity. Here, we report a case of deep muscular lipoma of the transverse colon. As bloody stool was the main symptom in this patient, he was misdiagnosed with malignant stromal tumor. A definite diagnosis was made by postoperative pathological examination.
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Dai SL, Wang M, Yang QN, Wan Q. One-case analysis of misdiagnosis for transverse colon lymphoma. Shijie Huaren Xiaohua Zazhi 2008; 16:1708-1709. [DOI: 10.11569/wcjd.v16.i15.1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Transverse colon involvement of malignant lymphoma is rare in clinic. It has peculiar manifestations, and is easy to be misdiagnosed. We report a patient who has been misdiagnosed with pyogenic peritonitis, intestinal perforation, and intestinal tuberculosis. He was confirmed with non-Hondgkin's lymphoma in a superior hospital after focuses were found by colonoscopy. Clinicians should be broad-minded, patients should be transferred to a superior hospital if necessary.
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Sato T, Yamazaki K, Akaike J, Toyota J, Karino Y, Ohmura T, Nishioka H. Transverse colonic varices successfully treated with endoscopic procedure. Clin J Gastroenterol 2008; 1:52-5. [PMID: 26193462 DOI: 10.1007/s12328-008-0010-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 03/03/2008] [Indexed: 01/27/2023]
Abstract
A 75-year-old woman with hepatitis C virus antibody-positive liver cirrhosis was admitted to our hospital with anal bleeding. Colonoscopy revealed red color-positive tortuous transverse colonic varices near the splenic flexure. Colonic varices were considered to be the most probable cause of bleeding, although the precise site could not be determined. Endoscopic injection sclerotherapy was performed for colonic varices. Endoscopic clipping was performed for bilateral sites of varices as an additional treatment. Four months after endoscopic treatments, colonoscopy revealed ulcer scars in the transverse colon and shrinkage of the varices.
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