Giant sigmoid colonic diverticulitis: case report

Giant colonic diverticulum is a rare condition, and the usual site is the sigmoid colon. In this report, magnetic resonance imaging was performed in a patient with lower abdominal pain. The modality was useful for the evaluation of giant sigmoid colonic diverticulitis and the differential diagnosis.     

CT demonstration of a giant colonic diverticulum

A case of giant sigmoid colonic diverticulum (GCD) is presented in which plain films showed an unchanging persistent large gas collection that did not opacify on barium enema. The computed tomographic scan revealed the GCD in close apposition to the adjacent sigmoid diverticulosis. Its walls were thin and more irregular than noted on plain films, and there was a suggestion of intraluminal contrast within it.     

Sigmoid colon duplication with ectopic immature renal tissue in an adult: A case report

BACKGROUNDColonic duplication is a rare congenital anomaly. Many types of heterotopic tissue were identified within the wall of duplication. However, studies of ectopic immature renal tissue (EIRT) involving colon duplication in an adult have yet to be reported.CASE SUMMARYA 23-year-old woman visited our hospital with symptoms of recurrent abdominal pain and chronic constipation. Image analysis via abdomino-pelvic computed tomography, Gastrografin contrast study, and colonoscopy showed a blind and dilated bowel loop filled with fecal material located on the mesenteric side of the sigmoid colon. We established a diagnosis of sigmoid colon duplication and decided to perform a laparoscopic investigation. Segmental resection of the sigmoid colon with duplication was done. Microscopically, the duplicated segment showed all three layers of the bowel wall and EIRT in the wall of the duplication. The postoperative period was uneventful and the patient was discharged nine days after the surgery without complications. She has been doing well 12 mo after the follow-up period.CONCLUSIONA comprehensive histopathologic examination for ectopic tissues or tumors is mandatory after resection of colon duplication.     

Panniculitis of the descending colon caused by enterocolic phlebitis: a case report

A 73-year-old male was referred to our hospital for abdominal pain, diarrhea and general fatigue lasting for 3 weeks. Physical examination of the abdomen revealed a firm mass in the left abdominal region. Computed tomography revealed a mass around the descending colon. Colonoscopy and barium enema revealed poor extensibility of the lumen with edematous mucosa, and narrowing of the descending colon with rugged mucosal surface. Because of the clinical symptoms and findings, the patient was diagnosed clinically as suffering from panniculitis of the descending colon. He underwent the left hemi-colectomy with side-to-side colo-colostomy after making of a loop ileostomy. Histological analysis of the resected colon showed an infiltration of inflammatory cells, predominantly lymphocytes, into veins and venules of the submucosa, muscularis propria and fat tissue of the colonic mesentery, with an involvement of all layers of the vessel wall. Arteries were escaped from inflammatory changes. The histopathological diagnosis of enterocolic phlebitis and venulitis was made because of these findings.     

Bilateral tension pneumothoraces and subcutaneous emphysema following colonoscopic polypectomy: a case report and discussion of anesthesia considerations

A 78-year-old man presented preoperatively with severe abdominal pain, dyspnea, and subcutaneous emphysema in his face, neck, and chest approximately 8 hours after colonoscopy with a sigmoid polypectomy. A pneumoperitoneum, free air in the mesentery, pneumoretroperitoneum, pneumomediastinum, and bilateral pneumothoraces were diagnosed using radiography and computed axial tomography. He emergently underwent an exploratory laparotomy with colostomy following bilateral chest tube placement. At laparotomy, a perforation of the posterior sigmoid colon was identified at the site of earlier polypectomy. The patient remained intubated and mechanically ventilated for 3 days postoperatively. Perforations of the colon during colonoscopies are the most serious complication of the procedure. Continued insufflation of air or carbon dioxide into a perforated colon can result in extraluminal gas that can result in life-threatening tension pneumothoraces. This case examines the consequences of colonic perforation and the anesthetic management for the definitive surgical treatment of a posterior sigmoid wall perforation. Anesthesia providers' awareness of the risk factors for colonic perforation due to colonoscopy, early signs and symptoms of perforation, and knowledge of the surgical and anesthetic management of perforation could lead to early recognition and intervention and likely to improved patient outcomes.     

Cecal infarction secondary to a distal obstructing fecaloma: association with drug abuse

A case of cecal infarction proximal to an obstructing fecaloma is presented. The patient's medical records revealed a 19-year history of the abuse of prescribed narcotic, sedative, psychotropic, and anticholinergic drugs. Gangrene in this case was caused by compression of intramural vessels secondary to a sustained increased in intracolonic pressure. The greatest effect of this increased pressure was found in the cecum, where wall tension and colonic distention were greatest. This report indicates that the colonic effects of chronic drug abuse have the potential for becoming a true surgical emergency.     

379例结肠憩室病的临床特点及内镜表现

目的通过回顾电子结肠镜检出结肠憩室患者的资料,分析结肠憩室发病特点及其与伴发疾病的相关性。方法回顾性分析2014年6月-2019年5月该院13 638例行电子结肠镜检查的内镜资料,采用SPSS 19.0统计软件分析结肠憩室患者检出情况及内镜下组织表现,以及其与伴发疾病的相关性。结果共发现结肠憩室379例,检出率为2.78%,呈逐年升高趋势,由1.79%增长至3.35%,第5年较第1年检出率明显提高(P 0.05)。结肠憩室发病与结肠息肉、结肠癌、结肠脂肪瘤、结肠黏膜黑变病和肠道手术史呈正相关(P 0.05),与缺血性结肠炎无明显相关性(P 0.05)。结论 5年间电子结肠镜下结肠憩室检出率明显升高,结肠憩室检出率与结肠息肉、结肠癌、结肠脂肪瘤、结肠黑变病及肠道手术史均有相关性。     

口服法肠道准备正常结肠的经腹超声表现

目的 研究正常结肠的超声表现.方法 对47名经过口服法肠道准备的成人行超声检查,分部位观察盲肠至乙状结肠(329个部位)内腔状态、肠壁显示、分层、厚度等.结果 329个结肠部位中,内腔"排空"228个(69.30%);近、远侧壁均被显示276个(83.89%);管壁为显示5层结构的201个(61.09%);管壁厚度平均(0.44±0.19)cm.结论 经过口服法肠道准备后,超声检查可以清晰地显示结肠大多数部位的近、远侧肠壁和壁内层次.     

CT appearance of giant colonic diverticulum

The plain film, barium enema, and CT findings in a case of giant colonic diverticulum with the atypical feature of marginal calcifications are presented. The value of CT in the diagnosis and evaluation of giant colonic diverticulum is discussed.     

Laparoscopic reduced port surgery for schwannoma of the sigmoid colon: A case report

A 74‐year‐old woman who developed schwannoma of the sigmoid colon was referred to our hospital for colonography to determine the cause of her stool occult blood. Colonoscopy revealed a submucosal tumor, which measured 3 cm in diameter, in the sigmoid colon. Endoscopic ultrasonography revealed a low echoic, homogeneous and demarcated submucosal tumor that continued into the fourth layer of the colonic wall. Gastrointestinal stromal, myogenic or neurogenic tumor was suspected, and thus, laparoscopic sigmoidectomy was carried out. We used two ports during the operation, a SILS Port in the umbilical region and a 12‐mm port in the right lower abdominal wall, and performed sigmoidectomy with D2 lymph node dissection. Histological findings revealed spindle‐like tumor cells with multiform nuclei. The tumor was diagnosed by immunostaining as benign schwannoma of the sigmoid colon. The conventional surgical treatment for schwannoma of the digestive tract is partial resection, but if preoperative diagnosis is unknown, radical resection with lymphadenectomy is acceptable for submucosal tumors in the digestive tract. In this case, laparoscopic reduced port surgery using only one or two ports may be more feasible and beneficial with regard to cosmesis and reduced postoperative pain than conventional laparoscopic colectomy.     

Cystic lymphangiomyoma of the colon causing protein-losing enteropathy.

This report documents a case of cystic lymphangiomyoma of the sigmoid colon in a 35-year-old woman who presented with symptoms of a protein-losing enteropathy. This case was unique in that it involved not only the colonic wall and mesentery but also extended into the retroperitoneum. Surgical excision of the affected segment has resulted in reversal of hypoproteinaemia and return to normal of the excessive faecal loss of 51Cr-labeled protein over a 2-year follow-up period.     

Giant sigmoid diverticulum causing colonic and urinary obstruction

Diverticulosis of the colon is a fairly common disease, but a solitary giant diverticulum is relatively rare. This case presented with symptoms of urinary and bowel obstruction.     

Right colonic diverticulitis: MR appearance

Background: We evaluated the magnetic resonance (MR) features of right colonic diverticulitis. Methods: This prospective study was based on five patients selected from a group of 156 patients admitted to the radiology department for further evaluation because of clinically suspected appendicitis. All five patients had ultrasound (US) and MR studies, and four patients also had computed tomography (CT). Results: In all five patients, right-side diverticulitis was seen as an outpouching of the right colon with associated circumferential wall thickening of the colon and surrounding inflammatory changes. Conclusions: Our results suggest that MR imaging can be useful in the diagnosis of right colonic diverticulitis. An inflamed diverticulum with adjacent colonic wall thickening and surrounding inflamed fat are characteristic MR signs. MR imaging can be a valuable alternative to CT in young or pregnant patients who have suspected appendicitis and an equivocal US result.     

A hamartoma of the colon with unusual features.

An unusual case of colonic hamartoma in a 67-year-old man is reported. Colonoscopy polyp surveillance revealed a polypoid lesion of the sigmoid colon which had the characteristics of a hamartoma on microscopic examination. The lesion, which was classified as a colonic hamartoma, is described. Review of the literature revealed no previous report of such a colonic poylp.     

结肠脂肪瘤11例临床分析

目的：提高结肠脂肪瘤的诊断和治疗水平。方法：回顾分析复旦大学附属中山医院普外科1993—2005年收治的11例结肠脂肪瘤患者临床资料。结果：11例结肠脂肪瘤患者的临床症状主要有腹痛、便血和大便习惯改变。肿瘤位于横结肠5例（45.5%）,盲升结肠4例（36.4%）,乙状结肠2例（18.2%）,均为单发。肿瘤最大直径2.5~6cm,平均4.1±1.3cm。10例（90.9%）患者手术前行纤维肠镜检查发现结肠肿块,活检病理结果均为阴性。所有患者均按结肠癌接受了相应的手术治疗。结论：结肠脂肪瘤诊断较为困难,CT是诊断结肠脂肪瘤正确率较高的检查手段。治疗以手术为主,仅需行局部肠段切除。     

妊娠并结肠肿瘤误诊为腹壁下血肿病例分析

目的探讨妊娠合并结肠肿瘤的误诊原因并提出预防措施。方法对1例误诊为腹壁下血肿的妊娠合并结肠肿瘤的临床资料进行回顾性分析。结果本例因停经28+2周、持续下腹痛伴阴道少量流血2 h入院,经妇科查体、血常规及B超等检查诊断为子痫前期(重度)、胎盘早剥、贫血(重度)。为挽救患者生命,急诊行剖宫产,术后对症治疗期间,患者出现左中腹疼痛,考虑腹壁下血肿、完全性肠梗阻,再次剖腹探查,术中见乙状结肠中段可触及15 cm×8 cm×4 cm大小的包块,术后病理诊断为(结肠)浆膜梭形细胞瘤。待患者病情平稳后转入普外科继续治疗。结论临床表现不典型、诊断思维局限及缺乏诊断经验是造成妊娠合并结肠肿瘤误诊的主要原因。     

Successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy: A case report

BACKGROUND Surgery 5-10 d after stent insertion was recommended by the European Society of Gastrointestinal Endoscopy for obstructing colonic cancer. For some obstructive patients, this may be not a good choice. Here, we report the successful treatment of obstructing colonic cancer by combining self-expandable stent and neoadjuvant chemotherapy.CASE SUMMARY The patient was a 72-year-old man who was admitted with a chief complaint of abdominal pain for more than 1 mo. Computed tomography(CT) scanning revealed that there was a mass in the descending colon, which led to intestinal obstruction. On admission, a series of therapeutic measures, such as fasting and water deprivation, gastrointestinal decompression, total parenteral nutrition, and octreotide acetate, were taken to improve the obstructive symptoms. At the same time, a self-expandable metal stent was successfully placed across the stenosis,and a biopsy was obtained and diagnosed as adenocarcinoma. CT scanning 14 d after insertion of the stent revealed that the intestine was swollen significantly.Systemic chemotherapy with modified FOLFOX6(mFOLFOX6) was administered. After two courses of mFOLFOX6, CT scanning showed clearly that swelling of the intestine was improved. Subsequently, the patient underwent left hemi-colectomy without stoma placement. The postoperative course was uneventful, and he has been disease-free for 6 mo after surgery.CONCLUSION This modified treatment strategy may provide an alternative therapy for patients with obstructing colonic cancers.     

Long-term outcome of indwelling colon observed seven years after radical resection for rectosigmoid cancer: A case report

BACKGROUNDIndwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon. We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.CASE SUMMARYA 73-year-old male had undergone extended radical resection for rectosigmoid cancer. The invaded ileocecal area and sigmoid colon were removed during the procedure, and the ileum was anastomosed side-to-side with the rectum. The excluded ascending, transverse, and descending colon were sealed at both ends and left in the abdomen. After 7 years, the patient developed persistent abdominal pain and distension. Work-up indicated intestinal obstruction. The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained, but the symptoms persisted; therefore, surgery was planned. Intraoperatively, extensive adhesions were found in the abdominal cavity, and the small intestine and the indwelling colon were widely dilated. The dilated colon was 56 cm long, 5 cm wide (diameter), and contained about 1500 mL of viscous liquid. The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue. The bacterial culture of the secretions was negative. The patient recovered after the operation.CONCLUSIONAlthough colonic exclusion is routinely performed, this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.     

Tuboovarian abscess simulating giant colonic diverticulum

The plain abdominal film finding of a large air-filled cavity has a differential diagnosis that includes giant colonic diverticulum, volvulus, giant Meckel's or other small-bowel diverticulum, emphysematous cystitis, vesicoenteric fistula, bowel duplication, and mesenteric cyst. The case presented here expands this differential diagnosis to include tuboovarian abscess with fistulous communication to the bowel.     

Sonographic features of colonic Crohn's disease: comparison of in vivo and in vitro studies

The entire length of the colon, starting at the recto-sigmoid junction and ending at the cecum, can be sonographically visualized by retrograde water instillation into the colon. In order to evaluate the validity of colonic sonography as a diagnostic method, in vivo transabdominal ultrasound examination of the colon wall after water insufflation was compared with in vitro ultrasound examination of the same colon wall on four resected surgical specimens from patients with colonic Crohn's disease and four controls. The normal colon wall specimens were easy to recognize in that they had a thickness of 4 mm and five layers of different echo patterns, which could be demonstrated both in vivo and in vitro. On the other hand, in patients with Crohn's disease, a distinct wall thickening of up to 1.5 cm was found, and the typical five-layer stratification could no longer be recognized. The sonographic changes demonstrated in vivo and in vitro were thus comparable both in wall thickness and wall structural alterations. This study shows that transabdominal colonic sonography of the fluid-filled colon is a diagnostic method that permits a detailed and accurate assessment of the normal and the pathologically changed colonic wall.