Diffuse cavernous hemangioma of the rectosigmoid colon

Diffuse cavernous hemangioma of the rectosigmoid colon is an uncommon benign vascular lesion. We report 5 cases of diffuse cavernous hemangioma, focusing on the clinical features, diagnosis procedure and treatment. Five patients have undergone sphincter–saving procedures, 3 cases had coloanal sleeve anastomoses and 1 patient each had pull–through anastomosis and lower anterior resection. During the follow–up, which ranged from 3 to 10 years, 3 patients had no further anal bleeding and 2 patients had minor intermittent anal bleeding. Continence for normal stool was satisfactory in all patients. In conclusion, sphincter–saving procedure is most appropriate and curative approach for the treatment of diffuse cavernous hemangioma. Imaging study plays an important role in the diagnosis, preoperative staging and follow–up.     

Adenocarcinoma of the rectosigmoid colon seeding into pre-existing anal fistula

This paper reports a rare case of rectosigmoid colon carcinoma metastasizing to anal fistula. The patient is a 57-year old man with a 7-year history of a fistula in ano. Colonoscopy revealed a rectosigmoid carcinoma. He underwent high-anterior resection. Two years and 3 months later, a subcutaneous tumor was found at the external opening of fistula. Trans perineal tumor excision plus fistulectomy was performed. Pathology revealed that the colon cancer and the perianal tumor were both moderately differentiated adenocarcinoma. Many reports support the concept of tumor cell implantation in mucosa that have been altered or denuded by various factors. Sixteen reports could be found of implantation metastasis of colorectal cancer into anal fistula. In diagnosis, it is important to differentiate implantation of colorectal cancer in anal fistula from primary anal fistular adenocarcinoma. The histology of the perianal tumor in this patient closely resembles the tumor of the colon. Furthermore, immunohistochemistry for cytokeratins 7 and 20 was performed on tissues to distinguish colorectal adenocarcinoma from anal gland carcinoma. Both colorectal cancer and perianal tumor showed CK7-/CK20+.     

Diffuse cavernous hemangioma of the rectosigmoid colon with extraintestinal involvement.

Cavernous hemangioma of the colon is a rare cause of gastrointestinal bleeding. These lesions can be encountered as solitary, multiple, or part of a more complex syndrome with cutaneous manifestations. We herein describe a 26-year-old woman with cavernous hemangioma involving the rectosigmoid area. Additional hemangiomas were identified in the pelvic structures, spine, iliac bone and spleen. This multi-visceral involvement without cutaneous manifestations represents an intermediate variety between solitary hemangioma and well-defined syndromes with cutaneous and structural anomalies. The potential presence of extraintestinal hemangiomatosis should be considered and investigated in patients with cavernous hemangioma of the colon even without cutaneous manifestations or with a limited colonic involvement.     

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.     

Myoelectric spiking activity of right colon,left colon,and rectosigmoid of healthy humans

The tip of an intraluminal probe was positioned in the cecum, and before and after a standard meal (>800 kcal), the rapid myoelectrical activity of the right, the left, and the rectosigmoid colon in six healthy subjects was recorded. In each colonic site, we recorded two different patterns of spike bursts: Short spike bursts and long spike bursts, as previously described. We observed no difference in either the duration or the amplitude of the two kinds of spike bursts among the three different parts of the colon. Before the meal, the number of long spike bursts was lower in the right than in the left colon (P<0.01) and than in the rectosigmoid (P<0.01). After the meal, a significant activity increase in long spike bursts lasted 20 min in the right colon (P<0.001), 100 min in the left colon, and in the rectosigmoid (P<0.001–P<0.05). This activity was always significantly less intense in the right colon than in the two other sites (P<0.001–P<0.01) and was less marked in the left colon than in the rectosigmoid (P 0.01–P<0.05). The short spike burst activity remained unchanged. These results provide evidence for the heterogeneity of motility in the different parts of the colon, with a relative hypomotility of the right colon compared to the left colon and the rectosigmoid in the healthy human.Prof. Robert Tournut died on January 2, 1987.     

Risk for colon adenomas in patients with rectosigmoid hyperplastic polyps

OBJECTIVE: To determine whether hyperplastic polyps found in the rectosigmoid area of the colon are associated with proximal adenomas, and to judge whether patients with distal hyperplastic polyps found during sigmoidoscopy might benefit from full colonoscopy. DESIGN: Data on patients having colonoscopy collected prospectively according to a set protocol. The size and location of all polyps were noted, and all polyps were biopsied. SETTING: Two university hospitals. PATIENTS: One thousand eight hundred and thirty-six consecutive patients referred for colonoscopy between 31 December 1987 and 31 August 1989. RESULTS: Of the 970 patients who met eligibility requirements, 274 (28.3%) had adenomas and 108 (11.1%) had hyperplastic polyps. The proportion of patients with distal hyperplastic polyps and proximal adenomas (31.9%) was similar to the proportion of those without distal hyperplastic polyps (23.0%) (crude odds ratio, 1.57; 95% CI, 0.77 to 3.06). After adjusting for age and sex, the results were unchanged (adjusted odds ratio, 1.53; CI, 0.82 to 2.88). Patients with distal adenomas, on the other hand, were three times more likely to have proximal adenomas than those without distal adenomas (adjusted odds ratio, 3.42; CI, 1.99 to 5.88). CONCLUSIONS: Distal hyperplastic polyps are not strong predictors of risk for proximal adenomas. Based on the magnitude of the risk difference, we do not believe that finding a hyperplastic polyp during sigmoidoscopy justifies doing a full colonoscopy to search for proximal adenomas. Because rectosigmoid adenomas are associated with proximal adenomas, however, small polyps seen during sigmoidoscopy should be biopsied to determine their type. Colonoscopy should be reserved for patients who are proved to have adenomas.     

Differential gene expression in colon cancer of the caecum versus the sigmoid and rectosigmoid

BACKGROUND AND AIMS: There are epidemiological, morphological, and molecular differences between normal mucosa as well as between adenocarcinomas of the right and left side of the large bowel. The aim of this study was to investigate differences in gene expression. METHODS: Oligonucleotide microarrays (GeneChip) were used to compare gene expression in 45 single samples from normal mucosa and sporadic colorectal carcinomas (Dukes' B and C) of the caecum compared with the sigmoid and rectosigmoid. Findings were validated by real time polymerase chain reaction. RESULTS: Fifty eight genes were found to be differentially expressed between the normal mucosa of the caecum and the sigmoid and rectosigmoid (p<0.01), including pS2, S100P, and a sialyltransferase, all being expressed at higher levels in the caecum. A total of 118 and 186 genes were differentially expressed between normal and right or left sided tumours of the colon, showing more pronounced differences in Dukes' C than B tumours. Thirty genes differentially expressed in tumour tissue were common to adenocarcinomas of both sides, including known tumour markers such as the matrix metalloproteinases. Keratins 8, 19, and 20 as well as carbonic anhydrases (II, IV, VII) showed side specific expression and were downregulated in left sided tumours whereas teratocarcinoma growth factor and cyclooxygenase 2 (COX-2) were upregulated in left sided adenocarcinomas. Immunohistochemical analysis confirmed differences in side specific expression for cytokeratin 20 and COX-2. CONCLUSIONS: Differences in gene expression between normal mucosa as well as between adenocarcinomas of the caecum and sigmoid or rectosigmoid exist and should be taken into account when examining new targeted therapeutic regimens.     

Mucosal destruction and regeneration of the colon by local hyperthermia

An experimental model has been developed to produce colonic mucosal destruction followed by regeneration. The canine model consists of a defunctioned portion of the large intestine which has been subjected to water at a temperature of 125°F for 7 hours. Colonic specimens were harvested at different periods of up to six weeks and studied macro- and microscopically. It has been shown that it is possible to achieve significant mucosal destruction and regeneration. Possible adaptation to clinical states is presented and discussed.     

Is rectosigmoid response to food modulated by proximal colon stimulation?

Rectosigmoid motor activity and postprandial breath hydrogen levels were monitored in eight healthy males under basal conditions and for 3 1/2 hr after a meal (beefburger and breadroll and ice cream incorporating 20 g lactulose). Within minutes of ingestion there was a significant increase in motility index (P<0.05) and also an initial temporary rise in breath hydrogen. A late increase in motor activity occurred in seven of eight subjects 123 ±19 min after the meal and was temporally related to the beginning of a second, much larger rise in breath hydrogen (r=0.99;P<0.01). The close association between the timing of the rises in breath hydrogen and rectosigmoid motor activity would support the possibility that the latter may be generated by chemical or mechanical stimulation of the proximal colon.     

Deviation of the rectosigmoid colon simulating a presacral tumor: Report of a case

Summary The rectosigmoid colon has a potential for a great deal of mobility and variation of position. This is partially due to the wide variation in length and distal attachment of the sigmoid mesocolon. When anterior or lateral deviations of the distal sigmoid and rectum are found on bariumenema examinations, the possibility of anomalous fixation of the rectosigmoid should be considered.     

Experimental phantoms for studying diagnostic and therapeutic procedures of the rectosigmoid and upper colon

The authors represent lifelike exercise models for the training without patient of diagnostic and therapeutic interventions in the rectosigmoid and in the colon. The two models are used for the practical training of the rectosigmoidoscopy with the rigid rectoscope and the coloscopy with the fibre-optical examination technique. In the excorporated animal rectum may be performed polypectomies by means of removal of the loop, exploratory excisions from the intestinal wall as well as electro-surgical and cryosurgical interventions. The experiences got up to now in training classes are described.     

Frequency of advanced neoplasia in the proximal colon without an index polyp in the rectosigmoid

PURPOSE: Screening endoscopy has the potential to reduce colorectal cancer mortality. However, the efficacy of screening flexible sigmoidoscopy compared with colonoscopy strongly depends on the frequency of advanced proximal neoplasms without an index polyp in the rectosigmoid. We have therefore determined this frequency in our endoscopy population. METHODS: Endoscopic and histologic data were analyzed from all patients on whom integral colonoscopy was performed between 1980 and 1995. Advanced neoplasia was defined as cancer or adenomas >10 mm in diameter, adenomas with a villous component, or severe dysplasia. Patients with polyposis syndrome or inflammatory bowel disease were excluded. RESULTS: Colonoscopy was performed on 11,760 patients. 2,272 (19.3 percent) had at least one colorectal neoplasm, of which 39 percent had the neoplasm above the rectosigmoid. Twenty-two percent of all patients with neoplasia had no index polyp in the rectosigmoid and 16 percent of these had no index polyp, but at least one advanced proximal neoplasm. CONCLUSIONS: Although 39 percent of patients had neoplasms above the rectosigmoid, only 16 percent had an advanced proximal neoplasm without an index polyp in the rectosigmoid. This gives a figure on which to base the evaluation of screening sigmoidoscopy programs against those of screening colonoscopy.