Irritable bowel syndrome evaluation using computed tomography colonography

AIM To evaluate the morphology of the colon in patients with irritable bowel syndrome(IBS) by using computed tomography colonography(CTC).METHODS Twelve patients with diarrhea type IBS(IBS-D), 13 patients with constipation type IBS(IBS-C), 12 patients with functional constipation(FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were measured.RESULTS The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C(P 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm(NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colonin group IBS-D was significantly shorter than that in group IBS-C(P 0.01) and that in group FC(P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm(NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C(P = 0.03) and that in group FC(P 0.001). The descending colon diameter in group FC was significantly greater than that in group C(P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm(NS).CONCLUSION CT colonography might contribute the clarification of subtypes of IBS.     

提高对结肠冗长症的认识、诊断及外科治疗

结肠冗长症是一种先天性结肠畸形,是结肠在发育过程中因基因再复制而生长过长所致。主要表现为腹痛、腹胀和长期顽固性便秘。X线钡剂灌肠造影是诊断结肠冗长症的主要手段。如果升、横、降结肠或乙状结肠的任何一段长度超过标准长度的35%～40%,即可诊断为结肠冗长症。具有长期顽固性便秘者,非手术治疗无效者,可行外科手术治疗,并且多数学者主张行扩大范围的切除。     

Colitis cystica profunda: presenting with complete intestinal obstruction and recurrence

An unusual case of colitis cystica profunda is described. The patient presented with intestinal obstruction due to a polypoid mass in the descending colon, which was diagnosed as colitis cystica profunda after the patient underwent colectomy. Three other separate lesions were present in the ascending, transverse, and sigmoid colon. There was no antecedent or associated colonic disease. The disease recurred 1 yr later in the remaining colon and rectum.     

Right Colon, Sigmoid Colon, and Transverse Colon Diverticulitis in the Same Patient: Report of a Case

Although sigmoid colon diverticulitis is frequently seen, right colon and transverse colon diverticulitis remain rare forms of the disease. This case report examined the disease course of a 46-year-old female who first presented to our institution in 1990 with perforated right-sided diverticulitis. During the next 11 years, she developed sigmoid colon diverticulitis and then transverse colon diverticulitis. The right and sigmoid colon diverticulitis were treated with surgery and the transverse colon diverticulitis was managed conservatively. This is the first reported case of a single patient who had separate episodes of diverticulitis in the right, transverse, and sigmoid colon. The evaluation and management of this patient has mirrored a trend in the literature and clinical practice.Reprints are not available.     

Distension-stimulated propagated contractions in human colon

To investigate the mechanisms for elicitation of peristaltic activity in the human colon, we studied the effect of balloon distension of the transverse, descending, and sigmoid colon and the rectum. Fifteen healthy subjects were studied by means of a colonoscopically positioned probe carrying a 5-cm latex balloon. After positioning of the probe, stepwise distension was performed for each colonic segment (transverse, descending, sigmoid, rectum), and the onset of large (>50 mm Hg) and small (<50 mm Hg) propagated waves was observed. Analysis of the tracings showed: (1) In 8/15 subjects (53.3%), balloon distension elicited propagated contractions, but these contractions were qualitatively different from the spontaneously occurring high-amplitude propagated contractions previously found to occur in association with defecation. Therefore, intraluminal distension is probably not the cause of defecation-associated high-amplitude propagated contractions. (2) Pain reports were poorly correlated with propagated contractions elicited by balloon distension, suggesting that these contractions are not the cause of the pain produced by balloon distension. (3) The transverse colon shows lower pressures, fewer pain reports, and fewer large propagated contractions in response to balloon distension as compared to the descending and the sigmoid colon.     

A case report: an ileus caused by cecal volvulus and intersigmoidal hernia due to mesenterium commune]

A 33-year old woman was referred to our hospital because of gradually progressing abdominal pain and abdominal distension. A computed tomography demonstrated that distended cecum was located in the left retroperitoneal space. Barium enema revealed that the descending colon was positioned at the right side of the abdomen and transverse colon became severely tapered. Ceacal volvulus in addition to the internal herniation into the left retroperitoneal space was clinically diagnosed. The patient received an emergent operation. Operative findings showed that mesenterium commune, no fixation of the colon to the retroperitonium, and the internal herniation of terminal ileum to transverse colon into the sigmoid mesentery. Moreover, the cecal volvulus was diagnosed at the left retroperitoneal space. The mesenterium commune with internal herniation and cecal volvulus is extremely rare but one of important causes of acute abdomen.     

Colonic Vascular Anomalies and Colon Cancer in Neurofibromatosis: Report of a Case

We report a case of neurofibromatosis with synchronous adenocarcinomas in the sigmoid and transverse colon. There was widespread intimal proliferation in arteries in the region of the tumors and also in the cecum. Such vascular lesions are associated with von Recklinghausen’s disease. The cecal lesion produced mural thickening visible on computed tomography. This case supports a possible genetic link between neurofibromatosis and adenocarcinoma of the colon.     

Trends in the anatomical distribution of colorectal carcinoma in Hawaii, 1960–1978

The incidence of colorectal adenocarcinoma increased in the five major ethnic groups in Hawaii, but more in men than women. The highest rates were in the Chinese and Japanese. The site-specific time trend patterns revealed that the greatest increase occurred in rectosigmoid cancer, followed by cancer of the sigmoid colon and the transverse descending colon. Rectal cancer had minimal changes in rates over time. The comparison of site-specific rates between the Japanese in Hawaii and Miyagi Prefecture, Japan, showed that the occurrence of cancer of the rectosigmoid, sigmoid, and transverse descending colon was far greater in Hawaii than Miyagi with minimal differences in the rates of rectal cancer. The findings from this study indicate that the separate anatomical locations of colorectal cancer probably have some distinct etiologies that need further investigation.Supported in part by grant I-NOI-CA-15655 and contract NOI-CP-53511 from the National Cancer Institute, National Institutes of Health.     

Changes in site distribution of colorectal carcinoma in Connecticut, 1940–1973

The proportion of colorectal cancer occurring above the rectosigmoid junction has been increasing over time. The 40,771 cases of colorectal carcinoma reported to the Connecticut Tumor Registry from 1940 through 1973 were analyzed to determine the incidence in the ascending colon, the transverse, descending, and sigmoid colon, and the rectum. The numbers of cases, the proportion, and incidence rates of cancer in the ascending colon and sigmoid have increased over the 34 years. The increases were greatest among people over 65 years old. Only about half of colorectal cancer can now be identified with the rigid sigmoidoscope. Other tests must be used for early diagnosis of the increased numbers of cancers in the upper parts of the colon.     

溃疡性结肠炎相关腺瘤和结直肠癌回顾性临床病例分析

背景:研究表明溃疡性结肠炎(UC)患者发生结直肠癌的风险明显增加。目的:总结UC相关腺瘤和UC相关结直肠癌(UcCRC)的发病概况和临床病理特点。方法:选取2000年1月～2012年3月南京军区南京总医院住院确诊的UC患者603例,对其中UC相关腺瘤和UcCRC患者的性别、年龄、病程、临床症状、病理表现等临床资料进行回顾性分析经。结果:603例UC患者中,UC相关腺瘤28例,发病率为4.6%(28/603);UcCRC 4例,发病率为0.7%(4/603)。UC相关腺瘤患者的UC中位病程为3年,UcCRC患者的UC中位病程为29年。UC相关腺瘤好发部位依次为直肠/乙状结肠(16处)、降结肠(7处)、横结肠(6处)、升结肠以及回盲部(4处),UcCRC发病部位分别为升结肠(1例)、降结肠(2例)、乙状结肠(1例)。UC相关腺瘤和UcCRC的临床症状与一般UC相似。结论:UC相关腺瘤和UcCRC的发病率随UC病程的延长而增加。长期病程的UC患者应定期行结肠镜检查,对预防和早期检出结直肠癌具有积极意义。     

Effect of eating on colonic motility and transit in patients with functional diarrhea. Simultaneous scintigraphic and manometric evaluations

The aim of this study was to correlate colonic motility with transit in 8 patients with functional diarrhea compared to 12 healthy subjects. Intraluminal pressure was measured with perfused catheter ports in the transverse colon, splenic flexure, and descending and sigmoid colons. Transit of the luminal contents was measured by following the movement of 99mTC-diethylenetriaminepentaacetic acid instilled as a bolus in the splenic flexure. In patients with diarrhea, the intraluminal marker moved in and out of the transverse and sigmoid colon regions of interest during fasting, unlike healthy subjects, in whom the marker remained in the splenic flexure. After eating, radioactivity immediately increased in both the transverse and sigmoid colons in healthy subjects. In the patients with diarrhea, eating did not alter the marker movement into the different regions of the colon compared with fasting. Within 100 minutes of eating, the intraluminal marker almost disappeared from the regions of interest in patients with diarrhea. Postprandial colonic nonpropagating contractions increased in each region of the colon in healthy subjects; there was only a small postprandial increase in colonic motility in patients with diarrhea. However, the numbers of fasting and postprandial propagating contractions were increased in patients with diarrhea compared with healthy subjects (P less than 0.02). Each propagating contraction moved more tracer in patients with diarrhea than in healthy subjects (P less than 0.05). These studies suggest that (a) in patients with diarrhea, the fluctuation of marker in both transverse and sigmoid colons during the fasting and postprandial periods is associated with decreased nonsegmenting contractions and frequent propagating contractions; and (b) in healthy subjects, the intraluminal marker moved after eating because of a pressure gradient caused by nonpropagating contractions.     

SUCCESSFUL PLACEMENT OF SELF‐EXPANDABLE METALLIC STENTS FOR DOUBLE COLORECTAL CANCERS

Stent placement for the palliation of unresectable colon cancer is an alternative to surgical treatment that has recently become popular. A dedicated stent for colorectal cancer is not available in Japan. We report a patient with two colonic obstructions who underwent a successful palliative treatment using two stents. He was admitted to Toho University Ohashi Medical Center because of ileus. A colonoscopy revealed two advanced lesions with stenosis in the sigmoid and transverse colon. Because he had multiple liver metastases and severe Alzheimer dementia, we selected palliative stent placement for the treatment of both strictures. We placed a covered stent in the sigmoid colon stricture and subsequently attempted to place a second stent in the transverse colon stricture. However, the second stent could not be placed in the transverse colon because the modified delivery system could not pass through the first stent in the sigmoid colon. This probably led to a twisting of the stent in the sigmoid colon. We next used the 24 F introducer sheath that is included in Keller‐Timmermans Introducer Sets. This strategy allowed the modified delivery system to be easily passed through the initial stent in the sigmoid colon and then advanced into the transverse colon stricture, enabling both stents to be positioned properly.     

The leading cord method of colonofiberscopy

Although the colonofiberscope has undergone various modifications and improvements, the insertion principle remains unchanged; that is pushing and rotation and the elasticity of the scope itself are inevitable. It often is difficult to maintain proper balance among these dynamic factors; imbalance prevents deep insertion. Over-elongation of the scope leads to insertion failure, particularly if there are adhesions of the sigmoid colon, overextension of the colon, or transverse colon ptosis. Our “leading cord” method is an excellent aid to colonofiberscopy. It can be inserted from the clamp hole of a conventional fiberscope and hardened to straighten the scope, thereby permitting deep insertion. With this technique the region from the rectum to the descending colon, as well as a ptosed transverse colon, can be straightened. Our clinical experience indicates that the rate of successful insertions in colonofiberscopy will be increased considerably with this complementary device.     

Postprandial colonic transit and motor activity in chronic constipation

The aim of this study was to correlate colonic motility and transit in patients with constipation and symptoms of the irritable bowel syndrome. Studies were performed in 16 patients with constipation and compared with the results in 12 healthy subjects. Intraluminal pressure was measured with perfused catheter ports in the transverse colon, splenic flexure, and descending and sigmoid colon. Movement of the luminal contents was measured by following the movement of Technetium-99m-DTPA that was instilled as a bolus in the splenic flexure. In both healthy subjects and patients with constipation there was no movement of the intraluminal tracer and no increase in intraluminal pressure during fasting. After eating a meal, healthy subjects and one group of the constipated patients had an increase in the radioactive marker in the transverse colon (p less than 0.03) and in the sigmoid colon (p less than 0.03). The movement of the intraluminal contents was associated with a positive pressure gradient between the descending colon and the transverse and sigmoid colon. There was no retrograde movement of the intraluminal contents and no postprandial increase in intraluminal pressure in the second group of patients with constipation. In healthy subjects, propagating contractions, which were associated with the rapid movement of intraluminal contents, began 60 min after eating. There were no propagating contractions in patients with constipation. These studies suggest that (a) the movement of intraluminal contents in healthy and constipated patients is determined by the postprandial pressure gradients within the colon, and (b) the propagating contraction is necessary for a normal bowel habit.     

Anotransabdominal examination of the colon

Summary With the anotransabdominal technic for examining the colon and discovering lesions, the efforts of the surgeon and proctologist can be combined to provide an efficient procedure for removal of colonic polyps situated above the level normally reached by the sigmoidoscope. Advantages of the method are: Complete and direct visualization of the rectum, sigmoid flexure, descending colon and, on occasions, even the transverse colon. Elimination of potential complications such as contamination, hemorrhage and leakage associated with multiple colotomy. Locating lesions that cannot be reached by sigmoidoscopy, by roentgenologic examination of the colon, and by palpation of the colon. The procedure is not difficult. When radical surgical procedures are required, they can be performed without delay. The period of hospitalization is brief.     

Ion transport in human cecum, transverse colon, and sigmoid colon in vitro. Baseline and response to electrical stimulation of intrinsic nerves

In a flux chamber study of ion transport in human colon, we compared baseline rates with those measured during electrical stimulation of intrinsic nerves. In baseline studies, sodium was absorbed throughout, but maximally in transverse colon. In cecum, sodium absorption accounted for the short circuit current and chloride was not absorbed. Chloride was absorbed in transverse and sigmoid colon, however. Residual current was minimal in cecum and transverse colon, but increased in sigmoid colon. Neural stimulation caused chloride secretion in cecum, reduced chloride absorption in sigmoid colon, but caused no change in transverse colon; sodium absorption decreased in cecum. A neurotransmitter of unknown identity affects baseline short circuit current in sigmoid colon. Half of the increase in short circuit caused by neural stimulation in sigmoid colon is mediated by muscarinic receptors. The identity of the other transmitter(s) is not known. It is not substance P or histamine. The three divisions of the colon differ in relative rates of baseline ion transport and in their transport responses to intrinsic nerve stimulation.     

Patients with adenomatous polyps and carcinomas have increased colonic mucosal prostaglandin E2.

Colorectal carcinoma in humans and animal models is associated with increased synthesis of prostaglandin E2 (PGE2). PGE2 synthesis was measured in normal and neoplastic human colorectal mucosa to investigate its role in the adenoma-carcinoma sequence. Paired mucosal biopsy specimens for PGE2 synthesis and histological examination were obtained during 39 diagnostic colonoscopies. Twelve control patients in whom colonoscopies and histology were normal synthesised similar amounts of PGE2 at all sites. Their results were (mean (SD) pg PGE2/mg tissue) caecum 102.8 (15.9) (n = 6), ascending colon 110.8 (24.3) (n = 10), transverse colon 103.9 (19.5) (n = 11), descending colon 102.9 (23.2) (n = 12), sigmoid colon 96.4 (18.0) (n = 12), and rectum 107.1 (17.6) (n = 12). Nineteen patients had a total of 27 adenomatous polyps (rectum (1), sigmoid (22), descending (1), transverse (1), and ascending colon (1): histology-tubular (16), tubulo-villous (8), and villous adenomous (3)). The polyps (178.0 (55.0), n = 27) synthesised more PGE2 than controls (p < 0.001), but the values in polyp-associated mucosa (mean (SD) 115.4 (21.9), n = 15) were not different to control results. Eight patients had carcinomas (rectal (2), sigmoid (4), and caecal (2)) all of which were adenocarcinomas. The cancers (193.6 (40.2), n = 8) synthesised more PGE2 than control specimens (p < 0.001), but were not different to polyps. Cancer-associated mucosa (140.3 (27.7) n = 8) synthesised more PGE2 than control and polyp-associated mucosa. Colorectal neoplasia is associated with a progressive increase in PGE2 synthesis which may have a role in tumourigenesis and be a pathophysiological explanation for the beneficial effects of NSAIDs in animal models and human disease.     

Laparoscopic right hemicolectomy for ascending colon cancer with persistent mesocolon

Persistent ascending or descending mesocolon is an embryological anomaly that occurs during the final process of intestinal development in organogenesis.Specifically,the primitive dorsal mesocolon fails to fuse with the parietal peritoneum in the fifth month of gestation.Herein,we describe a case of ascending colon cancer with persistent ascending and descending mesocolon treated by laparoscopic right hemicolectomy.Preoperative computed tomography imaging of the abdomen demonstrated that the descending colon shifted at the midline of the abdomen and the sigmoid colon was located under the ascending colon.The detailed preoperative imaging examination revealed malpositioning of the large intestine and aided in the procedural planning.Because persistent mesocolon may result in the formation of abnormal adhesions,an accurate preoperative diagnosis is essential.We propose that it is important to consider this anomaly when making the preoperative imaging diagnosis to ensure a safe operation.     

Transverse and sigmoid colon motility in healthy humans: effects of eating and of cimetropium bromide

There have been few studies of the motility of the colon proximal to the rectosigmoid area. For this purpose we evaluated (1) fasting and postprandial transverse and sigmoid colon motor activity and (2) the effects of a new nonselective anticholinergic drug, cimetropium bromide, on transverse and sigmoid motor responses to eating. Two paired studies were carried out in 11 healthy volunteers by means of a colonscopically positioned manometric probe. After placebo, eating significantly increased transverse and sigmoid motility indices throughout the recording period. Cimetropium significantly reduced the motor responses to eating in both the transverse and the sigmoid colon.     

腹腔镜乙状结肠癌伴降结肠系膜旋转不良一例报道

降结肠系膜旋转不良（PDM）是由降结肠与腹膜后融合不全引起的，PDM通常无症状。然而，降结肠系膜旋转不良、乙状结肠向右侧与回盲部的先天粘连以及肠系膜下动脉的解剖变异等均可能会对结直肠癌的手术决策及难易度产生影响。我们报道一例乙状结肠癌伴肝转移瘤合并PDM的诊治，对其腹腔镜手术治疗的体会及注意要点加以阐述。