Cisapride accelerates colonic transit in constipated patients with colonic inertia

A double-blind cross-over trial of oral cisapride 10 mg before meals and placebo was performed to determine its effects on colonic transit in patients with severe idiopathic constipation. Nine patients with less than 3 spontaneous bowel movements/wk were studied. After passing a tube to the cecum, 50 muCi of 111In-DTPA were instilled into the cecum and followed for 48 h using colonic transit scintigraphy. In the group as a whole, cisapride had little effect on transit. The patients were then divided into two groups based on transit: functional rectosigmoid obstruction (FRSO) and colonic inertia (CI). In the CI group, cisapride accelerated the half emptying time of the cecum and ascending colon from 2.50 to 1.21 h (p less than 0.05). The progression of the geometric center was also faster after cisapride in CI. In FRSO, the geometric center was unchanged by cisapride except at 48 h. Cisapride thus has a prokinetic effect on colonic transit in patients with severe idiopathic constipation, colonic inertia subtype. It may be a useful agent in the treatment of this group of patients.     

Nonsuture colonic anastomosis

Summary Methyl-2-cyanoacrylate was used for nonsuture end-to-end anastomosis of the ascending colon in 35 male Sprague-Dawley rats. The results were studied in seven sacrificed rats and eight rats that died after the procedure. The mortality rate was 22 per cent in a six-month period. Twenty animals are being observed for further studies of the anastomotic site and possible late carcinogenic activity of the monomer. The local histotoxicity of methyl-2-cyanoacrylate, the strong binding capacity, the abundance of scar tissue, and the distraction of the mucosa, as pointed out by several earlier investigators, were confirmed in this work. Also, it was strongly evident that the age of the glue has a significant influence on survival. The use of tissue adhesives as a substitute for standard suture technique or as a reinforcement of an inadequate suture line requires further study. Investigations designed for improving properties of these monomers appear warranted.     

Bleeding colonic diverticula

Diverticula of the large intestine constitute a common source of lower gastrointestinal (GI) bleeding both occult and massive and are a particular common cause of right-sided colonic hemorrhage. Bleeding in all cases is due to rupture of the underlying vasa rectum. In all cases, rupture of the artery is not circumferential, but eccentric having occurred toward the lumen of the diverticula. It is rare to see either acute or chronic diverticulitis associated with this situation. Lower GI bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10% to 30% GI bleeds and actually is much less frequent than upper GI bleeding. Diverticular disease actually is uncommon in people under the age of 40. However, by the age of 50 almost one-third of the population has diverticulosis. Ninety percent of the diverticula are in the left colon, but bleeding is from the right colon at least 50% of the time. Diverticular hemorrhage will cease spontaneously in about 90% cases. Most often, there is no inflammatory process around the diverticular bleeding. Hypertension even may be a predisposing factor. Also anticoagulation, diabetes mellitus, and ischemic heart disease are associated with diverticular hemorrhage. As far as treatment is concerned, conservative therapy is usually the best approach. One would like to avoid angiography and surgery if at all possible. There is a significant recurrence of bleeding in those patients who are treated even with angiography and with surgery. Etiology of the bleeding is not really well understood and the diagnosis and treatment is quite difficult in some situations.     

Giant colonic diverticulum

PURPOSE: Giant colonic diverticulum are rare, with 103 reported cases in 95 patients. The experience of any one surgeon is limited. We aimed to retrospectively review our experience and to review the literature on origin, pathology, and management of this rare and unusual problem. METHOD: Cases were identified by review of pathologic database and by computerized audit from three hospitals. RESULTS: Five giant colonic diverticulum were identified in four patients, and the pathology and management were reviewed. CONCLUSION: A definition and classification system of giant colonic diverticulum is suggested. Giant colonic diverticulum should be the universal term to cover all colonic diverticulum larger than 4 cm, and we suggest that there are two types based on histology. Literature review reveals 103 reported cases in 95 patients. Type I (87 percent) is a pseudodiverticulum, perhaps related to conventional diverticular disease, whereas Type II (13 percent) is a true diverticulum, which is probably a type of communicating cystic congenital duplication. These lesions tend to occur in the sigmoid colon (93 percent) and present with complications similar to conventional diverticular disease. In the presence of conventional diverticular disease, consideration should be given to anterior resection, and in the absence, diverticulectomy should be considered.     

The risk of colonic adenomas and colonic cancer in obesity

Increasing body fatness has been associated with an increased burden from colorectal cancer. An increased susceptibility spanning the entire continuum from precancerous adenomatous polyps to the development of colorectal cancer, poor outcome with treatment, and reduced survival when compared to those with normal body weight has been described. It is unknown which age period and which degree and duration of excess weight are associated with increased colorectal cancer risk. It is uncertain whether weight loss can reverse this risk. If it can, how long will the new lower or normal weight be maintained to effect enduring risk reduction? Furthermore, it is controversial whether the increased burden of colorectal cancer warrants earlier and/or more frequent screening for obese persons. This article reviews the relationship between obesity and colorectal neoplasia, explores the postulated mechanism of carcinogenesis, discusses interventions to reduce the burden of disease, and suggests future directions of research.     

Colonoscopy-related colonic ischemia

Colonoscopy is a risk factor for colon ischemia. The colon is susceptible to ischemia due to its minor blood flow compared to other abdominal organs; the etiology of colon ischemia after colonoscopy is multifactorial. The causative mechanisms include splanchnic circulation impairment, bowel preparation, drugs used for sedation, bowel wall ischemia due to insufflation/barotrauma, and introduction of the endoscope. Gastroenterologists must be aware of this condition and its risk factors for risk minimization, early diagnosis, and proper treatment.     

Vasculitis-induced colonic strictures

PURPOSE: The clinical presentations of gastrointestinal involvement from systemic vasculitis are diverse. Colonic involvement from systemic vasculitis is unusual. We report the first case of a symptomatic colonic stricture associated with rheumatoid vasculitis and another associated with systemic lupus erythematosus. METHODS: The clinical, radiologic, and histologic features of two cases of symptomatic colonic strictures secondary to colonic involvement with vasculitis are described. The literature covering gastrointestinal involvement from vasculitis in these conditions is reviewed. RESULTS: Surgical resection of the colonic strictures was required in both patients and had a satisfactory outcome. CONCLUSIONS: These cases provide further evidence of the protean clinical presentations of intestinal involvement in systemic vasculitis. Although immunosuppression has been shown to be of value in the treatment of vasculitis affecting the gastrointestinal tract, surgical resection is required for established strictures.     

Total colonic necrosis

Diffuse ischemic colitis leading to colonic necrosis is a rare complication of systemic lupus erythematosus. A 16-year-old girl who developed such a complication and underwent emergency subtotal colectomy is described. The incidence and significance of intestinal symptoms and the difficulties in the differential diagnosis in patients with systemic lupus erythematosus presenting with abdominal manifestations are discussed.     

Drug-induced colonic pseudo-obstruction

Colonic pseudo-obstruction may have many possible causes. Some of these are well described and pose no diagnostic problems. Drug-related colonic pseudo-obstruction remains underreported, but is of importance in modern society where drugs are endemically abused. This case highlights the importance of drugs in altering colonic motility and emphasizes the nonsurgical management of this condition.