A case of colonic ischemia mimicking carcinoma

In this article, we describe a case of colonic ischemia masquerading as colonic carcinoma in a 75-yr-old female. Although this clinical diagnostic problem has been described before, it is rather unusual that the clinical, roentgenographical, endoscopic, and even histopathologic evaluation could not exclude carcinoma with certainty.     

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.     

缺血性结肠炎与溃疡性结肠炎临床特征、内镜特点比较分析

目的 提高缺血性结肠炎(IC)和与溃疡性结肠炎(UC)诊断的正确率.方法 选择2008年1月至2011年6月的住院患者,确诊IC 43例,UC 36例,对其临床特征、内镜特点进行回顾性比较分析.结果 组间性别、年龄、病程和基础疾病比较差异有统计学意义(P＜0.05),而主要临床表现比较,差异无统计学意义.IC组以老年女性多见,病程短,多伴发心脑血管等基础疾病(29/43,67.0％).IC组C反应蛋白高于UC组,血小板低于UC组(P＜0.05).IC多累及乙状结肠,直肠少见;病变为区域局限性,溃疡为纵形或不规则形,病灶愈合迅速,病理以黏膜炎症为主.UC组病变多起源于直肠,一般累及肠壁全周,病变为倒灌连续性,以散在针尖样地图状溃疡为主,病理表现为隐窝炎和脓肿.结论 年龄、病程、基础疾病、C反应蛋白、内镜及病理特征是鉴别诊断的要点.     

Enterocolitis Associated With Cocaine Use

PURPOSE Cocaine use has been reported to cause gastrointestinal complications. This retrospective review describes the presentation and clinical course of cocaine-associated enterocolitis. METHODS Charts with a diagnoses of colitis or abdominal pain, between 1991 to 2001, were reviewed for a positive urine drug screen or documented cocaine use. Data about the patients' symptoms and physical findings, results of clinical studies, and outcome were collected. RESULTS There were 18 patients identified. The interval from last use to the onset of pain was fewer than one day for seven patients, one to three days for seven patients, and more than three days for four patients. Physical examination demonstrated diffuse peritonitis in 2 patients, tenderness localized to a single quadrant in 11 patients, and tenderness in two or more quadrants in 5 patients. Computed tomography was obtained in 11 patients with 10 demonstrating signs of inflammation or ischemia. The anatomic locations of disease were proximal colon (14 patients), small bowel/gastric (1 patient), and distal colon (3 patients). The initial management was nonoperative in 15 patients. One patient presented in shock and died. Another developed peritonitis and underwent laparotomy. Surgical intervention occurred in four patients (3 initially, 1 on Day 4) for peritonitis. Two died postoperatively, a 50-percent surgical mortality. CONCLUSIONS Cocaine-associated enterocolitis usually presents within three days of cocaine use. Inflammatory or ischemic changes are most common in the proximal colon. The majority of patients will recover with nonoperative therapy; however, those who develop peritonitis and undergo laparotomy have a 50 percent mortality. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Chicago, Illinois, June 3 to 8, 2002, and the Tripartite Colorectal Meeting, Melbourne, Australia, October 27 to 30, 2002 . Reprints are not available.     

Cytomegalovirus colitis followed by ischemic colitis in a non-immunocompromised adult:A case report

We report a rare case of cytomegalovirus(CMV) colitis followed by severe ischemic colitis in a nonimmunocompromised patient. An 86-year-old woman was admitted after experiencing episodes of vomiting and diarrhea. The next day, hematochezia was detected without abdominal pain. The initial diagnosis of ischemic colitis was based on colonoscopy and histological findings. The follow-up colonoscopy revealed a prolonged colitis. Immunohistochemical staining detected CMVpositive cells following conservative therapy. Intravenous ganciclovir therapy led to successful healing of ulcers and disappearance of CMV-positive cells. The prevalence of CMV infection is common in adults. CMV colitis is relatively common in immunocompromised patients; however, it is rare in immunocompetent patients. In our case, CMV infection was allowed to be established due to the disruption of the colonic mucosa by the prior severe ischemic colitis. Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed.     

Total and subtotal colectomy for colonic obstruction

Colectomy (total or subtotal) is not the operation of choice for elective colonic cancer unless the patient is under 50 years of age, is undergoing curative resection, and has associated adenomatous polyps. Routine colectomy is not supported when a partial obstruction prevents preparation of the colon and interferes with proximal colonic examination. Colectomy (especially subtotal) is acceptable for the acutely obstructed colon but it is technically demanding and requires experience in patient selection Read at the Joint Meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Asymptomatic colonic metastases from primary squamous cell carcinoma of the lung with a positive fecal occult blood test

We describe a 74-year-old man with a colonic metastatic squamous cell carcinoma （SCC） from the lung. His chest X-ray revealed an abnormal shadow in the right upper lobe. Computed tomography （CT） of the chest demonstrated a large lung tumor in the right upper lobe obstructing the right upper bronchus. Bronchoscopy revealed an easy-bleeding tumor in the right upper bronchus that was diagnosed as poorly differentiated squamous cell lung carcinoma. He underwent colonoscopy because he had a positive fecal occult blood test. Colonoscopy revealed a large protruding lesion with central ulceration in the descending colon. Histological examination of the biopsy specimen obtained from the colonic lesion revealed SCC. The lesion was diagnosed as metastatic colonic SCC. He had no abdominal symptoms. He underwent chemotherapy with an infusion of cisplatin 130 mg i.v. day 1, and docetaxel hydrate 100 mg i.v. day 1, repeated every 4 wk, followed by 4 courses of chemotherapy. The primary lesion shrank by less than 10% and was judged to be ＂Partial Response＂ （PR） after 3 courses of treatment. The patient still lived 23 wk after the diagnosis of metastatic colonic SCC. Colonic metastasis of primary SCC of the lung is rare.     

Ischemic colitis and immunosuppression

The incidence of ischemic colitis in renal transplant recipients approaches 1 percent. The mortality in these patients with ischemic colitis is nearly 70 percent. Immunosuppressive agents have been implicated in the development of ischemic colitis. To study the effect of immunosuppressive agents on ischemic colitis, a 4-cm segment of the colon was devascularized in 27 male Fischer rats. The animals were divided into one control and two treatment groups. One treatment group received methylprednisolone and the other, azathioprine, in doses similar to those of renal transplant recipients. Both experimental groups, either separately or combined, showed significantly greater areas of colonic ischemic changes than did the control group. This study demonstrates that systemic administration of immunosuppressive agents may augment the development of ischemic colitis. Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, San Diego, California, May 5 to 10, 1985. Supported by Biomedical Research Support Grant RR 05374 from the Division of Research Facilities and Resources, NIH.     

Ischemic colitis masquerading as colonic tumor: case report with review of literature

Ischemic colitis can mimic a carcinoma on computed tomographic (CT) imaging or endoscopic examination. A coexisting colonic carcinoma or another potentially obstructing lesion has also been described in 20% of the cases of ischemic colitis. CT scan can differentiate it from colon cancer in 75% of cases. However, colonoscopy is the preferred method for diagnosing ischemic colitis as it allows for direct visualization with tissue sampling. Varied presentations of ischemic colitis have been described as an ulc...     

Mortality from ischemic colitis

Thirty-nine hospital-based cases of ischemic colitis were reviewed. There were 18 males and 21 females. Average age was 68.7 years (range, 18 to 92 years). Associated diseases among 13 patients younger than 65 included renal failure in seven patients and hematologic, vasculitic, or collagen vascular diseases in four. In 26 patients 65 or older, congestive heart failure was seen in 13, vascular disease in eight, and previous aortic surgery in four. Nineteen patients were treated nonsurgically and 8 died (42 percent mortality). Twenty patients (51 percent) underwent surgery: 18 had resection with colostomy or ileostomy and two had resection with reanastomosis; one patient underwent laparotomy followed by second-look exploration without resection. Thirteen of the 20 surgical patients died (65 percent mortality). Both patients who underwent reanastomosis died of sepsis. The data show a close association between ischemic colitis and a number of serious systemic diseases including renal failure, arteriosclerotic heart and vascular disease, and hematologic, vasculitic, and connective-tissue disease. A predilection for the right colon and sigmoid colon and splenic flexure was seen. A formidable mortality rate (53 percent) was found among patients treated both surgically and nonsurgically. Read at the meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17 1988.     

Collagenous colitis: A transient condition?

We have seen two patients with watery diarrhea whose work-up revealed a collagenous infiltration beneath the rectal epithelium. Within a year, symptoms disappeared in both. Repeated rectal biopsy revealed the disappearance of the collagen layer. Collagenous colitis may thus present as a transient condition.     

结肠镜相关缺血性结肠炎2例并文献分析

病例1：患者女,76岁,因＂结肠息肉切除术后7个多月,腹部不适1个多月＂就诊于本院。患者既往体质一般,6年前行宫腔镜下子宫息肉摘除术。入院查体：体温37.2℃,血压正常。无贫血貌,神志清,腹平软,无压痛、反跳痛。结肠镜检查示,升结肠见3枚绿豆大小息肉,亚蒂,表面光滑。活检后予氩离子凝固（APC）术灼     

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.     

缺血性结肠炎与溃疡性结肠炎的对比分析

目的:研究缺血性结肠炎(ischemic colitis,IC)与溃疡性结肠炎(ulcerative colitis,UC)临床及组织病理学的差异,有助两者的鉴别诊断,利于临床治疗.方法:收集20例IC和30例UC患者,对其临床及组织病理学等资料进行对比分析.结果:IC组发病时间[(5±7)d]明显较UC组发病时间[(953±1354)d]短.IC组中65%的患者伴有高血压、冠状动脉性心脏病、心房颤动、房性早搏、腹部手术史等疾病史中的一项或几项,明显高于UC组的20%;IC组以急性发病、腹痛(85%)、血便(60%)及腹泻(50%)多见,而UC且以腹痛(83%)、腹泻(63%)、黏液脓血便(57%)及里急后重(20%)为主要临床表现;在内镜表现方面,IC多以沿肠系膜侧分布的纵形溃疡为主(60%),且病变多仅累及肠腔的1/4～1/2周(80%),呈节段性分布(60%),与邻近正常黏膜分界清楚(75%),而UC则以弥漫性地图状溃疡为主(43%),病变多累及肠腔全周(90%),炎性息肉明显多见(37%).在组织病理学方面,血管扩张充血(90%)、间质严重水肿(95%)在IC中多见,血管壁增厚(50%)是其特征性表现,隐窝脓肿(47%)则在UC中多见.两组以上差异均有统计学意义(P<0.05).结论:组织病理学特点、肠镜下表现以及患者临床特征的差异,为IC和UC的鉴别提供了有力依据.     

Isolated ischemic necrosis of the cecum in patients with chronic heart disease

Isolated ischemic necrosis of the cecum is an infrequently described entity. We report three cases seen at our institution within a three-year period. All three patients had been hospitalized for congestive heart failure in the past, but none was in failure at the time of the most recent hospitalization. All three patients prsented with clinical and laboratory findings consistent with acute appendicitis. At surgery the cecum was ischemic in each case, while the appendix and the remainder of the intestine appeared normal. There was no evidence of major vascular occlusion or embolization at the time of original operation. We propose that the cecum, like the splenic flexure, is a “watershed area”, with poor blood supply relative to that of the adjacent intestine. While cecal ischemia has been described in association with a variety of clinical entities, we propose a newly recognized association with poor myocardial function. In such patients, isolated ischemic necrosis of the cecum should be considered in the differential diagnosis of right lower quadrant pain.     

Spectrum of non-inflammatory bowel disease and non-infectious colitis

A variety of inflammatory diseases of the colon, which can be differentiated from inflammatory bowel disease （IBD） and infectious colitis by their clinical, endoscopic and histological characteristics, are reported as non- IBD and non-infectious colitis. These diseases include microscopic colitis, ischemic colitis, segmental colitis associated with diverticula, radiation colitis, diversion colitis, eosinophilic colitis and Behcet＇s colitis. The etiopathogenesis of most of these diseases remains obscure and the epidemiological data are rather limited. These conditions are often troublesome for the patient and are associated with diagnostic difficulties for the physician. In many cases the treatment is empirical and there is a need for future research using randomized controlled trials.     

凋亡相关基因caspase-9,Bax在大肠腺瘤和大肠癌中的表达及意义

目的 探讨细胞凋亡相关基因caspase-9、Bax在大肠癌发生、发展中的可能作用及相互关系。方法 采用免疫组织化学S-P法和TUNEL技术分别检测20例正常大肠黏膜,48例大肠腺瘤,56例大肠癌中caspase-9,Bax蛋白的表达水平及细胞凋亡。结果 Caspase-9在正常大肠黏膜,腺瘤,癌组织中的表达率分别为5.00％、33.33％、64.29％,三者间有明显差异(P<0.01),在腺瘤和癌组织中其表达均高于正常黏膜;Bax在三者间的表达率分别为5.00％、27.08％、57.14％,三者间亦有明显差异(P<0.01)。大肠癌及大肠腺瘤中的细胞凋亡率显著高于正常黏膜(P<0.01),随着癌组织分化程度的下降,凋亡率逐渐降低。caspase-9,Bax的阳性表达与凋亡指数呈密切相关(P<0.01);Caspase-9,Bax的表达均与癌组织的分化程度有关,与病理因素无关。结论 在大肠癌细胞的凋亡过程中,caspase-9可能参与了大肠癌的凋亡,caspase-9和Bax在细胞凋亡的调节中可能存在密切关系。     

缺血性结肠炎与溃疡性结肠炎的临床鉴别诊断

背景:缺血性结肠炎(IC)与溃疡性结肠炎(UC,左半结肠型)在临床和内镜表现上有一定相似之处,对于临床表现不典型者,初步诊断颇具难度。目的:分析IC与UC的临i床鉴别诊断要点。方法:收集武汉大学中南医院2008年1月～2009年12月确诊为IC或UC左半结肠炎的住院患者,对其病史资料进行回顾性分析。结果:21例IC和25例UC患者纳入研究。IC患者以老年女性居多,病程相对较短,常伴有高血压和糖尿病,最突出的临床表现为突发腹痛后24 h内出现便血,贫血少见;UC患者的主要临床表现为黏液血便伴腹痛,贫血常见。IC病变多仅累及单一肠段,直肠受累少见,溃疡小而表浅,病理学表现为慢性炎,隐窝炎罕见;UC病变多起源于直肠,呈连续性,溃疡弥漫,病理学表现为慢性炎伴多种炎性细胞浸润,隐窝炎、隐窝脓肿常见。结论:根据性别、年龄、病程以及临床、实验室、内镜和病理检查结果进行综合分析,有助于IC与U C的鉴别诊断。     

Massive gangrene of the colon—A complication of fecal impaction

A case of extensive gangrene of the colon secondary to fecal impaction is reported. The role of ischemia in the management of colonic obstruction and the pathogenesis and treatment of colonic gangrene are discussed.     

缺血性结肠炎与溃疡性结肠炎临床表现及内镜特点的对比分析

目的 比较缺血性结肠炎(IC)与溃疡性结肠炎(UC)临床及内镜表现的差异,研究对两者的鉴别以利对其的诊断和治疗.方法 回顾分析2007年1月～2010年8月诊断为IC 30例和UC 40例患者的资料,重点分析两者在年龄分布、性别构成、病程、基础疾患、临床和内镜表现及病理诊断的异同点.结果 IC组和UC组在年龄分布、病...