Actinomycosis of the colon: a rare form of presentation

Actinomycosis is an uncommon entity, caused by an anaerobic bacterium, Actinomyces israelii, which is a component of the human oral and gastrointestinal flora. The cervicofacial region is the commonest site of disease, and the abdomen is the second commonest. In this situation the disease is almost always unifocal and restricted to the right colon, especially to the cecum. We report here the case of a patient with a very rare form of this entity, characterized by multiple foci of abdominal involvement with the most severe lesions localized in the transverse and sigmoid colon. The clinical presentation resembled a picture of colon perforation by cancer or diverticulitis, and the diagnosis was made by histopathologic examination of the lesions removed at surgery. No predisposing factor was found. The infection was successfully treated with a prolonged course of penicillin, after the surgical removal of the lesions.     

Colonic tuberculosis

Tubercle bacillus was discovered in 1882 by Robert Koch. With the introduction of chemotherapy for tuberculosis in the 1940s the incidence of this entity decreased. The incidence of the tuberculosis of the colon began to increase at the 1980s with the rise in numbers of patients considered as high risk for this entity, such as HIV-infected individuals, patients with chronic renal disease, and immunosuppressed patients with prolonged steroid therapy. We report on two patients with history of chronic abdominal pain and weight loss with a palpable mass in the right lower quadrant. In one patient chest radiography revealed a miliary reticulonodular pattern. In both, abdominal CT scan showed retroperitoneal lymphadenopathy and colonic wall thickness. Colonoscopic examination showed ulcerative lesions and ileocecal valve disruption. Microscopic examination of intestinal content showed evidenced M. tuberculosis. Tuberculosis of the colon should be suspected in patients suffering from chronic abdominal pain and weight loss.     

Non-specific aorto-arteritis in Singapore with special reference to hypertension.

Aorto-arteritis has recently emerged as a distinct disease entity with involvement of aorta and its major branches by a non-specific inflammation of unknown etiology. Though the distribution of this disease is worldwide, it is more prevalent in Japan, India, and South-east Asia. This paper describes a series of 48 cases seen in Singapore and emphasizes the protean nature of this disease. Though modes of clinical presentation were many, hypertension appeared to be the commonest as it occurred in 33 patients, giving an incidence of 69 per cent. This incidence was much higher than the 48 per cent reported among Europeans and 42 per cent reported among South Africans. It would therefore appear that hypertension was a far more common manifestation of aorto-arteritis among Asians. The commonest cause of hypertension in aorto-arteritis in this series was renovascular, with renal artery stenosis or occlusion occurring in 27 cases (85 per cent). The frequency of involvement of the renal artery is much greater than the 34 per cent reported by the Japanese. Therefore renovascular hypertension should be regarded as a predominant feature of aorto-arteritis in Singapore.     

Salmonella typhimurium bacteriuria. An increased infection rate in systemic lupus erythematosus

Three of 59 patients with systemic lupus erythematosus developed a total of eight Salmonella typhimurium bacilluria over five years of study. Lupus was the commonest disease entity associated with this urinary infection.     

Pedunculated extraluminal leiomyoma of the sigmoid colon

Leiomyoma of the colon is an extremely rare entity. Reports are those of sessile intraluminal lesions that are accessible to colonoscopy. This is a case report of a pedunculated extraluminal leiomyoma of the sigmoid colon which has not been previously reported.     

Tuberculous ileo-colitis in Ibadan: a clinico-radiological review

Twenty cases of tuberculous ileo-colitis with radiographic changes seen in the University College Hospital, Ibadan, Nigeria, are reviewed and the clinical features and radiographic patterns examined. The intestinal lesions in all cases were secondary to healed and active pulmonary tuberculosis.Although the ileo-caecal region is the commonest site of involvement, lesions also occurred in the distal part of the colon and the entire colon was sometimes involved. Rare occurrences, such as the diverticular type, enterolithiasis, tuberculosis presenting as intussusception and as an appendicular mass, are also reported. Four principal radiological types of colonic change emerged from the study, namely, the hyperplastic, the ulcerative, the mixed ulcero-hyperplastic, and the carcinoma-like types.The salient features in the differential diagnosis of ileo-colonic lesions in a tropical setting are discussed.     

Regional colitis

Summary and Conclusions Regional colitis may involve any segment of the colon with or without concomitant involvement of the small bowel. It is an entity, separate and distinct from ulcerative colitis. Usually the correct diagnosis can be established by clinical, radiologic and histologic examination. Careful rectal biopsy, or microscopic examination of tissue removed from anal and perianal lesions, may reveal granulomas or sarcoid reactions typical of the disease. Because most patients with regional colitis limited to thecolon only do very well after surgery, prompt resection and anastomosis is advocated. In regional colitis, the rectum should be preserved if possible, even if a temporary ileostomy is required in order to treat severe perianal lesions. There is little danger that the rectum will become involved by carcinoma or that systemic complications such as arthritis, uveitis, pyoderma and hepatitis will occur. Read at the meeting of the American Proctologic Society, Cleveland, Ohio, June 20 to 22, 1966.     

Colorectal carcinoma: A decade of experience at the Lahey Clinic

Summary Carcinoma of the colon and rectum is the commonest visceral malignancy in this country today. Uncorrected fiver-year survival rates (1967–1971) for Dukes' A, B, and C lesions were 81 per cent, 62 per cent, and 33 per cent respectively, and are essentially the same as those observed in the previous five-year period (1962–1966). The actuarially corrected five-year survival rates for Dukes' A, B, and C lesions for the ten-year period (1962–1971) were 95 per cent 90 per cent, and 55 per cent. Further improvement in these statistics depends on bringing the patient to operation with less advanced disease and possibly on supplementing resection with other modalities of therapy.     

Primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries

Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.     

Pancreatic lesions in von Hippel-Lindau disease

OBJECTIVE: Von Hippel-Lindau disease is an inherited neoplasia syndrome. The main endocrine manifestations are phaeochromocytoma and paraganglioma. The presence of pancreatic disease has also been variably reported. This study was undertaken to describe the prevalence, nature, natural history and clinical associations of pancreatic lesions in von Hippel-Lindau disease. PATIENTS AND DESIGN: A retrospective analysis of the case notes of 17 consecutive patients. Average duration of follow-up was 5.5 years. Clinical, biochemical, genetic and radiological testing was routinely performed. RESULTS: Eleven (64.7%) patients had pancreatic lesions either on computed tomography or magnetic resonance imaging. Serous microcystic adenomas and multiple cysts were the commonest findings, but solid lesions were also found. The commonest clinical association was diabetes mellitus in patients with extensive serous microcystic adenomas. None of the pancreatic lesions showed evidence of biochemical function. All patients with pancreatic lesions also had renal lesions. Mutations were found at several points in the gene and there was no apparent association between pancreatic lesions and a particular mutation. CONCLUSIONS: Pancreatic lesions are very common in von Hippel-Lindau disease and all patients had coexisting renal lesions. The main clinical correlate was diabetes mellitus, but otherwise the lesions were clinically and biochemically silent.     

"The three-lies disease": solitary rectal ulcer syndrome]

Solitary rectal ulcer syndrome is an uncommon benign condition characterized by rectal bleeding, passage of mucus, and pain. Histological features are well established as obliteration of the lamina propria by fibrosis and smooth-muscle fibers extending from a thickened muscularis mucosa to the lumen. Diagnosis can usually be made on sigmoidoscopy, and biopsies should always be taken. Ulceration is not universally present, and polypoid, non-ulcerated lesions and erythematous areas are also seen. The lesion or lesions are most often found on the anterior or anterolateral wall of the rectum, although they can also be located in the left colon and be more extensive or even circumferential. Lesions are multiple in 30 percent of cases. These are the reasons why this entity is also known as "the disease of three lies". We report a case of solitary rectal ulcer syndrome presenting at endoscopy with an erythematous area on the left side wall of the rectum.     

A case of diffuse inflammatory colonic pseudopolyposis caused by Crohn's disease

Inflammatory pseudopolyposis of the colon is an uncommon anatomoclinical entity. It is generally associated with ulcerative colitis, Crohn's disease or schistosomiasis. We report a case of a pseudopolyposis in Crohn's disease involving the entire colon. This case was characterized by three particular facts: a) the pseudopolyps were composed of granulation tissues only, b) severe exudative enteropathy was the most important symptom, c) the endoscopic ablation of the polyps, performed for the first time in Crohn's disease pseudopolyposis, resulted in clinical and biological improvement.     

Acute spontaneously recovering ulcerating colitis (ARUC)

Six patients each with an extensive ulcerating colitis are reported. Common features were a febrile nonbloody diarrhea; radiological involvement of the whole colon with superficial ulcerations and preservation of haustra, and integrity of the terminal ileum and rectum; the absence of any specific pathological finding; and, most important, the spontaneous recovery of the lesions in the absence of any treatment except symptomatic measures. The present follow up after recovery ranges from 18 months to 5 years. Four cases were young women taking oral contraceptives and two patients were older. These patients with colitis could represent a new entity or could be a particular form of Crohn's disease of the colon, with delayed diagnostic pathological features.     

Diverticulite solitaire du c?lon droit

Diverticula of the right colon are a rare clinical entity. Diverticulitis can occur with these lesions, but the diagnosis is frequently missed as the presentation is similar to that of acute appendicitis and can mimic other acute intraabdominal infections such as cholecystitis. The authors report a case of solitary diverticulitis of the right colon in a young woman, an incidental discovery during surgery for suspected appendicitis, with emphasis on the diagnostic and therapeutic modalities.     

Idiopathic fibrosing pancreatitis and Crohn's disease: an interesting association

Idiopathic fibrosing pancreatitis is an uncommon condition in children and adolescents of unknown aetiology. This syndrome has been reported in 36 cases so far. To our knowledge none of these cases was definitively associated with Crohn's disease. In this report we describe a young female patient who developed Crohn's disease of the colon 5 years after having been diagnosed with idiopathic fibrosing pancreatitis. The differential diagnosis between this syndrome associated with Crohn's disease and pancreatic Crohn's disease or fibrosing colonopathy, an entity related to pancreatic enzyme therapy, is discussed.     

Idiopathic cardiomyopathy in Botswana.

During a review of all cases of heart disease, including hypertensive cardiac failure, seen in Botswana during a period of sixteen months by one Specialist Physician observer, the importance of Idiopathic Cardiomyopathy as the commonest cause of cardiac failure clearly emerged. The aetiology of this condition and its relationship to hypertension and other factors causing an increased load on the myocardium are discussed. Viral myocarditis is presented as a separate entity, possibly playing a part in causation.     

Submucosal arterial malformation of the colon with massive hemorrhage

The case of a 60-year-old man with massive lower intestinal bleeding, secondary to erosion of an abnormally large submucosal muscular artery in the ascending colon, is reported. The bleeding site was localized by angiography. The clinicopathologic presentation of this case is identical to Dieulafoy's disease, which occurs almost exclusively in the stomach. Three similar patients with lesions also located in the ascending colon have been reported in the English medical literature.     

Ulcerative disease of the colon proximal to partially obstructive lesions: Report of two cases and review of the literature

Carcinoma complicating idiopathic ulcerative colitis is well known. Conversely, acute colitis complicating obstructing carcinomas and other partially obstructing lesions of the colon has not been recognized until recently. The present study reports two cases of colitis secondary to obstruction: 1) a giant ulcer with colitis proximal to partially obstruction diverticulitis of the sigmoid colon, and 2) colitis proximal to obstructing carcinoma of the sigmoid colon. The purpose of this report is to document these cases and review the literature on this variety of colitis to facilitate its recognition and subsequent correct treatment. An unawareness of this entity prejudices the anastomosis and results in anastomotic complications (approximately 25 per cent), with significant morbidity and mortality.     

Síndrome de Sweet

Sweet's syndrome (acute febril neutrophilic dermatosis) is an entity classified into neutrophilic dermatosis group, the dermatoses most frequently associated with internal diseases.Clinical manifestations of Sweet's syndrome include arthralgias and/or myalgias in 66% of cases. So, articular involvement is the commonest extracutaneous manifestation of Sweet's syndrome. Nevertheless, this involvement is usually moderate and limited to the episode of cutaneous lesions and rarely these patients are examined by the rheumatologist. Cases of arthritis, myositis and osteitis have been described associated with neutrophilic infiltrate of Sweet's syndrome in these organs.On the other hand, rarely this neutrophilic dermatosis that is a reactive dermatosis has been described associated with rheumatologic diseases including rheumathoid arthritis, lupus erythematosus, Behçet's disease, etc.Sweet's syndrome is a very important diagnosis because this neutrophilic dermatosis is associated with solid and hematologic tumours, inflammatory diseases, infectious diseases, drugs, etc. In this manner, when this dermatosis is present an adequate study to exclude these associations is necessary.