Stoma operations are one of the most frequently performed operation by the colorectal surgeons. And the consequences of the stoma operation of the patients are well known. However, most colorectal surgeons who performed stoma operation were not aware of the problems that are part of the rehabilitation of the ostomates. In order to elucidate the current status of the stoma studies in Korea, literature reviews were performed by using the Korean medical literature database. Most of the Korean literatures written by the colorectal surgeons are related with the postoperative complications of stoma surgeries. Very few papers are concerned with rehabilitation issues including postoperative adaptation of ostomates, quality of life, and stoma nursing care. Recently, more and more papers concerning the stoma rehabilitation issues were published and the interests in the patient's adjustment to a change in body function are growing. Stoma rehabilitation program should be the part of the nations' welfare program which would be successful with the active participation of the colorectal surgeons, enterostomal therapists and ostomates. We, colorectal surgeons, and the Korean Society of Coloproctology should do the major role in stoma-related researches and cooperate with the enterostomal therapists and ostomates organizations in order to establish and develop the stoma rehabilitation program in Korea.
Humans ; Korea* ; Nursing Care ; Postoperative Complications ; Quality of Life ; Rehabilitation

Malignant intestinal lymphoma complicating ulcerative colitis has been reported. Although the association of colorectal cancer with ulcerative colitis is well described, the association of intestinal lymphoma, ulcerative colitis and prior immunosuppression remains unclear. However, it is important to be aware of the possible risk of lymphoma and carcinoma when patients shows unexpected signs of deterioration or when the clinical course of ulcerative colitis is atypical. Substantial biopsies with colonoscopy are required to make an unequivocal diagnosis in such patients. We report the case of non-Hodgkin's lymphoma in ulcerative colitis with review of the literature.
Biopsy ; Colitis, Ulcerative* ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Humans ; Immunosuppression ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Ulcer*

Diverticulum of the vermiform appendix is infrequently encountered, and in the absence of inflammation, it has been reported to be asymptomatic. Furthermore, hemorrhage from an appendiceal diverticulum is extremely rare, and has not yet reported in our country. We report a case of hemorrhage occurring in appendiceal diverticulum.
Appendix* ; Diverticulum* ; Hemorrhage* ; Inflammation

Many patients have functional disturbances after a traditional restorative rectal resection, complaining of urgency, frequent bowel movements, and occasional fecal incontinence. The rectal reservoir function is disturbed, and this is related to the size of the rectal remnant and the elastic properties of the neorectal wall. A straight anastomosis is recommended when the reservoir capacity of the rectal remnant is sufficient. A side-to-end anastomosis is probably preferable to an end-to-end anastomosis. If a straight anastomosis is considered, the descending colon is much better than the sigmoid colon. If optimal functional results are to be obtained soon after surgery, construction of a pouch is recommended when the rectal remnant is very short. There seems to be a balance between continence without urgency and evacuation ability. For patients with weak sphincter muscles and habitually loose feces, the surgeon should tailor the length of the pouch to be longer whereas it should be made smaller for patients with a pre-operative tendency toward constipation. In the long-term, bowel adaptation may also enable the function after a straight anastomosis to approximate that of a colonic J-pouch anal anastomosis. Where the pelvis is too narrow for a bulky colonic J-pouch anal anastomosis, a coloplasty-anal- anastomosis is an option. The latter results in postoperative bowel function comparable with that of the colonic J-pouch. Traditionally, poor bowel function has been managed expectantly. The colonic adaptation may take one or two years to occur after a low anterior resection. The patient is advised to take adequate soluble fiber in the diet and to avoid foods which aggravate the bowel dysfunction. Those with increased stool frequency are prescribed constipating agents to help control the symptoms. Patients with rectal evacuation problems are prescribed regular laxatives and enemas.
Colon ; Colon, Descending ; Colon, Sigmoid ; Colonic Pouches ; Constipation ; Diet ; Enema ; Fecal Incontinence ; Feces ; Humans ; Laxatives ; Muscles ; Pelvis ; Rectum

A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.
Colon ; Duodenum ; Gastrointestinal Tract ; Hemorrhage ; Jejunum ; Rectum ; Stomach

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.
Anal Canal ; Chickens ; Digital Rectal Examination ; Edema ; Female ; Hemorrhoids ; Humans ; Male ; Nylons ; Proctoscopy ; Prolapse ; Sigmoidoscopy ; Spasm ; Surgical Instruments

Although rare, traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration present substantial diagnostic and management challenges for surgeons. Between February 2004 and February 2006, six patients were treated for traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration at the Department of Surgery, Chonnam National University Hospital. All six patients underwent a diverting colostomy, primary repair, and presacral a drainage, but only three cases underwentva a sphincteroplasty. Three patients who underwent a sphincteroplasty had normal findings on anorectal manometry. Traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration have a high morbidity rate and a great influence on the quality of life. Thus, such injuries require aggressive management, and treatment modalities should be tailored to the individual case.
Anal Canal ; Colostomy ; Drainage ; Humans ; Lacerations ; Manometry ; Muscles ; Quality of Life ; Rectum

PURPOSE: The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.
Adenocarcinoma ; Breast Neoplasms ; Colon ; Colorectal Neoplasms ; Drainage ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mesentery ; Methylene Blue ; Neoplasm Metastasis ; Nitriles ; Pyrethrins ; Rectum

PURPOSE: The most common metastatic site of colorectal adenocarcinomas is the liver, and the next common site is the lung. Pulmonary metastasis has been reported to be more common in rectal cancer (esp. lower rectum) than in colon cancer, and for pulmonary survival metastasis, a hepatic metastatectomy results in longer. Likewise, for hepatic metastasis, a pulmonary metastatectomy may prolong survival, and many reports of longer survival after a pulmonary metastatectomy have been published. We compared chest CT to chest PA as a preoperative diagnostic tool for the detection of pulmonary metastasis. METHODS: The retrospective analysis was done for 369 consecutive patients with preoperative chest CT and chest PA who had a histologically-proven adenocarcinoma. RESULTS: The detection rates of pulmonary metastases by preoperative chest PA and preoperative chest CT were 3.5% (13/369) and 8.4% (31/369), respectively. Pulmonary metastases were confirmed by surgical pathology and follow up for over 6 months to have occurred in 22 patients. Chest PA's sensitivity and specificity for metastasis of colorectal cancer were 45% and 99%, respectively, and the positive predictive value was 76.9%. Chest CT had a sensitivity of 86%, a specificity of 96%, and a predictive positive value of 61.2% for pulmonary metastasis. CONCLUSIONS: Chest CT was more sensitive than chest PA in identifying pulmonary metastasis. Also, the detection rate for pulmonary metastasis by using chest CT was higher than that by using chest PA. Chest CT may be more useful in the diagnosis of pulmonary metastasis than chest PA as a preoperative work-up tool. The preoperative chest CT may help surgeons make decisions in the treatment for patients with a colorectal adenocarcinoma.
Adenocarcinoma ; Colonic Neoplasms ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Pathology, Surgical ; Rectal Neoplasms ; Retrospective Studies ; Sensitivity and Specificity ; Thorax

PURPOSE: This study was to evaluate the safety and efficacy of endoscopic balloon dilatation for anastomotic strictures that developed after colorectal cancer (CRC) operations. METHODS: Between Jan. 2001 and Dec. 2006, 18 patients (12 men, 6 women) who underwent endoscopic balloon dilatation for anastomotic strictures that developed after CRC operation at the Center for Colorectal Cancer, National Cancer Center, were enrolled, and their medical records were reviewed retrospectively. The median distance from the anal verge to the stricture was 10 cm (range, 3~40 cm). Dilatations were performed using through-the-scope balloons with diameters of 18 to 20 mm on inflation. RESULTS: The overall success rate of endoscopic balloon dilatation was 94.4% (17 patients). The mean number of treatment sessions per patient was 1.9 (range, 1~7). Of the 17 patients treated successfully, 11 patients (64.7%) required only one dilatation, 4 patients (23.2%) required 2 dilatations, and two patients (11.8%) required 7 dilatations. Failure of balloon dilatation occurred in one patient. No complications occurred. CONCLUSIONS: Endoscopic balloon dilatation of anastomotic strictures after a CRC operation is safe and efficient.
Colorectal Neoplasms ; Constriction, Pathologic ; Dilatation ; Humans ; Inflation, Economic ; Male ; Medical Records ; Retrospective Studies