Amyloidosis is known as a disease caused by the deposition of a insoluble and fibrous amyloid protein in the extracellular space of various organs and tissue. Intestinal amyloid deposition may develop motility disturbance, malabsorption, bleeding and perforation. A 70-year old woman with lower abdominal pain, watery diarrhea was admitted and had the past history of diabetes mellitus, hypertension for 8 years and rheumatoid arthritis for 10 year. On colonoscopic examination for evaluation of diarrhea, multiple edematous and shallow ulcers was found from distal sigmoid to terminal ileum. A green colored positive birifringent stained amorphous material was found in polarizing microscopy of colon biopsy specimen stained with Congo-red on microscopic examination,. We report a case of amyloidosis causing colon ulcers confirmed by colonoscopic biopsy with review literature.
Abdominal Pain ; Aged ; Amyloid* ; Amyloidosis ; Arthritis, Rheumatoid* ; Biopsy ; Colitis* ; Colon ; Colon, Sigmoid ; Diabetes Mellitus ; Diarrhea ; Extracellular Space ; Female ; Hemorrhage ; Humans ; Hypertension ; Ileum ; Microscopy ; Plaque, Amyloid ; Ulcer

Multiple primary cancer for the colon and rectum was reported in numorous literature. Therefore, complete preoperative evaluation of patients presenting with colorectal cancer seems to be essential. In addition, it is fundamental that patients who have been treated for colorectal cancer require careful follow up evaluation. When symptoms and signs of tumor develop in a patient who has been treated for an initial colorectal cancer, the possibility of a localized and curable second, third primary cancer should be considered and evaluated. We report 2 cases of metchronous triple primary cancer with a review of literature.
Colon ; Colorectal Neoplasms ; Humans ; Rectum

While colon perforation as a complication of diseases such as carcinoma, colitis, diverticular disease, or abdominal trauma is not uncommon, spontaneous perforation of the colon is rare. Although spontaneous perforation is classified as either stercoral or idiopathic on the basis of its etiological background, the pathological mechanisms of the lesions have yet to be determined in detail. Stercoral perforation is a very rare cause of acute abdomen, with fewer than 70 cases documented in the literature; and idiopathic perforation is also infrequently reported. Both disease entities have often been grouped together as idiopathic or spontaneous perforation, resulting in confusion. We report herein two cases of stercoral perforation of the sigmoid colon. The clinical features, diagnosis, and treatment of the disease are reviewed. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage of the disease because it has significantly high mortality if surgery is delayed.
Abdomen, Acute ; Colitis ; Colon* ; Colon, Sigmoid ; Diagnosis ; Incidence ; Mortality

PURPOSE: Small-sized carcinoids, less than 1 cm, are easily detected using flexible sigmoidoscopy or total colonoscopy and can be treated by local excision. Recently, there has been many advances in the technique of endoscopic resection. The aim of this study was to determine the endoscopic findings of a rectal carcinoid and to evaluate the effectiveness of endoscopic resection. METHODS: We experienced 22 rectal carcinoids in 21 patients who were treated by endoscopic resection from June 1996 to February 1999. Nineteen cases were followed for an average of 21 months. Follow-up studies consisted of chest P-A, hepatic ultrasonography, and total colonoscopy. RESULTS: The male-to-female ratio was 1.6 to 1. The most common age group was the 4th decade. The tumor was located at the lower rectum in 10 patients, at the upper rectum in 10 patients, and at the rectosigmoid junction in 2 patients. The tumor sizes ranged from 3 to 12 mm in diameter and were smaller than 10 mm in 20 cases (90.1%). Endoscopic finding revealed that the tumors were covered by a normally appearing mucosa in 12 cases, were yellow-discolored polyps in 17 cases, and were sessile-type tumors in 19 cases. The method of treatment was an endoscopic mucosal resection (EMR, 14 cases) or a snare polypectomy (8 cases). Microscopically positive margins were noticed in four cases, two cases of EMR (2/14, 14%) and two cases of snare polypectomy (2/8, 25%). All the patients were alive and clinically free of disease; however, the duration of the follow-up is short. CONCLUSIONS: Endoscopic resection for rectal carcinoid tumors smaller than 1 cm in diameter is a safe, functional, time-saving, and effective treatment. If the tumor suggests a carcinoid, EMR is advised rather than a polypectomy even though the tumor is small. Microscopically positive margins are not absolute indications for further surgery in the treatment of carcinoids smaller than 1 cm in diameter. It is much more important for an endoscopist to be confident that the endoscopic resection is done completely. It is necessary to identify the factors influencing the malignancy potential and to have a longer follow-up.
Carcinoid Tumor* ; Colonoscopy ; Follow-Up Studies ; Humans ; Mucous Membrane ; Polyps ; Rectum ; Sigmoidoscopy ; SNARE Proteins ; Thorax ; Ultrasonography

PURPOSE: Elderly patients of colorectal cancer compose a steadily expanding portion of the population in Korea. The decision whether or not to operate on elderly patients who have carcinoma of colon and rectum is often unduly complicated. The aim of this study is to evaluate the results of the operations for colorectal cancers in the elderly. METHODS: This report is a retrospective clinical analysis for 365 cases of colorectal cancer who were treated surgically at the Department of surgery, Chonbuk National University Medical School from January 1994 to December 1998. To evaluate the age factor in colorectal cancer, the patients were divided into two groups: The elderly group included 79 patients who were aged > or =70 years on first presentation; The control group comprised 286 patients aged <70. RESULTS: There is no significant difference between the two group with regard to the mode of presentation, gender, location of tumor, clinical symptom and sign, duration of symptom, coexistent disease, operation method, tumor size, histopathologic findings, the Astler-Coller classification, lymphatic and distant metastasis, perioperative complication and 5-year survival. The emergency operation is significantly higher incidence in the elderly group. CONCLUSIONS: It is concluded that surgical resection of colorectal cancer in elderly is standard method and should not be restricted on the basis of age alone.
Age Factors ; Aged* ; Classification ; Colon ; Colorectal Neoplasms* ; Emergencies ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Neoplasm Metastasis ; Rectum ; Retrospective Studies ; Schools, Medical

PURPOSE: Preoperative concurrent chemoradiation for locally advanced rectal cancer can reduce tumor volume and can eliminate viable tumor cells at surgical margin (lateral or posterior margin). It also achieve a rate of high resectability, and negative margin and also have been known to be a safe treatment modality even though its fatal complication was reported as 4%. The aim of this study is to analyze its efficacy and complications after concurrent chemoradiation treatment for advanced rectal cancer. METHODS: We recruited a total thirty three patients with locally advanced rectal cancer, which were staged preoperatively as T3 or T4 and multiple enlarged lymph nodes by Transrectal Ultrasonography or pelvic Magnetic Resonance Image between march 1996 and June, 1998. 5 Fluorouracil 450 mg/m2 and leucovorin 30 mg infused intravenously during the first and fifth weeks of radiation therapy (4500~5040 cGy). Surgical resection was performed after four or six weeks after completing radiation therapy. To follow up tumor response, digital rectal examination and transrectal ultrasonography were done every two weeks. RESULTS: Tumor level was distal (N=16, 48.4%), middle (N=9, 27.2%) and upper (N=8, 24.4%). mean age was fifty two years old. Overall resectability was 91%. Types of operations were abdominoperineal resection (N=10, 30.3%), Low anterior resection (N=8, 24.2), Hartmann (N=8, 24.2%), Posterior exenteration (N=2. 6.1%), Total pelvic exenteration (N=2, 6.1%), colostomy only (N=3, 9.1%). Tumor response was Complete remission (N=3,10%), Partial response (N=17, 57%), Non-response (N=10, 33%), progressive disease (N=3). Pathological status was No residual tumor (N=3, 10%), T2N1 (N=5, 16.6%), T3N0 (N=6, 20%), T4N0 (N=4, 13.3%), T2N1 (N=1, 3.3%), T3N1 (N=11, 36.6%). Downstaging status was as follows: from T3 to T0 (N=2), to T2 (N=3) and From T4 to T0 (N=1), to T2 (N=3), to T3 (N=3). Postoperative morbidity was noted in 2 patients (1 case of anastomotic leakage, 1 case of wound infection). CONCLUSIONS: Preoperative concurrent chemoradiation therapy for locally advanced rectal cancer can be performed safely and show high tumor response and resectability.
Anastomotic Leak ; Chemoradiotherapy* ; Colostomy ; Digital Rectal Examination ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Lymph Nodes ; Neoplasm, Residual ; Pelvic Exenteration ; Rectal Neoplasms* ; Tumor Burden ; Ultrasonography ; Wounds and Injuries

Metastases to the liver from carcinoma of the colon and rectum occur as many as 80% of cases. As resection of metastases is proven to enhance survival and to reduce hepatic recurrence, the criteria for selection of patients and surgery type appear to be indispensable. Purpose: The aim of this study was to assess the prognostic factors after hepatic resection for metastatic colorectal cancer and propose the optimal surgical principles for resection of metastatic colorectal cancer. Methods: Sixty-three patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1989 and 1998 were analyzed regarding clinical and pathologic parameters. Results: Overall 5-year survival rate was 32%. Preoperative serum CEA level and resection margin of metastatic tumors were found to be significant predictors for poor long-term outcome. Resection margin of greater than 5 mm was closely associated with better survival. In multivariate analysis, resection margin alone was an independent prognostic factor. Conclusions: Preoperative serum CEA level and surgical resection margin may affect the outcome for the patients who underwent hepatic resection for metastatic colorectal cancer. Surgical resection margin must be kept enough to avoid re-recurrence or metastasis during hepatic resection for metastatic colorectal cancer.
Colon ; Colorectal Neoplasms* ; Humans ; Liver ; Multivariate Analysis ; Neoplasm Metastasis ; Rectum ; Recurrence ; Survival Rate

PURPOSE: Nalbuphin has definitive advantages over the more commonly used narcotic analgesic:a ceiling respiratory depression, little effect on the cardiovascular system and a lower incidence of nausea and vomiting. The use of a small incision results in early return of bowel function and shortening of hospital stay. Narcotic use has been felt to be proportional to the length of the abdominal incision. The aim of this study was to determine whether return of bowel function after colectomy in the postoperative period and incision length were directly proportional to the narcotics. METHODS: 38 patients undergoing colon and rectal resection for benign and malignant colorectal disease between July 2000 and April 2001 participated in this study. Nalbuphin and ketorolac was administered continually by patient controlled analgesia for 48 hours. Additional nalbuphin was used for further pain control. Patients were followed for return of bowel function as measured by first audible bowel sounds, first passage of flatus and first defecation. RESULTS: There was a significant correlation between the amount of total nalbuphin administered and return of bowel function as measured by bowel sound (r=0.89; P=0.01), time to first passage of flatus (r=0.76; P=0.01), and time to first defecation (r=0.58; P=0.05). Incision length did not show any correlation with either nalbuphin use or return of bowel function. CONCLUSIONS: There is no apparent benefit for lesser incision length. Return of bowel function is influenced by use of postoperative nalbuphin. So adequate sized abdominal incision is needed and lesser use of narcotics is more beneficial for the return of bowel function.
Abdominal Wall* ; Analgesia, Patient-Controlled ; Cardiovascular System ; Colectomy* ; Colon ; Defecation ; Flatulence ; Humans ; Incidence ; Ketorolac ; Length of Stay ; Narcotics ; Nausea ; Postoperative Period ; Respiratory Insufficiency ; Vomiting

PURPOSE: The standard treatment for sigmoid volvulus has been considered as a resection of involved segment after nonoperative decompression. This study was performed to investigate the clinical characteristics and compare the results of managements in patients with sigmoid volvulus. METHODS: We recruited twelve patients with sigmoid volvulus registered and treated at Asan Medical Center during 1989 and 1999. The medical records were reviewed retrospectively. Telephone inerviews were performed to inquire recent status. We analyzed clinical variables including symptoms on admission, physical findings, findings of radiologic studies, managements and their outcomes. The median age was 64 years (range:45 to 84 years). The median follow-up period was 46 months (range:2 to 94). RESULTS: Nine patients among twelve were male. Presenting symptoms were abdominal pain (92%), abdominal distension (67%), constipation (50%) and hematochezia. The diagnostic modalities utilized included plain film of the abdomen, CT scan and sigmoidoscopy. Nine cases (75%) were correctly diagnosed prior to operation, of which eight (67%) were diagnosed by plain film. The remaining three cases were by operation. In these cases, preoperative diagnoses were ischemic colitis and obstruction due to colonic malignancy. In seven cases, only nonoperative managements were employed. Nonoperative management included decompression by nasogastric tube or rectal tube insertion and use of bulk forming agents and stool softner afterwards to improve bowel habits. Five patients underwent anterior resection. We couldn't perform surgery in seven cases because of high operative risk due to underlying serious medical conditions such as bronchial asthma, malignancies and refusal by the patients after clinical improvement in 4 and 3cases, respectively. Three of them were died of underlying disease or sepsis. Recurrence occurred in two patients (50%) who underwent nonoperative management only and none in patients who underwent surgical intervention. CONCLUSIONS: In patients with sigmoid volvulus, elective surgery after appropriate nonoperative management is mandatory to prevent recurrence and fatal outcome, especially in good surgical risk patients. Considerable patients, however, did not undergo surgery due to poor physical status or refusal of surgery.
Abdomen ; Abdominal Pain ; Asthma ; Chungcheongnam-do ; Colitis, Ischemic ; Colon ; Colon, Sigmoid* ; Constipation ; Decompression ; Diagnosis ; Disulfiram ; Fatal Outcome ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Humans ; Intestinal Volvulus* ; Male ; Medical Records ; Recurrence ; Retrospective Studies ; Sepsis ; Sigmoidoscopy ; Telephone ; Tomography, X-Ray Computed

PURPOSE: We assessed the nature of the ultraslow wave in patients with hemorrhoids and chronic anal fissure according to clinical findings and manometry in this study. METHODS: Three hundred and thirty-three patients with hemorrhoids and 88 patients with chronic anal fissure were included. Anorectal manometry was performed according to a modified protocol based on the Coller's study. The ultraslow wave was determined as an undulating wave equal or less than two waves/min. RESULTS: The ultraslow wave was found in 142 of the 333 patients (42.6%) with hemorrhoids and 44 of the 88 patients (50%) with chronic anal fissure. The pressure variables (maximal resting and squeeze pressure, rectal pressure at the beginning of rectoanal inhibitory reflex, rectal pressure on sense or fullness of balloon) were significantly higher in patients with ultraslow wave than in those without (P<0.001-0.05). The ultraslow wave frequency was inversely proportional to aging and to its amplitude (P=0.006 and <0.001, respectively). Maximal squeeze pressure was closely correlated with maximal resting pressure in a multiple regression analysis (P=0.002). The defecation difficulty and anorectal bleeding were more frequent in patients with ultraslow wave than those without in the hemorrhoids (P=0.008 and 0.021, respectively). CONCLUSIONS: The ultraslow wave closely correlates with an anorectal pressure and frequently occurs in patients with hemorrhoids and chronic anal fissure. It appears to be associated with the internal anal sphincter as well as with the external anal sphincter and levator ani muscles.
Aging ; Anal Canal ; Defecation ; Fissure in Ano* ; Hemorrhage ; Hemorrhoids* ; Humans ; Manometry ; Muscles ; Reflex