The occurrence of a fistula between the duodenum and the colon is very rare, although these two structures commonly lie in intimate relationship to each other. It is not uncommon for tumor of the right colon and proximal transverse colon to involve the duodenum by continuity, but fistulous connection between the duodenum and colon are infrequent In most of the reported malignant cases, the fistulas follow carcinomas of the transverse colon or the hepatic flexure of the colon. We report a rare case of malignant duodenocolic fistula which was first suspected by endoscopic examination and confirmed by operation.
Colon ; Colon, Transverse ; Duodenum ; Endoscopy* ; Fistula*

When patients present with malignant cologastric fistulas, the tumor stage is often advanced and management is only palliative. We report the case of a 75-year-old man with a symptomatic cologastric fistula arising from an advanced tumor in the transverse colon, previously stented owing to malignant obstruction. An 8-cm-long covered self-expanding metal stent (COMVI enteral colonic stent; Taewoong Medical) was placed inside the primary stent, which sealed the fistula and completely alleviated the symptoms. Considering the successful outcome, we propose that insertion of a covered stent be considered in the palliative management of patients with malignant cologastric fistulas.
Aged ; Colon ; Colon, Transverse ; Fistula* ; Humans ; Stents*

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.
Colon* ; Colon, Ascending ; Colon, Transverse ; Diagnosis ; Humans ; Intussusception* ; Laparoscopy ; Lipoma*

Intestinal intussusception in adults is a rare disease. Most of the cases of adult intussusception are secondary to a definable lesion, and so surgical treatment generally needed. Intussusception that occurs after colonoscopic polypectomy is apparently a rare malady. A 77-year old man undergoing colonoscopic polypectomy was diagnosed as having colonic intussusception at the hepatic flexure. As there was no clinical improvement with conservative treatment, he underwent segmental resection of the ascending and transverse colon. Pathologic examination revealed that the colonoscopic polypectomy site was a leading point of the intussusception.
Adult ; Colon ; Colon, Transverse ; Colonoscopy ; Humans ; Intussusception ; Rare Diseases

The association of congenital colonic atresia with imperforate anus is extremely rare. The authors were able to find only three case on our investigation of the English literature. We have recently managed a female infant with imperforate anus associated with atresia of the transverse colon.
Anus, Imperforate* ; Colon* ; Colon, Transverse ; Female ; Humans ; Infant

Percutaneous cecostomy is an uncommon procedure but is reported as an effective temporising measure to achieve acute decompression of bowel obstruction. It has been reported as a safe procedure in the setting of bowel obstruction providing relief of symptoms. The insertion of a cecostomy in the distal colon is not routinely advised as it will not allow passage of formed faeces. Cases of antegrade stenting of proximal colonic obstruction via cecostomy have been described; however, antegrade stenting of the distal colon from access in the ascending colon can be technically challenging. We describe a case of a percutaneous colostomy inserted temporally at the splenic flexure, which provided close access to an obstructing descending colonic tumour, allowing definitive management with placement of a colonic stent. This technical feasibility case provides evidence that a temporary cecostomy placed in the distal colon can be performed as a measure to facilitate definitive management.
Cecostomy ; Colon* ; Colon, Ascending ; Colon, Descending ; Colon, Transverse ; Colostomy ; Decompression ; Stents*

Anisakiasis refers to the infestation of humans by a species of marine nematode larvae belonging to the subfamily Anisakidae, and this condition is seen in people who eat inadequately prepared or raw salt-water fish and squid. Because Koreans like to eat raw fish, anisakiasis of the stomach has been reported occasionally, but involvement of the small bowel or colon is relatively rare. In the case of the colon, anisakiasis of the ascending colon or the transverse colon has been only infrequently reported, and the incidence of rectal anisakiasis is very rare. The present case is a 58-year-old man with no definite abdominal symptoms who visited our hospital for a medical checkup. A 2 cm sized whitish linear live larva was revealed in the rectum and it was removed by colonoscopy.
Anisakiasis* ; Anisakis ; Colon ; Colon, Ascending ; Colon, Transverse ; Colonoscopy ; Decapodiformes ; Humans ; Incidence ; Larva ; Middle Aged ; Rectum ; Stomach

It is well known that total colonoscopy is one of the essential procedure to make diagnosis of colonic and terminal ileal diseases, to detect early atage of colonic cancer and to do prophylactic removal of premalignant polyp. Previously commonly used longer colonoscope has been reached to ileocecal area with patients much discomfort arising from excessive loop formation at sigmoid or transverse colon because of no limitation of the length. (continue...)
Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Colonoscopes ; Colonoscopy ; Diagnosis ; Humans ; Ileal Diseases ; Polyps

PURPOSE: Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy. METHODS: The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed. RESULTS: In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas. CONCLUSIONS: Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.
Colon ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Humans ; Medical Records ; Peritonitis ; Rectovaginal Fistula ; Rectum ; Retrospective Studies

BACKGROUND/AIMS: The successful colonoscopic insertion has been predicted by several clinical factors including female gender, obesity, poor bowel preparation, and a history of surgery. In addition, anatomical differences, such as Kudo's pattern (B, C of the sigmoid colon), rotation of the hepatic and splenic flexure, and the diameter of the sigmoid colon have also been considered to affect the success of colonoscopic insertion. The aim of this study was to evaluate the anatomical factors using virtual CT colonscopy in the case where the colonoscopic insertion is difficult. METHODS: From April 2005 to June 2005, 32 patients who experienced a delayed insertion time > or =10 minutes during colonoscopy (Group I) and other 34 patients whose insertion time was <10 minutes (Group II) were examined by virtual CT colonoscopy. The shape of the sigmoid colon was compared with Kudo's pattern, rotation of hepatic (HFR) and splenic flexure (SFR), and the diameter of the most distended sigmoid colon at the supine position (SCD) in both groups. Excessive SFR or HFR was defined if the splenic flexure or hepatic flexure was rotated by more than 360 degrees from the natural course of the colon. RESULTS: There were significant differences between group I (M : F=16 : 16, mean age: 61.7+/-13.8, SCD: 40.9+/-7.4 mm) and group II (M : F=25 : 9, mean age: 46.9+/-11.4, SCD: 39.7+/-7.2 mm) in terms of gender, age, BMI (24.1+/-3.5 kg/m2 in group I, 23.5+/-2.1 kg/m2 in group II), and the colonoscopic insertion time (18.1 minutes in group I, 6.3 minutes in group II). The Kudo's pattern was as follows: pattern A : B : C=23.3% : 36.7% : 40.0% in group I, and pattern A : B : C=50.0% : 37.5% : 12.5% in group II. Excessive rotation of the splenic flexure was 50% in group I, and 21.9% in group II. However, there were no clinical significant difference in bowel preparation, sedation, previous bowel operation, the type of cathartics and SCD. CONCLUSIONS: Anatomical differences can affect a difficult colonoscopic insertion, which includes shape of the sigmoid colon, excessive rotation of the splenic flexure. However a further large randomized trial study will be needed.
Cathartics ; Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy* ; Female ; Humans ; Obesity ; Supine Position