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*

PURPOSE: Depressed colorectal cancer is a newly recognized colorectal cancer. It has the characteristics of rapid growth and early invasion of the submucosa. Accordingly, recognition of that lesion is important. However, it is still rarely detected in Korea. This study was designed to evaluate the characteristics of depressed colorectal neoplastic lesions. METHODS: We experienced 22 cases of depressed neoplastic lesions from January 1997 to December 1998. All of them were detected by performing colonoscopy. Among them, 6 were early colorectal cancers. The twenty-two cases accounted for 1.3% of all neoplastic lesions but advanced colorectal cancers encountered during the same period, and the six accounted for 6.6% of all early colorectal cancers during that period. We reviewed and analyzed those 22 lesions with respect to their clinicopathologic characteristics, especially size and histology. RESULTS: The most common age group was the 6th decade. The male-to-female ratio was 2.7 to 1. The predilection of sites were the descending colon, the transverse colon, and the sigmoid colon in that order. The most common size was 3~4 mm, 9 lesions (40.9%) and the next was 5~6 mm, 7 lesions (31.8%). Twenty lesions (90.9%) were 8 mm or smaller in size. The overall malignancy rate was 27.3% (6/22), comprising 9.1% (2/22) for mucosal cancers, and 18.2% (4/22) for submucosal ones. The two lesions which were larger than 10 mm were submucosal cancers. Endoscopic mucosal resection (EMR) was the most common type of treatment, accounting for 59.1%. Two submucosal cancers and one mucosal cancer were operated on without any endoscopic treatment. That one mucosal cancer had initially been suspected of being a submucosal one upon endoscopic examination. There were neither complications nor recurrences during the average 10-month follow-up. CONCLUSIONS: The target for detecting and treating depressed colorectal cancer should be lesions below 10 mm in size, and the treatment of choice should be EMR.
Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis* ; Follow-Up Studies ; Humans ; Korea ; Recurrence

Malignant colonic obstruction can lead an emergency operation for decompression, and this can cause post-operative complications due to poor bowel preparation. Self-expandable metal stent (SEMS) insertion is useful for avoiding an emergency operation and unnecessary complications. However, SEMS insertion for dual malignant colonic obstructions is very rare. We report here on a case of two SEMS that were inserted in dual malignant colonic obstructions caused by synchronous colon cancer. A 66-year-old man visited our hospital due to abdominal distension. Sigmoidoscopy and an abdominopelvic computerized tomographic (CT) scan revealed synchronous colon cancer at the splenic flexure and distal descending colon with dual obstruction. The initial SEMS insertion on the descending colon was not effective for decompression due to the proximal obstruction. After the second SEMS insertion on the splenic flexure through the first stent, all the signs and symptoms due to obstruction disappeared. SEMS insertion is considered to be useful for treating dual malignant colonic obstruction caused synchronous colon cancer.
Aged ; Colon ; Colon, Descending ; Colon, Transverse ; Colonic Neoplasms ; Decompression ; Emergencies ; Humans ; Sigmoidoscopy ; Stents

PURPOSE:During colonoscopy, smooth insertion of the colonoscope is an important basic procedure. However, it is not necessarily easy. An understanding of the passage patterns of the colon is helpful for colonoscopy. In this study, the authors aimed to contribute information that could be useful to effect a smooth and effective introduction of the colonoscope. METHODS:The authors performed 7,560 colonoscopies from May 2000 to December 2000. All cases were performed without using sedatives or analgesics. Out of those 7,560 cases, 2,289 cases, which were performed by one colonoscopist, were selected, excluding those with incomplete colonoscopy, those with a history of bowel resection, those with poor bowel preparation, those with advanced disease, such as inflammatory bowel disease, cancer, etc., and those with conditions that could markedly affect colonoscopy. Those 2,289 cases were classified as 4 patterns according to the passage patterns through the colon during colonoscopy:pattern A, passage is possible using right torque and pull-back; pattern B, bowel-shortening is possible at the peak point of the sigmoid colon; pattern C, bowel-shortening is possible at the transverse colon because of a markedly redundant sigmoid colon; and pattern D, pattern is difficult to specify. Those 2,289 cases were also analyzed regarding age. As to age, they were divided into two groups, those under the 6th decade and those of the 6th decade or older. RESULTS:The most common pattern was pattern A, comprising 71.3%; next was pattern B, 19.7%. There was no significant difference in distribution of the passage patterns between the two age groups (P>0.05). CONCLUSIONS:Ninety-one percent (91%) of the cases were patterns A and B. An understanding of the passage patterns will be helpful for smooth insertion of the colonoscope. The 'axis-maintaining and bowel-shortening method' is a useful and effective approach to colonoscopy.
Analgesics ; Colon* ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopes ; Colonoscopy* ; Humans ; Hypnotics and Sedatives ; Inflammatory Bowel Diseases ; Torque

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