No abstract available.
Adult ; Behcet Syndrome/complications/*diagnosis ; Colon/blood supply/pathology/surgery ; Colonoscopy ; Gastrointestinal Hemorrhage/*diagnosis/etiology/surgery ; Humans ; Ileum/blood supply/surgery ; Male ; Rectum/blood supply/surgery

OBJECTIVETo analyze the vascular anatomy and complications of the right colon under laparoscope.

METHODSVideotapes of 55 laparoscopic extended right hemicolectomy with D3 lymphadenectomy were reviewed and the anatomic relationship and bleeding vessels were determined.

RESULTSThe superior mesenteric vein, superior mesenteric artery, ileocolic artery, and middle colic artery were present in all the patients. The right colic artery was present in 45.5%(25/55) of the patients. The incidence of the gastrocolic venous trunk was 74.5%. The overall incidence of intraoperative bleeding was 43.6%. Vessels in the pre-pancreatic region including the right gastroepiploic artery, the gastrocolic venous trunk, and its tributaries had a higher risk of bleeding than the middle colic vein and artery (16.4% vs. 14.5%). Intraoperative bleeding significantly prolonged the overall operative time and lymphadenectomy time.

CONCLUSIONSThe vascular anatomy of the right colon is intricate and variable and laparoscopic extended right hemicolectomy with D3 lymphadenectomy is associated with a high risk of hemorrhage. Understanding the vessels anatomic relationship of the right colon is valuable to decrease vascular complication.

Colon ; blood supply ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Male ; Postoperative Complications

Colonic arteriovenous malformation (AVM) is one of the causes of lower gastrointestinal bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or elevated bright red lesion. Herein, we report a case of non-solitary and small cecal AVMs which were removed by endoscopic biopsy. A 66-yr-old woman was referred for routine gastrointestinal cancer screening. She was suffering from diabetes, hypertension, end-stage renal disease, and anemia of chronic disease. On colonoscopic finding, three semi-pedunculated polyps, less than 5 mm in size, were noticed near to the appendiceal orifice. Since the lesions revealed normal-looking epithelium with converging folds on the cecal base, lesions were diagnosed as inflammatory polyps on gross finding. Three biopsies were taken from each lesion. Bleeding from the biopsied site ceased spontaneously. Histopathologic evaluation demonstrated intramucosal hemorrhage and dilated submucosal vessels which were consistent with polypoid colonic AVMs.
Aged ; Arteriovenous Malformations/*diagnosis/pathology/surgery ; Biopsy ; Cecum/blood supply/pathology ; Colon/*blood supply/pathology ; Colonic Polyps/pathology/*surgery ; Colonoscopy ; Female ; Humans

Arteriovenous malformation of the gut is well known to have been an important bleeding focus in past ages. We report a young Korean male patient, who had been known to have ventricular septal defect, presenting massive lower gastrointestinal bleeding from an arteriovenous malformation involving a long segment of the left colon. Angiographic, gross and histologic findings are presented and the literature is reviewed.
Adult ; Arteriovenous Malformations/pathology ; Arteriovenous Malformations/complications* ; Colon/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Heart Septal Defects, Ventricular/complications* ; Human ; Male

In laparoscopic colorectal resection, the poor blood supply of the anastomosis after tumor excision is difficult to be determined during the operations sometimes. The change in blood supply of the bowel is mainly due to the mesenteric anatomy and the operative techniques. The direct blood supply of colon is the marginal vessels in the mesentery. The integrity and patency of the marginal vessels determine the vitality of the bowel. However, the marginal vessels are different in diameter, pulsation or even discontinue in various areas, affecting the excision of the colon and following anastomosis. The most common three dangerous areas to anastomosis include:(1)area between ileocolic artery and right colonic artery; (2)area between middle colonic artery and left colonic artery-the Griffiths point. (3)area between the terminal branch of sigmoid colonic artery and superior rectal artery-Sudeck dangerous area. In laparoscopic colorectal resection, one should pay attention to protect the blood supply of the bowel and the marginal blood vessels, and be vigilant to the three vascular variations above mentioned. The vessels should be ligated accurately to ensure sufficient blood supply to the anastomosis and consequent normal healing of the rectal and colonic anastomosis. More attention should be paid to the elderly, morbid, and diabetic patients. If the safety of the anastomosis is unsure, prophylactic ileostomy should be performed.
Anatomic Variation ; Colon ; blood supply ; physiology ; Digestive System Surgical Procedures ; Humans ; Laparoscopy ; Ligation ; Mesenteric Artery, Inferior ; Mesentery

Phlebosclerotic colitis is a rare form of ischemic colitis characterized by the thickening of the wall of the affected colon due to fibrous degeneration of submucosal layer of colon and fibrotic obstruction of the colono-mesenteric vein, resulting in the disturbance of venous return from the colon. The pathogenic mechanism of this entity remains unknown but chronic liver disease with portal hypertension is maybe thought to be one of the speculated mechanisms. Here we first report the case of surgically confirmed phlebosclerotic colitis, that was in the early stage but showed the aggressive nature, in a 61-yr-old cirrhotic patients with portal hypertension in Korea.
Colitis/pathology ; Colon/blood supply/*pathology ; Colonoscopy ; Humans ; Hypertension, Portal/*pathology ; Korea ; Liver Cirrhosis/pathology ; Male ; Middle Aged ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the feasibility and efficacy of laparoscopic anterior resection of rectal carcinoma with preservation of the left colonic artery.

METHODSFrom February 2006 to February 2009, 52 patients with rectal carcinoma formerly scheduled for Dixon operation (clinical stage I and II) received laparoscopic Dixon surgery. The inferior mesenteric artery, left colonic artery, sigmoid artery or superior rectal artery, and lymph nodes were dissected through the vasa vasorum approach. The left colonic artery was retained by transecting the inferior mesenteric artery inferior to the left colonic artery. The operative time, intraoperative hemorrhage volume, intraoperative complications, anastomotic tension, number and histopathological features of the dissected lymph nodes surrounding the inferior mesenteric artery, and the rates of local recurrence, lymph node metastasis and anastomotic leakage were analyzed.

RESULTSThe operation was successfully completed in all the 52 cases. The operative time ranged from 115 to 320 min with a mean of 150 min. The mean intraoperative hemorrhage was 25 ml (range 15-75 ml). None of the patients had perforation of the rectum, injuries to blood vessel, ureter or adjacent organs, or anastomotic tension. The number of dissected lymph nodes surrounding the inferior mesenteric artery ranged from 4 to 8, with a mean of 6.2. The dissected lymph nodes in the base of the inferior mesenteric artery showed no cancer cell metastasis, while 4 patients had cancer cell metastasis in the lymph nodes surrounding superior rectal artery. None of patients had anastomotic leakage. Local recurrence was found in only 1 case at 7 months after the operation.

CONCLUSIONLaparoscopic anterior resection of the rectal carcinoma with preservation of the left colonic artery can be completed in patients with rectal carcinoma planning to receive Dixon operation (clinical stage I or II). This surgical approach preserves more supplying vessels and prevents anastomotic leakage without increasing the anastomotic tension or affecting lymph node dissection surrounding the inferior mesenteric artery.

Adult ; Anastomosis, Surgical ; methods ; Arteries ; surgery ; Colon ; blood supply ; Female ; Humans ; Laparoscopy ; methods ; Male ; Mesenteric Artery, Inferior ; surgery ; Middle Aged ; Rectal Neoplasms ; surgery

OBJECTIVE To investigate the etiology, prevention and treatment of colon ischemia after operation for abdominal aortic aneurysm (AAA). METHOD Seven of 140 cases complicated with colon ischemia who had received AAA operation were analyzed retrospectively. RESULTS Three cases underwent emergency operation. The seven cases were subjected to removal of AAA, implantation of prosthesis, and ligation of the inferior mesenteric artery. Two cases had the ligation of the bilateral internal iliac artery (IIA). Epilateral IIA was ligated in 2 cases. Bowel resection was carried out in 3 cases, 1 of which received reconstruction of the inferior mesenteric artery (IMA). Three cases received conservative therapy, but died from multiply organ failure. CONCLUSION Correct prevention and management of colon ischemia can effectively reduce the operative morbidity of AAA patients.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal ; surgery ; Colon ; blood supply ; Humans ; Ischemia ; etiology ; prevention & control ; therapy ; Male ; Mesenteric Artery, Inferior ; surgery ; Middle Aged ; Postoperative Complications ; etiology

OBJECTIVETo compare the long-term outcome of ligating the middle colic artery in radical surgical treatment of right hemicolon cancer.

METHODSThe operation safety, complications and short-term outcome between two groups of patients undergone either ligating the middle colic artery from its root (A group) or ligating the middle colic artery from its right branch (B group) in right hemicolectomy for colon cancer.

RESULTSBetween January 1981 and December 2004, 308 patients underwent radical right hemicolectomy in which 103 patients were treated by ligating the middle colic artery from its roots(Jan. 1996 to Dec. 2004, A group), and 205 patients via ligating the middle colic artery from the roots of its right branch(Jan. 1981 to Dec. 1995, B group). The complications were compared between the two groups(P>0.05). The mean follow-up time of A and B group were(50.1+/-7.2) months and(49.1+/-7.2) months respectively. Local recurrences of 1-year, 3-year and cumulative survival probability at the 60th month in group A were 1.9%, 13.6% and(78.3+/-3.4)% respectively, which were significantly better than 19.0%, 24.9% and(64.8+/-2.8)% in group B(P<0.05).

CONCLUSIONLigating the middle colic artery from its root in right hemicolectomy can be performed safely and effectively, which is to be highly recommended in curative resection of right colon.

Aged ; Colectomy ; methods ; Colon ; blood supply ; Colonic Neoplasms ; mortality ; surgery ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged

OBJECTIVE: To analyze the contrast-enhancement patterns obtained at pulseinversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect. MATERIALS AND METHODS: We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns. RESULTS: Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively. CONCLUSION: Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.
Adult ; Aged ; Carcinoma, Hepatocellular/blood supply/*ultrasonography ; Colon/pathology ; Contrast Media/*administration & dosage ; Diagnosis, Differential ; Female ; Hemangioma/blood supply/*ultrasonography ; Human ; Image Enhancement/*methods ; Liver/pathology/ultrasonography ; Liver Neoplasms/blood supply/secondary/*ultrasonography ; Lung/pathology ; Male ; *Microbubbles ; Middle Aged ; Pancreas/pathology ; Polysaccharides/administration & dosage/diagnostic use ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Stomach/pathology ; Support, Non-U.S. Gov't