1.The Association of Anisakiasis in the Ascending Colon with Sigmoid Colon Cancer: CT Colonography Findings.
Hye Jin YOO ; Se Hyung KIM ; Jeong Min LEE ; Min A KIM ; Joon Koo HAN ; Byung Ihn CHOI
Korean Journal of Radiology 2008;9(Suppl):S56-S60
The association of anisakiasis of the colon with colon cancer is rare and difficult to diagnose. Only one case of this type has been reported to date. In this study, we report a case of synchronous colon cancer and colonic anisakiasis. A 50-year-old woman was admitted for abdominal pain, and a volume-rendered surface-shaded image of CT colonography (CTC) revealed a concentric narrowing in the sigmoid colon and a segmental fold thickening in the ascending colon. A total colectomy was performed and the diagnosis of synchronous sigmoid colon cancer and anisakiasis of the ascending colon was confirmed. This case is the first reported visualization of synchronous colon cancer and colonic anisakiasis on a CTC.
Adenocarcinoma/*complications/*radiography/surgery
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Anisakiasis/*complications/*radiography/surgery
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Colectomy
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Colonic Diseases/*complications/*radiography/surgery
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*Colonography, Computed Tomographic
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Female
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Humans
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Middle Aged
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Sigmoid Neoplasms/*complications/*radiography/surgery
2.CT Findings of Colonic Complications Associated with Colon Cancer.
Sang Won KIM ; Hyeong Cheol SHIN ; Il Young KIM ; Young Tong KIM ; Chang Jin KIM
Korean Journal of Radiology 2010;11(2):211-221
A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.
Abdominal Abscess/complications/radiography
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Adult
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Aged
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Aged, 80 and over
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Appendicitis/complications/radiography
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Colitis, Ischemic/complications/radiography
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Colon/*radiography
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Colonic Diseases/complications/radiography
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Colonic Neoplasms/*complications/*radiography
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Female
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Humans
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Intestinal Diseases/*complications/*radiography
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Intestinal Obstruction/complications/radiography
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Intussusception/complications/radiography
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Male
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Middle Aged
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Tomography, X-Ray Computed/*methods
3.The Efficacy of the Coaxial Technique Using a 6-Fr Introducer Sheath in Stent Placement for Treating the Obstructions Proximal to the Descending Colon.
Il Soo CHANG ; Sang Woo PARK ; Dae Yong HWANG ; Moo Kyung SEONG ; Hee Kyung JOH ; So Young YOON ; Yo Han CHO ; Won Hyeok CHOE
Korean Journal of Radiology 2011;12(1):107-112
OBJECTIVE: We wanted to evaluate the efficacy of stent placement using the coaxial technique with a stiff, long introducer sheath in patients with technical failure using an angiographic catheter for the obstructions proximal to the descending colon. MATERIALS AND METHODS: Self-expandable metallic stent placement was attempted under fluoroscopy-guidance in 77 consecutive patients who had malignant colorectal obstruction. Stent placement was performed using an angiographic catheter and a guide wire. If the angiographic catheter could not be advanced over the guide wire into the obstructive lesions proximal to the descending colon, then a 6-Fr introducer sheath was used. The technical success rate, the clinical success rate and the complications were analyzed. RESULTS: Successful stent placement was achieved in 75 of 77 patients (97%). The angiographic catheter failed to advance into the obstructive lesions of 11 patients (M:F = 7:4; mean age, 65.5 years) whose lesions were at the level of the splenic flexure or transverse colon. Therefore, the coaxial technique was implemented in all these 11 patients using a 6-Fr stiff introducer sheath and then the stent placement was successful. There were no complications related to the use of a stiff introducer sheath. Clinical success, which was defined as relief of clinical obstructive bowel symptoms, was obtained within 24 hours in all of patients. CONCLUSION: The coaxial technique using a stiff introducer sheath can increase the technical success of fluoroscopy-guided, self-expandable metallic stent placement in patients with colonic obstruction proximal to the descending colon.
Adult
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Aged
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Aged, 80 and over
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*Catheters
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*Colon, Descending
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Colonic Diseases/etiology/*therapy
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Colonic Neoplasms/complications
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Female
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*Fluoroscopy
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Humans
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Intestinal Obstruction/etiology/*therapy
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Male
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Middle Aged
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*Radiography, Interventional
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*Stents
4.A Case of Lower Gastrointestinal Bleeding Caused by Primary Iliac Arterio-colic Fistula.
Young Il KIM ; Seon Young PARK ; Won Joo KI ; Ho Seok KI ; Kyoung Won YOON ; Hyun Soo KIM ; Sung Kyu CHOI ; Jong Sun REW
The Korean Journal of Gastroenterology 2010;56(2):113-116
Arterio-enteric fistula is a very rare cause of massive lower gastrointestinal hemorrhage. We report here on a case of massive hematochezia caused by iliac arterio-colic fistula in a 60-year-old woman who had a recent history of spinal surgery for herniated nucleus pulposus. Abdomen computed tomography showed the extravasation of radiocontrast media from right iliac artery encased by an intraabdominal abscess into the adjacent dilatated colon. Also, diagnostic angiography revealed the active extravasation of radiocontrast media via a fistula between right iliac artery and colon. Although successful endovascular exclusion of the fistula with stent graft and coils was performed, disseminated intravascular coagulation and multi-organ failure were developed.
Colonic Diseases/complications/*diagnosis
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Female
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Gastrointestinal Hemorrhage/*etiology
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Humans
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Iliac Artery/*radiography
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Intestinal Fistula/complications/*diagnosis
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Middle Aged
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Stents
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Tomography, X-Ray Computed
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Vascular Fistula/complications/*diagnosis
6.The Efficacy of Metallic Stent Placement in the Treatment of Colorectal Obstruction.
Sung Gwon KANG ; Gyu Sik JUNG ; Soon Gu CHO ; Jae Gyu KIM ; Joo Hyung OH ; Ho Young SONG ; Eun Sang KIM
Korean Journal of Radiology 2002;3(2):79-86
DBJECTIVE: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. MATERIALS AND METHODS: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. RESULTS: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30). After clinically successful stent placement, bowel decompression occurred within 1-4 (mean, 1.58+/-0.9) days. Five of six clinical failures involved stent migration and one stent did not expand after successful placement. In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful. In the palliative group, 19 stents were placed in 15 patients. The mean period of patency was 96.25+/-105.12 days: 146.25+/-112.93 for type-A, 78.82+/-112.26 for type-B, and 94.25+/-84.21 for type-C. Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%). The migration rate was significantly higher in the type-B group than in other groups (p=0.038). CONCLUSION: Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction. The migration rate of covered stents with flaring is higher than that of other types. For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.
Adolescent
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Adult
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Aged
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Aged, 80 and over
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Colonic Diseases/radiography/*therapy
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Colorectal Neoplasms/*complications
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Equipment Design
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Female
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Human
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Intestinal Obstruction/radiography/*therapy
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Male
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Middle Age
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Palliative Care
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Rectal Diseases/radiography/*therapy
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*Stents
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Support, Non-U.S. Gov't
7.Chronic Recurrent Volvulus of the Colonic Splenic Flexure Associated with the Eventration of Left Diaphragm.
Hee Sun KIM ; Jeong Seon YOO ; Seok Joo HAN ; Hyojin PARK
The Korean Journal of Gastroenterology 2007;49(1):37-40
The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.
Adult
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Barium Sulfate/diagnostic use
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Chronic Disease
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*Colon, Transverse
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Colonic Diseases/*radiography/surgery
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Diaphragmatic Eventration/*complications/radiography/surgery
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Humans
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Intestinal Volvulus/etiology/*radiography/surgery
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Male
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Recurrence
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Tomography, X-Ray Computed
9.Clinical Analysis of Stercoral Perforation of the Colon.
Jung Kwang NAM ; Byung Seok KIM ; Kyung Soo KIM ; Duk Jin MOON
The Korean Journal of Gastroenterology 2010;55(1):46-51
BACKGROUND/AIMS: A stercoral perforation of the colon (SPC) is a rare, life-threatening disease. The aim of this study was to represent the definition of SPC and help the diagnosis and treatment of this condition. METHODS: We reviewed 92 medical records of patients who underwent operation due to colonic perforation from January 2000 to February 2009 retrospectively. Maurer's diagnostic criteria were used for the diagnosis of SPC. RESULTS: Eight patients (8.7%) were diagnosed as SPC. The age of the patients ranged from 59 to 85 years old. All of the patients were female and had a history of long-standing constipation. Only two patients (25%) were diagnosed as SPC preoperatively. The site of perforation of all patients was sigmoid colon. The methods of operation were Hartmann's procedure (7 cases), and primary repair with sigmoid loop colostomy (1 case). There were one recurrence and two deaths (25%) due to sepsis and multiple organ failure. CONCLUSIONS: SPC should be considered in chronically constipated, and bedridden patients who present with acute abdomen. Hartmann's procedure is the treatment of choice in most situations. Mortality is high but can be minimized with early definitive surgery.
Aged
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Aged, 80 and over
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Colon, Sigmoid/pathology
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Colonic Diseases/*diagnosis/radiography/surgery
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Female
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Humans
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Intestinal Perforation/*diagnosis/radiography/surgery
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Middle Aged
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Postoperative Complications
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Respiratory Distress Syndrome, Adult/etiology
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Retrospective Studies
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Sepsis/etiology
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Tomography, X-Ray Computed