Chronic colonic pseudo-obstruction is a rare disease that results in colorectal dilatation without any obstructing lesions. Colonic dilatation does not usually cause colonic wall thickening and colonic visceral myopathy with muscular hypertrophy has not been reported in Korea. A 31-year-old female patient was transferred for treatment of refractory constipation accompanied by megacolon. She had suffered from recurrent attacks of severe abdominal pain with the sensation of a mass in the left lower quadrant. An abdominal CT revealed a large luminal dilatation of the sigmoid colon where massive stool was impacted. There was no obstructing lesion or luminal dilatation of the rectum. To relieve her refractory symptoms, a total colectomy with an ileorectal anastomosis was performed. Pathologic examination of the sigmoid colon revealed that the muscle layers were dysplastic and hypertrophied, and the innervations into the muscle fibers were markedly decreased. She was discharged without any intra-abdominal symptoms.
Abdominal Pain ; Adult ; Colectomy ; Colon ; Colon, Sigmoid ; Colonic Pseudo-Obstruction ; Constipation ; Dilatation ; Female ; Humans ; Hypertrophy ; Intestinal Pseudo-Obstruction ; Korea ; Megacolon ; Muscles ; Phenobarbital ; Rare Diseases ; Rectum ; Sensation

Crohn's disease is an inflammatory bowel disease like ulcerative colitis. Distinct from ulcerative colitis, Crohn's disease may involve any portion of the alimentary tract from the mouth to the anus. Recently, the incidence of Crohn's disease has been increasing in Korea. The proportion of the colon type is smaller than that of the ileocecal type or the small-bowel type. In the colon, Crohn's disease affects mainly the right side. Relatively, the sigmoid colon is rarely involved. Small-bowel obstruction is the most common complication requiring surgery in Crohn's disease. On the contrary, an obstruction limited to the colon requiring surgery is less common in Crohn's disease. We experienced a case of a severe acute sigmoid colon obstruction with peritonitis. At first, we suspected colon cancer, but after an emergency laparotomy, we diagnosed it as Crohn's disease. Such a situation is rare in Korea, so we hope this case report may provide a good opportunity to reconsider Crohn's disease.
Anal Canal ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid* ; Colonic Neoplasms ; Crohn Disease* ; Emergencies ; Hope ; Incidence ; Inflammatory Bowel Diseases ; Korea ; Laparotomy ; Mouth ; Peritonitis

Patients with ulcerative colitis (UC) have the increased risk of colorectal cancer. The risk of colorectal cancer development in UC is associated with the extent of colitis and duration of disease. It is generally agreed that there is little or no increased risk associated with proctitis or proctosigmoiditis. A dysplasia-associated lesion or mass (DALM) is difficult to distinguish from sporadic adenoma. The DALM indicate a high association with colon cancer. The presence of DALM as a premalignant lesion has been considered as an indication for colectomy because of the high risk of progression to malignancy within a short period. We report a case of polyp with high grade dysplasia in a 27-year-old man of ulcerative colitis confined to rectum and sigmoid colon.
Adenoma ; Adult ; Colectomy ; Colitis ; Colitis, Ulcerative* ; Colon, Sigmoid ; Colonic Neoplasms ; Colorectal Neoplasms ; Humans ; Polyps* ; Proctitis ; Proctocolitis ; Rectum ; Ulcer*

Colonic pseudo-obstruction, which is characterized by repetitive episodes or continuous symptoms and signs of a bowel obstruction, is a rare disease that results in colorectal dilatation without any obstructing lesions. Cases with neuropathic chronic colonic pseudo-obstruction have rarely been reported in Korea. We report a case of neuropathic colonic pseudo-obstruction, which results in decreased number of interstitial cells of Cajal and hypoganglionosis, in a 50-year-old man with chronic constipation accompanied by megacolon.
Colon ; Colonic Pseudo-Obstruction ; Constipation ; Dilatation ; Humans ; Interstitial Cells of Cajal ; Korea ; Megacolon ; Middle Aged ; Rare Diseases

Colorectal carcinoma invading the submucosa but not the muscularis propria (pT1) represents the earliest form of clinically relevant colorectal cancer in most patients. T1 colorectal cancer with synchronous liver metastasis is considered to be rare. We report a rare case of T1 colon cancer with synchronous liver metastasis not detected by preoperative imaging study. A 54-year-old male patient presented to our department for treatment of sigmoid colon cancer following an endoscopic submucosal dissection. Histopathological examination revealed the pedunculated mass was moderately differentiated adenocarcinoma without lymphovascular invasion and the depth of submucosal invasion was 2,000 µm, the resection margin was not involved. We performed a laparoscopic anterior resection with lymph node dissection. After the 3 months, the patient's carcinoembryonic antigen level elevated from 1.4 to 7.26 ng/mL (normal level: <1.5 ng/mL) and the abdominal computed tomography and FDG-PET/CT (positron emission tomography-computed tomography) showed multiple hepatic metastases in both hepatic lobes (SUVmax: 5.6) without evidence of local recurrence or lymphadenopathy. We strongly suspected a synchronous liver metastasis not detected by imaging study as opposed to a systemic recurrence. Therefore, evaluation and follow-up protocol of T1 colorectal cancer should be changed for discovery and prediction of synchronous liver metastasis; because we cannot exclude the possibility of synchronous liver metastasis.
Adenocarcinoma ; Carcinoembryonic Antigen ; Colon ; Colonic Neoplasms ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Liver ; Lymph Node Excision ; Lymphatic Diseases ; Male ; Middle Aged ; Neoplasm Metastasis ; Recurrence ; Sigmoid Neoplasms

Ulcerative colitis is a chronic inflammatory bowel disease and may have many intestinal and extraintestinal complications. Compared with general population, patients with longstanding ulcerative colitis have an increased risk of colorectal cancer. Patients with ulcerative colitis have an increased frequency of thromboembolism too. However, hepatic vein thrombosis is a very rare extraintestinal complication. This is the first reported case of a young patient with ulcerative colitis who developed synchronous colonic neoplasm and chronic Budd-Chiari syndrome manifested as esophageal variceal bleeding. We report a case of ulcerative colitis complicated by Budd-Chiari syndrome and colon cancer in a 28-year-old female.
Adult ; Budd-Chiari Syndrome* ; Colitis, Ulcerative* ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Esophageal and Gastric Varices ; Female ; Humans ; Inflammatory Bowel Diseases ; Thromboembolism ; Ulcer*

PURPOSE: Non-specific ulceration of colon is a rare disease of unknown etiology. To establish correctly the diagnosis of nonspecific colon ulcer preoperatively is difficult, but with more wide spread use of colonoscopy and complementary diagnostic aids, this lesion may be accurately diagnosed more often. The presentating symptoms were mainly lower abdominal pain, which mimic such conditions as acute appendicitis, diverticulitis, intestinal obstruction, and colon cancer. If its serious complications (perforation, abscess formation, or uncontrolled bleeding) were developed, resection of ulcerated segment or more extensive colectomy was recommended. The purpose of this study was to establish correctly the diagnosis of nonspecific colon ulcer preoperatively and to identify definitive treatment of complicated colon ulcer. METHODS: 6 cases, surgically treated as non-specific colon ulcer at Chosun University hospital from January 1995 to December 1999 were studied retrospectively. RESULTS: The ages of the patient ranged from 35 to 70 years; the ratio of male to female is 2: 1. The main clinical symptoms were abdominal pain (6 cases), nausea and vomiting (4 cases), hematochezia (3 cases), constipation (2 cases) and palpable mass (1 case). The preoperative diagnosis was generalized peritonitis (2 cases), colon cancer (2 cases), acute appendicitis (1 case), mechanical obstruction (1 case). 3 cases had past medication history, one was anti-hypertensive drug and the two were nonsteroidal anti-inflammatory drug. The preoperative diagnostic study were simple abdomen (6 cases), abdominal CT (6 cases), colon study (3 cases), abdominal sonograph (4 cases) and selective angiogram (1 cases), The location of ulcer were cecum (2 cases), sigmoid colon (2 cases), transversecolon (1 case) and descending colon (1 case). The methods of operation were hemicolectomy (3 cases), segmental resection (1 case) and anterior resection (2 case). There was one death, but 5 cases were completely recovered. CONCLUSIONS: Non-specific ulcer of the colon is not detected until complicated by bleeding, perforation, or obstruction. The patient who has chronic abdominal pain and rectal bleeding can be diagnosed preoperatevely by colonoscopy and colon study. The recommended therapy of complicated cases is resection of the ulcerated segment or more extensive colectomy. Non-specific colonic ulcer should be suspected as one of colonic disease in the patients with complications.
Abdomen ; Abdominal Pain ; Abscess ; Appendicitis ; Cecum ; Colectomy ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonic Diseases ; Colonic Neoplasms ; Colonoscopy ; Constipation ; Diagnosis ; Diverticulitis ; Female ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Intestinal Obstruction ; Male ; Nausea ; Peritonitis ; Rare Diseases ; Retrospective Studies ; Tomography, X-Ray Computed ; Ulcer* ; Vomiting

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

Multiple primary colorectal carcinomas are not rare and occur more often than what can be ascribed to chance, but the frequencies on record vary. The tumors are usually classified as synchronous if they are present at the same time. It is often difficult to detect all these multiple lesions preoperatively:a correct diagnosis is frequently obtained only upon examination of the resected specimen. Triple synchronous primary colon cancer is an exceedingly rare disease. Despite of its rarity, multiple colon cancers should be investigated in the patients in whom clinical or laboratory evidence of colon cancer is suspected. Recently, we experienced one case of triple synchronous primary colon cancer diagnosed by colonoscopy before operation and report here with the review of the literature.
Colon* ; Colonic Neoplasms* ; Colonoscopy* ; Colorectal Neoplasms ; Diagnosis ; Humans ; Rare Diseases

Diffusely infiltrating primary colorectal carcinoma is a rare disease. This type of carcinoma extensively spreads beneath the mucosal layer. Clinically, it resembles inflammatory colorectal disease and metastatic carcinoma and is difficult to diagnosis. Moreover, the prognosis is extremely poor. A 66-year-old man was admitted to our hospital because of lower abdominal pain. Barium enema showed circumferential long segment narrowing in the proximal sigmoid colon without definite mass or ulceration and abdominal CT demonstrated colonic wall thickening. So it was diagnosed as inflammatory condition by image study. Colonoscopic examination showed hypertrophied mucosa and luminal narrowing on the 40 cm from the anal verge, but the oral side couldn't be examined because of stenosis. Biopsy revealed poorly differentiated adenocarcinoma, and left hemicolectomy was done. The pathology showed diffusely infiltrating adenocarcinoma with metastasis in regional lymph node and mesentry involvement.
Abdominal Pain ; Adenocarcinoma ; Aged ; Barium ; Biopsy ; Colon* ; Colon, Sigmoid ; Colonic Neoplasms* ; Colorectal Neoplasms ; Constriction, Pathologic ; Diagnosis ; Enema ; Humans ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Pathology ; Phenobarbital ; Prognosis ; Rare Diseases ; Tomography, X-Ray Computed ; Ulcer