No abstract available.
Colitis, Ischemic

It is rare to find three separate primary cancers in one individual. But, multiple primary cancers have been increasing because of improved methods of diagnosis and treatment and greater longevity of the population. We experienced a 52-year old male patient with synchronous triple primary adenocarcinomas occurring at the duodenum, right colon and sigmoid colon, who complained of abdominal pain and hematochezia for 2 months. The patient underwent pancreaticoduodenectomy, right hemicolectomy, and anterior resection, and was recovered uneventfully. After surgery, postoperative adjuvant chemotherapy (5-FU and Leucovorin) is currently being administered.
Abdominal Pain ; Adenocarcinoma* ; Chemotherapy, Adjuvant ; Colon* ; Colon, Sigmoid* ; Diagnosis ; Duodenum* ; Gastrointestinal Hemorrhage ; Humans ; Longevity ; Male ; Middle Aged ; Pancreaticoduodenectomy

A parastomal hernia is an incisional hernia in relation to an intestinal stoma on the abdominal wall and a common complication after stoma formation. Most parastomal hernias are relatively asymptomatic, but sometimes, a loop of bowel may become trapped in the sac, resulting in obstruction or strangulation. We reported a case with a para-colostomy hernia causing small bowel obstruction in a 45-years-old female who had had a transverse loop colostomy for severe rectovaginal fistula 2 years before due to recurrent cervix cancer. The patient required resection of gangrenous portions of small bowel and large bowel. A review of the preventative information of parastomal hernia and management is discussed. A parastomal hernia shonld be considered as a cause of small bowel obstruction in anyone who has a stoma. Early detection and repair of the strangulated hernia are recommended.
Abdominal Wall ; Colostomy ; Female ; Hernia* ; Humans ; Rectovaginal Fistula ; Uterine Cervical Neoplasms

Desmoid tumor is a subtype of fibromatosis arising from deep fascial or soft tissue structure. It is characterized by locally aggressive behavior with a tendency to local recurrence, but is generally accepted the lack of ability for distant metastasis. Although excision is the best initial therapy, surgery is not always amenable in cases of lesions lying in difficult anatomical area. Two female patients with recurrent desmoid tumor in abdomen and pelvis after excision were treated with tamoxifen, goserelin, and sulindac. This therapy led to a progressive decrease of tumor size within 13 months in one patient. However, in the other patient, this combined therapy failed to reduce the size of the tumor. Despite the success of combined therapy with hormone and nonsteroidal anti-inflammatory drug is anecdotal, this treatment may improve the survival and reduce the recurrence in certain sub-group of desmoid tumor.
Abdomen* ; Deception ; Female ; Fibroma ; Fibromatosis, Aggressive* ; Goserelin* ; Humans ; Neoplasm Metastasis ; Pelvis ; Recurrence ; Sulindac* ; Tamoxifen*

Familial Adenomatous Polyposis (FAP) is a rare and autosomal dominantly inherited disorder characterized by the development of hundreds to thousands of colorectal polyps. Korean Polyposis Registry was established in July, 1990 for early detection and management of the FAP patient. Recently, we have experienced in our institution a case of the FAP family kindred living in Jeju Island of Korea. Their relatives have been managed for the past 20 years and are listed in the Korean polyposis registry. Pathologic diagnosis of our proband was stage III (T3N1M0) rectal cancer with thousands of colonic polyps. Intrafamilial strife and psychologic distress was significant due to the late detection and progression to rectal cancer. Therefore, we reviewed our case of the FAP family with literature regarding the psychologic distress and the role of the regional registry.
Adenomatous Polyposis Coli ; Colonic Polyps ; Diagnosis ; Humans ; Korea* ; Pedigree* ; Polyps ; Rectal Neoplasms

PURPOSE: The results for treatment of fistula-in-ano have much improved, along with the development of anatomical knowledge, classification, and operative techniques, during last several decades. The authors retrospectively reviewed the results for treatment of fistula-in-ano, especially complex fistulas, during the last 11 years. METHODS: A retrospective study of fistula-in-ano was performed for 229 patients who had been operated on in St. Benedict Hospital between January 1988 and December 1998. Complex fistulas (IIH, III & IV) were analyzed separately. RESULTS: The most common type was IILs (92 cases, 40.2%), and the most common horseshoe type was IIIBc (5 cases, 2.2%). The average hospital stay was 11.5 days for all fistula-in-ano types, but 15.1 days for complex fistulas. Non-specific inflammation (209 cases, 91.3%) was the most common pathologic finding. Various operative procedures were used : fistulotomy (80 cases, 34.9%), fistulectomy (74 cases, 32.3%), coring out fistulectomy (63 cases, 27.5%), seton technique (11 cases, 4.8%), and muscle-filling technique (1 case, 0.4%). There was no difference in the recurrence rate among the operative types. Various procedures were tried for complex fistulas, but the sphincter-preserving fistulectomy by Takano seemed to have a low recurrence rate and a short postoperative course. However, because of the small number of cases, this difference in recurrence rate and postoperative course was not statistically significant. The overall postoperative complication rate was 7%: anal infection (4 cases, 1.7%), anal bleeding (3 cases, 1.3%), and urinary retention (2 cases, 0.9%). CONCLUSIONS: The operations for most of the fistulae, IH, IL & IIL, were simple and uneventful. However, the operations for complex fistulae were complicated and more skill was required. We have thought Takano's operation to be a good curative procedure with less postoperative deformity and shortened postoperative course. However this research couldn't prove that with statistical significance, probably because of the insufficient number of patients. If further cases are collected and continuous follow-up is done, then a better result can be expected.
Classification ; Congenital Abnormalities ; Fistula ; Hemorrhage ; Humans ; Inflammation ; Length of Stay ; Postoperative Complications ; Recurrence ; Retrospective Studies* ; Surgical Procedures, Operative ; Urinary Retention

PURPOSE: Mucocele of the appendix is merely a descriptive term for abnormal mucus accumulation causing distension of the appendiceal lumen, irrespective of the underlying cause. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The purpose of this study is to clarify the clinical pictures of appendiceal mucocele and to provide a guide for treatment. METHODS: To search the clinical characteristics of appendiceal mucocele, we retrospectively investigated 16 cases of appendiceal mucocele treated from January 1983 to December 1998 at the Department of Surgery, Masan Samsung Hospital. RESULTS: There were 3 males and 13 females aged 44 to 83 years (mean 59.3 years). The peak incidence was in the 6th decade (6 cases, 37.5%). The most common symptom was right lower quadrant pain, and right lower quadrant tenderness was the most common physical finding. Histopathologic diagnoses were mucosal hyperplasia in 12 cases and mucinous cystadenoma in four. Simple appendectomy was performed in 8 patients with uncomplicated mucosal hyperplasia. Right hemicolectomy was performed in 3 patients with mucinous cystadenoma. Ileocecal resection was performed in one patient with mucosal hyperplasia and in another patient with mucinous cystadenoma. Appendectomy and oophorectomy was performed in 2 patients with mucosal hyperplasia and coexisting ovarian cyst, and appendectomy and fistulectomy, in one patient with mucosal hyperplasia and coexisting appendiceocutaneous fistula. Postoperative complications such as intestinal obstruction and wound infection occurred in 4 cases (25%). There was no postoperative mortality. Thirteen patients remain free of disease after surgical intervention, and one patient died 6 year later of peritoneal seeding caused by advanced gastric cancer. CONCLUSIONS: Simple appendectomy is a reasonable choice for uncomplicated, unruptured mucoceles; however, a right hemicolectomy or ileocecal resection may be indicated if the mucocele is adherent to, or shows signs of invasion to cecum or ileum. At operation, a careful search should be made for 'coexisting' tumors of the ovary and gastrointestinal tract.
Appendectomy ; Appendix ; Cecum ; Cystadenoma, Mucinous ; Diagnosis ; Female ; Fistula ; Gastrointestinal Tract ; Humans ; Hyperplasia ; Ileum ; Incidence ; Intestinal Obstruction ; Male ; Mortality ; Mucocele* ; Mucus ; Ovarian Cysts ; Ovariectomy ; Ovary ; Postoperative Complications ; Pseudomyxoma Peritonei ; Retrospective Studies ; Rupture ; Stomach Neoplasms ; Wound Infection

PURPOSE: To evaluate factors that predict prognosis of colon perforation, we review the hospital records of 37 patients who underwent emergency operation for colon perforation. METHODS: Information of clinical findings, Acute Physiology and Chronic Health Evaluation (APACHE II score), perforation sites and causes, operation methods, and postoperative complications were obtained. RESULTS: The causes of perforation were traumatic 11 (29.7%), iatrogenic 10 (27.0%), diverticular 6 (16.2%), cancerous process 6 (16.2%), strangulated hernia 2 (5.4%), ischemic colitis 1 (2.7%) and stercoral 1 (2.7%). The longer duration from colon perforation to operation, the more severe intra-abdominal fecal contamination was seen. The complication rate was increased as the intra-abdominal fecal contamination increased or APACHE II score increased (p<0.05). But there were no correlation between the complication rate and perforation sites and causes. In according to operative managements, one-stage operation (simple closure or resection with anastomosis) group had more lower complication rate than two-stage operation (formation of colostomy) group, unexpectedly (31.3% vs. 52.4%, p>0.05). Also former group had lower complication rate compared to latter group in left colon (40% vs 50%). CONCLUSIONS: The factors that predict of mortality and morbidity are not perforation site, causes, and operation method, but preoperative physiologic status (APACHE II score) and intra-abdominal fecal contamination. So preoperative proper and vigorous treatment for improvement of physiologic status and shortening of interval to operation are important for better results. And primary closure and resection with anastomosis is useful for colon perforation in selected circumstance regardless of its site and cause.
APACHE ; Colitis, Ischemic ; Colon* ; Colostomy ; Emergencies ; Hernia ; Hospital Records ; Humans ; Mortality ; Postoperative Complications ; Prognosis

PURPOSE: This study was undertaken to evaluate retrospectively the clinical results of surgery for the rectal villous adenoma. METHODS: The study took place from the period of Mar. of 1988 to Feb. 1998 at the Dept. of Surgery, Sungkyunkwan Univ., Medical college. The study consisted of : Among the 97 cases diagnosed with colon & rectal villous adenoma, and 59 were rectal villous adenoma, and 42 cases underwent resection. We focused on these 42 cases, especially on the position of tumor, its size, surgical technique, histologic results & keeping close follow up post-surgically. RESULTS: The sex ratio was 2:1 with male predominence, 18 cases were in their fifties with the average age of 55. In 30 cases, the lesion was situated within the 8 cm of anal verge. The average size of tumor was 3.64 cm. The applied methods were; rectotomy 19 cases, anterior resection 13 cases (including low anterior resection), endoscopic excision and transanal excision were 7 cases, and 2 cases, respectively. And in one case where the tumor size was 14.5 cm and which was situated within 3 cm of anal verge, Miles' operation was conducted. Death due to post-operative complication was not observed. 2 cases of wound infection in postoperation, one case of transient urinary incontinence & hematoma were found. And in the case of explo-laparotomy, anastomosis site leakage, in one case, anastomosis site stricture in 2 cases were noted. malignant cells were observed in total of 73.8%, among these, 80% were from villous adenoma, 70% from tubullovillous adenoma. In the case of tumor size less 1 cm, and tumor size greater than 1 cm, the probability of finding malignant lesion were 33.3% and 76.9%, respectively. CONCLUSIONS: We suggest that wideexcision through York-Mason approach is a safe and effective technique for huge villous adenomas of the rectum.
Adenoma ; Adenoma, Villous* ; Colon ; Constriction, Pathologic ; Follow-Up Studies ; Hematoma ; Histological Techniques ; Humans ; Male ; Rectum ; Retrospective Studies ; Sex Ratio ; Urinary Incontinence ; Wound Infection

PURPOSE: The clinical guidelines and rationale published by the American Gastroenterological Association in 1997 recommended that it is not necessary to screen patients in the average risk group who are below the age of 50. The purpose of this study was to evaluate both the effectiveness of flexible sigmoidoscopy (FS) as a diagnostic and screening tool and the utility of screening at an age earlier than 50 years. METHODS: From Jan. to Dec. 1997, FS was used in 8964 cases. These cases were divided into three groups: Group A, 1336 outpatients; Group B, 5308 cases involving a hemorrhoidal operation; and Group C, 2320 cases of mass screening. RESULTS: The mean age was lower in Group B (42.4 11.5) than in Group A (47.0 14.5) and Group C (46.1 10.7). The incidences of cancer, inflammatory bowel disease (IBD), and nonspecific proctocolitis in Group A were significantly higher than they were in Groups B and C, and the FS findings in Groups B and C were similiar. The locations of the polyps, cancer, IBD, and nonspecific proctocolitis were below the left colon in 91.9% cases involving an abnormal finding. Also, the locations of polyps and IBD determined by using FS and by using colonoscopy (CS) were not very different. About two-thirds of the carcinomas found by using FS in all three groups were located in the upper rectum and the sigmoid. In Group B, the FS findings did not depend on whether or not an enema had been administered. Also, the total incidence of cancer in patients less than forty years of age was nearly the same as the incidence of cancer in Group B and the incidence of cancer in Group C. CONCLUSIONS:The risk of cancer for patients in the average risk group who are under 50 years of age should not be underestimated. FS is effective not only for the diagnosis of colorectal disease but also as an initial screening technique for patients below forty years of age.
Colon ; Colon, Sigmoid ; Colonoscopy ; Diagnosis ; Enema ; Hemorrhoids ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Mass Screening* ; Outpatients* ; Polyps ; Proctocolitis ; Rectum ; Sigmoidoscopy*