Colitis Cystica Profunda(CCP) is an uncommon disease in Korea, and little knowledge exists about CCP, including knowledge about its incidence and prevalence. However, it may be speculated that the disease will be diagnosed more often due to advancement in diagnostic tool and growing interest. CCP is essentially the same disorder as Solitary Rectal Ulcer Syndrome(SRUS), but it has been reported separately because of its external appearances such as broad shaped polyps or nodules. Both CCP and SRUS are called MPS. Of importance is that a submucosal-cyst-containing lesion needs to be differentiated from mucus- producing adenocarcinoma. This differentiation is obvious from the CCP histologic features, such as fibromuscular obliteration of lamina propria and submucosal cysts. In light of these facts, it is important to obtain a sufficient biopsy specimen to examine accurately. It is not uncommon for CCP to be accampanied by rectal prolapse or incomplete intussusception, so diagnostic approaches of these associated disorders should be done at the same time. The authors have recently experienced one case of CCP associated with rectal prolapse. The case was treated effectively and is reported in this paper along with a review of the literature on this subject.
Adenocarcinoma ; Biopsy ; Colitis* ; Incidence ; Intussusception ; Korea ; Mucous Membrane ; Polyps ; Prevalence ; Rectal Prolapse ; Ulcer

An external thrombotic hemorrhoid is a very painful disease with a high incidence rate. The chief complaints encountered by the surgeon are protrusion and pain. However, because the spontaneous healing rate is very high, there is no consensus on whether conservative management or surgery is a more effective treatment policy. In an attempt to resolve this problem, we performed a clinical analysis of fifty patients with external thrombotic hemorrhoids who were treated by conservative management at Song-Do Colorectal Hospital from October 1996 to December 1996. We recorded the time required for the protrusion and the pain to disappear and performed manometry to check the sphincter pressure and tissue pathology to determine the pathogenesis of the external thrombotic hemorrhoid. The results are as follows: 1) Based on pathology, the cause of the external thrombotic hemorrhoids was venous thrombosis due to venous stasis, not a hematoma due to venous rupture. 2) Manometry showed that the resting sphincter pressure and the squeezing sphincter pressure for the patients with external thrombotic hemorrhoids was higher than those of the control group, which was the reason for the venous stasis. In conclusion, because an external thrombotic hemorrhoid is just a thrombosis due to venous stasis, the thrombosis can be improved by using methods such as a warm sitz bath and analgesics to decrease the sphincter pressure. Hence, conservative management should be the preferred treatment in almost all cases.
Analgesics ; Baths ; Consensus ; Hematoma ; Hemorrhoids ; Humans ; Incidence ; Manometry ; Pathology ; Rupture ; Thrombosis ; Venous Thrombosis

PURPOSE: Elderly patients of colorectal cancer compose a steadily expanding portion of the population in Korea. The decision whether or not to operate on elderly patients who have carcinoma of colon and rectum is often unduly complicated. The aim of this study is to evaluate the results of the operations for colorectal cancers in the elderly. METHODS: This report is a retrospective clinical analysis for 365 cases of colorectal cancer who were treated surgically at the Department of surgery, Chonbuk National University Medical School from January 1994 to December 1998. To evaluate the age factor in colorectal cancer, the patients were divided into two groups: The elderly group included 79 patients who were aged > or =70 years on first presentation; The control group comprised 286 patients aged <70. RESULTS: There is no significant difference between the two group with regard to the mode of presentation, gender, location of tumor, clinical symptom and sign, duration of symptom, coexistent disease, operation method, tumor size, histopathologic findings, the Astler-Coller classification, lymphatic and distant metastasis, perioperative complication and 5-year survival. The emergency operation is significantly higher incidence in the elderly group. CONCLUSIONS: It is concluded that surgical resection of colorectal cancer in elderly is standard method and should not be restricted on the basis of age alone.
Age Factors ; Aged* ; Classification ; Colon ; Colorectal Neoplasms* ; Emergencies ; Humans ; Incidence ; Jeollabuk-do ; Korea ; Neoplasm Metastasis ; Rectum ; Retrospective Studies ; Schools, Medical

Ischemic colitis is an uncommon disease in Korea, but nowadays, the incidence of this disease is increasing in Korea. The reason is that the number of old patients is increasing and colonoscopic diagnosis is performed more frequently. It is especially important to differentiate it from other inflammatory bowel disease, such as infectious colitis, ulcerative colitis, Crohn's disease, and drug-induced colitis, because ischemic colitis is similar to other inflammatory bowel disease in symptoms and colonoscopic findings. However, the authors were able to differentiate ischemic colitis from other inflammatory bowel disease by close examination of a patient's history, microscopic examination and culture studies of the bacteria in the stool, and close observation of the changes in the colonoscopic findings with time. We experienced six cases of ischemic colitis and report them along with a brief review of the literature.
Bacteria ; Colitis ; Colitis, Ischemic* ; Colitis, Ulcerative ; Crohn Disease ; Diagnosis ; Humans ; Incidence ; Inflammatory Bowel Diseases ; Korea

BACKGROUND/AIMS: Many endoscopists in Korea lack an understanding of laterally spreading, or creeping tumors(LSTs) which characteristically grow laterally, as opposed to other polypoid lesions, and which show superficially elevated lesions. An LST is similar in color to the adjacent normal mucosa, so it is difficult to recognize, but it can be detected by chromoscopy. When it grows to over 2-3 cm in its largest diameter, it can have malignant foci. It is important not to overlook the lesion and to remove it in a timely manner. METHODS: The authors experienced 9 cases of LSTs from Jan. 1996 to Jan. 1997. We reviewed those 9 cases clinically, endoscopically, and pathologically, and tried to establish the diagnostic and therapeutic key points. RESULTS: The most common age group was the fifth decade. The male-to-female ratio was 5:4. Four cases were asymptomatic, and lower abdominal pain and rectal bleeding were seen in 2 cases respectively. The rectum and the sigmoid colon were the most commonly involved sites showing 88.9% (8/9). Granular-type(nodule-aggregating-type) LSTs were seen in 4 cases and nongranular types(non-noodule-aggregating type) in 5 cases. 66.7%(6/9) were larger than 2 cm in the largest diameter. A tubular adenoma was seen in each of 5 cases; among them, 1 case had cellular atypia and another case revealed a submucosal(sm) carcinoma. Two granular types with large nodules had mucosal carcinomas. The sm carcinoma was a nongranular type. Endoscopically, redness was observed in 66.7%(6/9) of the cases and depression in 33.3%(3/9). The sm carcinoma had both redness and depression. Three cases underwent endoscopic piecemeal mucosal resection(EPMR) and the other 3 cases underwent endoscopic mucosal resection (EMR). A low anterior resection was performed on one patient; there was no lymph node metastasis. CONCLUSIONS: The characteristics of LSTs are important in their diagnosis and management. Nongranular-type LSTs are not uncommon, despite the difficulty in recognizing them by endoscopy. Pathologically, LSTs, in general, are tubular or tubulovillous adenomas. When they are over 2 cm in their largest diameter, they are likely to have malignancies. Giant nodule, redness and depression are important features indicating malignancy, especially an sm carcinoma. An EPMR or an EMR is the main treatment option, but depending on the depth of invasion, surgical resection may need to be considered.
Abdominal Pain ; Adenoma ; Colon, Sigmoid ; Depression ; Diagnosis ; Endoscopy ; Hemorrhage ; Humans ; Korea ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Rectum

Lymphoid polyp is a rare disease in the colorectal area. It occurs commonly in the rectum. It is a nonepithelial benign tumor. Because of the benignancy of its nature, it has other names as well, such as benign lymphoma or rectal tonsil. A lymphoid polyp can be differentiated from a malignant lymphoma by the proliferation of normal lymphoid tissue which has a prominent follicular pattern and a clearly defined germinal center. A lymphoid polyp can regress spontaneousely without any treatment. There is no recurrence or malignant transformation. Recently, the authors experienced a case of lymphoid polyp in the rectum. We report a case of lymphoid polyp in the rectum diagnosed by piecemeal polypectomy.
Germinal Center ; Lymphoid Tissue ; Lymphoma ; Palatine Tonsil ; Polyps* ; Rare Diseases ; Rectum* ; Recurrence

Lymphoid polyp is a rare disease in the colorectal area. It occurs commonly in the rectum. It is a nonepithelial benign tumor. Because of the benignancy of its nature, it has other names as well, such as benign lymphoma or rectal tonsil. A lymphoid polyp can be differentiated from a malignant lymphoma by the proliferation of normal lymphoid tissue which has a prominent follicular pattern and a clearly defined germinal center. A lymphoid polyp can regress spontaneousely without any treatment. There is no recurrence or malignant transformation. Recently, the authors experienced a case of lymphoid polyp in the rectum. We report a case of lymphoid polyp in the rectum diagnosed by piecemeal polypectomy.
Germinal Center ; Lymphoid Tissue ; Lymphoma ; Palatine Tonsil ; Polyps* ; Rare Diseases ; Rectum* ; Recurrence

The pain after a hemorrhoidectomy is widely feared by many patients who are mostly still treated with oral/intramuscular narcotics to control their pain postoperatively. In an effort to decrease posthemorrhoidectomy pain by applying newer methods of analgesia, a prospective trial was conducted to investigate the postoperative analgesic effect of Tarasyn(R) (ketorolac tromethamine) injected into the internal sphincter muscle at the time of the hemorrhoidectomy. Tarasyn(R) is a nonsteroidal anti-inflammatory drug introduced for intramuscular injection to control postoperative pain. It's action is peripheral. Therefore, it seems appropriate to inject it directly into the anal sphincter muscles when these are exposed during anorectal procedures. A total loading dose of 60 mg(2 cc, 30 mg/ml) of ketorolac was used intraoperatively. It was injected intramuscularly locally after completion of hemorrhoidectomy. Postoperative pain after a hemorrhoidectomy can be safely controlled in a patient by using newer methods of pain control, including supplemental use of the nonsteroidal analgesic ketorolac, which allows early release of the patient, the day of surgery by diminishing the postoperative pain in our study group. Another important advantage of a local injection of ketorolac was the elimination of urinary retention.
Anal Canal ; Analgesia ; Hemorrhoidectomy* ; Humans ; Injections, Intramuscular ; Ketorolac ; Muscles ; Narcotics ; Pain Management* ; Pain, Postoperative ; Prospective Studies ; Urinary Retention

Ulcerative colitis is increasing now in Korea, and the diagnosis has become relatively easy because sigmoidoscopy and colonoscopy are frequently used. However, the result of treatment is not satisfactory because the relapse rate is very high. Hence, the aim of treatment is to put this disease into remission as soon as possible and to keep it in remission. The authors reviewed 80 confirmed ulcerative colitis cases which were treated from Feb. 1997 to Sep. 1997 at Song Do Colorectal Hospital. The results are as follows: 1) The male to female ratio for these 80 cases was 41:39, and the most prevalent age group was the 4th decade. 2) The most common clinical symptoms were anal bleeding in 77 cases(96%), diarrhea in 68 cases(85%), and abdominal pain in 21 cases(26%). 3) The extension of the disease were the proctitis in 47 cases(59%), the left - side colitis in 28 cases(35%), the total colitis in 4 cases(5%), and the atypical colitis in 1 case(1.3%). 4) The duration of the disease was below 6 month in 30 cases, 6 months to 1 year in 35 cases, and 1~5 years in 11 cases, and over 5 years in 4 cases. 5) Clinical types were the one-attack-only type(18 cases), the relapsing-remitting type(60 cases), the chronic continuous type(1 case), and the acute fulminating type(1 case). 6) In the 28 cases of left side colitis, the average time to remission depended on the medication was 18 days for a 5-ASA 5-ASA suppository, 14.5 days for a 5-ASA oral steroid, and 8.3 days for a 5-ASA budesonide enema. Thus, a budesonide enema is the most effective medication for obtaining remission. 7) The most commonly suspected predisposing factors for relapse were cessation of medication(58 cases), mental stress(18 cases), physical stress(15 cases), and inadequate diet(8 cases). As indicated above, ulcerative colitis is increasing now in Korea, and the rectum is the most commonly involved site for this disease. Relapsing-remitting ulcerative colitis is the most frequently occurring type. Almost all cases were easily put into remission within 4 weeks, but relapse frequently occurred. Suspected predisposing factors, such as mental stress, physical stress, and inadequate diet, should be avoided in order to prevent relapse, and medication, such as 5-aminosalicylic acid, should be continued to maintain remission.
Abdominal Pain ; Budesonide ; Causality ; Colitis ; Colitis, Ulcerative* ; Colonoscopy ; Diagnosis ; Diarrhea ; Diet ; Enema ; Female ; Hemorrhage ; Humans ; Korea ; Male ; Mesalamine ; Music ; Proctitis ; Rectum ; Recurrence ; Sigmoidoscopy ; Ulcer*

BACKGROUND: This study was undertaken to review cases of juvenile polyps with respect to clinical and endoscopic features. METHODS: Of the 544 cases of colonoseopic polypectomies performed from Jan. 1 to Jan. 1997, 14 cases(2.6%) involved juvenile poiyps. Those 14 cases were analyzed with special consideration given to colonoscopic aspects. RESULTS: The most common age groups were the fifth and the sixth decades, comprising 50%. There were two children below 10 years of age. Males were predominant in the ratio of 1.3:1. Rectal bleeding was the most common symptom, and 4 cases were asymptomatic. Mediumsized(6~10 mm) polyps were the most common, 7 eases(50%), and large(> 1 cm) polyps were the next most common, 5 cases(35.7%). The first predilection of site was the rectum, 8 cases(57.1%); the second was the sigmoid colon with 5 cases(35.7%). Grossly, pedunculated polyps were the largest in number, accountieg for 64.3% of the cases; the others were all subpedunculated. In 9 cases(64.3%), the preoperative macroscopic diagnoses were consistent with the final diagnoses; in the other cases, the polyps were initially diagnosed as being adenomatous. Adenomatous and inflammatory polyps were associated with 3 cases, who were all men. White spots were noticed around the polyp base in 4 cases (28.6%); the clinical significance of those should be investigated further. All 14 patients underwent polypectomy by endoscopic snare resection without any complications. CONCLUSIONS: Colonoscopy should be the main tool for diagnosis and treatment of juvenile polyps. Juveoile polyps should be taken into account in cases of rectal bleeding and need to be differentiated from adenomatous polyps. Endoscopic polypectomy is an adequate procedure for the treatment of a solitary juvenile paiyp.
Adenomatous Polyps ; Child ; Colon, Sigmoid ; Colonoscopy ; Dental Caries ; Diagnosis ; Hemorrhage ; Humans ; Male ; Polyps* ; Rectum ; SNARE Proteins