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

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

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

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

Hemorrhoids are the most common problem in anorectal disease, presenting bleeding and prolapse. The definitive treatmant for severe hemorrhoids is surgery, but for milder cases, it is difficult to recommend a hemonhoidectomy. Some patients, especially relatively young and active males, don't want to be admitted, and they ask for ambulatory surgery. For that reason, we have developed a modified bipolar probe which can be simply and conveniently applied and which produces as good a result as that produced by a radical hemouhoidectomy. We restrospectively analyzed the cases of 341 patients who had received a BHC(bipolar homo-coagulation) between July 1994 and December 1995 and who had been followed up for at least six months. The results are as follows: 1) 309 cases(90.6%) were Grade II, and 32 cases(9.4%) were Grade III hemorrhoids. The chief complaint was bleeding in 179 cases(52.5%) and prolapse in 148 cases(43.4%). 2) Evaluation of the BHC procedure was based on patient satisfaction. About threefourths of the patients were very satisfied, and 59 patients(17.3%) were somewhat satisfied. Grade III patients were relatively more satisfied than others, regardless of the number of piles managed by BHC, and patients whose symptom was bleeding were significantly more satisfied, in general, than those with prolapse. Only 26 patients(7.6%) were dissatisfied. 3) No postoperative discomfort was observed in 153 cases(44.9%). However, post-operalive pain and bleeding were present in 92 and 50 cases, respectively. 4) Complications were observed in a total of 26 cases(7.6%). Skin tags were the most frequently observed complication(13 cases), followed by secondary bleeding which was managed by sutures(6 cases). 5) Three patients experienced recurrent hemorrhoids. Two were treated by using a radical hemorrhoidectomy, and one by using a second BHC. Based on these five results, we consider BHC to be a very useful technique for treating Grade II and early Grade III hemorrhoids by outpatient surgery and to be a time-saving procedure for treating accessory piles after main pile extirpation. Furthermore, early detection of hemorrhoids along with their early management by BHC will reduce the need for more radical surgery at some later time.
Ambulatory Surgical Procedures ; Hemorrhage ; Hemorrhoidectomy ; Hemorrhoids* ; Humans ; Male ; Patient Satisfaction ; Prolapse ; Skin

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

Intersphincteric fistulas are the most prevalent fistulas encountered by a surgeon. In general, there are two surgical methods for treating intersphincteric fistulas: fistulotomy and fistulectomy. The advantage of a fistulotomy is less sphincter muscle destruction; the disadvantage is a higher recurrence rate. The advantage of a fistulectomy is a lower recurrence rate; the disadvantage is more sphincter muscle destruction and a higher flatus incontinence rate. Because of the disadvantages with both surgical methods, the authors have developed a new method for treating intersphincteric fistulas. The new method is a fistulectomy with seton. A fistulectomy with seton is a seton tightening of the remaining internal sphincter and subcutaneous external sphincter after coring out of the fistula tract. The advantages of this method are a lower recurrence rate due to complete removal of the fistula and a lower flatus incontinence rate due to the seton slowly cutting the remaining sphincter muscle. For that reason, the authors submit that fistulectomy with seton is the most effective operation method for treating intersphincteric fistulas, especially because fistulectomy with seton has many advantages such as a lower recurrence rate, a lower flatus incontinence rate, and less anal deformity.
Congenital Abnormalities ; Fistula* ; Flatulence ; Recurrence

BACKGROUND/AIMS: A villous tumor, histologically villous or tubulovillous adenoma, is a clinical challenge because of its higher potential for malignancy and higher recurrence rate. However, information and experience with these tumors in the Korean people is still lacking. For that reason, we designed this study to review and analyze the colonoscopic features, the potential for malignancy, and the treatiment with respect to the confirmation of guidelines for the accurate diagnosis and reasonable management of such tumors in the Korean population. MATERIALS AND METHODS: We performed 753 polypectomies, including 4 transanal excisions and several bowel resections, from January 1996 to May 1997 at Song-Do Colorectal Hospital in Seoul, Among them, 447 cases (59.4%) were adenomas, comprising 405 (53.8%) tubular adenomas, 31 (4.1%) tubulovillous adenomas, and 11 (1.5%) villous adenomas. We analyzed the 42 (5.6%) tubulovillous and villous adenomas.
Adenoma ; Adenoma, Villous* ; Colon* ; Diagnosis ; Rectum* ; Recurrence ; Seoul

BACKGROUND: Fecal continence is maintained by complex coordination of the sphincter mechanism and the anorectal sensation. Although most patients with fecal incontinence have a dysfunction of anal sphincter, fecal soiling seems to be related with a change in the anorectal sensation. PURPOSE: This study was done to evaluate the manometric findings and the methods of treatment for patients with fecal soiling. METHODS: The manometric findings from 25 patients with fecal soiling were compared with those from 22 normal controls. The patients were treated with biofeedback and with bulking agent. RESULTS: All the patients affected by fecal soiling were male except for one. There were no differences in the mean maximal resting pressure (MRP), and the mean maximal squeezing pressure (MSP) between the patients and the controls. The mean sphincter length and the mean length of the high pressure zone (HPZ) of the patients were significantly longer (50.5 vs. 55.6 mm and 28.2 vs. 31.3 mm, respectively; p<0.05 student t-test) than those of the controls. The minimal sensory volume (MSV) was significantly larger in the patient group, with a mean of 24.2 ml vs. 17.8 ml, than in the control group (p<0.05). The mean volume necessary to induce the recto-anal inhibitory reflex (RR) was 47.1 ml for the control group and 32.6 ml for the patient group (p<0.05). In the longitudinal profile of the anal sphincter, the HPZ was shifted proximally and the pressure peak was broader in the fecal soiling group. Of the 14 patients treated with biofeedback, 11 responded well. CONCLUSION: Almost all of the patients affected by fecal soiling were men. The MRP and the MSP of the patients with fecal soiling were not lower than those of the normal controls. The sphincter length was longer in the patients with soiling than in the controls(p<0.05). However, for the fecal soiling group the distribution of the pressure along the anal canal was different in the sense that the HPZ was shifted proximally and the pressure peak was broader. The changes in the MSV and the RR suggest that there may be a defect in the anorectal sensation. The patients responded well to the combined use of biofeedback and a bulking agent.
Anal Canal ; Biofeedback, Psychology ; Fecal Incontinence ; Humans ; Male ; Manometry ; Reflex ; Sensation ; Soil*

Anal stricture is a mechanical narrowing of the anal canal due to contracture of the epithelial lining which has been supplanted by fibrous connective tissue. We reviewed 82 patients with anal strictures who were admitted at Song-Do Colorectal Hospital from Jan. 1994 to Dec. 1996. The etiology of the strictures were injection therapy with necrotizing agent in 62 patients(78%), secondary to hemorrhoid and fistular operations in 13 patients(17%), and other causes in 7 patients(8.5%). The degree of anal stricture was mild in 40 patients, moderate in 33 patients, and severe in 9 patients. The operation methods used to treat the anal strictures were infernal sphincterotomy in 27 patients, local advancement flap in 42 patients, and rotational flap in 13 patients; the selection of the operation method was based on the cause, severity and level of the stricture. During the local advancement or rotational flap operation, a concurrent internal sphincterotomy was also employed in selected patients who had a fibrotic muscular component contributing to the stricture. We preferred to use a sliding skin graft in the advancement flap operation and a C-flap in rotational flap operation. According to a follow-up study with an average follow-up of 20 months, 24 of the 27 patients with mild stricture, 19 of the 24 patients with moderate stricture, and 7 of the 8 patients with severe stricture had good results, and remained 3 patients with mild stricture, 5 patient with moderate stricture, and 1 patient with severe stricture had fair results. Mild anal strictures were effectively treated by sphincterotomy or one or two sliding skin grafts, moderate to severe anal strictures with diaphragmatic type were treated by anorectoplasty, and moderate to severe low anal stoictures with annular type were effectively treated by two or three sliding skin grafts. Based on these results, sliding skin grafts should be effective in most cases of moderate to severe anal canal stricture, although occasionally a rotational flap may be indicated in cases of severe lack of the anoderm.
Anal Canal ; Connective Tissue ; Constriction, Pathologic* ; Contracture ; Follow-Up Studies ; Hemorrhoids ; Humans ; Skin ; Transplants