A 59-year-old man presented with abdominal and left flank pain. The symptom had started 30 days before as an acute nephrolithiasis, which had worsened despite conservative management. The abdomen was slightly distended and tender over the lower abdomen, without signs of generalized peritoneal irritation. A computed tomography (CT) scan showed an abscess in left para-renal space up to the subphrenic space and an unexpected pneumomediastinum. An emergency operation was performed, which showed retroperitoneal diverticulitis perforation of the sigmoid descending junction with abscess formation. A segmental resection of the diseased colon and end-colostomy was performed (Hartmann's procedure). However, the patient's condition progressively deteriorated, and he died of sepsis and multi-organ failure on the 5th postoperative day. Although pneumomediastinum caused by colonic diverticulitis perforation is extremely rare, it could be a life-threatening condition in patients without signs of peritonitis because of delayed diagnosis.
Abdomen ; Abscess ; Colon ; Colon, Sigmoid ; Delayed Diagnosis ; Diverticulitis ; Diverticulitis, Colonic ; Emergencies ; Flank Pain ; Humans ; Mediastinal Emphysema ; Middle Aged ; Nephrolithiasis ; Peritonitis ; Sepsis

Colouterine fistula is an extremely rare condition because the uterus is a thick, muscular organ. Here, we present a case of a colouterine fistula secondary to colonic diverticulitis. An 81-year-old woman was referred to the emergency department with abdominal pain and vaginal discharge. Computed tomography showed a myometrial abscess cavity in the uterus adherent to the thick sigmoid wall. Upon contrast injection via the cervical os for fistulography, we observed spillage of the contrast into the sigmoid colon via the uterine fundus. Inflammatory adhesion of the distal sigmoid colon to the posterior wall of the uterus was found during surgery. The colon was dissected off the uterus. Resection of the sigmoid colon, primary anastomosis, and repair of the fistula tract of the uterus were performed. The postoperative course was uneventful. This case represents an unusual type of diverticulitis complication and illustrates diagnostic procedures and surgical management for a colouterine fistula.
Abdominal Pain ; Abscess ; Colon ; Colon, Sigmoid ; Diverticulitis ; Diverticulitis, Colonic ; Emergencies ; Female ; Fistula ; Humans ; Uterus ; Vaginal Discharge

PURPOSE: Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP. METHODS: Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups. RESULTS: The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001). CONCLUSION: The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.
Abdominal Pain ; Anti-Bacterial Agents ; Colonoscopy ; Diagnosis ; Diet ; Early Diagnosis ; Humans ; Incidence ; Length of Stay ; Mortality ; Retrospective Studies

PURPOSE: An individualized surveillance protocol based on stratified prognostic factors is needed for the early detection of recurrent disease. The aim of this study was to determine both the clinicopathological characteristics for early-recurring colorectal cancer and the impact on survival. METHODS: From January 1996 to September 2000, 1,504 patients with curatively resected colorectal cancer were recruited. The primary goal of this study was to evaluate the time interval until first loco-regional or distant recurrence, and the secondary goal was the last survival status. Early recurrence was defined as recurrence within the first 12 months postoperatively. Clinicopathologic data and preoperative CT records were reviewed. The follow-up period was over 48 months. RESULTS: The 5-year recurrence rate was 25.4%, and 39.5% of these were detected within the first 12 months postoperatively. In the multivariate analysis, the independent prognostic factors for early recurrence were cell differentiation (PD/MUC/SRC), lymphovascular invasion, and absence of adjuvant chemotherapy in stage III and curatively resected colorectal cancer in stage IV. Inaccurate interpretation by a low-quality CT scan resulted in a stage III cancer being understaged preoperatively. The 5-year overall survival rate according to the recurrent time interval was significantly different (early recurrence: 7.4% vs. late recurrence: 23.6%, P<0.05). The resection rate was similar in both groups (early recurrence: 22.7% vs. late recurrence: 27.6%, P=0.392). CONCLUSIONS: Colorectal cancer that recurred within 12 months showed more aggressive biologic behaviors and poor survival. Understaging caused by incomplete preoperative evaluation for disease extension may cause treatment failure.
Cell Differentiation ; Chemotherapy, Adjuvant ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Recurrence ; Survival Rate ; Treatment Failure

Metastases from colorectal cancer can occur by either lymphatic or hematogenous spread, and the sites most commonly involved are the liver and lung. Although skeletal muscle comprises a considerable portion of body mass and receives abundant blood supply, it is one of the most unusual sites of metastasis from any malignancies. We report a case of skeletal muscle metastasis from colorectal cancer. An 83-year-old female patient presented with a painful mass in the right posterior thigh. She had already undergone low anterior resection and right lobectomy of liver for rectal cancer with liver metastasis (T2N1M1) about 4 years ago. Although a follow-up computed tomography scan showed a metastatic solitary pulmonary nodule in the left lobe 2 years after the primary operation, she refused further aggressive treatment. Magnetic resonance imaging showed a localized mass in the semimembranosus muscle of the right thigh, and fine-needle aspiration cytology demonstrated clusters of atypical cells compatible with adenocarcinoma. The patient underwent excision of the painful mass located in the right semimembranosus muscle. Histologically, the thigh mass proved to be adenocarcinoma identical to the primary lesion. The patient died of heart failure on the 2nd postoperative day.
Adenocarcinoma ; Aged, 80 and over ; Biopsy, Fine-Needle ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Liver ; Lung ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Muscles ; Neoplasm Metastasis ; Rectal Neoplasms ; Solitary Pulmonary Nodule ; Thigh

PURPOSE: This article compares the results of various methods of inguinal hernia repair in adults. METHODS: We retrospectively reviewed the medical records of 473 patients over 20 years of age who received an inguinal hernia repair procedure between January 2000 and June 2007. We analyzed the patients' clinical factors and outcomes, dividing them into five groups according to method of repair: Bassini group, Lichtenstein group, mesh plug group, Prolene Hernia System (PHS) group, and laparoscopic group. RESULTS: The mean number of used analgesics was significantly smaller in the PHS group than in other groups (P<0.05, PHS group: 0.46, Bassini group: 1.55, Lichtenstein group: 1.20, mesh plug group: 0.82, laparoscopic group: 1.44). The mean operation time was significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 45.18 min, Bassini group: 59.85 min, Lichtenstein group: 68.20 min, mesh plug group: 66.73 min, laparoscopic group: 83.33 min). Finally, the mean postoperative hospital staywas significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 2.93 day, Bassini group: 4.96 day, Lichtenstein group: 4.17 day, mesh plug group: 4.01 day, laparoscopic group: 5.11 day). Out of five groups, there was onecase of postoperative recurrence in the Bassini group. CONCLUSION: Mesh PHS operation is a more preferred method of inguinal hernia repair in adults because it offers a lower postoperative pain, shorter operation time, shorter postoperative hospital stay.
Adult ; Analgesics ; Hernia ; Hernia, Inguinal ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Medical Records ; Pain, Postoperative ; Polypropylenes ; Recurrence ; Retrospective Studies

PURPOSE: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery METHODS: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. RESULTS: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. CONCLUSION: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.
Consultants ; Humans ; Ileus ; Incidence ; Intraoperative Complications ; Necrosis ; Ovarian Neoplasms ; Pancreas ; Postoperative Complications ; Retrospective Studies ; Wound Infection

Anorectal trauma associated with retained rectal foreign body is an infrequent clinical problem, but presents a challenge to physicians taking care of patients with this problem. We report a case of rectal foreign body (glass cup) extracted by laparotomy. A 49-year-old male with a history of alcoholism presented to the emergency room four days after inserting a glass cup into his rectum. He complained of vague anal pain and failure to pass flatus or stool for four days. He had attempted to extract the glass cup using various methods (digital, instrumental manipulation, enema), none of which was successful. Computed tomography revealed a glass cup lodged in the rectum, without complication. The patient was brought to the operating room, administered spinal anesthesia, and placed in lithotomy position after failure of extraction in the emergency room. Although the object was palpable, it could not be extracted either manually or by the use of forceps. We decided to perform an emergent laparotomy under general anesthesia. After the abdomen was opened, an attempt was made to milk the object toward the distal rectum. However, this proved to be impossible secondary to severe rectal mucosal edema. The glass cup was eventually extracted through performing a colotomy at the rectosigmoid junction, with primary repair. The patient's postoperative course was uneventful, and he was discharged on the eighth postoperative day.
Abdomen ; Alcoholism ; Anesthesia, General ; Anesthesia, Spinal ; Edema ; Emergencies ; Flatulence ; Foreign Bodies ; Glass ; Humans ; Laparotomy ; Male ; Middle Aged ; Milk ; Operating Rooms ; Rectum ; Surgical Instruments

PURPOSE: A retrospective study was performed to provide an overview of changes over time by age, stage, tumor location, and surgical therapy of colorectal cancer over the past 15 years. METHODS: We analyzed the cases 6,314 colorectal cancer patients who underwent surgery at Asan Medical Center between January 1990 and December 2004. The period was divided into three periods: 1990 to 1994, 1995 to 1999, and 2000 to 2004. We analyzed trends over time for stage, resectability, and demographic factors of colorectal cancer over the past 15 years. RESULTS: The mean age of the patients in the periods from 1990 to 1994, from 1995 to 1999, and from 2000 to 2004 were 57.1 (21~89), 57.4 (14~91), and 58.9 (15~91) years, respectively, showing an increasing tendency over time (P<0.001). The male-to-female ratios were 1.2 : 1, 1.3 : 1, and 1.6 : 1, repectively, and this male preponderance has been more marked in recent years (P=0.003). There was no change in tumor location over time. The ratios of early cancer to advanced cancer were 0.06 : 1, 0.09 : 1, and 0.11 : 1, respecfively, showing an increasing tendency over time (P=0.002). The curative resection rate increased over time (P<0.001). The non-curative resection rate was higher and the non-resected rate was lower in the period 2000 to 2004 than in the period 1990 to 1999 (P<0.001). The ratios of the lowest anterior resection to the abdominoperineal resection were 0.06 : 1, 0.49 : 1, and 1.02 : 1, respectively. With decreasing tendency of abdominoperineal resection, the lowest anterior resection rate has increased gradually over time (P<0.001). CONCLUSIONS: Etiologic studies are necessary to understand the male preponderance in colorectal cancer, and multi-center studies should be conducted to understand the changing trend of colorectal cancer in Korea.
Chungcheongnam-do* ; Colorectal Neoplasms* ; Demography ; Humans ; Korea ; Male ; Retrospective Studies

PURPOSE: Anastomotic leakage (AL) is a serious and life-threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery. METHODS: We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2~96 months). RESULTS: AL rate was 2.5% (n=35). Gender (male), age (>60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18~7.22; HR: 2.42, 95% CI: 1.12~7.83; HR: 2.68, 95% CI: 1.08~7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P<0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P<0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05). CONCLUSIONS: Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival.
Anastomotic Leak* ; Autonomic Pathways ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prognosis ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Risk Factors* ; Survival Rate