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*

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

We obtained sixty normal chest postero-anterior(PA) radiographs with high kilovoltage technique(90-110kVp), 10 radiographs from the consecutive normal persons in each decade from twenties to seventies to analyze normal course and appearance of azygoesophageal recess (AER) line. (AER) line. CT scans from sixty consecutive normal persons were correlated with the radiographs to see how the line is formed and what structure the line abuts. In 20 patients with a lesion in AER area(10 with subcarinal lymphadenopathy of various size, five with left atrial enlargement, three with lesions in the esophagus, and two with dilated azygos vein), radiographic and CT correlation was done with main attention to the pattern of displacement of the azygoesophageal line. In normal chest PA radiographs, AER was shown as a straight line in young adults. As age increased, it was seen as a smooth are with convexity to the left. Sigmoid shape with midline cross was noted in an aged person. At the level of the right main bronchus on CT, AER was noted along the right lateral aspect to the vertebral margin in young adults. It extended medially as age increased. Caudally the recess extended more medially. The azygos vein usually bordered the recess. The esophagus or mediastinal fat sometimes bordered the recess in caudal level. In normal persons, the recess appeared deeper on plain radiographs than on CT. On plain radiographs, there were no changes in contour of AER with subcarinal lymphadenopathy of less than 2.5cm in diameter. However right sided and downward displacement of AER line just below the carina was noted with lymphadenopathy of more than 2.5cm in diameter. With left atrial enlargement, obliteration of the line was noted at T8-10 level. Focal right sided bulging of the line was noted with esophageal cancer Dilatation of azygos vein caused the line to appear with right sided displacement. In conclusion, AER line can be delineated with various features on radiographs with high KVP technique, depending on the age of normal persons and the formation of the line can be explained with CT. Displacement and change in the contour of the line can be seen with various mediastinal diseases.
Azygos Vein ; Bronchi ; Colon, Sigmoid ; Dilatation ; Esophageal Neoplasms ; Esophagus ; Humans ; Lymphatic Diseases ; Mediastinal Diseases ; Thorax ; Tomography, X-Ray Computed ; Young Adult

Turcot's syndrome is a rare hereditary disease marked by the association of central nervous system neuroepithelial tumor with colonic polyposis. Authors report herein a case of a 15-year-old girl diagnosed as having Turcot's syndrome, otherwise known as brain tumor-polyposis syndrome, combined with sigmoid colon cancer. The patient was carried out craniostomy and brain tumor removal. The tumor was confirmed histologically to be oligodendroglioma. The patient visited the department of internal medicine for bloody diarrhea during 6 months. Colonoscopy and biopsy was done. The patient was diagnosed as having Turcot's syndrome combined with sigmoid colon cancer, and was then transferred to the department of surgery for treatment of sigmoid colon cancer. Total proctocolectomy and IPAA (ileal pouch-anal anastomosis) was carried out. Multiple polyps were found in the colon, two large masses were confirmed histologically to be adenocarcinoma. The remaining polyps were adenomas. This case report describes the characteristic features of Turcot's syndrome presented by this patient.
Adenocarcinoma ; Adenoma ; Adolescent* ; Biopsy ; Brain ; Brain Neoplasms ; Central Nervous System ; Colon* ; Colonic Neoplasms* ; Colonoscopy ; Diarrhea ; Female* ; Genetic Diseases, Inborn ; Humans ; Internal Medicine ; Neoplasms, Neuroepithelial ; Oligodendroglioma ; Polyps ; Sigmoid Neoplasms

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

The vast majority of malignant tumors involving the vagina are secondary spread from primary malignant lesion of the cervix uteri, the sigmoid colon, the bladder and the vulva. Primary invasive carcinoma of the vagina remains among the rare gynecologic malignant tumor. The diagnosis of primary carcinoma of the vagina requires that the cervix and the vulva be intact and no clinical evidence of other primary tumors exist. Greater than 80-90% of all vaginal tumors are squamous cell type. We experienced two cases of primary vaginal cancer of 68 years old woman without any other gynecologic disease and 67 years old woman after hysterectomy for benign desease. We presented these cases with a brief review of related literatures.
Aged ; Cervix Uteri ; Colon, Sigmoid ; Diagnosis ; Female ; Genital Diseases, Female ; Humans ; Hysterectomy ; Neoplasms, Squamous Cell ; Urinary Bladder ; Vagina ; Vaginal Neoplasms* ; Vulva

In order to relieve mechanical obstruction caused by rectal carcinoma, a bare rectal stent was inserted in the sigmoid colon of a 70-year-old female. The proce-dure was successful, and for one month the patient made good progress. She then complained of abdominal pain, however, and plain radiographs of the chest and abdomen revealed the presence of free gas in the ubdiaphragmatic area. Surgical findings showed that a spur at the proximal end of the bare rectal stent had penetrated the rectal mucosal wall. After placing a bare rectal stent for the palliative treatment of colorectal carcinoma, close follow-up to detect possible perforation of the bowel wall is necessary.
Aged ; Case Report ; Female ; Human ; Intestinal Obstruction/*therapy ; Intestinal Perforation/*etiology ; *Palliative Care ; Rectal Neoplasms/*therapy ; Sigmoid Diseases/*etiology ; Stents/*adverse effects

Adenocarcinoma ; complications ; Aged ; Colonic Diseases ; etiology ; surgery ; Humans ; Intestinal Fistula ; etiology ; surgery ; Male ; Sigmoid Neoplasms ; complications ; Urinary Bladder Fistula ; etiology ; surgery

The rare association of obstructing colorectal carcinoma and ischemic colitis in patients without an antecedent history of inflammatory bowel disease has been documented intermittently since the early 1960s after first case was described by Kremen in 1945. The etiology is not clear, but it is thought that sluggish mucosal blood flow and consequent ischemia occurs secondary to raised intraluminal pressure distally. The radiologic features are typically 'thumbprinting' appearence by the barium study, but maybe variable according to the stage of ischemic colitis. In many cases, radiologic features may be similar inflammatory bowel disease such as ulcerative colitis and may mask the presence of the predisposing carcinoma. Sigmoidoscopy or colonoscopy may detect irregular ulceration, mucosal friability, submucosal hemorrhage and bulging folds. The mucosa is usually covered by hemorrhagic and purulent exudate. We report a case of the ischemic colitis associated with sigmoid colon adenocarcinoma in 75-year- old man.
Adenocarcinoma ; Barium ; Colitis, Ischemic* ; Colitis, Ulcerative ; Colon* ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Exudates and Transudates ; Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Ischemia ; Masks ; Mucous Membrane ; Sigmoidoscopy ; Ulcer

The association of anisakiasis of the colon with colon cancer is rare and difficult to diagnose. Only one case of this type has been reported to date. In this study, we report a case of synchronous colon cancer and colonic anisakiasis. A 50-year-old woman was admitted for abdominal pain, and a volume-rendered surface-shaded image of CT colonography (CTC) revealed a concentric narrowing in the sigmoid colon and a segmental fold thickening in the ascending colon. A total colectomy was performed and the diagnosis of synchronous sigmoid colon cancer and anisakiasis of the ascending colon was confirmed. This case is the first reported visualization of synchronous colon cancer and colonic anisakiasis on a CTC.
Adenocarcinoma/*complications/*radiography/surgery ; Anisakiasis/*complications/*radiography/surgery ; Colectomy ; Colonic Diseases/*complications/*radiography/surgery ; *Colonography, Computed Tomographic ; Female ; Humans ; Middle Aged ; Sigmoid Neoplasms/*complications/*radiography/surgery