PURPOSE: Melanosis coli, which is a relatively common disease encountered during colonoscopy, is a brownish or blackish pigmentation of the colon and is associated with the ingestion of anthraquinone compounds. Its histopathological pathogenesis is recognized as colonic epithelial apoptosis. This study was designed to identify the relation between melanosis coli and the colonic transit time, as well as the relation between melanosis coli and other clinical characteristics. METHODS: We reviewed the clinical records of 80 patients with melanosis coli who had been diagnosed by colonoscopy between Jan. 1997 and Sep. 1998. The colonic transit time was checked in 26 cases of patients with melanosis coli and in 28 cases of patients with constipation without melanosis coli by using the multiple marker bolus technique. RESULTS: 1) The frequency of melanosis coli in patients undergoing a total colonoscopy was 1.25% (80/6422). 2) The age distribution was 20 to 76 years old (mean: 49). The grade of melanosis coli seemed to be related with age. 3) The four causative agents related with melanosis coli were anthraquinone compounds (69.2%), tea (12.3%), herbs (12.3%) and health foods in that order. 4) The duration of medication was from 2 months to 20 years (mean: 48 months). The grade of melanosis coli seemed to be related with the duration of medication. 5) The colonic transit time was normal in 11 cases (42.3%) and delayed in 15 cases (57.5%) of melanosis coli and normal in 10 cases (35.7%) and delayed in 18 cases (64.3%) of patients with constipation without melanosicoli. 6) Colon polyps were detected in 12 cases (15%). However, no relation between the incidence of colon polyps and either the grade of melanosis coli or the duration of medication was noted. CONCLUSIONS: Melanosis coli is a marker of ingestion of some drugs, such as anthraquinone compounds, and/or some kinds of acidic polysaccharides. Melanosis coli is not an indicator of colonic motility disorder or a danger signal for colon polyps or cancer.
Age Distribution ; Aged ; Apoptosis ; Colon ; Colonoscopy ; Constipation ; Eating ; Food, Organic ; Humans ; Incidence ; Melanosis* ; Pigmentation ; Polyps ; Polysaccharides ; Tea

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

PURPOSE: Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to review and analyze our cases for more information and in order to achieve more adequate and prudential application. METHODS: We performed 2609 colonoscopic polypectomies from January 1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or the EPMR technique. We analyzed those 77 lesions with special reference to size, configuration, and histologic diagnosis. RESULTS: The most common age group was the 5th decade. The male-to-female ratio was 1.75:1. The most common sites of the lesions were the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile (31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size, and the only submucosal cancer was below 5 mm in size and was a depressed lesion. Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for 9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no complications such as bleeding, perforation, or recurrence. CONCLUSIONS: EMR and EPMR are useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic lesions. Lesions up to 15~20 mm in size are good candidates for EMR and those up to 40 mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent recurrence or complications such as bleeding or perforation.
Adenocarcinoma ; Adenoma ; Carcinoid Tumor ; Colon, Sigmoid ; Colorectal Neoplasms ; Diagnosis ; Hemorrhage ; Humans ; Inflammation ; Rectum ; Recurrence

Thirteen women with rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy were operated on during Jan. 1993 - Jul. 1997 at Song-Do Colorectal Hospital. The mean age was 36.9 (range, 25~56) years. The mean follow-up after operation was 33 (range, 8~62) months. The etiology of the fistula in the majority of patients was obstetric injury and operative trauma (10/13). Seven patients were referred after attempts at repair elsewhere. Eleven patients were managed with a mucosal flap advancement and a 3-layered repair of the rectovaginal septum: 4 without and 7 with a perineal body reconstruction or sphincter repair. Two patients were managed with a mucosal flap advancement only without a repair of rectovaginal septum. In all cases, a concomitant colostomy was not performed. Postoperative complications were noticed in 3 of the patients managed by a mucosal flap advancement and 3-layered repair of the rectovaginal septum with perineal body reconstruction or sphincter repair and all were perineal wound infections. All of these infections were cured, without recurrence, by simple rubber seton drainage. Recurrence occurred in one case managed by a mucosal flap advancement only. Three patients with liquid incontinence became continent after a sphincter reconstruction. We conclude that most rectovaginal fistulas unrelated to inflammatory bowel disease or previous radiotherapy can be managed with a mucosal flap advancement and 3-layered reconstruction of the rectovaginal septum. If any signs or symptoms of sphincter injury are noticed preoperatively while taking the patient's history or during manometry and endorectal ultrasonography, a perineal body reconstruction or sphincter repair should be performed.
Colostomy ; Drainage ; Female ; Fistula ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Manometry ; Postoperative Complications ; Radiotherapy ; Rectovaginal Fistula* ; Recurrence ; Rubber ; Ultrasonography ; Wound Infection

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*

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

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 AND AIMS: There are two main routes in the growth and development of colo-rectal carcinomas, that is to say, the adenoma-carcinoma sequence and the route described by the de novo theory. The adenoma-carcinoma sequence has been considered a principal route for colorectal carcinomas for a long time, but recently the de novo cancer theory has become a controversial issue, and many authors have claimed that their cases were de novo carcinomas. Since Muto described small "flat elevations" and emphasized their significance as precursors of colorectal carcinomas, especially of flat colorectal carci-nomas, many flat elevations have been reported. He cautioned that the reported de novo carcinomas could also be carcinomas that developed from small flat adenomas. In addition, no data are available in Korea on the subject of flat elevations. Accordingly, we attempted to analyze flat elevations in the colon and to obtain correlations between their endoscopic and histologic features and their clinical implications. METHODS: The authors performed colonoscopic removal of 146 flat elevations from January 1997 to December 1997 at Song-Do Colorectal Hospital in Seoul, Korea. We reviewed and analyzed all those lesions. During colonoscopy, the sizes of the lesions were measured by an endoscopic ruler. RESULTS: The most common age group was the sixth decade. Only one case involved a patient under 30 years old. The male-to-female ratio was 3.2 : 1. The numbers of flat adenomas and flat adenocarcinomas were 68 and 1, respectively. These 69 cases amounted to 47.3% of the flat elevations. The malignancy rate for flat adenomas was 1.4% (1/69). There were no malignancies in flat elevations with diameters below 10 mm. Hyperplasticpolyps and chronic nonspecific inflammation showed 34.9% and 15.8%, respectively. Most of the flat elevations were smaller than 10 mm (98.6%). Recognizable endoscopic features of the flat elevations were redness (47.3%) and depression (15.8%), but 50 cases (34.2%) of the flat elevations had no specific features. Flat elevations smaller than 5 mm had discolorations in 15 cases (14%). The sigmoid colon was the most common site of the flat elevations. The percentage of flat elevations found in the sigmoid colon and the rectum was 70.5%. Hot biopsy was the main treatment for lesions smaller than 5 mm (75.7%), and snare polypectomy was the main treament for lesions from 5 mm to 9 mm. CONCLUSIONS: Flat elevations were detected without difficulty through careful examination. Nearly half of the flat elevations were flat adenomas. Accordingly, flat elevations may have some clinical significance on the basis of the adenoma-carcinoma sequence, but flat elevations greater than 10 mm should be managed cautiously because of possible malignancy.
Adenocarcinoma ; Adenoma ; Adult ; Biopsy ; Colon* ; Colon, Sigmoid ; Colonoscopy ; Colorectal Neoplasms ; Depression ; Growth and Development ; Humans ; Inflammation ; Korea ; Rectum ; Seoul ; SNARE Proteins

PURPOSE: Hidradenitis suppurativa is a chronic suppurative and cicatricial inflammatory disease involving apocrine gland- bearing areas including the axilla, groin, and anogenital regions. Recurrence after surgery is not rare, and there is much debate about operative methods. This study analyzed the clinical characteristics and the relationship between different surgical methods and recurrences of perianal hidradenitis suppurativa. METHODS: A retrospective study of 20 patients with perianal hidradenitis suppurativa was done. The clinical characteristics were examined. The patients were divided into several groups (acute, chronic regional, chronic extensive) according to lesion status; then, different operative methods and recurrence rates were compared. RESULTS: All of the patients were male smokers. The mean age of onset was 28.4 years. The mean duration of disease was 10 years. The total number of operations, including incision and drainage, was 29 cases. Only 4 patients were overweight or obese. The most common symptom was pus discharge (52%). The recurrence rate after final surgery was 30.0%. After incision and drainage in the acute group, 7 of 8 cases (87.5%) recurred. In the chronic regional group, 5 of 9 cases (55.6%) experienced recurrence after excision and primary repair. After excision and healing by secondary intention, 1 of 7 cases (14.3%) had recurrence. In the case of one unroofing and marsupialization, there was no recurrence. In the chronic extensive group, 1 recurrence was noted in 4 unroofings and marsupializations. CONCLUSIONS: In the case of abscess, proper incision and drainage is needed, but further definitive surgery must be done. In the case of chronic disease, if the lesions are regional, excision and healing by secondary intention is more ideal for decreasing the recurrence rate. If the lesions are extensive, unroofing and marsupialization is recom-mended.
Abscess ; Age of Onset ; Axilla ; Chronic Disease ; Drainage ; Groin ; Hidradenitis Suppurativa* ; Hidradenitis* ; Humans ; Intention ; Male ; Overweight ; Recurrence ; Retrospective Studies ; Suppuration