PURPOSE: Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer. MATERIALS AND METHODS: Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon. RESULTS: Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnosticinterval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single-segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases. CONCLUSION: In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.
Appendix ; Cecum ; Colectomy ; Colon ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colorectal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Male ; Prognosis ; Rectum

Congenital anomalies such as positional anomalies of the right half of the colon are more common when compared to its left half. We report a rare case of congenital anomaly where the transverse colon was totally absent. Ascending colon continued as descending colon at the right colic flexure. Ascending and descending colons formed an inverted U shaped loop which was situated in the right half of the abdomen. The sigmoid colon began from the descending colon, on the right side of the midline and coursed to the left iliac fossa. The terminal part of ascending colon and entire descending colon had a persistent mesocolon. The jejunum and ileum were situated in the upper left part of the abdominal cavity. This anomaly can cause volvulus of the colon at any stage of life. Furthermore, the knowledge of this anomaly is very useful for radiologists, gastroenterologists and surgeons.
Abdomen ; Abdominal Cavity ; Colon ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse* ; Ileum ; Intestinal Volvulus* ; Jejunum ; Mesocolon*

The local arrangement of sensory nerve cell bodies and nerve fibers in the brain stem, spinal ganglia and nodose ganglia were observed following injection of cholera toxin B subunit(CTB) and wheat germ agglutinin-horseradish peroxidase(WGA-HRP) into the rat intestine. The tracers were injected in the stomach(anterior and posterior portion), duodenum, jejunum, ileum, cecum, ascending colon or descending colon. After survival times of 48-96 hours, the rats were perfused and their brain, spinal and nodose ganglia were frozen sectioned(40microM). These sectiones were stained by CTB immunohistochemical and HRP histochemical staining methods and observed by dark and light microscopy. The results were as follows: 1. WGA-HRP labeled afferent terminal fields in the brain stem were seen in the stomach and cecum, and CTB labeled afferent terminal fields in the brain stem were seen in all parts of the intestine. 2. Afferent terminal fields innervating the intestine were heavily labeled bilaterally gelalinous part of nucleus of tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS(medNTS), wall of the fourth ventricle, ventral border of area postrema and comNTS in midline dorsal to the central canal. 3. WGA-HRP labeled sensory neurons were observed bilaterally within the spinal ganglia, and labeled sensory neurons innervating the stomach were observed in spinal ganglia T2-L1 and the most numerous in spinal ganglia T8-9. 4. Labeled sensory neurons innervating the duodenum were observed in spinal ganglia T6-L2 and labeled cell number were fewer than the other parts of the intestines. 5. Labeled sensory neurons innervating the jejunum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T12 in left and T13 in right. 6. Labeled sensory neurons innervating the ileum were observed in spinal ganglia T6-L2 and the most numerous area in the spinal ganglia were T11 in left and L1 in right. 7. Labeled sensory neurons innervating the cecum were observed in spinal ganglia T7-L2 and the most numerous area in the spinal ganglia were T11 in left and T11-12 in right. 8. Labeled sensory neurons innervating the ascending colon were observed in spinal ganglia T7-L2 in left, and T9-L4 in right. The most numerous area in the spinal ganglia were T9 in left and T11 in right. 9. Labeled sensory neurons innervating the descending colon were observed in spinal ganglia T9-L2 in left, and T6-L2 in right. The most numerous area in the spinal ganglia were T13 in left and L1 in right. 10. WGA-HRP labeled sensory neurons were observed bilaterally within the nodose ganglia, and the most numerous labeled sensory neurons innervating the abdominal organs were observed in the stomach. 11. The number of labeled sensory neurons within the nodose ganglia innervating small and large intestines were fewer than that of labeled sensory neurons innervating stomach These results indicated that area of sensory neurons innervated all parts of intestines were bilaterally gelatinous part of nucleus tractus solitarius(gelNTS), dorsomedial part of gelNTS, commissural part of NTS(comNTS), medial part of NTS, wall of the fourth ventricle, ventral border of area postrema and com NTS in midline dorsal to the central canal within brain stem, spinal ganglia T2-L4, and nodose ganglia. Labeled sensory neurons innervating the intestines except the stomach were observed in spinal ganglia T6-L4. The most labeled sensory neurons from the small intestine to large intestine came from middle thoracic spinal ganglia to upper lumbar spinal ganglia.
Animals ; Area Postrema ; Brain ; Brain Stem ; Cecum ; Cell Count ; Cholera Toxin* ; Cholera* ; Colon, Ascending ; Colon, Descending ; Duodenum ; Fourth Ventricle ; Ganglia, Spinal ; Gelatin ; Ileum ; Intestine, Large ; Intestine, Small ; Intestines* ; Jejunum ; Microscopy ; Nerve Fibers ; Neurons ; Nodose Ganglion ; Rats* ; Sensory Receptor Cells* ; Stomach ; Triticum* ; Wheat Germ Agglutinin-Horseradish Peroxidase Conjugate

PURPOSE: To differentiate tuberculous enteritis and Crohn's disease with barium study using Bayes theory. MATERIALS AND METHODS: The study group consisted of 34 patients with tuberculous enteritis (age range 16-86 years, mean age 43.3 years, M:F=19:15) and 36 patients with Crohn's disease (age range 19-78 years, mean age 35.2 years, M:F=18:18). These diagnoses were confirmed by therapeutic tests (tuberculous enteritis: 15, Crohn's disease:16) or histopathological examinations (tuberculous enteritis: 19, Crohn's disease: 20) conducted from January 1993 to May 2003. Three radiologists (two abdominal specialists and one trainee) analyzed each radiological finding of tuberculous enteritis and Crohn's disease by means of a barium enema and/or small bowel series. We used Fisher's exact test to verify the statistical significance of each radiological finding and p-values less than 0.05 were considered to be significant. We calculated the likelihood ratio (LR) of tuberculous enteritis versus Crohn's disease for each finding by employing Bayes theory. RESULTS: The radiological findings associated with a high likelihood ratio for tuberculous enteritis were the involvement of the cecum (LR=2.65) and ascending colon (LR=1.99), rigid narrowing (LR=1.94), shortening of the bowel (LR=1.99), haustral loss (LR=1.97) and sacculation (LR=3.88). The radiological findings associated with a high LR for Crohn's disease (low LR for tuberculous enteritis) were age between 20 and 29 years (LR=0.53), the involvement of the jejunum (LR=0.12), terminal ileum (LR=0.19), sigmoid colon (LR=0.30) or rectum (LR=0.17), and the presence of skip lesions (LR=0.19) or strictures (LR=0.21). With these LRs, the probability of the subject having tuberculous enteritis versus Crohn's disease could be calculated using Bayes theory. CONCLUSION: The analysis of a barium study using Bayes theory could provide an objective, easy and fast method of differentiating tuberculous enteritis and Crohn's disease.
Barium* ; Bays* ; Cecum ; Colon, Ascending ; Colon, Sigmoid ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Enema ; Enteritis* ; Humans ; Ileum ; Intestine, Small ; Jejunum ; Rectum ; Specialization ; Tuberculosis, Gastrointestinal

BACKGROUND/AIMS: Changes in subsite distribution of colorectal cancer have been shown in recent years. The carcinoma tend to shift to more proximal colon and this proximal shift is influenced by age and sex. This study was designed to delineate the relationship of age to subsite incidence of colorectal cancer and to define the role of gender in this difference. METHOD: We have analyzed the data by patients with colorectal cancer from 1985 to 1995 for elucidate the relationships between age, sex and prinmry location of colorectal cancer. 749 patients(male 454, female 295) were diagnosed of colorectal cancer performed by colonoscopy and/or sigmoidoeopy were divided into three groups by their location of cancer (Right colon: appendix, ascending colon, hepatic flexure, T-colon proximal 2/3 Left colon: T-colon distal 1/3, splenic flexure, descending colon, sigmoid colon Rectum: rectum). RESULTS: 1) The mean age of all patients was 53.84 +/- 13.11(yr). Mean ages of Right colon, Left colon, and Rectal cancer group were 55.54 +/- 14.12, 55.32 +/- 12.51, 52.22 +/- 13.09(yr), respectively. The mean age of Right colon and Left colon cancer group is significantly older than that of Rectal cancer group (p=0.0040, p=0.0042). 2) Infemale age group over 56, mean age of Right colon cancer group is shown to be 3.35 and 4.82 years older than Left colon cancer group and Rectal cancer group, respectively (p=0.0062, p=0.0053) and Colon cancer tend to develop on more right side according to increase in age. 3) Above correlation was not observed below 55 of both sexes and male age group over 56. 4) No significant differences in histological differentiation and tumor stage were observed among the three groups. 5) The study was conducted to evaluate the difference in the location of colorectal cancer between two following groups; The first group diagnosed from 1985 to 1990 and the second group from 1991 to 1995, yet significant statistical difference was not observed. CONCLUSION: Age increase seems to show correlation with right shifting of colon cancer, and this correlation was most significant in old women age group. This finding suggests unknown factor strongly linked to age and sex might play important role in carcinogenesis of colorectal cancer.
Appendix ; Carcinogenesis ; Colon ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; Female ; Humans ; Incidence ; Male ; Rectal Neoplasms ; Rectum

PURPOSE: This study was performed to evaluate the role of colonoscopy in children with hematochezia. METHODS: We retrospectively reviewed the medical records of 277 children who underwent colonoscopy because of hematochezia between January, 2003 and July, 2010. RESULTS: The mean age of the patients was 6.0+/-4.4 (7 days~17.8 years) years. The male to female ratio was 2.2 : 1. The duration between the 1st episode of hematochezia and colonoscopy was 4.9+/-12.1 months. Characteristics of hematochezia included red stool (65.1%), blood on wipe (12.8%), bloody toilet (11.9%), and blood dripping (10.2%). The most proximal region of colonoscopic approach was terminal ileum (84.5%), cecum (9.5%), hepatic flexure (2.8%), and splenic flexure (3.2%). Eighty five patients (30.6%) had no specific abnormal findings. Major causes of hematochezia were polyp (26.4%), food protein induced proctocolitis (6.9%), infectious colitis (5.4%), lymphofolliculitis (5.7%), non specific colitis (5.7%), and vascular ectasia (5.1%). The hemorrhagic sites included the rectum (24.0%), rectosigmoid junction (18.1%), sigmoid colon (13.5%), ascending colon (14.2%), transverse colon (11.3%), descending colon (7.8%), cecum (8.1%), and terminal ileum (3.1%). The recurrence rate of hematochezia after colonoscopy was 19.1%. Colonoscopy was performed in 262 patients (94.6%) with conscious sedation. Endoscopic hemostasis was performed in 5 patients. Complications of colonoscopy or sedation were not found. CONCLUSION: The causes and lesional localization of pediatric hematochezia were diverse. Colonoscopy has an important role in the diagnosis and treatment of hematochezia in children. Total colonoscopy is recommended to detect the cause of hematochezia.
Cecum ; Child ; Colitis ; Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Colonoscopy ; Conscious Sedation ; Dilatation, Pathologic ; Female ; Gastrointestinal Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Ileum ; Male ; Medical Records ; Polyps ; Proctocolitis ; Rectum ; Recurrence ; Retrospective Studies

This study was an attempt to investigate the relative distribution and morphology of serotonin cells (SC) in intestinal glands of adult rodents, rats, guinea pigs and mice. The intact isolated epithelial sheets of intestinal glands from duodenum, jejunum, ileum, cecum, and proximal and distal colon were prepared for immunohistochemistry using antiserotonin antisera. Examination of isolated epithelia reveals an actual number of SC in one intestinal gland and whole image of individual serotonin cell. In small intestine of all species in this study, the average number of SC per one intestinal gland was the highest in duodenum, and decreased in jejunum and ileum. The distributional patterns of SC in large intestine of three species, however, were different. The number of SC decreased towards distal colon in both rat and guinea pig, and vice versa in mouse. And in the rat, the number of SC in colon was even higher than in duodenum, while in the guinea pig the number of SC in colon was lower than any other part of small intestine. In all the intestinal region of three species, SC were more numerous towards the bases of glands. The open type of SC whose apical cytoplasmic process reach glandular lumen were predominant (over 97% in average) in small intestine of all species in this study. The frequency of closed type was increased in large intestine (up to 44.9% in proximal colon of guinea pig). And closed type was more frequently detected towards the upper part of gland. In small intestine of all species in this study, SC were predominantly flask-like in shape without basal processes. In large intestine, SC with basal processes were often detected, and their frequencies increased towards the upper part of gland. In mice, basal processes were usually long in length (over the long axis of cell), while all the basal precesses of SC of guinea pig were short. We found that the isolated epithelium were very useful to figure out the actual number and whole images of enteroendocrine cells in intestinal mucosal epithelium. The present results demonstrated that relative distribution and morphology of SC were very different among the species especially in large intestine.
Adult ; Animals ; Axis, Cervical Vertebra ; Cecum ; Colon ; Cytoplasm ; Duodenum ; Enteroendocrine Cells ; Epithelium ; Guinea ; Guinea Pigs ; Humans ; Ileum ; Immune Sera ; Immunohistochemistry ; Intestinal Mucosa* ; Intestine, Large ; Intestine, Small ; Jejunum ; Mice ; Rats ; Rodentia* ; Serotonin*

BACKGROUND/AIMS: Expandable stents were inserted for temporary decompression of the colorectum before single-stage surgery or for palliation. The aim of this study was to evaluate the usefulness of a self-expandable nitinol stent, which can be placed through the working channel of an endoscope, for treatment of malignant colorectal obstructions. METHODS: From May 2000 to April 2001, twenty patients (eleven female, nine male, aged 39~81 years) with malignant colorectal obstructions were treated for relief from the obstructions with endoscopically guided intubation of an expandable nitinol stent through the working channel of an endoscope. Of twenty patients, thirteen underwent placement of the stent for presurgical decompression; seven, for palliative decompression. RESULTS: The site of obstructions were on the rectum (n=8), sigmoid colon (n=6), descending colon (n=2), transverse colon (n=3) and ascending colon (n=1). Stent placement was successful in 18 (90%) of the 20 patients. Failure occurred in two patients with long and tortuous lesions involving hepatic flexure or splenic flexure. All patients tolerated placement of the stent well, with no procedure-related complications. In patients with successful placement of the stent, symptoms of obstruction resolved within 72 hours. Twelve patients underwent the formal bowel preparation and elective single-stage surgery without complications 4~7 days after stent placement. In six patients, the stents provided palliative decompression of the colorectum. There was stent migration in two patients during follow-up. CONCLUSIONS: Placement of a self-expandable nitinol stent through the working channel of an endoscope is technically feasible and safe. Stent placement allowed patients with malignant colorectal obstruction to undergo single-stage surgery in cases of operable disease and to provide palliative decompression in cases of inoperable disease.
Colon, Ascending ; Colon, Descending ; Colon, Sigmoid ; Colon, Transverse ; Decompression ; Endoscopes* ; Female ; Follow-Up Studies ; Humans ; Intubation ; Male ; Rectum ; Stents*

Familial adenomatous polyposis(FAP) is an inherited autosomal dominant disorder characterized by the appearance in early life of numerous adenomas of colon and rectum. According to the recent studies, familial polypolis is a disease which produces polypoid lesions not only in the large intestine but also in the stomach duodenum, ileum and jejunum. The natural course of extracolonic lesions is variable, but the colonic polyps are associated with high incidence of cancer. The risk of malignant change is virtually 100% if untreated. The authors report a case of FAP in a 36-year-old-female who presented colorectal polyposis with multiple adenomas of the gallbladder. A review of literature with emphasis on the association of adenoma of the gallbladder was made.
Adenoma ; Adenomatous Polyposis Coli* ; Colon ; Colonic Polyps ; Duodenum ; Gallbladder* ; Ileum ; Incidence ; Intestine, Large ; Jejunum ; Polyps* ; Rectum ; Stomach

A 31-year-old woman with a 5-year history of Crohn's disease was admitted to our hospital because of recurrent right lower quadrant pain and diarrhea. Abdominal computed tomography showed multiple fistulas between the terminal ileum, the sigmoid colon, and the cecum, and mucosal wall thickenings due to an active inflammatory process and mucosal enhancements. Colonoscopic examinations showed a finger-like projection of a polypoid mass at the ileocecal valve, long-neck, finger-like pseudopolyps at the cecum, and soft, lumen narrowing and multiple pseudopolyps at the sigmoid colon and the intact rectum. There was healing scarring of the anal fistula. These findings were compatible with those of Crohn's disease. Histologic findings were chronic inflammation with erosion and regenerative crypt epithelium. The patient underwent infliximab therapy. She underwent a right colectomy, a Hartman's procedure, and a small bowel segmental resection due to multiple fistulas. The pathologic diagnosis was a signet-ring-cell carcinoma with non-caseating granuloma in the ascending colon, ileum, and sigmoid colon. We report this case of Crohn's disease associated with a colonic signet-ring cell carcinoma.
Adult ; Cecum ; Cicatrix ; Colectomy ; Colon ; Colon, Ascending ; Colon, Sigmoid* ; Crohn Disease* ; Diagnosis ; Diarrhea ; Epithelium ; Female ; Fistula ; Granuloma ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Infliximab ; Rectal Fistula ; Rectum