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Removal of Rectal Foreign Bodies Using Tenaculum Forceps Under Endoscopic Assistance.

Keun Joon LIM ; Joon Sung KIM ; Boo Gyoung KIM ; Sung Min PARK ; Jeong Seon JI ; Byung Wook KIM ; Hwang CHOI

Intestinal Research.2015;13(4):355-359. doi:10.5217/ir.2015.13.4.355

The incidence of rectal foreign bodies is increasing by the day, though not as common as that of upper gastrointestinal foreign bodies. Various methods for removal of foreign bodies have been reported. Removal during endoscopy using endoscopic devices is simple and safe, but if the foreign body is too large to be removed by this method, other methods are required. We report two cases of rectal foreign body removal by a relatively simple and inexpensive technique. A 42-year-old man with a vibrator in the rectum was admitted due to inability to remove it by himself and various endoscopic methods failed. Finally, the vibrator was removed successfully by using tenaculum forceps under endoscopic assistance. Similarly, a 59-year-old man with a carrot in the rectum was admitted. The carrot was removed easily by using the same method as that in the previous case. The use of tenaculum forceps under endoscopic guidance may be a useful method for removal of rectal foreign bodies.
Adult ; Daucus carota ; Endoscopy ; Foreign Bodies* ; Humans ; Incidence ; Middle Aged ; Rectum ; Surgical Instruments*

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Small Bowel Metastatic Cancer Observed With Double Balloon Enteroscopy in a Patient With a Past History of Multiple Cancers.

Ji Young SONG ; Beom Jae LEE ; Eun Sang YU ; Young Ju NA ; Jong Jae PARK ; Jae Seon KIM ; Young Tae BAK

Intestinal Research.2015;13(4):350-354. doi:10.5217/ir.2015.13.4.350

Small bowel tumors are very rare and generally malignant. As a result of the anatomical location and nonspecific manifestations of small bowel tumors, they are very difficult to diagnose. Balloon-assisted enteroscopy is a relatively noninvasive method compared to surgical resection, and allows for real-time observation, tissue confirmation with biopsy, and interventional procedures. Here, we report the case of a 69-year-old woman with a small bowel metastatic carcinoma observed with double balloon enteroscopy (DBE). She had a history of multiple cancers including ovarian cancer, bladder cancer, and breast cancer. The antegrade DBE procedure was performed before surgery for biopsy tissue confirmation. The patient underwent small bowel resection, and the final diagnosis was the same as that determined by preoperative biopsy. The final diagnosis was metastatic small bowel cancer originating from a cancer of the breast. This is the first detailed report of the preoperative diagnosis of small intestinal metastatic breast cancer by DBE.
Aged ; Biopsy ; Breast Neoplasms ; Diagnosis ; Double-Balloon Enteroscopy* ; Female ; Humans ; Ovarian Neoplasms ; Urinary Bladder Neoplasms

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A Rare Case of Hypermobile Mesentery With Segmental Small Bowel Pneumatosis Cystoides Intestinalis.

Chetan RATHI ; Nirav PIPALIYA ; Prateik PODDAR ; Vikas PANDEY ; Meghraj INGLE ; Prabha SAWANT

Intestinal Research.2015;13(4):346-349. doi:10.5217/ir.2015.13.4.346

Pneumatosis intestinalis is a rare condition that affects 0.03% of the population. Pneumatosis cystoides intestinalis (PCI) is characterized by the presence of multiple gas-filled cysts in the intestinal wall and the submucosa and/or intestinal subserosa. It is usually a secondary finding caused by a wide variety of underlying gastrointestinal or extragastrointestinal diseases. Here, we present the case of a 47-year-old man who was referred to our gastroenterology department with a history suggestive of intermittent small bowel obstruction associated with abdominal pain. Abdominal computed tomography demonstrated PCI of the small bowel. The mesentery and branches of the superior mesenteric artery and superior mesenteric vein were twisted with minimal pneumoperitoneum. Exploratory laparotomy was performed, and demonstrated segmental small bowel PCI secondary to hypermobile mesentery. The affected segment of the ileum was resected, and jejunoileal anastomosis was performed. Here, we report a rare case of segmental PCI probably due to repeated twisting of hypermobile mesentery. The clinical and imaging features of this disorder may mimic those of visceral perforation or bowel ischemia. PCI can be a cause of severe abdominal pain that may require surgical intervention.
Abdominal Pain ; Gastroenterology ; Humans ; Ileum ; Ischemia ; Laparotomy ; Mesenteric Artery, Superior ; Mesenteric Veins ; Mesentery* ; Middle Aged ; Pneumatosis Cystoides Intestinalis* ; Pneumoperitoneum

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Colon Transit Time May Predict Inadequate Bowel Preparation in Patients With Chronic Constipation.

Hong Jun PARK ; Myeong Hun CHAE ; Hyun Soo KIM ; Jae Woo KIM ; Moon Young KIM ; Soon Koo BAIK ; Sang Ok KWON ; Hee Man KIM ; Kyong Joo LEE

Intestinal Research.2015;13(4):339-345. doi:10.5217/ir.2015.13.4.339

BACKGROUND/AIMS: We evaluated whether colonic transit time (CTT) can predict the degree of bowel preparation in patients with chronic constipation undergoing scheduled colonoscopy in order to assist in the development of better bowel preparation strategies for these patients. METHODS: We analyzed the records of 160 patients with chronic constipation from March 2007 to November 2012. We enrolled patients who had undergone a CTT test followed by colonoscopy. We defined patients with a CTT > or =30 hours as the slow transit time (STT) group, and patients with a CTT <30 hours as the normal transit time (NTT) group. Boston Bowel Preparation Scale (BBPS) scores were compared between the STT and NTT groups. RESULTS: Of 160 patients with chronic constipation, 82 (51%) were included in the STT group and 78 (49%) were included in the NTT group. Patients with a BBPS score of <6 were more prevalent in the STT group than in the NTT group (31.7% vs. 10.3%, P=0.001). Multivariate analysis showed that slow CTT was an independent predictor of inadequate bowel preparation (odds ratio, 0.261; 95% confidence interval, 0.107-0.634; P=0.003). The best CTT cut-off value for predicting inadequate bowel preparation in patients with chronic constipation was 37 hours, as determined by receiver operator characteristic (ROC) curve analysis (area under the ROC curve: 0.676, specificity: 0.735, sensitivity: 0.643). CONCLUSIONS: Patients with chronic constipation and a CTT >30 hours were at risk for inadequate bowel preparation. CTT measured prior to colonoscopy could be useful for developing individualized strategies for bowel preparation in patients with slow CTT, as these patients are likely to have inadequate bowel preparation.
Colon* ; Colonoscopy ; Constipation* ; Humans ; Multivariate Analysis ; ROC Curve ; Sensitivity and Specificity

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Clinical Features and Prognosis of Resectable Primary Colorectal Signet-Ring Cell Carcinoma.

Ho Su LEE ; Jae Seung SOH ; Seohyun LEE ; Jung Ho BAE ; Kyung Jo KIM ; Byong Duk YE ; Jeong Sik BYEON ; Seung Jae MYUNG ; Suk Kyun YANG ; Sun A KIM ; Young Soo PARK ; Seok Byung LIM ; Jin Cheon KIM ; Chang Sik YU ; Dong Hoon YANG

Intestinal Research.2015;13(4):332-338. doi:10.5217/ir.2015.13.4.332

BACKGROUND/AIMS: We attempted to investigate the prognosis of signet-ring cell carcinoma (SRC) patients who underwent curative surgery by comparing them with age-, sex-, and stage-matched non-mucinous adenocarcinoma (NMAC) patients. METHODS: Between January 2003 and December 2011, 19 patients with primary SRC of the colorectum underwent curative surgery. Four SRC patients under the age of 40 were excluded, and the clinicopathological data of 15 patients (7 men; median age, 56 years) were reviewed and compared with the data of 75 NMAC patients matched by age, sex, and pathologic stage. RESULTS: The median follow-up duration was 30.1 months for the SRC group and 43.7 months for the NMAC group (P=0.141). Involvement of the left side of the colon (73.3% vs. 26.7%, P=0.003) and infiltrative lesions such as Borrmann types 3 and 4 (85.7% vs. 24.0%, P=0.001) were more common in the SRC group than in the NMAC group. The five-year overall survival rate was significantly lower for patients with SRC than for those with NMAC (46.0% vs. 88.7%, hazard ratio, 6.99; 95% confidence interval, 2.33-20.95, P=0.001). CONCLUSIONS: Patients with even resectable primary colorectal SRC had a poorer prognosis than age-, sex-, and stage-matched colorectal NMAC patients.
Adenocarcinoma ; Colon ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Male ; Prognosis* ; Survival Rate

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Is Retroflexion Helpful in Detecting Adenomas in the Right Colon?: A Single Center Interim Analysis.

Hyun Seok LEE ; Seong Woo JEON

Intestinal Research.2015;13(4):326-331. doi:10.5217/ir.2015.13.4.326

BACKGROUND/AIMS: Colonoscopy is less effective at screening for colorectal cancer in the right side of the colon. Retroflexion during colonoscopy is expected to improve the detection rate of colorectal adenomas. The aim of the present study was to evaluate the usefulness of retroflexion in the right-sided colon. METHODS: From April to November 2013, a total of 398 patients were enrolled in this study. For each patient, a cap-assisted colonoscopic examination was performed. After cecal intubation, a forward view examination from the cecum up to the hepatic flexure was performed and all identified polyps were removed. The colonoscope was reinserted to the cecum, and a careful second forward view examination of the cecum to the hepatic flexure was performed, with removal of additionally identified polyps. The colonoscope was then reinserted to the cecum and retroflexed; a third colonoscopic examination was then performed to the hepatic flexure in retroflexion with removal of additional polyps. Total polyp numbers and characteristics were compared between the two forward view examinations and the retroflexion examination. RESULTS: A successful retroflexion was performed in 90.2% of patients. A total of 213 polyps and 143 adenomas were detected in the right-sided colon using the routine method of examining the right colon twice in forward view. An additional 35 polyps and 24 adenomas were detected on retroflexion. Of these 35 polyps, 27 (77.1%) were small-sized polyps (< or =5 mm) and 24 (71.4%) were adenomas. Finding additional adenomas using the retroflexion technique was associated with older age. CONCLUSIONS: Colonoscopic retroflexion is helpful in the detection of cecum and ascending colon adenomas, especially small-sized adenomas (< or =5 mm). It is particularly useful in older patients.
Adenoma* ; Cecum ; Colon* ; Colon, Ascending ; Colonoscopes ; Colonoscopy ; Colorectal Neoplasms ; Humans ; Intubation ; Mass Screening ; Polyps

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Colonic Chicken Skin Mucosa is an Independent Endoscopic Predictor of Advanced Colorectal Adenoma.

Eun Ju CHUNG ; Ji Young LEE ; Jaewon CHOE ; Hye Sook CHANG ; Jongcheol KIM ; Dong Hoon YANG ; Byong Duk YE ; Jeong Sik BYEON ; Kyung Jo KIM ; Suk Kyun YANG ; Jin Ho KIM ; Seung Jae MYUNG

Intestinal Research.2015;13(4):318-325. doi:10.5217/ir.2015.13.4.318

BACKGROUND/AIMS: Chicken skin mucosa (CSM), surrounding colorectal adenoma, is an endoscopic finding with pale yellow-speckled mucosa; however, its clinical significance is unknown. This study aimed to evaluate the prevalence and clinical characteristics of CSM, and the association between colorectal carcinogenesis and CSM. METHODS: This cross-sectional study was performed in 733 consecutive patients who underwent endoscopic polypectomy for colorectal adenoma after the screening of colonoscopy at the Asan Health Promotion Center between June 2009 and December 2011. The colonoscopic and pathological findings of colorectal adenoma including number, size, location, dysplasia, morphology, and clinical parameters were reviewed. RESULTS: The prevalence of CSM was 30.7% (225 of 733 patients), and most CSM-related adenomas were located in the distal colon (93.3%). Histological analysis revealed lipid-laden macrophages in the lamina propria of the mucosa. Multivariate analyses showed that CSM was significantly associated with advanced pathology, including villous adenoma and high-grade dysplasia (odds ratio [OR], 2.078; 95% confidence interval [CI], 1.191-3.627; P=0.010), multiple adenomas (i.e., > or =2 adenomas; OR, 1.692; 95% CI, 1.143-2.507; P=0.009), and a protruding morphology (OR, 1.493; 95% CI, 1.027-2.170; P=0.036). There were no significant differences in polyp size or clinical parameters between patients with and without CSM. CONCLUSIONS: CSM-related adenoma was mainly found in the distal colon, and was associated with advanced pathology and multiple adenomas. CSM could be a potential predictive marker of the carcinogenetic progression of distally located colorectal adenomas.
Adenoma* ; Adenoma, Villous ; Carcinogenesis ; Chickens* ; Chungcheongnam-do ; Colon* ; Colonoscopy ; Cross-Sectional Studies ; Health Promotion ; Humans ; Macrophages ; Mass Screening ; Mucous Membrane* ; Multivariate Analysis ; Pathology ; Polyps ; Prevalence ; Skin*

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Reappraisal of Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy.

Won Young PARK ; Tae Hee LEE ; Joon Seong LEE ; Su Jin HONG ; Seong Ran JEON ; Hyun Gun KIM ; Joo Young CHO ; Jin Oh KIM ; Jun Hyung CHO ; Sang Wook LEE ; Young Kwan CHO

Intestinal Research.2015;13(4):313-317. doi:10.5217/ir.2015.13.4.313

BACKGROUND/AIMS: Pneumoperitoneum is recognized as a benign and self-limiting finding after the insertion of a percutaneous endoscopic gastrostomy (PEG) tube, while complicated pneumoperitoneum is rarely reported. The aim of this study was to reappraise pneumoperitoneum following PEG. METHODS: We retrospectively reviewed 193 patients who underwent PEG from May 2008 to May 2014. All patients had a follow-up upright chest or simple abdominal radiograph after PEG. Pneumoperitoneum was quantified by measuring the height of the air column under the diaphragm and graded as small (<2 cm), moderate (2-4 cm), or large (>4 cm). Clinically significant signs were defined as fever, abdominal tenderness or leukocytosis occurring after PEG insertion. RESULTS: Of the 193 study patients, 9 (4.6%) had a pneumoperitoneum visualized by radiographic imaging, graded as small in 5 patients, moderate in 2 patients and large in 2 patients. Clinically significant signs were observed in 5 (55.5%) patients with fever reported in 4 patients, abdominal tenderness in 4 patients and leukocytosis in 4 patients. The time to resolution of free air was 2-18 days. Two patients (22.2%) with moderate or large pneumoperitoneum after PEG died from either pneumonia or septic shock. CONCLUSIONS: The clinical course of pneumoperitoneum after PEG is not always benign and self-limiting. These findings suggest that clinicians should not neglect a moderate or large pneumoperitoneum, particularly in patients who have an altered mental status or received antibiotics, since peritoneal irritation cannot be observed under these circumstances.
Anti-Bacterial Agents ; Diaphragm ; Endoscopy, Gastrointestinal ; Fever ; Follow-Up Studies ; Gastrostomy* ; Humans ; Leukocytosis ; Pneumonia ; Pneumoperitoneum* ; Retrospective Studies ; Shock, Septic ; Thorax

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Pharmacologic Agents for Chronic Diarrhea.

Kwang Jae LEE

Intestinal Research.2015;13(4):306-312. doi:10.5217/ir.2015.13.4.306

Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.
Abdominal Pain ; Anti-Inflammatory Agents ; Bile ; Budesonide ; Cholestyramine Resin ; Citric Acid ; Colitis, Collagenous ; Colitis, Lymphocytic ; Colitis, Microscopic ; Diarrhea* ; Drug Therapy ; Humans ; Irritable Bowel Syndrome ; Loperamide ; Mesalamine ; Parasympatholytics ; Probiotics ; Receptors, Serotonin, 5-HT3 ; Serotonin

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Recent Updates on the Treatment of Constipation.

Han Seung RYU ; Suck Chei CHOI

Intestinal Research.2015;13(4):297-305. doi:10.5217/ir.2015.13.4.297

The treatment of constipation aims to regulate the frequency and quantity of stool in order to promote successful defecation. Numerous studies on pharmacologic treatments and non-pharmacologic therapies for constipation have attempted to overcome limitations such as temporary and insufficient efficacy. Conventional laxatives have less adverse effects and are inexpensive, but often have limited efficacy. Recently developed enterokinetic agents and intestinal secretagogues have received attention owing to their high efficacies and low incidences of adverse events. Studies on biofeedback and surgical treatment have focused on improving symptoms as well as quality of life for patients with refractory constipation.
Biofeedback, Psychology ; Constipation* ; Defecation ; Humans ; Incidence ; Laxatives ; Quality of Life

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