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Primary ovarian lymphoma is a rare malignancy whose symptoms or signs are usually nonspecific. In this article, we report a very rare case initially presenting as a rectal submucosal-tumor-like lesion with a defecation disturbance caused by primary ovarian lymphoma with bilateral involvement. A 42-year-old woman visited chungnam national university hospital complaining of persistent defecation disturbance for 6 months. Colonoscopy demonstrated compression of the rectum by an extrinsic mass mimicking a rectal submucosal tumor. Magnetic resonance imaging detected bilateral ovarian tumors, 9.3 cm and 5.4 cm each in diameter, compressing the rectum without enlarged lymph nodes. The diagnosis was established following a bilateral adnexectomy and histological studies of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient was prescribed six cycles of standard CHOP (cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone) regimen and is presently on treatment.
Adult ; Colonoscopy ; Defecation ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, B-Cell ; Magnetic Resonance Imaging ; Rectum ; Vincristine

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Giant Peritoneal Loose Body in the Pelvic Cavity.

Joung Teak JANG ; Haeng Ji KANG ; Ji Young YOON ; Seo Gue YOON

Journal of the Korean Society of Coloproctology.2012;28(2):108-110. doi:10.3393/jksc.2012.28.2.108

We report a case of a large peritoneal loose body diagnosed on computed tomography. The most common causes of a peritoneal loose body are thought to be torsion and separation of the appendices epiploicae. Peritoneal loose bodies are usually small, 0.5 to 2.5 cm in diameter. However, "giant" peritoneal loose bodies, larger than 4 cm in diameter, are an uncommon disease and present with various symptoms, and are difficult to diagnose preoperatively. Especially, abdominal large peritoneal loose bodies are frequently misdiagnosed as tumorous disease preoperatively. In our case, the loose body appeared as a round pelvic mass with central calcifications and a distinct fat plane separating it from adjacent organs. Preoperatively, we suspected a tumorous lesion from the wall of the upper rectum; however, at laparoscopy, a large peritoneal loose body was detected. An extraction of the giant peritoneal loose body was performed laparoscopically.
Laparoscopy

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Oncologic Outcomes and Risk Factors for Recurrence after Tumor-specific Mesorectal Excision of Rectal Cancer: 782 Cases.

Sam Hee KIM ; Ki Beom BAE ; Jung Min KIM ; Jae Ho SHIN ; Min Sung AN ; Tae Geun HA ; Sung Mok RYU ; Kwang Hee KIM ; Tae Hyeon KIM ; Chang Soo CHOI ; Jin Yong SHIN ; Minkyung OH ; Seung Hun BAEK ; Kwan Hee HONG

Journal of the Korean Society of Coloproctology.2012;28(2):100-107. doi:10.3393/jksc.2012.28.2.100

PURPOSE: The aim of this study was to analyze the oncologic outcomes and the risk factors for recurrence after a tumor-specific mesorectal excision (TSME) of resectable rectal cancer in a single institution. METHODS: A total of 782 patients who underwent a TSME for resectable rectal cancer between February 1995 and December 2005 were enrolled retrospectively. Oncologic outcomes included 5-year cancer-specific survival and its affecting factors, as well as risk factors for local and systemic recurrence. RESULTS: The 5-year cancer-specific survival rate was 77.53% with a mean follow-up period of 61 +/- 31 months. The overall local and systemic recurrence rates were 9.2% and 21.1%, respectively. The risk factors for local recurrence were pN stage (P = 0.015), positive distal resection margin, and positive circumferential resection margin (P < 0.001). The risk factors for systemic recurrence were pN stage (P < 0.001) and preoperative carcinoembryonic antigen level (P = 0.005). The prognostic factors for cancer-specific survival were pT stage (P < 0.001), pN stage (P < 0.001), positive distal resection margin (P = 0.005), and positive circumferential resection margin (P = 0.016). CONCLUSION: The oncologic outcomes in our institution after a TSME for patients with resectable rectal cancer were similar to those reported in other recent studies, and we established the risk factors that could be crucial for the planning of treatment and follow-up.
Carcinoembryonic Antigen ; Follow-Up Studies ; Humans ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

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Clinical Characteristics and Surgical Safety in Patients with Acute Appendicitis Aged over 80.

Kwon Sang MOON ; Yong Hwan JUNG ; Eun Hun LEE ; Yong Hee HWANG

Journal of the Korean Society of Coloproctology.2012;28(2):94-99. doi:10.3393/jksc.2012.28.2.94

PURPOSE: The aim of this study was to evaluate the clinical characteristics and treatment outcomes, including surgical safety, in patients over 80 years of age who underwent an appendectomy. METHODS: This study involved 160 elderly patients who underwent an appendectomy for acute appendicitis: 28 patients over 80 years old and 132 patients between 65 and 79 years old. RESULTS: The rate of positive rebound tenderness was significantly higher in the over 80 group (P = 0.002). Comparisons of comorbidity, diagnostic tool and delay in surgical treatment between the two groups were not statistically different. American Society of Anesthesiologists score was significantly higher in the over 80 group than in the 65 to 79 group (2.4 +/- 0.5 vs. 1.6 +/- 0.5; P < 0.00005). Comparisons of operative times and use of drainage between the two groups were not statistically different. In the pathologic findings, periappendiceal abscess was more frequent in the over 80 group (P = 0.011). No significant differences existed between the two groups when comparing the results of gas out and the time to liquid diet, but the postoperative hospital stay was significantly longer in the over 80 group (P = 0.001). Among the postoperative complications, pulmonary complication was significantly higher in the over 80 group (P = 0.005). However, operative mortality was zero in each group. CONCLUSION: In case of suspicious appendicitis in elderly patients, efforts should be made to use aggressive diagnostic intervention, do appropriate surgery and prevent pulmonary complications especially in patients over 80 years of age.
Abscess ; Aged ; Appendectomy ; Appendicitis ; Comorbidity ; Diet ; Drainage ; Humans ; Length of Stay ; Operative Time ; Postoperative Complications

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Bezoar-induced Small Bowel Obstruction.

Se Heon OH ; Hwan NAMGUNG ; Mi Hyun PARK ; Dong Guk PARK

Journal of the Korean Society of Coloproctology.2012;28(2):89-93. doi:10.3393/jksc.2012.28.2.89

PURPOSE: The aim of this study was to observe the clinical features of a bezoar-induced small bowel obstruction and to investigate the role of abdominal computed tomography (CT) in establishing the diagnosis. METHODS: We retrospectively reviewed 20 cases of bezoar-induced small bowel obstruction in our hospital from 1996 to 2010. RESULTS: Thirteen patients (65%) had a history of abdominal surgery. Nine patients (45%) were diagnosed with a bezoar before surgery, seven patients were diagnosed by using abdominal CT, and two patients were diagnosed with a small bowel series. Abdominal CT was performed in 15 patients, and the diagnostic accuracy was 47% (7/15). Surgery revealed ten bezoars in the jejunum and 11 in the ileum. Two patients had bezoars found concurrently in the stomach. Spontaneous removal took place in two patients. An enterotomy and bezoar extraction was performed in 15 patients. Fragmentation and milking, a small bowel resection, and a Meckel's diverticulectomy were performed in one patient each. Early operative treatment was possible (P = 0.036) once the bezoar had been diagnosed by using abdominal CT. There tended to be fewer postoperative complications in patients who were diagnosed with a bezoar by using abdominal CT, but the result was not statistically significant (P = 0.712). CONCLUSION: A preoperative diagnosis of bezoar-induced small bowel obstruction by using clinical features was difficult. Increased use of abdominal CT led to a more accurate diagnosis and to earlier surgery for bezoar-induced small bowel obstructions, thereby reducing the rate of complications.
Bezoars ; Humans ; Hypogonadism ; Ileum ; Jejunum ; Milk ; Mitochondrial Diseases ; Ophthalmoplegia ; Postoperative Complications ; Retrospective Studies ; Stomach

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Intestinal Anastomosis by Use of a Memory-shaped Compression Anastomosis Clip (Hand CAC 30): Early Clinical Experience.

Hak Youn LEE ; Jin Hee WOO ; Si Young PARK ; Nam Wook KANG ; Ki Jae PARK ; Hong Jo CHOI

Journal of the Korean Society of Coloproctology.2012;28(2):83-88. doi:10.3393/jksc.2012.28.2.83

PURPOSE: The safety and the efficacy of the compression anastomosis clip (Hand CAC 30) have been demonstrated by animal studies. This study was designed to evaluate the clinical validity of the Hand CAC 30 in enterocolic side-to-side anastomosis after colonic or enteric resections. METHODS: A non-randomized prospective data collection was performed for patients undergoing a side-to-side anastomosis using the Hand CAC 30. Eligibility criteria for the use of the Hand CAC 30 were for anastomoses between the colon and the ileum or between two small bowels. The primary short-term endpoint was the rate of anastomotic leakage. Other clinical outcomes, including intra- and postoperative complications, length of operation time and hospital stay, and the clip elimination time were recorded. RESULTS: A total of 63 patients (male, 36) underwent an enteric or right-sided colonic resection followed by a side-to-side anastomosis using the Hand CAC 30. Laparoscopic surgery was performed in 36 patients, in whom one patient who underwent a laparoscopic right hemicolectomy was converted to an open procedure (1/32, 3.1%). One patient with ascending colon cancer showed postoperative anastomotic leakage and died of co-morbid ischemic heart disease. There were no other surgical mortalities. The exact date of expulsion of the clip could not be recorded because most patients were not aware of clip elimination. No patients manifested clinical symptoms of anastomotic stricture. CONCLUSION: Short-term evaluation of the Hand CAC 30 anastomosis in patients undergoing enterocolic surgery proved it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.
Anastomotic Leak ; Animals ; Colon ; Colon, Ascending ; Data Collection ; Hand ; Humans ; Ileum ; Laparoscopy ; Length of Stay ; Myocardial Ischemia ; Postoperative Complications ; Prospective Studies

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Comparison of a Fistulectomy and a Fistulotomy with Marsupialization in the Management of a Simple Anal Fistula: A Randomized, Controlled Pilot Trial.

Bhupendra Kumar JAIN ; Kumar VAIBHAW ; Pankaj Kumar GARG ; Sanjay GUPTA ; Debajyoti MOHANTY

Journal of the Korean Society of Coloproctology.2012;28(2):78-82. doi:10.3393/jksc.2012.28.2.78

PURPOSE: This randomized clinical trial was conducted to compare a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula. METHODS: Forty patients with simple anal fistula were randomized into two groups. Fistulous tracts were managed by using a fistulectomy (group A) while a fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were operating time, postoperative wound size, postoperative pain, wound infection, anal incontinence, recurrence and patient satisfaction. RESULTS: Postoperative wounds in group B healed earlier in comparison to group A wounds (4.85 +/- 1.39 weeks vs. 6.75 +/- 1.83 weeks, P = 0.035). No significant differences existed between the operating times (28.00 +/- 6.35 minutes vs. 28.20 +/- 6.57 minutes, P = 0.925) and visual analogue scale scores for postoperative pain on the first postoperative day (4.05 +/- 1.47 vs. 4.50 +/- 1.32, P = 0.221) for the two groups. Postoperative wounds were larger in group A than in group B (2.07 +/- 0.1.90 cm2 vs. 1.23 +/- 0.87 cm2), however this difference did not reach statistical significance (P = 0.192). Wound discharge was observed for a significantly longer duration in group A than in group B (4.10 +/- 1.91 weeks vs. 2.75 +/- 1.71 weeks, P = 0.035). There were no differences in social and sexual activities after surgery between the patients of the two groups. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks. CONCLUSION: In comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.
Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Pain, Postoperative ; Rectal Fistula ; Recurrence ; Sexual Behavior ; Wound Healing ; Wound Infection

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Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids.

Seok Won LIM

Journal of the Korean Society of Coloproctology.2012;28(2):73-77. doi:10.3393/jksc.2012.28.2.73

A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment.
Alum Compounds ; Aluminum ; Hemorrhoidectomy ; Hemorrhoids ; Potassium ; Recurrence ; Tannins

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