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Difficult Polypectomy.

Hyun Shig KIM

Journal of the Korean Society of Coloproctology.2003;19(6):399-405.

No abstract available.
Colonoscopy

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Mucosa-associated Lymphoid Tissue Lymphoma of the Rectum: A case report.

Yu Na KANG ; Sun Young KWON ; Sang Pyo KIM ; Kwan Kyu PARK ; Kun Young KWON ; Sang Sook LEE ; Kyung Sik PARK ; Jung Hyeok KWON ; Chul Hyun KIM

Journal of the Korean Society of Coloproctology.2003;19(6):394-398.

Primary colorectal lymphoma accounts for only 0.2~.65% of large intestinal malignancies. Mucosa-associated lymphoid tissue lymphoma in the rectum is very rare. We report the case of a 73-year-old woman with morphologic and immunophenotypic findings consistent with mucosa-associated lymphoid tissue lymphoma of the rectum. The woman complained of consistent bloody diarrhea and recently developed abdominal pain, febrile and chilling sensation. Ultrasonography of upper abdomen detected multiple stones within the gallbladder and the gallbladder was resected using laparoscopic surgery. An ulcerative polypoid mass in the rectum was detected by colonoscopy and computerized tomography of abdomen. Microscopic and immunohistochemical studies showed a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma. This patient was consulted to the department of radiotherapy because of poor general condition and old age. Chemotherapy was not performed. She was followed up with no relapse of the lesions during 7 months after the diagnosis.
Abdomen ; Abdominal Pain ; Aged ; Colonoscopy ; Diagnosis ; Diarrhea ; Drug Therapy ; Female ; Gallbladder ; Humans ; Laparoscopy ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Radiotherapy ; Rectum* ; Recurrence ; Sensation ; Ulcer ; Ultrasonography

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Dermoid Cyst in the Ischiorectal Space.

Jai Kyun JOO ; Seong Yeob RYU ; Dong Yi KIM ; Young Jin KIM ; Je Hyeok LEE

Journal of the Korean Society of Coloproctology.2003;19(6):391-393.

Despite the relatively common incidence of sacrococcygeal dermoids, rectal or vaginal cysts are uncommon. We report a case of a dermoid cyst occurring in the ischiorectal space. A 42-years-old woman visited our hospital because of anal pain. Computed tomography showed a well-circumscribed cystic mass of about 9 9 8 cm along the ischiorectal space abutting the vagina and occupying almost the entire pelvic cavity. The resected tumor was a cyst entirely covered with a firm, fibrous, capsule, which was filled with an amorphous white creamy substance. The histological findings showed that the cyst consisted of a keratinizing stratified squamous epithelium with sebaceous glands, which was compatible with a benign cystic teratoma. The patient had an uneventful postoperative course and was discharged from the hospital 5 days after the opreation.
Dermoid Cyst* ; Epithelium ; Female ; Humans ; Incidence ; Sebaceous Glands ; Teratoma ; Vagina

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Western Blotting to Assess the Expression of Survivin in Colorectal Cancer.

Sung Ku KANG ; Ryung Ah LEE ; In Kyoung KIM ; Sun Mi MOON ; Dae Yong HWANG

Journal of the Korean Society of Coloproctology.2003;19(6):386-390.

PURPOSE: The balance between cell death and proliferation is a key step in cellular homeostasis. Inhibition of apoptosis could trigger an abnormal malignant change. Survivin is a recently reported anti-apoptotic molecule that inhibits the caspase system along the apoptosis pathway. It is expressed in fetal tissue and transformed tissue, but not in normal tissues except durung the mitosis period. Some authors have described abnormal survivin expression in various cancer tissues. We performed western blotting in colorectal cancer to assess the expression pattern of survivin. METHODS: Thirty-four colorectal cancer tissues and adjacent normal colonic epithelia of patients operated an at KCCH from June 1998 were assessed. We used the common western blotting method with the polyclonal anti-survivin antibody. RESULTS: Survivin was expressed in all cases (34 cases, 100%) of cancer tissues and two cases (5.8%) of normal tissue. Seven of 34 cases showed a strong positive result. Univariate analysis of sex, age, stage, original site, lymphatic invasion, neural invasion, and vessel invasion between the positive group and the strongly positive group revealed no significant relationship except for neural invasion. CONCLUSIONS: Survivin should be a good tumor marker of colorectal cancer.
Apoptosis ; Blotting, Western* ; Cell Death ; Colon ; Colorectal Neoplasms* ; Fetus ; Homeostasis ; Humans ; Mitosis

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Characteristic Clinical Behaviors of and Prognosis for Mucinous Adenocarcinomas in the Colon and Rectum.

Yeun Sik YU ; Hee Cheol KIM ; Sang Jun PARK ; Jang Hak YU ; Jung Sun KIM ; Gang Hong LEE ; Chang Sik YU ; Jin Cheon KIM

Journal of the Korean Society of Coloproctology.2003;19(6):379-385.

PURPOSE: The clinical significance of a mucinous-type colorectal adenocarcinoma is still controversial. Mucinous colorectal adenocarcinomas have been suggested to have distinct clinicopathologic features, i.e., early-onset, right-side dominancy, and poor prognosis. We aimed to verify the biological behaviors of and survivals for mucinous adenocarcinomas compared with non-mucinous adenocarcinomas. METHODS: Using a database of colorectal cancers at Asan Medical Center between 1989 and 2000, we enrolled 121 mucinous adenocarcinoma and 2,289 non-mucinous adenocarcinoma patients in this study. Clinical, pathological characteristics of and prognoses for mucinous adenocarcinomas were analyzed and compared with those for non-mucinous adenocarcinomas, retrospectively. The median follow-up period was 24 (0~113) months for mucinous adenocarcinomas and 32 (0~130) months for non-mucinous adenocarcinoma. RESULTS: Compared to non-mucinous adenocarcinomas, mucinous adenocarcinomas showed distinctive clinicopathologic features of early-onset (P<0.001), frequent family history (P<0.001), right-side dominancy (P=0.010), advanced stage at diagnosis (P<0.001), and common peritoneal seeding at diagnosis (P<0.001). The recurrence rate in the mucinous adenocarcinoma group was 45.2% during the follow-up period: 21.6% distant metastasis, 14.3% peritoneal dissemination, 5.7% local recurrence, and 3.6% simultaneous local recurrence and distant metastasis. The five-year survival rates in stages II and III were 70% and 48.7%, respectively, for mucinous adenocarcinomas and 92% and 50.2%, respectively, for non-mucinous adenocarcinomas. This difference was statistically significant. CONCLUSIONS: Mucinous adenocarcinomas seem to have distinct biologic behaviors with different clinicopathologic features and poor prognosis. A surgical approach with a follow-up schedule considering the characteristics of mucinous adenocarcinomas is needed.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Appointments and Schedules ; Chungcheongnam-do ; Colon* ; Colorectal Neoplasms ; Diagnosis ; Follow-Up Studies ; Humans ; Mucins* ; Neoplasm Metastasis ; Prognosis* ; Rectum* ; Recurrence ; Retrospective Studies ; Survival Rate

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Clinical Value of the Change in the Serum Carcinoembryonic Antigen (CEA) Level after Curative Surgery in Colorectal Cancer.

Young Hoon KIM ; Byung Noe BAE ; Ki Hwan KIM ; Se hwan HAN ; Hong Joo KIM ; Young Duck KIM ; Hong Yong KIM

Journal of the Korean Society of Coloproctology.2003;19(6):372-378.

PURPOSE: This retrospective study was designed to evaluate the clinical value of changes in the serum carcinoembryonic antigen (CEA) level after curative surgery in colorectal cancer patients. METHODS: The clinical value of preoperative serum CEA and dCEA (postoperative 7-day CEA/preoperative CEA) in 115 patients with colorectal cancer, who underwent curative surgery at our Department of General Surgery from 1994 to 1997, was investigated. RESULTS: The preoperative CEA level was significantly associated with histologic differentiation (P=0.035) and reccurence (P=0.044), but not gender, tumor size, lymph node metastases, Duke's stage, and vascular invasion. dCEA was significantly associated with lymph-node metastases (P=0.017), histologic differentiation (P=0.024), Duke's stage (P=0.021), recurrence (P=0.008), and survival rate (P=0.0379). Especially, in the abnormal preoperative CEA level (>5 ng/mL) group, if dCEA was more than 0.5, these patients had a very poor prognosis (P=0.0003). CONCLUSIONS: dCEA was associated with more clinicopathologic prognostic factors than preoperative CEA, especially with survival rate. Therefore, we expect dCEA to be a more useful tool for predicting patient outcome.
Carcinoembryonic Antigen* ; Colorectal Neoplasms* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Biomarkers, Tumor

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Analysis of Colonic Synchronous Lesions in Colorectal Cancer.

Byung Wook MIN ; Jae Bok LEE ; Jun Won UM ; Hong Young MOON

Journal of the Korean Society of Coloproctology.2003;19(6):367-371.

PURPOSE: The aim of this study is to evaluate the incidence of synchronous colonic lesions and to identify the impact of an incomplete preoperative colonoscopy in colorectal cancer patients. METHODS: We studied 187 patients with colorectal cancer who received colonoscopic examinations pre or postoperatively in our hospital from January 2000 to March 2002. The pre and postoperative colonoscopic findings were reviewed. Most post-operative colonoscopies were performed 12 months after the operation, but in cases of incomplete pre-operative examination, they were performed at 6 months. We analyzed the incidence of synchronous lesions of the colon and the rectum and then compared the findings for complete and incomplete pre-operative examinations. RESULTS: Complete pre-operative colonoscopic examinations were performed in 152 patients, but in 35 patients, the colonoscopy was performed incompletely. Twenty-two of these 35 patients had obstructive colorectal cancer. In the complete examination group, 23 patients had synchronous lesions preoperatively; 20 cases were benign, and 3 cases were malignant. By postoperative colonoscopic examination, 27 patients had synchronous polyps. In 19 of the 27, the polyps had not been detected preoperatively. The incidence of synchronous lesions in the complete examination group was 27.6% (42/152), and the incidence of synchronous cancer was 2.0% (3/152). In the incomplete examination group, the incidence of synchronous lesions was 37.1% (13/35), and the incidence of malignancy was 2.9% (1/35). The incidence of synchronous lesions in the preoperative incomplete examination group was higher than it was in the complete examination group, but the difference was not statistically significant (P=0.161). CONCLUSIONS: In our study, the incidence of synchronous lesions with colorectal cancer patients was 29.4%, and the incidence of malignancy was 2.1%, these are similar to figures in others reports. Patients with an incomplete preoperative entire-colon examinations should have immediate postoperative colonoscopy.
Colon* ; Colonoscopy ; Colorectal Neoplasms* ; Humans ; Incidence ; Polyps ; Rectum

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Is a Hemorrhoidectomy Safe in Patients Requiring Anticoagulation?.

Jai Young CHO ; Suk Byung LIM ; Min Ro LEE ; Kyu Joo PARK

Journal of the Korean Society of Coloproctology.2003;19(6):360-366.

PURPOSE: The aim of this study was to determine the risks of a hemorrhoidectomy in patients requiring long-term anticoagulation. METHODS: Between March 1998 and February 2001, 13 patients requiring long-term oral anticoagulation because of prosthetic valve replacement (n=4), atrial fibrillation (n=7), and coronary artery disease (n=2) underwent a hemorrhoidectomy at Seoul National University Hospital. We performed a retrospective analysis on these patients regarding the results of the hemorrhoidectomy. The control group consisted of 148 patients without any medical problems who had undergone a hemorrhoidectomy during the same period. Patients on anticoagulation stopped their oral medication three days before the operation and full intravenous (IV) heparinization was commenced. Heparin was stopped six hours before the operation and restarted postoperatively, and warfarin was re-started on the evening of postoperative day 1. The hemorrhoidectomy consisted of excising three main piles, followed by submucosal excision of all intervening piles. Student's t-test and Fisher's exact test were used for statistical analysis. RESULTS: The PTs (prothrombin times) of the anticoagulation group and the control group obtained at admission were INRs (international normalized ratios) of 1.75+/-0.54 and 1.04 0.08, respectively (P=0.0005). After discontinuation of oral medication and full IV heparinization, the INR of the anticoagulation group at the time of operation was 1.06+/-0.09, which was not statistically different from the PT (INR) of the control group at admission (P=0.603). There were two cases of postoperative bleeding requiring blood transfusions in the anticoagulation group (15.4%), and four cases of postoperative bleeding requiring blood transfusions in the control group (2.7%), but there was no statistical difference between the rates for the two groups (P=0.075). The mean postoperative hospital stays were 6.69+/-3.68 and 3.64+/-2.98 for the anticoagulation and control groups, respectively (P=0.074). Postoperative analgesic requirements and urinary difficulty were similar in both groups (P=0.478 and 0.397, respectively). No systemic thromboembolism in both groups, and there was no bacterial endocarditis or valvular thrombosis was seen in patients with prosthetic heart valves. CONCLUSIONS: Our results indicate that patients taking oral warfarin for anticoagulation may safely undergo a hemorrhoidectomy after strict heparinization.
Atrial Fibrillation ; Blood Transfusion ; Coronary Artery Disease ; Endocarditis, Bacterial ; Heart Valves ; Hemorrhage ; Hemorrhoidectomy* ; Heparin ; Humans ; International Normalized Ratio ; Length of Stay ; Retrospective Studies ; Seoul ; Thromboembolism ; Thrombosis ; Warfarin

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Clinical Features of Intestinal Obstruction after Colorectal Surgery.

Yeon Sun KIM ; Chang Sik YU ; Kang Hong LEE ; Hwan NAMGUNG ; Hee Cheol KIM ; Jin Cheon KIM

Journal of the Korean Society of Coloproctology.2003;19(6):354-359.

PURPOSE: The purposes of this study are to determine the incidence of postoperative ileus after colorectal surgery, to analyze its clinical features, and to identify the risk factors for its development. METHODS: We reviewed the cases of 263 patients with mechanical ileus among 3,237 patients who underwent colorectal surgery in our clinic between June 1989 and December 2000. RESULTS: A total of 263 (8.1%) patients of postoperative ileus were documented, 193 (73.4%) cases occurred during the 1st. year. Postoperative ileus is influenced by the initial site of surgery; the rectum has more impact than the colon (P=0.028). The causes of postoperative ileus were adhesion, recurrence of cancer, and parastomal hernia. Adhesion (81.1%) was the most common cause of ileus, and cancer recurrence (18.0%) was the second. However, in postoperative ileus requiring surgery, cancer recurrence increased with time (2 year: 58.1%). The cases receiving postoperative adjuvant radiation therapy presented a significant increase in the incidence of postoperative ileus (10.3% vs 6.7% P=0.01) and in the requirement for surgical treatment (4.6% vs 2.7%, P=0.04). Patients with a temporary stoma presented a significant increase in the incidence of postoperative ileus than patients with a permanent stoma (P=0.001). The frequency of prior episodes of ileus was the strongest predictor of recurrence. CONCLUSIONS: There is a high risk of adhesion-related problems after colorectal surgery. The risk factors are associated with rectal surgery, postoperative radiation therapy, and a temporary stoma.
Colon ; Colorectal Surgery* ; Hernia ; Humans ; Ileus ; Incidence ; Intestinal Obstruction* ; Postoperative Complications ; Rectum ; Recurrence ; Risk Factors

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Surgical Management of Fournier's Gangrene.

Jeong Heum BAEK ; Sang Jin YOON ; Jae Hwan OH

Journal of the Korean Society of Coloproctology.2003;19(6):349-353.

PURPOSE: Fournier's gangrene is a potentially fatal infectious necrotizing fasciitis of the scrotum, penis, and perineal region. If not recognized early, this process will extend along the fascia plane to the lower abdominal and back regions, causing severe morbidity and even mortality. The aims of this study were to investigate the clinical characteristics and to evaluate the outcome of our experience with 16 cases of Fournier's gangrene. METHODS: Clinical data from 16 patients with the diagnosis of Fournier's gangrene, who were treated at Gil Medical Center from January 1995 until October 2001, were analyzed retrospectively. RESULTS: The patients consisted of 14 men and 2 women, with an average age of 62 years. The potential ports of entry for the causative bacteria included the anorectum (75.0%), the urinary tract (18.8%), and the skin (6.3%). Predisposing factors included diabetes mellitus (62.5%), alcoholism (6.3%), steroid use (6.3%), malignancy (6.3%), and ulcerative colitis (6.3%). Escherichia coli and Staphylococcus aureus were most commonly identified in bacterial cultures. All patients were treated with a broad spectrum antibiotics and serial surgical debridement. Twelve patients had fecal diversions, and five patients had urinary diversions. Three patients underwent orchiectomies. One patient (6.3%) died due to sepsis. CONCLUSIONS: The management of this infectious entity should be aggressive with early recognition. Patients with Fournier's gangrene need prompt extirpation of all nonviable tissue and a cystostomy or a colostomy when necessary. A broad-spectrum antimicrobial regimen and aggressive debridement are mandatory.
Alcoholism ; Anti-Bacterial Agents ; Bacteria ; Causality ; Colitis, Ulcerative ; Colostomy ; Cystostomy ; Debridement ; Diabetes Mellitus ; Diagnosis ; Escherichia coli ; Fascia ; Fasciitis, Necrotizing ; Female ; Fournier Gangrene* ; Humans ; Male ; Mortality ; Orchiectomy ; Penis ; Retrospective Studies ; Scrotum ; Sepsis ; Skin ; Staphylococcus aureus ; Urinary Diversion ; Urinary Tract

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