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Chang Woo KIM ; Yon Hee KIM ; Min Soo CHO ; Byung Soh MIN ; Seung Hyuk BAIK ; Nam Kyu KIM

Annals of Coloproctology.2014;30(5):241-244. doi:10.3393/ac.2014.30.5.241

The incidence of extramammary Paget's disease (EMPD) is very low. An 84-year-old Korean man was treated with topical and oral medications at a local dermatologic clinic for a year, but the symptoms did not improve. He visited Severance Hospital and underwent a perianal skin biopsy and was finally diagnosed with EMPD. The authors performed a wide local excision according to a 1-cm margin around the lesion. For the skin and the soft tissue defects, bilateral inferior gluteal artery perforator flap transpositions were performed. The size of the lesion was 14 cm2 x 9 cm2, and the lateral and the basal margins were all disease free.
Aged, 80 and over ; Arteries ; Biopsy ; Humans ; Incidence ; Paget Disease, Extramammary ; Perforator Flap ; Skin

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Intramedullary Spinal Cord Metastasis From Rectal Cancer.

Kyung Ho YANG ; Hye Ran LEE ; Seong Yoon YI ; Joo Hyuk JUNG ; Seung Hee KANG ; Pyong Hwa CHOI

Annals of Coloproctology.2014;30(5):237-240. doi:10.3393/ac.2014.30.5.237

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed.
Aged ; Breast Neoplasms ; Central Nervous System ; Colorectal Neoplasms ; Drug Therapy ; Humans ; Hypesthesia ; Korea ; Leg ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Neoplasm Metastasis* ; Radiotherapy ; Rectal Neoplasms* ; Spinal Cord Neoplasms ; Spinal Cord* ; Steroids

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Mullerian Adenosarcoma Arising From Rectal Endometriosis.

Chunseok YANG ; Hoon Kyu OH ; Daedong KIM

Annals of Coloproctology.2014;30(5):232-236. doi:10.3393/ac.2014.30.5.232

A Mullerian adenosarcoma is an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. A Mullerian adenosarcoma occurs mainly in the uterus, but also in extrauterine locations. Extrauterine Mullerian adenosarcomas are thought to arise from endometriotic deposits. A 36-year-old female presented to Daegu Catholic University Medical Center with a symptom of loose stool for several months. The imaging studies revealed a rectal mass, so she underwent a laparoscopic low anterior resection. Although extemporary pathology revealed an inflammatory myofibroblastic tumor, the final histologic diagnosis was a Mullerian adenosarcoma arising from rectal endometriosis. To our knowledge, except a concomitant rectal villotubular adenoma, cases of Mullerian adenosarcomas arising the rectal wall are rare. An adenosarcoma arising from endometriosis should be considered in the differential diagnosis of a pelvic mass, even one appearing in rectal wall, because ectopic endometrial tissue exists everywhere.
Academic Medical Centers ; Adenoma ; Adenosarcoma* ; Adult ; Daegu ; Diagnosis ; Diagnosis, Differential ; Endometriosis* ; Female ; Humans ; Myofibroblasts ; Pathology ; Rectal Neoplasms ; Uterus

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Prompt Management Is Most Important for Colonic Perforation After Colonoscopy.

Hyun Ho KIM ; Bong Hyeon KYE ; Hyung Jin KIM ; Hyeon Min CHO

Annals of Coloproctology.2014;30(5):228-231. doi:10.3393/ac.2014.30.5.228

PURPOSE: The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation. METHODS: From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy. RESULTS: A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly. CONCLUSION: Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.
Colectomy ; Colon* ; Colon, Sigmoid ; Colonoscopy* ; Colostomy ; Diagnosis ; Hemorrhage ; Humans ; Incidence ; Intestinal Perforation ; Male ; Mortality ; Retrospective Studies ; Risk Factors

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Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation.

Ki Hwan SONG ; Wu Seok SUH ; Jin Sik JEONG ; Dong Sik KIM ; Sang Woo KIM ; Dong Min KWAK ; Jong Seong HWANG ; Hyun Jin KIM ; Man Woo PARK ; Min Chul SHIM ; Ja Il KOO ; Jae Hwang KIM ; Dae Ho SHON

Annals of Coloproctology.2014;30(5):222-227. doi:10.3393/ac.2014.30.5.222

PURPOSE: Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction. METHODS: In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale. RESULTS: The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B. CONCLUSION: Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.
Citric Acid* ; Colon ; Colonoscopy* ; Humans ; Nausea ; Patient Satisfaction ; Polyethylene Glycols ; Secondary Care Centers ; Sodium* ; United States Food and Drug Administration ; Surveys and Questionnaires

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Safety of Nonoperative Management After Acute Diverticulitis.

Javier SUAREZ ALECHA ; Sonia AMOZA PAIS ; Xavi BATLLE MARIN ; Begona ORONOZ MARTINEZ ; Enrique BALEN RIBERA ; Concepcion YARNOZ IRAZABAL

Annals of Coloproctology.2014;30(5):216-221. doi:10.3393/ac.2014.30.5.216

PURPOSE: The role of surgery in the management of diverticular disease after an episode of acute diverticulitis (AD) managed in a conservative form is evolving. Age, number of episodes of AD, type of episode, and symptoms after the episodes are factors related to the need for elective surgery. The aim of this study is to evaluate the safety of conservative management and the risk factors for emergency surgery after a first episode of AD managed without surgery. METHODS: We retrospectively evaluated 405 patients diagnosed as having had a first episode of AD. Sixty-nine patients underwent emergency surgery on the first admission, and 69 patients had an elective operation in the follow-up (group A). The remaining 267 patients were managed initially without surgery (group B). Thirteen of these 267 patients needed a further urgent surgical procedure. Factors involved in the decision of elective surgery and the probability of emergency surgery after the first episode of AD managed without surgery were evaluated in relation to demographic factors, risk factors, presence of recurrences, and type of the first episode. RESULTS: Patients, mean age was 62.7 years, 71 were aged less than 51, and 151 were males. The mean follow-up for patients with nonoperative management was 91.2 months. An elective operation was performed in 69 patients. Compared to patients in group B, those in group A more frequently had a first episode of complicated acute diverticulitis (CAD) (37.1% vs. 16.4%; P = 0.000) and were more likely to be smokers (46.3% vs. 19.3%; P = 0.000) and to suffer more than one episode of AD (42% vs. 26.9%; P = 0.027). Nonoperative management was chosen for 267 patients, but 13 patients needed an emergency operation later. In the multivariate analysis, we found a significant relation between the presence of CAD in the first episode and the need for emergency surgery. There were no differences in surgical mortality between the patients in the two groups, but patients treated with elective surgery had a higher rate of stoma than patients treated non-operatively (7.2% vs. 1.4%; P = 0.028); this difference was not observed in the subgroup of patients with CAD (15.3% vs. 6.8%; P = 0.458). CONCLUSION: After an episode of AD, nonoperative management is safe because fewer than 5% of patients will need an emergent procedure in a subsequent attack of AD. A first episode of CAD is the only risk factor for emergency surgery in patients managed conservatively.
Demography ; Diverticulitis* ; Diverticulitis, Colonic ; Emergencies ; Follow-Up Studies ; Humans ; Male ; Mortality ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors

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High Rate of Sexual Dysfunction Following Surgery for Rectal Cancer.

Wafi ATTAALLAH ; Caglar ERTEKIN ; Ilker TINAY ; Cumhur YEGEN

Annals of Coloproctology.2014;30(5):210-215. doi:10.3393/ac.2014.30.5.210

PURPOSE: Although rectal cancer is a very common malignancy and has an improved cure rate in response to oncological treatment, research on rectal-cancer survivors' sexual function remains limited. Sexual dysfunction (SD) after rectal cancer treatment was measured, and possible predisposing factors that may have an impact on the development of this disorder were identified. METHODS: Patients undergoing curative rectal cancer surgery from January 2012 to September 2013 were surveyed using questionnaires. The female sexual function index or the International Index of Erectile Function was recorded. A multiple logistic regression was used to test associations of clinical factors with outcomes. RESULTS: Fifty-six men (56%) and 28 women (44%) who completed the questionnaire were included in the study. A total of 76 patients of the 86 patients (90.5%) with the diagnosis of rectal cancer who were included in this study reported different levels of SD after radical surgery. A total of 64 patients (76%) from the whole cohort reported moderate to severe SD after treatment of rectal cancer. Gender (P = 0.011) was independently associated with SD. Female patients reported significantly higher rates of moderate to severe SD than male patients. Patients were rarely treated for dysfunction. CONCLUSION: Sexual problems after surgery for rectal cancer are common, but patients are rarely treated for SD. Female patients reported higher rates of SD than males. These results point out the importance of sexual (dys)function in survivors of rectal cancer. More attention should be drawn to this topic for clinical and research purposes.
Causality ; Cohort Studies ; Diagnosis ; Female ; Humans ; Logistic Models ; Male ; Rectal Neoplasms* ; Survivors ; Surveys and Questionnaires

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Chronic Pelvic Abscedation After Completion Proctectomy in a Rectal Stump Insufficiency; Treatment With Gracilis Muscle Flap Following Vacuum Assisted Closure Therapy.

Fatma Ayca GULTEKIN ; Bekir Hakan BAKKAL ; Sait TAYFUN ; Orhan BABUCCU ; Mustafa COMERT

Annals of Coloproctology.2013;29(4):172-176. doi:10.3393/ac.2013.29.4.172

Presacral abscess formation due to rectal stump insufficiency following Hartmann procedure is very rare complication. If the abscess cavity is large, it might delay the reversal of the stoma and will probably result in a devastating future functioning of the neorectum. Moreover, very invasive treatments will be required in order to prevent severe septic complications. We present the case of a 58-year-old man with a past history of Hartmann procedure for a low rectal carcinoma who presented with rectal stump insufficiency and a large presacral abscess. Following extensive debridement and rectal stump resection, a vacuum-assisted closure (VAC) system was applied to the large abscess cavity to facilitate gracilis muscle flap reconstruction and to optimize wound healing. The satisfactory results showed in the present report led us to favor a combination of VAC therapy and a gracilis muscle flap in intrapelvic and perineal reconstruction in the case of large defects associated with high risks of septic complications.
Abscess ; Debridement ; Muscles ; Negative-Pressure Wound Therapy ; Surgical Flaps ; Vacuum ; Wound Healing

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Colon Cancer After Acute Diverticulitis Treatment.

Kwang Hoon OH ; Koon Hee HAN ; Eun Jung KIM ; Je Hoon LEE ; Kyu Un CHOI ; Myung Sik HAN ; Jae Hong AHN ; Gab Jin CHEON

Annals of Coloproctology.2013;29(4):167-171. doi:10.3393/ac.2013.29.4.167

Diverticulitis is the most common clinical complication of diverticular disease, affecting 10-25% of the patients with diverticula. The prevalences of diverticulitis and colon cancer tend to increase with age and are higher in industrialized countries. Consequently, diverticulitis and colon cancer have been reported to have similar epidemiological characteristics. However, the relationship between these diseases remains controversial, as is the performance of routine colonoscopy after an episode of diverticulitis to exclude colon cancer. Recently, we experienced three cases of colon cancer after treating acute diverticulitis, based on which we suggest the importance of follow-up colonoscopy after acute diverticulitis.
Colon ; Colonic Neoplasms ; Colonoscopy ; Developed Countries ; Diverticulitis ; Diverticulum ; Follow-Up Studies ; Humans ; Prevalence

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Mechanical Bowel Preparation and Prophylactic Antibiotic Administration in Colorectal Surgery: A Survey of the Current Status in Korea.

Byung Mo KANG ; Kil Yeon LEE ; Sun Jin PARK ; Suk Hwan LEE

Annals of Coloproctology.2013;29(4):160-166. doi:10.3393/ac.2013.29.4.160

PURPOSE: The usefulness of mechanical bowel preparation (MBP) in colon surgery was recently challenged by many multicenter clinical trials and meta-analyses. The objectives of this study were to investigate current national opinions about MBP and prophylactic antibiotics (PA) and to provide preliminary data for developing future Korean guidelines for MBP and PA administration in colorectal surgery. METHODS: A questionnaire was mailed to 129 colorectal specialists. The questionnaires addressed the characteristics of the hospital, the MBP methods, and the uses of oral and intravenous antibiotics. RESULTS: A total of 73 questionnaires (56.6%) were returned. First, in regard to MBP methods, most surgeons (97.3%) used MBP for a mean of 1.36 days. Most surgeons (98.6%) implemented whole bowel irrigation and used polyethylene glycol (83.3%). Oral antibiotic use was indicated in over half (52.1%) of the responses, the average number of preoperative doses was three, and the mean time of administration was 24.2 hours prior to the operation. Finally, the majority of responders stated that they used intravenous antibiotics (95.9%). The responses demonstrated that second-generation cephalosporin-based regimens were most commonly prescribed, and 75% of the surgeons administered these regimens until three days after the operation. CONCLUSION: The results indicate that most surgeons used MBP and intravenous antibiotics and that half of them administered oral PA in colorectal surgery preparations. The study recommends that the current Korean guidelines should be adapted to adequately reflect the medical status in Korea, to consider the medical environment of the various hospitals, and to establish more accurate and relevant guidelines.
Anti-Bacterial Agents ; Colon ; Colorectal Surgery ; Korea ; Polyethylene Glycols ; Postal Service ; Specialization ; Surveys and Questionnaires

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