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Efficacy of Immunohistochemical Staining in Differentiating a Squamous Cell Carcinoma in Poorly Differentiated Rectal Cancer: Two Case Reports.

Sairafi RAMI ; Yoon Dae HAN ; Mi JANG ; Min Soo CHO ; Hyuk HUR ; Byung Soh MIN ; Kang Young LEE ; Nam Kyu KIM

Annals of Coloproctology.2016;32(4):150-155. doi:10.3393/ac.2016.32.4.150

A rectal carcinoma, including primary an adenosquamous and a squamous cell carcinoma (SCC), is a very rare disease, accounting for 0.025% to 0.20% of all large-bowel malignant tumors. Because SCCs have a higher mortality than adenosquamous carcinomas, determining whether the primary rectal cancer exhibits an adenomatous component or a squamous component is important. While differentiating between these 2 components, especially in poorly differentiated rectal cancer, is difficult, specific immunohistochemical stains enable accurate diagnoses. Here, we report the use of immunohistochemical stains to distinguish between the adenomatous and the squamous components in 2 patients with low rectal cancer, a 58-year-old man and a 73-year-old woman, who were initially diagnosed using the histopathologic results for a poorly differentiated carcinoma. These data suggest that using these immunohistochemical stains will help to accurately diagnose the type of rectal cancer, especially for poorly differentiated carcinomas, and will provide important information to determine the proper treatment for the patient.
Aged ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell* ; Coloring Agents ; Diagnosis ; Epithelial Cells* ; Female ; Humans ; Immunohistochemistry ; Middle Aged ; Mortality ; Rare Diseases ; Rectal Neoplasms*

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Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial.

Mina ALVANDIPOUR ; Babak GHAREDAGHI ; Hamed KHODABAKHSH ; Mohammad Yasin KARAMI

Annals of Coloproctology.2016;32(4):144-149. doi:10.3393/ac.2016.32.4.144

PURPOSE: Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. METHODS: This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. RESULTS: Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). CONCLUSION: After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.
Cicatrix ; Humans ; Ileostomy* ; Incidence ; Methods ; Patient Satisfaction ; Skin* ; Surgical Stomas ; Wound Infection ; Wounds and Injuries*

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Outcome of Colorectal Surgery in Elderly Populations.

Mostafa SHALABY ; Nicola DI LORENZO ; Luana FRANCESCHILLI ; Federico PERRONE ; Giulio P ANGELUCCI ; Silvia QUAREISMA ; Achille L GASPARI ; Pierpaolo SILERI

Annals of Coloproctology.2016;32(4):139-143. doi:10.3393/ac.2016.32.4.139

PURPOSE: The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. METHODS: The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. RESULTS: A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. CONCLUSION: Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.
Aged* ; Body Mass Index ; Colorectal Neoplasms ; Colorectal Surgery* ; Comorbidity ; Female ; Humans ; Intraoperative Complications ; Male ; Mortality ; Retrospective Studies

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Outcomes and Risk Factors Affecting Mortality in Patients Who Underwent Colorectal Emergency Surgery.

Nam Ho OH ; Kyung Jong KIM

Annals of Coloproctology.2016;32(4):133-138. doi:10.3393/ac.2016.32.4.133

PURPOSE: Emergency colorectal surgery has a high risk of mortality and morbidity because of incomplete bowel preparation, bacterial proliferation, and contamination. In this study, we investigated the outcomes and the risk factors affecting mortality in patients who had undergone emergency surgery for the treatment of various colorectal diseases. METHODS: This study is a retrospective analysis of prospectively collected data to survey the clinical results for patients who had undergone emergency colorectal surgery from January 2014 to December 2014. We analyzed various clinicopathologic factors, which were divided into 3 categories: preoperative, intraoperative, and postoperative. RESULTS: A total of 50 patients had undergone emergency colorectal surgery during the time period covered by this study. Among them, 10 patients (20%) died during the postoperative period. A simple linear regression analysis showed that the risk factors for mortality were old age, preoperative hypotension, and a high American Society of Anesthesiologist (ASA) score. Moreover, a multiple linear regression analysis showed a high ASA score and preoperative hypotension to be independent risk factors. CONCLUSION: In this study, emergency colorectal surgery showed a relatively high mortality rate. Furthermore, the independent risk factors for mortality were preoperative hypotension and high ASA score; thus, patients with these characteristics need to be evaluated more carefully and receive better care if the mortality rate is to be reduced.
Colorectal Surgery ; Emergencies* ; Humans ; Hypotension ; Linear Models ; Mortality* ; Postoperative Period ; Prospective Studies ; Retrospective Studies ; Risk Factors*

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Effect of Social Deprivation on the Stage and Mode of Presentation of Colorectal Cancer.

Ahmed ELHADI ; Sarah ASHFORD-WILSON ; Stephanie BROWN ; Atanu PAL ; Roshan LAL ; Kamal ARYAL

Annals of Coloproctology.2016;32(4):128-132. doi:10.3393/ac.2016.32.4.128

PURPOSE: Based in a hospital serving one of the most deprived areas in the United Kingdom (UK), we aimed to investigate, using the Indices of Deprivation 2010, the hypothesis that deprivation affects the stage and mode of presentation of colorectal cancer. METHODS: All newly diagnosed patients with colorectal cancer presenting to a District General Hospital in the UK between January 2010 and December 2014 were included. Data were collected from the Somerset National Cancer Database. The effect of social deprivation, measured using the Index of Multiple Deprivation Score, on the stage and mode of presentation was evaluated utilizing Microsoft Excel and IBM SPSS ver. 22.0. RESULTS: A total of 701 patients (54.5% male; mean age, 76 years) were included; 534 (76.2%) underwent a surgical procedure, and 497 (70.9%) underwent a colorectal resection. Of the patients undergoing a colorectal resection, 86 (17.3%) had an emergency surgical resection. Social deprivation was associated with Duke staging (P = 0.09). The 90-day mortality in patients undergoing emergency surgery was 12.8% compared to 6.8% in patients undergoing elective surgery (P = 0.06). No association was found between deprivation and emergency presentation (P = 0.97). A logistic regression analysis showed no increase in the probability of metastasis amongst deprived patients. CONCLUSION: This study suggests an association between deprivation and the stage of presentation of colorectal cancer. Patients undergoing emergency surgery tend to have a higher 90-day mortality rate, although this was not related to deprivation. This study highlights the need to develop an individual measure to assess social deprivation.
Colorectal Neoplasms* ; Emergencies ; Great Britain ; Hospitals, General ; Humans ; Logistic Models ; Male ; Mortality ; Neoplasm Metastasis ; Social Class

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Colorectal Surgery in Elderly Patients.

Byung Chun KIM

Annals of Coloproctology.2016;32(4):126-127. doi:10.3393/ac.2016.32.4.126

No abstract available.
Aged* ; Colorectal Surgery* ; Humans

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Emergent Colorectal Surgery: What Should Be Considered?.

Chang Nam KIM

Annals of Coloproctology.2016;32(4):124-125. doi:10.3393/ac.2016.32.4.124

No abstract available.
Colorectal Surgery*

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Is A Mode of Presentation of Colorectal Cancer Different According to Each Individual's Social-economic Status?.

Chinock CHEONG ; Nam Kyu KIM

Annals of Coloproctology.2016;32(4):123-123. doi:10.3393/ac.2016.32.4.123

No abstract available.
Colorectal Neoplasms*

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Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage.

Takashi SAKAMOTO ; Akira SAITO ; Alan Kawarai LEFOR ; Tadao KUBOTA

Annals of Coloproctology.2016;32(6):239-242. doi:10.3393/ac.2016.32.6.239

Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.
Abdominal Pain ; Adult ; Colon* ; Colon, Ascending ; Hematoma ; Hemorrhage* ; Humans ; Ischemia ; Male

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Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection.

Hee Cheul JUNG ; Hyun Jin KIM ; Sung Bok JI ; Jun Hyeong CHO ; Ji Hye KWAK ; Chang Min LEE ; Wan Soo KIM ; Jin Ju KIM ; Jae Min LEE ; Sang Su LEE

Annals of Coloproctology.2016;32(6):234-238. doi:10.3393/ac.2016.32.6.234

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.
Colon ; Colon, Sigmoid ; Colonoscopy ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

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