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Incidental Mesenteric Paraganglioma: A Case Report and Literature Review.

Jennie GRANGER ; Roy MAHAPATRA ; Bushra HAMID ; Katherine GILLESPIE ; Matthew FOK ; Dale VIMALACHANDRAN

Annals of Coloproctology.2017;33(5):197-200. doi:10.3393/ac.2017.33.5.197

Mesenteric paragangliomas are a rare entity; consequently, only 12 cases have been reported to date. Although considered benign and often found incidentally, they have the potential to metastasize and are an important diagnosis to consider for patients with a mesenteric tumor. We report the case of a 71-year-old woman who was found on magnetic resonance imaging to have an incidental, large, complex, intra-abdominal mass that had initially been misdiagnosed as ovarian in origin. She underwent an open resection of the tumor and adjacent small bowel with no perioperative complications; histology confirmed the mass to be a mesenteric paraganglioma. This case report highlights several important key issues regarding paraganglioma, including diagnosis, imaging, genetic testing, and surgical resection. The results of a literature review are also discussed.
Aged ; Diagnosis ; Female ; Genetic Testing ; Humans ; Magnetic Resonance Imaging ; Paraganglioma*

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Accuracy of Preoperative Local Staging of Primary Colorectal Cancer by Using Computed Tomography: Reappraisal Based on Data Collected at a Highly Organized Cancer Center.

Jung Sub SO ; Chinock CHEONG ; Seung Yeop OH ; Jei Hee LEE ; Young Bae KIM ; Kwang Wook SUH

Annals of Coloproctology.2017;33(5):192-196. doi:10.3393/ac.2017.33.5.192

PURPOSE: In patients with colorectal cancer, preoperative staging using various imaging technologies is important for establishing the treatment plan and predicting the prognosis. Although computed tomography (CT) has been used most widely, the versatility of CT accuracy was primarily because of the lack of specialization. In this study, we aimed to identify whether any advancement in abdominal CT accuracy in the prediction of local staging has occurred. METHODS: Between December 2014 and November 2015, patients with colorectal cancer were retrospectively enrolled. All CT findings were retrospectively reported. A total of 285 patients were included, and their retrospectively collected data were retrospectively reviewed, focusing on a comparison between preoperative and postoperative staging. RESULTS: The overall prediction accuracy of the T stage was 55.1%, with overstaging occurring in 63 (22.1%) and understaging in 65 patients (22.8%). The sensitivity and specificity were 90.0% and 68.4%, respectively. The overall prediction accuracy of the N stage was 54.7%, with overstaging occurring in 89 (31.2%) and understaging in 40 patients (14.1%). The sensitivity and specificity were 71.9% and 63.2%, respectively. The CT accuracies by pathologic stage were 0%, 62.2%, 25.3%, and 81.2% for stages 0 (Tis N0), I, II, and III, respectively. CONCLUSION: CT has good sensitivity for detecting colon cancers with tumor invasion beyond the bowel wall. However, detection of nodal involvement using CT is unreliable. In our opinion, abdominal CT alone has limitations in predicting the local staging of colorectal cancer, and additional technologies, such as CT plus positron emission tomography and/or colonography, will improve its accuracy.
Colonic Neoplasms ; Colorectal Neoplasms* ; Humans ; Neoplasm Staging ; Positron-Emission Tomography ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

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Laparoscopic and Robotic Surgeries for Patients With Colorectal Cancer Who Have Had a Previous Abdominal Surgery.

Soeun PARK ; Jeonghyun KANG ; Eun Jung PARK ; Seung Hyuk BAIK ; Kang Young LEE

Annals of Coloproctology.2017;33(5):184-191. doi:10.3393/ac.2017.33.5.184

PURPOSE: The impact of previous abdominal surgery (PAS) on surgical outcomes from laparoscopic and robot surgeries is inconclusive. This study aimed to investigate the impact of PAS on perioperative outcomes from laparoscopic and robotic colorectal surgeries. METHODS: From March 2007 to February 2014, a total of 612 and 238 patients underwent laparoscopic and robotic surgeries, respectively. Patients were divided into 3 groups: those who did not have a PAS (NPAS), those who had a major PAS, and those who had a minor PAS. We further divided the patients so that our final groups for analysis were: patients with NPAS (n = 478), major PAS (n = 19), and minor PAS (n = 115) in the laparoscopy group, and patients with NPAS (n = 202) and minor PAS (n = 36) in the robotic surgery group. RESULTS: In the laparoscopy group, no differences in the conversion rates between the 3 groups were noted (NPAS = 1.0% vs. major PAS = 0% vs. minor PAS = 1.7%, P = 0.701). In the robotic surgery group, the conversion rate did not differ between the NPAS group and the minor PAS group (1.0% vs. 2.8%, P = 0.390). Among the groups, neither the operation time, blood loss, days to soft diet, length of hospital stay, nor complication rate were affected by PAS. CONCLUSION: PAS did not jeopardize the perioperative outcomes for either laparoscopic or robotic colorectal surgeries. Therefore, PAS should not be regarded as an absolute contraindication for minimally invasive colorectal surgeries.
Colectomy ; Colorectal Neoplasms* ; Colorectal Surgery ; Diet ; Humans ; Laparoscopy ; Length of Stay

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Clinical Features and Factors Associated With Surgical Treatment in Patients With Complicated Colonic Diverticulitis.

Pill Sun PAIK ; Jung A YUN

Annals of Coloproctology.2017;33(5):178-183. doi:10.3393/ac.2017.33.5.178

PURPOSE: Colonic diverticulitis is uncommon in Korea, but the incidence is rapidly increasing nowadays. The clinical features and the factors associated with complications of diverticulitis are important for properly treating the disease. METHODS: A retrospective review of the medical records of 225 patients that were prospectively collected between October 2007 and September 2016 was conducted. RESULTS: Diverticulitis was detected mainly in men and women aged 30 to 50 years. Diverticulitis more frequently affected the right colon (n = 194, 86.2%), but age was higher in case of left colonic involvement (42 years vs. 57 years, P < 0.001). Percentages of comorbidities (65.6% vs. 23.8%, P < 0.001), complications (65.6% vs. 6.2%, P < 0.001), and surgical treatment (50.0% vs. 4.1%, P < 0.001) were significantly higher in patients with left colonic diverticulitis. In the multivariate analysis, a risk factor for complicated diverticulitis was left colonic involvement (P < 0.001; relative risk [RR], 47.108; 95% confidence interval [CI], 12.651–175.413). In complicated diverticulitis, age over 50 was the only significant risk factor for surgical treatment (P = 0.024; RR, 19.350; 95% CI, 1.474–254.023). CONCLUSION: In patients over 50 years of age with left colonic diverticulitis, a preventive colectomy should be reconsidered as one of the options for treatment.
Colectomy ; Colon* ; Comorbidity ; Diverticulitis ; Diverticulitis, Colonic* ; Female ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Multivariate Analysis ; Prospective Studies ; Retrospective Studies ; Risk Factors

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Does Anastomosis Configuration Influence Long-term Outcomes in Patients With Crohn Disease?.

Parajuli ANUJ ; Yong Sik YOON ; Chang Sik YU ; Jong Lyul LEE ; Chan Wook KIM ; In Ja PARK ; Seok Byung LIM ; Jin Cheon KIM

Annals of Coloproctology.2017;33(5):173-177. doi:10.3393/ac.2017.33.5.173

PURPOSE: In this study, we evaluated the role of various anastomoses in surgical recurrence for patients with Crohn disease (CD). METHODS: We analyzed data retrospectively from consecutive laparotomy cases involving complicated CD between 1991 and 2008. Clinical data were compared in terms of reoperation-free survival (RFS) according to the types of anastomoses, the materials used for the anastomoses, and the operating surgeon. RESULTS: Of 233 patients with entero-enteric or entero-colic anastomoses, 199 (85%), 11 (5%), and 23 (10%) experienced side-to-side (SS), side-to-end (SE), and end-to-end (EE) anastomoses, respectively. The SS group had the following characteristics: more extensive bowel involvement, frequent obstruction, and greater stapler use; the SS anastomoses were also frequently made by specialized surgeons (P < 0.001–0.004). EE anastomoses were frequently made by general surgeons using a hand-sewing technique (P < 0.001). No differences in RFS were noted among the 3 groups according to the type of anastomosis and the operating surgeon. However, the hand-sewn group showed better RFS than the stapler group (P = 0.04). CONCLUSION: The roles of the anastomotic configuration, the material used, and the operating surgeon were not significantly correlated with reoperations or complications in our retrospective CD cohort, irrespective of the higher risk of anastomosis site stricture for EE anastomoses.
Cohort Studies ; Constriction, Pathologic ; Crohn Disease* ; Humans ; Inflammatory Bowel Diseases ; Laparotomy ; Recurrence ; Retrospective Studies ; Surgeons ; Treatment Outcome

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Association of LCT-13910 C/T Polymorphism and Colorectal Cancer.

Genco GENÇDAL ; Esin SALMAN ; Omer ÖZÜTEMIZ ; Ulus S AKARCA

Annals of Coloproctology.2017;33(5):169-172. doi:10.3393/ac.2017.33.5.169

PURPOSE: The activity of epithelial lactase (LCT) is associated with a polymorphism 13910 bp upstream in the lactase encoding gene. Because the association between the LCT-13910 polymorphism and the risk for colorectal cancer is not clear, we investigated the role of the LCT-13910 polymorphism as a potential risk factor for colorectal cancer and colorectal polyps in the Turkish population. METHODS: One hundred sixty-six subjects (74 with polyps, 44 with colorectal cancer, 48 controls), who had undergone a total colonoscopy between January 2012 and November 2012 in our endoscopy unit were genotyped for the LCT-13910 polymorphism by using the polymerase chain reaction and minisequencing. RESULTS: The CC genotype in the lactose gene 13910 locus, which is accepted as the genetic indicator of lactase deficiency, was determined as 83.7%. The CC genotype rate was determined as 89.1% in patients who had a history of lactose intolerance and 81.5% in those without a history of lactose intolerance (P = 0.236). No difference was detected between the patients who had colorectal polyp(s) and/or cancer and the controls with regard to the LCT-13910 polymorphism. No differences were determined between groups when they were compared with regard to the C or the T allele. CONCLUSION: No differences were detected between the patients who had colorectal polyp(s) and/or cancer and those with normal colonoscopy findings with regard to lactase gene polymorphisms. No differences were determined between the groups when they were compared with regard to the C or the T allele.
Adenocarcinoma ; Alleles ; Colonoscopy ; Colorectal Neoplasms* ; Endoscopy ; Genotype ; Humans ; Lactase ; Lactose ; Lactose Intolerance ; Polymerase Chain Reaction ; Polyps ; Risk Factors

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Electrophysiological Basis of Fecal Incontinence and Its Implications for Treatment.

Elroy Patrick WELEDJI

Annals of Coloproctology.2017;33(5):161-168. doi:10.3393/ac.2017.33.5.161

The majority of patients with neuropathic incontinence and other pelvic floor conditions associated with straining at stool have damage to the pudendal nerves distal to the ischial spine. Sacral nerve stimulation appears to be a promising innovation and has been widely adopted and currently considered the standard of care for adults with moderate to severe fecal incontinence and following failed sphincter repair. From a decision-to-treat perspective, the short-term efficacy is good (70%–80%), but the long-term efficacy of sacral nerve stimulation is around 50%. Newer electrophysiological tests and improved anal endosonography would more effectively guide clinical decision making.
Adult ; Biofeedback, Psychology ; Clinical Decision-Making ; Electrophysiology ; Endosonography ; Fecal Incontinence* ; Humans ; Pelvic Floor ; Pudendal Nerve ; Spine ; Standard of Care

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Correlation Between Anastomotic Configuration and Long-term Outcomes in Surgery for Crohn Disease.

Jin Su KIM ; Ji Yeon KIM

Annals of Coloproctology.2017;33(5):159-160. doi:10.3393/ac.2017.33.5.159

No abstract available.
Crohn Disease*

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Lactose Intolerance and Colorectal Cancer.

Jong Woo KIM

Annals of Coloproctology.2017;33(5):157-158. doi:10.3393/ac.2017.33.5.157

No abstract available.
Colorectal Neoplasms* ; Lactose Intolerance* ; Lactose*

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Acute Hyponatremia With Seizure and Mental Change After Oral Sodium Picosulfate/Magnesium Citrate Bowel Preparation.

Young Sun CHO ; Kyung Min NAM ; Jang Ho PARK ; Sang Hwan BYUN ; Jin Suck RYU ; Hyun Ju KIM

Annals of Coloproctology.2014;30(6):290-293. doi:10.3393/ac.2014.30.6.290

Sodium picosulfate/magnesium citrate (Picolight Powder), which is used as a bowel preparation for the colon and the rectum, can cause a severe electrolyte imbalance like hyponatremia. When hyponatremia gets severe or occurs rapidly, it can lead to death due to associated complications. We have experienced a case of hyponatremia associated with seizure and loss of consciousness in a 76-year-old woman, who took sodium picosulfate/magnesium citrate as a bowel preparation for colonoscopy. She was taking thiazide and synthroid for the treatment of hypertension and hypothyroidism, respectively, and she had other underlying medical conditions such as a history of seizure and dementia. Following the diagnosis of hyponatremia, we used an intravenous injection of 3% NaCl to normalize the sodium level in her serum, and her associated symptoms soon disappeared.
Aged ; Citric Acid* ; Colon ; Colonoscopy ; Dementia ; Diagnosis ; Female ; Humans ; Hypertension ; Hyponatremia* ; Hypothyroidism ; Injections, Intravenous ; Rectum ; Seizures* ; Sodium* ; Thyroxine ; Unconsciousness

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