BACKGROUND/AIMS: Diverticular bleeding can occasionally cause massive bleeding that requires urgent colonoscopy (CS) and treatment. The aim of this study was to identify significant risk factors for colonic diverticular hemorrhage. METHODS: Between January 2009 and December 2012, 26,602 patients underwent CS at our institution. One hundred twenty-three patients underwent an urgent CS due to acute lower gastrointestinal hemorrhage. Seventy-two patients were diagnosed with colonic diverticular hemorrhage. One hundred forty-nine age- and sex-matched controls were selected from the patients with nonbleeding diverticula who underwent CS during the same period. The relationship of risk factors to diverticular bleeding was compared between the cases and controls. RESULTS: Uni- and multivariate conditional logistic regression analyses demonstrated that the use of nonsteroidal anti-inflammatory drugs (odds ratio [OR], 14.70; 95% confidence interval [CI], 3.89 to 55.80; p<0.0001), as well as the presence of cerebrovascular disease (OR, 8.66; 95% CI, 2.33 to 32.10; p=0.00126), and hyperuricemia (OR, 15.5; 95% CI, 1.74 to 138.00; p=0.014) remained statistically significant predictors of diverticular bleeding. CONCLUSIONS: Nonsteroidal anti-inflammatory drugs, cerebrovascular disease and hyperuricemia were significant risks for colonic diverticular hemorrhage. The knowledge obtained from this study may provide some insight into the diagnostic process for patients with lower gastrointestinal bleeding.
Adult ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Case-Control Studies ; Cerebrovascular Disorders/complications ; Colonic Diseases/*etiology/surgery ; Colonoscopy ; Diverticulum, Colon/*complications/pathology/surgery ; Female ; Gastrointestinal Hemorrhage/*etiology/surgery ; Humans ; Hyperuricemia/complications ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

A 50-year-old Chinese man presented with abdominal pain associated with bloody mucoid stools, loss of appetite and weight loss. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a colocolic intussusception secondary to a lipoma. The patient subsequently underwent a left hemicolectomy. Clinical and imaging findings of intussusception in adults are discussed in this article.
Colectomy ; Colonic Diseases ; complications ; diagnostic imaging ; pathology ; surgery ; Colonic Neoplasms ; diagnostic imaging ; Humans ; Intussusception ; complications ; diagnostic imaging ; pathology ; surgery ; Lipoma ; complications ; diagnostic imaging ; Male ; Middle Aged ; Singapore

Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.
Aspirin/therapeutic use ; Colon/pathology ; Colonic Diseases/complications/*diagnosis/drug therapy ; Colonoscopy ; Drug Therapy, Combination ; Gastrointestinal Hemorrhage ; Humans ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Peritoneal Dialysis ; Recurrence ; Ticlopidine/therapeutic use ; Ulcer/complications/*diagnosis/drug therapy

OBJECTIVETo explore the effect of food allergy (FA) on the development of visceralgia sensibility and the substance P (SP) expression in colon of developing rats with FA.

METHODThree-week old female Sprague-Dawley (SD) rats were randomly divided into two groups (n = 10 in each). The rats in FA group were sensitized with ovalbumin (OVA) 40 µg and Al(OH)3 1 mg suspension solution (0.2 ml) intraperitoneal (i.p.) injection on day 0, only OVA 40 µg solution i.p. on day 2, 4, 7, 9, 11, respectively, and the rats were challenged by gavage with OVA solution 30 mg (2 ml) on day 20, 24, 28, 30. The rats in non-sensitized (NS) group were not challenged except handled in the same ways. The serum OVA-IgE were determined by enzyme-linked immuno sorbent assay (ELISA) on day 0, 30. Jejunum segments were used to observe morphological structure, the expression of eosinophils, and the density and the percentage of degranulation of mast cells (MC). The rats were appraised for the pain sensibility of intestinal tract under colorectal distension irritation by the electrophysiological method on external oblique in the 18-24 hr after the last challenge. Colons were used to analyze the expression of SP through immunohistochemical staining and computer image analyzing system.

RESULTThe serum OVA-IgE concentration and the eosinophils, mast cell, the percentage of mast cells degranulation in FA group were more than NS group (P < 0.01). The amplitudes of spike external oblique muscle of abdomen (EOMA, µV) of the FA group under the colorectal distension (CRD) pressures at 0, 15, 30, 45, 60, 75 mm Hg were (17.74 ± 0.72), (18.63 ± 1.72), (22.55 ± 1.70), (28.63 ± 7.00), (33.97 ± 7.34), (37.26 ± 8.40), and (17.43 ± 1.18), (17.27 ± 1.16), (17.73 ± 1.42), (19.55 ± 3.54), (23.29 ± 5.46), (25.20 ± 4.75) in NS group. With the CRD pressure increased, the amplitudes of spike EOMA increased significantly. There were significant differences between groups under the CRD pressures at 30, 45, 60, 75 mm Hg (F = 47.470, 13.367, 13.317, 15.390, P < 0.01). The expressions of colons SP in FA group and NS group are 247.12 ± 90.83 and 103.90 ± 58.94, respectively (t = 4.183, P < 0.01).

CONCLUSIONSensitization through i.p. pathway and challenge by gavage with OVA in early life could result in FA in young SD rats. FA in early life enabled the amplitudes of spike EOMA and the expression of colons SP increase significantly. It may be related to increase in amount and degranulation of MC and SP abnormal expression in colon, which could lead to the development of visceralgia sensibility.

Animals ; Colonic Diseases, Functional ; metabolism ; Disease Models, Animal ; Electrophysiology ; Female ; Food Hypersensitivity ; complications ; metabolism ; Hyperalgesia ; etiology ; metabolism ; physiopathology ; Intestinal Mucosa ; metabolism ; pathology ; Mast Cells ; metabolism ; Ovalbumin ; adverse effects ; Pain Threshold ; Rats ; Rats, Sprague-Dawley ; Stress, Psychological ; Substance P ; metabolism

No abstract available.
Colectomy/methods ; Colonic Neoplasms/*diagnosis ; Colonoscopy ; Endometriosis/complications/*diagnosis/pathology/surgery/ultrasonography ; *Endosonography ; Female ; Humans ; Laparoscopy ; Middle Aged ; Muscle Neoplasms/*diagnosis ; Pelvic Pain/etiology ; Predictive Value of Tests ; Sigmoid Diseases/complications/*diagnosis/pathology/surgery/ultrasonography

A 94-year-old female with end-stage renal disease presents with fever, fatigue, and hematochezia. She had previously resided in Hunan Province, China, and Myanmar, and she immigrated to Taiwan 30 years ago. Colonoscopy revealed a colonic ulcer. Biopsy of the colonic ulcer showed ulceration of the colonic mucosa, and many Paragonimus westermani-like eggs were noted. Serum IgG antibody levels showed strong reactivity with P. westermani excretory-secretory antigens by ELISA. Intestinal paragonimiasis was thus diagnosed according to the morphology of the eggs and serologic finding. After treatment with praziquantel, hematochezia resolved. The present case illustrates the extreme manifestations encountered in severe intestinal paragonimiasis.
Aged, 80 and over ; Animals ; Anthelmintics/therapeutic use ; Antibodies, Helminth/blood ; Antigens, Helminth/immunology ; Colonic Diseases/complications/drug therapy/*pathology ; Colonoscopy ; Enzyme-Linked Immunosorbent Assay ; Female ; Gastrointestinal Hemorrhage/complications/drug therapy/*pathology ; Humans ; Intestinal Diseases, Parasitic/complications/drug therapy/parasitology/*pathology ; Kidney Failure, Chronic/complications ; Paragonimiasis/complications/drug therapy/parasitology/*pathology ; Paragonimus westermani/*immunology ; Praziquantel/therapeutic use ; Taiwan ; Ulcer/complications/drug therapy/*pathology

No abstract available.
Adult ; Colonic Diseases/*diagnosis/etiology/surgery ; Colonoscopy ; Humans ; Intussusception/*diagnosis/etiology/surgery ; Lipoma/complications/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed

Antigens, CD20 ; metabolism ; CD5 Antigens ; metabolism ; Colonic Neoplasms ; complications ; metabolism ; pathology ; surgery ; Cyclin D1 ; metabolism ; Diagnosis, Differential ; Female ; Humans ; Ileal Diseases ; complications ; pathology ; surgery ; Ileocecal Valve ; Intestinal Neoplasms ; complications ; metabolism ; pathology ; surgery ; Intestinal Polyps ; complications ; metabolism ; pathology ; surgery ; Intussusception ; complications ; pathology ; surgery ; Leukemia, Lymphocytic, Chronic, B-Cell ; metabolism ; pathology ; Lymphoma, Mantle-Cell ; complications ; metabolism ; pathology ; surgery ; Middle Aged

OBJECTIVETo explore the significance of colonic epithelial cell apoptosis and tumor necrosis factor α (TNF-α) changing in pathogenesis of melanosis coli (MC) in guinea pig and the molecular mechanism of rhubarb (Rhu) in inducing the disease, by means of using different dosages of Rhu to induce the disease.

METHODSOne hundred and forty-four male guinea pigs, clean grade, were randomized according to their body weight into 5 groups, the untreated normal group and the 4 Rhu groups treated, respectively, with different doses of Rhu, 3 g/kg·d for low dose (Rhu-l) group, 6 g/kg·d for moderate dose (Rhu-m) group, 12 g/kg·d for high dose (Rhu-h) group and 24 g/kg·d for super-high dose (Rhu-s) group via gastric infusion. All animals were sacrificed 60 days later, their viscera were taken for observing the pathologic and morphologic changes with HE, melanin and melatonin staining, and the apoptosis of colonic epithelial cells was detected with TUNEL stain and transmission electric microscopy. In addition, the levels of TNF-α in serum and colonic tissue were measured using ELISA and RT-PCR.

RESULTSThe pathological changes of MC could be found by naked eye in all Rhu groups, especially apparent at caecum and proximal end of colon, but did not found in gallbladder, jejunum and ileum. In normal guinea pigs, the colonic membrane was pink in color with no apparent pigment deposition. Membranous color deepened in the Rhu groups depending on the dosage of Rhu used. MC scoring showed the highest scores revealed in the Rhu-s group (6.00±0.00), which was significantly different to those in the Rhu-l (3.86±0.69), Rhu-m (4.43±0.79) and Rhu-h groups (4.88±0.35, all P<0.05). Levels of cell apoptosis in colon and TNF-α in serum in all Rhu groups were higher than those in the normal group (P<0.01), but showed no significant difference among the Rhu groups (P>0.05). Moreover, a positive correlation was found in the degree of induced MC with apoptosis rate and TNF-α level.

CONCLUSIONSRhu (anthraquinone purgatives) had apparent effect on inducing MC; its molecular mechanism is maybe to destroy intestinal mucosal barrier and advance proinflammatory factor TNF-α releasing, which leads to colonic epithelial cells apoptosis, and finally induce the change of MC due to the deposition of brown pigments, i.e. the macrophage phagocytized apoptotic body, on the colonic membrane.

Animals ; Anthraquinones ; adverse effects ; Apoptosis ; drug effects ; Cathartics ; adverse effects ; Colon ; pathology ; ultrastructure ; Colonic Diseases ; blood ; chemically induced ; complications ; pathology ; Epithelial Cells ; drug effects ; pathology ; Gene Expression Regulation ; drug effects ; Guinea Pigs ; In Situ Nick-End Labeling ; Male ; Melanosis ; blood ; chemically induced ; complications ; pathology ; RNA, Messenger ; genetics ; metabolism ; Tumor Necrosis Factor-alpha ; blood ; genetics

Animals ; Colon ; blood supply ; pathology ; Colonic Diseases ; drug therapy ; etiology ; physiopathology ; Hemodynamics ; Hepatic Veins ; pathology ; physiopathology ; Hypertension, Portal ; complications ; physiopathology ; Intestinal Mucosa ; blood supply ; drug effects ; pathology ; Liver Cirrhosis, Experimental ; complications ; Losartan ; administration & dosage ; therapeutic use ; Male ; Microscopy ; Portal Pressure ; drug effects ; Random Allocation ; Rats ; Rats, Wistar