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05/01/1997 12:00 AM
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Outpatient Bowel Preparation For Elective Colon Resection
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colon; To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary anastomosis. Patients who required protective proximal stoma were excluded. Patients requiring emergency surgery, colostomy closure, and restorative proctocolectomy were excluded. Patients were separated into two groups equally matched by age, sex, procedure done, and comorbidity: 145 had bowel preparation as outpatients and 174 as inpatients. Both groups had similar numbers of days hospitalized, days receiving nothing by mouth, and days requiring nasogastric intubation or gastrostomy tube, as well as similar postoperative complications. There was one wound infection, one anastomotic leak, and one death in each group. Cost of outpatient preparation was approximately $40. Cost of inpatient preparation, including a semiprivate room, was approximately $400. Outpatient preparation with polyethylene glycol-electrolyte lavage solution and oral antibiotics before elective colon resection can be done with equivalent safety and at a substantial cost savings.
(C) 1997 Southern Medical Association
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07/01/1990 12:00 AM
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Surveillance Colonoscopy After Resection for Colon Carcinoma
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colon; Periodic surveillance colonoscopy was used to assess 207 asymptomatic patients with a previous history of colorectal carcinoma for 2 to 8 years. Thirty-five percent of the patients had a neoplastic lesion >=5 mm in diameter on initial colonoscopy. Synchronous or metachronous carcinomas were found in 11 patients; and of these second carcinomas, 82% were localized. The risk of a second carcinoma developing did not correlate with a finding of neoplastic polyps on the initial colonoscopy. Six recurrent carcinomas at the anastomosis were demonstrated. The stage of the recurrence correlated well with the stage of the primary carcinoma. Two negative colonoscopies at 1-year intervals were necessary to ensure that the colon had been cleared of neoplastic lesions. This study shows that surveillance colonoscopy in patients with a history of colorectal carcinoma has a high yield and is capable of detecting localized, asymptomatic carcinoma. After two annual colonoscopies fail to show neoplasms, surveillance colonoscopy may be scheduled at 3- to 5-year intervals.
(C) 1990 Southern Medical Association
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02/01/1919 12:00 AM
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Resection of the Cecum and Ascending Colon
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Resection of the Cecum and Ascending Colon .
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08/01/1917 12:00 AM
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Resection of the Descending Colon and Rectum
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Resection of the Descending Colon and Rectum.
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09/01/1991 12:00 AM
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Long-Term Results of Hepatic Resection for Colon Cancer
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LONG-TERM RESULTS OF HEPATIC RESECTION FOR COLON CANCER.
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09/01/1977 12:00 AM
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Is Postoperative Proximal Decompression a Necessary Complement to Elective Colon Resection?
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Postoperative nasogastric suction is not a necessary complement to elective colon resection. We studied two groups of patients who had elective colon resection: nasogastric suction was used in the postoperative management of 53 patients, while 23 patients were managed without nasogastric suction. The morbidity and mortality rates were comparable in the two groups.
(C) 1977 Southern Medical Association
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09/01/1966 12:00 AM
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The Trend Toward Prophylactic Resection in Diverticular Disease of the Colon
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This paper reviews what is known of the pathogenesis of this disease and an explanation of how complications arise. The author believes that certain clinical signposts point to a need for prophylactic resection of the diseased section of the colon.
(C) 1966 Southern Medical Association
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09/01/1993 12:00 AM
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Does Xylene Mesenteric Fat Clearance Improve Lymph Node Harvest After Colon Resection?
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DOES XYLENE MESENTERIC FAT CLEARANCE IMPROVE LYMPH NODE HARVEST AFTER COLON RESECTION ? Colon & Rectal Surgery: PDF Only
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10/01/2009 12:00 AM
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Giant Ulcerated Lipoma of the Colon Causing Iron Deficiency Anemia Successfully Treated with Endoscopic Ultrasound-Assisted Resection
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Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.
(C) 2009 Southern Medical Association
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10/01/1997 12:00 AM
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Oncology: LAPAROSCOPIC COLON RESECTION IS EMERGING AS SAFE AND EFFECTIVE THERAPY FOR COLORECTAL CANCER
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LAPAROSCOPIC COLON RESECTION IS EMERGING AS SAFE AND EFFECTIVE THERAPY FOR COLORECTAL CANCER.
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11/01/1951 12:00 AM
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Volvulus of the Colon
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Three cases of volvulus of the sigmoid are reported, treated by intubation and laparotomy. Attention is called to the possibility of conservative management without laparotomy by intubation via proctoscope. Prompt diagnosis by physical and x-ray findings, and the absence of leukocytosis or gangrene seen by proctoscope, make the conservative treatment ideal. Review of literature shows advisability of resection only in recurrent cases during free interval, or in those cases with existing gangrene. In the latter type, the Mikulicz resection, while safest and most easily done, can be used only where all the gangrenous loop can be extruded, and this is seldom possible due to the location of the distal loop strangulation. End-to-end and side-to-side anastomoses are attended with real difficulties due to the condition of the proximal bowel and fixation of the distal loop. None of our cases was attended by gangrene.
(C) 1951 Southern Medical Association
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09/01/1991 12:00 AM
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Total Pelvic Exenteration With or Without Sacral Resection in Patients With Recurrent Rectal Cancer
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TOTAL PELVIC EXENTERATION WITH OR WITHOUT SACRAL RESECTION IN PATIENTS WITH RECURRENT RECTAL CANCER. COLON & RECTAL SURGERY: PDF Only of Surgery and Colon and Rectal Surgery, Alton Ochsner Medical Foundation, New Orleans, La.
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10/01/1998 12:00 AM
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Adenocarcinoma Cells Harvested From Peritoneal Washings During Resection of Colo-Rectal Carcinoma: Comparison of Open Versus Laparoscopic Techniques
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ADENOCARCINOMA CELLS HARVESTED FROM PERITONEAL WASHINGS DURING RESECTION OF COLO-RECTAL CARCINOMA: Colon & Rectal Surgery: PDF Only Departments of Colon and Rectal Surgery and Pathology, Orlando Regional Healthcare System, Orlando,
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01/01/1990 12:00 AM
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Major Hepatic Resection: An Update
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colon; In 1981, we reported a series of 75 major hepatic resections done over a ten-year period; 58 were for hepatic trauma, nine were for benign disease, and eight were for malignant disease. Since that report, the indications for major hepatic resection have changed, with a more conservative approach to hepatic trauma and a more aggressive approach toward hepatic tumors. In this update, we report 88 hepatic resections from Vanderbilt University Hospital and Metropolitan Nashville General Hospital; 32 were for trauma, 25 were for benign disorders, and 31 were for malignant disease. Since 1977, nine adults and four children have had hepatic resection for primary malignant tumors; there were six hepatocellular lesions, three hepatoblastomas, two malignant hemangioendotheliomas, one malignant hepatoma, and one intrahepatic cholangiocarcinoma. At the time of this writing, the four children have survived for 7.3, 6, 6, and 3.8 years (mean 5.7), and all are alive without evidence of recurrence. For the nine adults, survival has averaged 1.7 years, excluding one postoperative death. Three adult patients are alive at this writing, one of whom is a five-year survivor without evidence of disease. Seventeen adults and one child had hepatic resection for metastatic lesions. In the adults, the primary tumor was in the colon in 14 cases and in the small bowel, stomach, and an unknown site in one case each. The one child had a metastatic Wilms' tumor. Survival has averaged two years, with two long-term survivors (nine years). Six patients are alive at this time. Operative mortality for elective resection has decreased from 12% (2/17) in our earlier report to 3% (1/31) in this series, which has encouraged us to assume a more aggressive approach to the resection of malignant primary and metastatic liver tumors.
(C) 1990 Southern Medical Association
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03/01/1994 12:00 AM
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Total Pelvic Exenteration With or Without Sacral Resection in Patients With Recurrent Colorectal Cancer
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colon; Pelvic recurrence from colorectal cancer produces significant morbidity. Radiation can help palliate the pain produced by this recurrence. Frequently patients with recurrent colorectal cancer will progress to a constant unrelenting pain and obstructive uropathy with sacral and bladder involvement. These patients can be candidates for an aggressive surgical resection with the hope of significant palliation and prolonged survival. From October 1988 to December 1991, six patients had total pelvic exenteration at our institution. Of these six patients, two had en bloc sacral resection at levels S1-S2 and one at S2-S3. Two patients had residual disease at the time of primary surgery, and in the other four patients, recurrence occurred 7 to 48 months after primary resection. One patient died with disease at 7 months, and five patients are alive at 9, 25, 25, 37, and 37 months since the pelvic resection; four have no evidence of disease. The present Karnofsky performance status is 80% or greater in all patients. There were no operative deaths. Of the five living patients, the survival from diagnosis of the primary lesion is 25 to 97 months. Total pelvic exenteration and abdomino-sacral exenteration can produce significant palliation and prolong survival in a selected group of patients with pelvic recurrence from colorectal cancer.
(C) 1994 Southern Medical Association
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08/01/1960 12:00 AM
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Volvulus of the Sigmoid Colon
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From a small series of cases the authors deduce that sigmoidoscopic intubation, if successful, is usually followed by subsequent bouts of recurrent volvulus, and that resection is usually needed. They review the clinical picture.
(C) 1960 Southern Medical Association
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01/01/1975 12:00 AM
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Volvulus of the Sigmoid Colon
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A study of 37 patients with sigmoid volvulus is presented. Subsequent bouts of recurrent volvulus are very common after sigmoidoscopic intubation, and overall mortality rates are high. Surgical resection is the preferred method of treatment.
(C) 1975 Southern Medical Association
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09/01/1993 12:00 AM
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Abdominoperineal Resection for Rectal Malignancy
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ABDOMINOPERINEAL RESECTION FOR RECTAL MALIGNANCY. Colon & Rectal Surgery: PDF Only
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02/01/1983 12:00 AM
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Transverse Colon Volvulus: Diagnosis and Treatment
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ABSTACT: Although considered rare, transverse colon volvulus (TCV) may actually comprise as many as 10% of all cases of colon volvulus. Correct identification clinically is necessary in order to reduce the high mortality. Unlike the treatment of sigmoid volvulus, conservative treatment of TCV is thought to be inadequate. Furthermore, simple proximal colostomy may lead to bowel necrosis. Bowel resection, rather than detorsion procedures, is advocated. The barium or diatrizoate enema examination can readily differentiate TCV from sigmoid and cecal volvulus if one pays careful attention to detail.
(C) 1983 Southern Medical Association
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07/01/1965 12:00 AM
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Endometriosis of the Colon: Sigmoid, Rectosigmoid and Rectovaginal Septum
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Endometriosis is not the rare disease it was thought to be in the past. Its diagnosis is not uncommonly difficult. The two papers which follow consider the clinical picture when endometriosis involves the lower bowel. Surgical management of this disease has undergone radical changes in recent years, and resection of the bowel is mandatory under certain circumstances. In any event, preoperative preparation of the bowel seems imperative, and the surgeon should be prepared to undertake partial or complete resections of the bowel with end-to-end anastomosis.
(C) 1965 Southern Medical Association
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05/01/1998 12:00 AM
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Carcinoma of the Colon: An Unusual Cause of Prolonged Fever
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colon; Solid tumors rarely present with fever. Among those that do, carcinoma of the colon has been infrequently reported as a primary cause of fever. This patient had carcinoma of the right colon with prolonged fever, but no evidence of infection or gastrointestinal symptoms. At surgical resection, a caecal adenocarcinoma was found with metastases to the mesentery and 10 of 40 lymph nodes. The patient's fever resolved after 3 days. The patient remained healthy during 8 years of follow-up. Right-sided colon cancer is not often considered in the complete evaluation of fever of undetermined cause.
(C) 1998 Southern Medical Association
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08/01/1967 12:00 AM
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Treatment of Perforating Wounds of the Colon and Rectum: A Revaluation
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The authors present their experience with primary suture or resection for injuries to the colon or rectum. The outcome with such management is highly successful and requires shorter hospitalization. The fatal cases in their series were in patients with injuries to other organs or structures over and above those of the large bowel.
(C) 1967 Southern Medical Association
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08/01/1985 12:00 AM
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Hepatic Resection in Cirrhotic Patients
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colon; Cirrhotic patients are at increased risk for the development of hepatocellular carcinoma, and surgical resection of the involved liver represents the only effective mode of therapy. The presence of cirrhosis significantly complicates hepatic resection. We describe the clinical course of a patient with ruptured hepatoma localized to the lateral segment of the left lobe. This case illustrates many of the problems encountered during hepatic resections in cirrhotic patients, which should be limited to segmental or subsegmental resections. Preoperative attention to bleeding and nutrition, meticulous intraoperative hemostasis, and postoperative management of any pulmonary complications, ascites, and renal or hepatic failure are mandatory for successful management.
(C) 1985 Southern Medical Association
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11/01/1978 12:00 AM
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Diverticular Disease of the Colon: Surgical Management at a Military Hospital
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A recent review of the surgical management of diverticular disease of the colon included 73 patients. One-stage resections were accomplished in 67%, primarily in patients operated on electively for recurrent diverticulitis or fistula, and in the group of patients with cecal diverticulitis operated on for presumed appendicitis. Single-stage resection with ileorectal anastomosis is also preferred in patients with massive diverticular bleeding. For patients with large abscesses or diffuse peritonitis a two-stage procedure which removes the site of disease in the initial operation is recommended. There were no deaths and a lower incidence of complications in the group of patients who had elective operations for recurrent diverticulitis and fistula.
(C) 1978 Southern Medical Association
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02/01/1975 12:00 AM
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One Hundred Consecutive Operations for Diverticulitis of the Colon
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This report describes 100 consecutive patients treated surgically for diverticulities of the colon. The main indications for operation were recurrent attacks (33), rapid progresive symptoms 917), bleeding (16), palpable mass (14), or combinatoins of the above. Eight-four patients had primary resection (two deaths), ten had staged procedure (two deaths), and six had Hartmann procedures (one death). The mortality was highest in staged procedures as this group of patients included those with complicatiuos resulting in the greatest operative risks. No deaths occured in the elective cases. In 25 cases, various complications developed. The most common was wound infection and sepsis. The five deaths in the series are reported in detail with an evaluatio of possible alternative methods of treatment. Follow-up of the series showed only one recurrence in the two years after operation.
(C) 1975 Southern Medical Association
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03/01/1997 12:00 AM
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Successful Resection of Multifocal Hepatic Adenoma During Pregnancy
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colon; Hepatic adenoma is an unusual complication of pregnancy. Most of these lesions are solitary and associated with hormonal contraceptives. We believe ours is the first case of successful resection of multifocal hepatic adenoma during pregnancy in a patient with no history of oral contraceptive use.
(C) 1997 Southern Medical Association
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06/01/1974 12:00 AM
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Endometriosis of the Colon: Report of 14 Patients Requiring Partial Colectomy
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Reviewed are the clinical, radiologie, operative and pathologic findings and the results in 14 women (ages 31 to 51 years) requiring partial colectomy for endometriosis. All had symptoms related to the lesion of the colon; eight had gynecologic symptoms. In only four instances did the physical examination reveal a palpable mass. Most important in making the preoperative diagnosis is radiographie examination of the colon (barium enema). In common localized endometrioma, features are those of an eccentric intramural, submucosal lesion with transverse ridging. More extensive endometriosis is more difficult to differentiate from carcinoma by radiographie means. Operative diagnosis, which was less accurate than radiologie diagnosis, should be suggested by uninvolved mucosa on examination of the unopened colon and frozen section diagnosis of endometriosis on an implant. When endometriosis of the colon is of a degree sufficient to cause symptoms, partial colectomy should be done; oophorectomy only, without resection, is not recommended.
(C) 1974 Southern Medical Association
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09/01/1991 12:00 AM
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Laparoscopically Assisted Anterior Rectal Wall Resection and Reanastomosis for Deeply Infiltrating Endometriosis
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RECTAL WALL RESECTION AND REANASTOMOSIS FOR DEEPLY INFILTRATING ENDOMETRIOSIS. COLON & RECTAL SURGERY: PDF Only
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02/01/1994 12:00 AM
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Surgical Management of the Temporomandibular Joint in Resection of Regional Tumors
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colon; The temporomandibular joint (TMJ) may require surgical violation or resection when involved in primary malignant or benign tumors of bone, regional tumors of the oral cavity adjacent to the mandible or with mandibular erosion, or in soft tissue tumors around the joint. The TMJ may require total resection with or without reconstruction, subtotal resection with preservation of the glenoid fossa and meniscus, resection of the capsule with dermal graft reconstruction, condylar resection with reconstruction, or subcondylar resection with mandibular reconstruction. TMJ anatomy is important in using joint structures as margins in resection of tumors, in preservation of uninvolved structures to obtain maximum joint function after surgery, and in reconstruction of ablated structures to reestablish joint function. Surgical cases are presented to illustrate surgical management and rehabilitation of the TMJ.
(C) 1994 Southern Medical Association
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03/01/1994 12:00 AM
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Postoperative Hyperthermia in a Patient Having Cortical Brain Resection
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colon; When a profound fever occurs in a surgical patient, clinicians usually start thinking about the malignant hyperthermia syndrome. Simple consideration of the clinical situation, the patient's medical history, and a few rapid laboratory assessments are enough to direct appropriate treatment.
(C) 1994 Southern Medical Association
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03/01/1974 12:00 AM
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Urologic Complications in Malignant Disease of the Rectosigmoid Colon
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colon; In order to evaluate the urologic complications following operation for malignant disease of the rectosigmoid colon, 68 patients were given thorough, preoperative urologic examinations. Microscopic study and cultures of the urine should be made of every patient before operation. Preoperative treatment of infection reduces the risk of postoperative infectious complications. The most severe complications arise from the surgical procedures themselves. Routine catheterization of the patient should be employed to protect the bladder from sagging and the detrusor muscle from being weakened. Neither preoperative nor simultaneous prostatectomy should be attempted in these patients. Perineal prostatectomy during abdominoperineal resection may lead to a urinary fistula. The risk of injury to the nerve supply of the bladder is reduced to a minimum if the surgeon locates the proper plane of dissection. Careful dissection also is required during the perineal stage to avoid damage of the urethra and the prostate.
(C) 1974 Southern Medical Association
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02/01/1994 12:00 AM
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Transesophageal Echocardiography During Resection of Renal Cell Carcinoma Involving the Inferior Vena Cava
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colon; We present a case of renal cell carcinoma extending into the inferior vena cava and resulting in total occlusion. Perioperative transesophageal echocardiography allowed us to assess cardiac function, follow the extent of vascular involvement, and prevent embolization of tumor and air.
(C) 1994 Southern Medical Association
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10/01/2008 12:00 AM
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Perforated Stercoral Ulcer of the Sigmoid Colon
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No abstract available
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06/01/1990 12:00 AM
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Bronchogenic Carcinoma Treated by Concomitant Resection of Lung and Chest Wall
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colon; Chest wall invasion by bronchogenic carcinoma is found in 5% of all cases of pulmonary carcinoma. During the last 3 years, 11 cases of lung cancer with chest wall involvement have been encountered at the Jackson Veterans Administration Medical Center. We reviewed these cases to reassess the role of concomitant resection of the lung and chest wall. From this experience, we have concluded that (1) chest wall involvement is potentially curable; (2) chest wall resection adds little if any morbidity to the procedure; (3) resections of fewer than four ribs usually require only soft tissue coverage, without a prosthesis; (4) patients with squamous cell cancer have longer survival; (5) chest wall resection is highly effective in the relief of pain due to invasion of the chest wall; and (6) survival is greater than in other stage III lung carcinomas and is more closely related to nodal involvement than to chest wall invasion.
(C) 1990 Southern Medical Association
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06/01/1994 12:00 AM
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Cementifying Fibroma: Resection of Recurrent Mandibular Lesion With Microsurgical Preservation of Inferior Alveolar Nerve and Immediate Reconstruction
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colon; Cementifying fibroma is a benign fibro-osseous lesion that may occur in either the mandible or the maxilla, with a predilection for the mandible. In the patient described, a recurrent mandibular cementifying fibroma was successfully resected, with microsurgical preservation of the inferior alveolar nerve and immediate reconstruction via an autogenous iliac bone graft.
(C) 1994 Southern Medical Association
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05/01/1992 12:00 AM
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Analysis of Local Recurrence of Midrectal Cancer After Low Anterior Resection and Stapled Anastomosis
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colon; We evaluated local recurrences of midrectal cancer in 33 patients treated with low anterior resection and stapled end-to-end anastomosis. All patients had follow-up for at least 2 years or until death. There were 21 men and 12 women. Data were analyzed with attention to Astler-Coller modified Dukes' stage, distal margin of resection, degree of histologic differentiation, location of the tumor, blood transfusion, and adjuvant therapy. Distal margin of resection, histologic differentiation, and location of the tumor had no prognostic significance regarding local recurrence. The use of adjuvant therapy remains controversial. The immunosuppressive effects of blood transfusion may affect local recurrence. Dukes' staging remains the standard for prognosis of recurrence in rectal cancer.
(C) 1992 Southern Medical Association
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07/01/1990 12:00 AM
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Preoperative Versus Postoperative Adjuvant Radiotherapy for Surgically Curable Carcinoma of the Rectum and Distal Sigmoid Colon
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colon; From January 1979 to October 1986, 86 patients with surgically resectable adenocarcinoma of the rectum or rectosigmoid were treated with adjuvant radiotherapy consisting of preoperative 2,400 cGy (22 patients), preoperative 4,000 cGy (14 patients), "sandwich" technique (27 patients), and postoperative irradiation (23 patients). Average follow-up was 42.9 months. The local recurrence rate was 4.5%, 9.1%, 7.4%, and 34.8%, respectively. The distant metastasis rate was 18.2%, 18.2%, 7.4%, and 30.4%, respectively. Preoperative radiotherapy with adequate surgical resection appears more effective in reducing the incidence of local recurrence.
(C) 1990 Southern Medical Association
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03/01/1997 12:00 AM
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Dermatomyositis in Association With Tubulovillous Adenoma: Resolution After Resection of Adenoma
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colon; Dermatomyositis (DM) has been associated with gastrointestinal malignancy but not with polyps or adenoma. We report a case of villous adenoma associated with DM. An 80-year-old white woman was referred for a rash of 2 months' duration that was suggestive of DM. On examination, Gottron's papules and heliotrope rash were seen. Muscle strength was 4/5 in the proximal upper and lower extremities. Despite normal muscle enzyme values, electromyographic and nerve conduction studies were supportive of the diagnosis of DM. DM was confirmed by deltoid muscle biopsy. Heme-positive stool was seen on rectal examination. Colonoscopy revealed a large tubulovillous adenoma in the cecum, which was resected. The patient was given oral prednisone, 60 mg/day. Within 4 weeks after surgery, steroids were tapered to one third the original dose. Within 9 months, steroid therapy had been discontinued with no evidence of disease activity.
(C) 1997 Southern Medical Association
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03/01/1994 12:00 AM
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Resection of Primary Hepatic Malignant Fibrous Histiocytoma, Fibrosarcoma, and Leiomyosarcoma
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colon; Four patients had resection for primary hepatic sarcoma: one with malignant fibrous histiocytoma (MFH), two with poorly differentiated fibrosarcoma, and one with leiomyosarcoma. Age ranged from 40 to 69 years. One patient had a cousin and a grandmother who had died of hepatic tumors. At presentation, all patients had pain; one had tumor rupture, and one had mental changes and hypoglycemia. None had hepatitis or cirrhosis. Results of laboratory evaluation were nonspecific, including normal carcinoembryonic antigen and [alpha]-fetoprotein levels. Computed tomography showed hypodense masses with enhancement. Angiography showed a hypervascular mass in three patients and an avascular mass in the patient with MFH. Despite large tumors (8 to 32 cm), portal and hepatic veins were not invaded. The pattern of vascularization and lack of venous invasion helps differentiate primary hepatic sarcomas from hepatocellular carcinoma, especially in noncirrhotic patients. All patients had extensive hepatic resections, with one operative death. Immunohistochemical stains of the tumors were positive for vimentin but negative for epithelial markers, differentiating these lesions from other hepatic tumors. The patient with MFH died with recurrence at 101/2 months. The patient with the ruptured fibrosarcoma had a second resection and chemotherapy, but died with recurrence at 3 years. The patient with the leiomyosarcoma had a second resection and was disease free at 4 years. Resection of primary hepatic sarcoma is warranted, with potential survival measured in years.
(C) 1994 Southern Medical Association
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09/01/2004 12:00 AM
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Photodynamic Therapy and Endoscopic Mucosal Resection for Barrett's Dysplasia and Early Esophageal Adenocarcinoma
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Background: Endoscopic mucosal resection (EMR) and endoscopic ablation with porfimer sodium photodynamic therapy (PDT) have recently been combined to improve the accuracy of histologic staging and remove superficial carcinomas.
Materials and Methods: All patients with Barrett's esophagus and high-grade dysplasia were evaluated with computed tomography and endosonography. Patients with nodular or irregular folds underwent EMR followed by PDT.
Results: In three patients, endoscopic mucosal resection upstaged the diagnosis to mucosal adenocarcinoma (T1N0M0). PDT successfully ablated the remaining glandular mucosa. Complications were limited to transient chest discomfort and odynophagia.
Conclusions: The use of EMR resection in Barrett's high-grade dysplasia patients with mucosal irregularities resulted in histologic upstaging to mucosal adenocarcinoma, requiring higher laser light doses for PDT. PDT after EMR appears to be safe and effective for the complete elimination of Barrett's mucosal adenocarcinoma. EMR should be strongly considered for Barrett's dysplasia patients being evaluated for endoscopic ablation therapy.
(C) 2004 Southern Medical Association
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10/01/2007 12:00 AM
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Colorectal Intussusception Secondary to Sigmoid Carcinoma in an Adult
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Although intussusception is relatively common in children, it is clinically rare in adults A 54-year-old woman who presented with cramping abdominal pain and rectal bleeding was found to have sigmoid rectal intussusception secondary to adenomatous polyps of the sigmoid colon. Following confirmation of intussusception by CT scan, surgical resection was performed after manual reduction.
(C) 2007 Southern Medical Association
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03/01/1988 12:00 AM
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Cecal Diverticulitis: Changing Trends in Management
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colon; Diagnosis of cecal diverticulitis remains a dilemma. Preoperatively it can mimic appendicitis, and intraoperatively the surgeon is confronted with an inflammatory mass that may masquerade as a neoplasm. We reviewed 18 cases of pathologically documented cecal diverticulitis and one case of solitary diverticulitis of the ascending colon. Ileocolonic resection was done in 16 patients, and three patients had local resection. Patients having local resection had greater morbidity and a significantly longer hospital stay. There were no deaths. We have found ileocolonic resection to be safe and effective, and we recommend it as the procedure of choice for cecal diverticulitis.
(C) 1988 Southern Medical Association
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01/01/1976 12:00 AM
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Surgical Treatment of Colovesical Fistula: The Value of a One-Stage Procedure
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The records of all patients (43) with colovesical fistulas at Ochsner Clinic were reviewed retrospectively. The presenting symptoms are more often related to the bladder and not to the colon; fecaluria and pneumaturia are almost pathognomonic. The diagnosis may be difficult to obtain on proctoscopy, cystography, or intravenous pyelograms. Roentgenograms after barium enema and cystoscopy are the best means of diagnosis, though operation is necessary in some instances for definitive diagnosis. Primary resection and anastomosis with closure of the bladder has been successful in our experience with little morbidity and only one postoperative death. The controversy regarding primary colon resection in treatment of colovesical fistulas is perplexing. We do not believe that it is "foolhardy" to save the patient extra time, morbidity, and expense by doing one instead of three procedures. Primary resection of the colon with simple closure of the bladder is our recommended treatment for chronic colovesical fistula. We have had no recurrences.
(C) 1976 Southern Medical Association
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01/01/1986 12:00 AM
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Extrarectal Colonic Carcinoma: Analysis of 138 Cases With Long-term Follow-up
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To identify factors that determine long-term survival after resection of extrarectal colonic cancer, we analyzed 138 such patients operated upon in a five-year period. Because rectal tumors have lower survival rates, they were excluded hoping to enhance the prognostic accuracy of the study. The sigmoid colon was the most common location of the tumor (59%) followed by the ascending (19%), the transverse (15%), and the descending colon (9%). In 95 patients (69%), operation was curative. In 12 patients (9%), a resection even with palliative aims could not be done; The five-year survival rates were 87% for 23 patients with Dukes' A and B lesions, 62% for 32 patients with Dukes' B2 lesions, 36% for 42 patients with Dukes' C1 lesions, and 0% for 34 patients with Dukes' C2 or higher. The overall five-year survival rate was 42%. These results emphasize the prognostic reliability-of pathologic staging methods and bring into focus the importance of enhancing efforts for detecting extrarectal colonic cancers at early stages of development when curative resection offers maximal chances for cure.
(C) 1986 Southern Medical Association
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10/01/2004 12:00 AM
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A Primary Case Presentation of Nephrolithiasis from Enteric Hyperoxaluria Due to Crohn's Disease
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He had undergone extensive ileal resection 25 years ago for Crohn's disease. absorption in his colon leading to subsequent excretion in his urine. small bowel resection in the presence of an intact colon , and is associated with calcium oxalate ne
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06/01/1995 12:00 AM
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Torsion, Necrosis, and Inflammation of an Epiploic Appendix of the Large Bowel: A Diagnostic and Therapeutic Dilemma
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colon; We present the case of a young patient with abdominal pain of 3 weeks' duration and a preoperative presumptive diagnosis of acute appendicitis, diverticulitis, colon perforation, or possibly neoplasm. Even after resection of a large mass involving the right colon, the diagnosis was not confirmed until surgical pathology identified torsion, partial necrosis, and inflammation of an epiploic appendix of the right colon.
(C) 1995 Southern Medical Association
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08/01/1993 12:00 AM
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Retroperitoneal Tumors With Vena Caval Extension: A Multidisciplinary Approach
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colon; In cases of retroperitoneal tumor with extension to the inferior vena cava (IVC), complete resection improves survival, but may require cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA). Since 1985, eight patients at our institution have had complete resection of retroperitoneal tumors with IVC or right atrial involvement. Preoperative evaluation included intravenous pyelography, computed tomography of the chest and abdomen, renal arteriography, and venography or magnetic resonance imaging of the IVC. Operative technique was determined primarily by the extent of IVC or RA involvement and included combined median sternotomy and laparotomy, control of the intrapericardial IVC, and radical tumor resection. IVC tumor thrombectomy was done using either temporary vascular occlusion, CPB, or CPB with HCA. Complete resection for improved survival of retroperitoneal tumors with IVC extension is technically feasible with acceptable morbidity and mortality rates. A multidisciplinary approach allows optimal management of these extensive tumors.
(C) 1993 Southern Medical Association
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07/01/1990 12:00 AM
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Sigmoid Volvulus in Childhood
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colon; Although it is common in the adult population, sigmoid volvulus is unusual in childhood. We report the cases of four children treated for sigmoid volvulus, and we review an additional 44 cases. The mean age of occurrence was 8 years. Predisposing factors were present in 33%. Abdominal pain (66%), vomiting (31%), and obstipation (10%) were the most common symptoms. Abdominal findings included distention (69%), tenderness (41%), and a mass (10%). The classic roentgenographic omega sign of volvulus was present on plain films in only 29% of the cases. Barium enema examination was diagnostic in 61% of the cases in which it was used. Nonoperative treatment by barium enema or proctoscopy was successful in all 17 cases in which it was attempted. The recurrence rate after nonoperative treatment was 31%. Thirty children had operation. The mortality in the group of patients having "derotation" alone was 29%. Immediate resection was associated with a 25% mortality; none of the patients who had elective resection died. Sigmoid resection is the definitive treatment for children as well as adults, but nonoperative decompression to allow for elective resection should be attempted in patients who have no evidence of peritonitis.
(C) 1990 Southern Medical Association
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06/01/1990 12:00 AM
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Surgical Treatment of Epilepsy: Initial Results Based Upon Epidural Electroencephalographic Recordings
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colon; We describe our initial results in 50 consecutive patients who had investigation for possible surgical treatment of intractable focal epilepsy. Forty-three were investigated using intracranial epidural or foramen ovale electrodes. Forty-five had cortical resection (43 temporal, one frontal, and one parietal). Thirty-two patients who had resection have been followed up for 6 months to 4 years, and 29 (90%) have had good results. Our findings suggest that epidural recordings are valuable in patients with epilepsy who are being considered for surgical resection. They offer an alternative to depth intracerebral investigations in the majority of patients.
(C) 1990 Southern Medical Association
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02/01/2009 12:00 AM
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Adult Segmental Hirschsprung Disease
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Hirschsprung disease (HD) is characterized by aganglionosis, which mainly occurs in the rectum and distal sigmoid colon. Typical HD is seldom diagnosed in adulthood, and segmental involvement is very rare. A 37-year-old man suffered from refractory constipation for 20 years. He could only defecate once a week and frequently needed an enema for defecation. A barium enema showed an annular stenotic segment of the rectosigmoid colon of 8 cm in length, which started 10 cm above anal circulation and showed dilated colon above the stenotic segment. The distal rectum was normal. The narrowed segment of the rectum was resected. At one-year follow up, the patient had normal defecation without laxatives.
(C) 2009 Southern Medical Association
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03/01/2004 12:00 AM
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Anorectal Melanoma: Report of Three Cases with Extended Follow-up
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Primary anorectal melanoma is rare. There is controversy regarding the best surgical treatment because of its poor prognosis. Three cases with extended follow-up are reported in this article. A 53-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. The patient died with distant metastases 8 months later. An 80-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent a transanal local excision. She remains alive 4 years later but with locally recurrent disease. A 78-year-old man with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. He died with local and metastatic disease 25 months later. Recent trends favor local excision when technically feasible, although some patients may require an abdominoperineal resection of the rectum, especially for larger tumors.
(C) 2004 Southern Medical Association
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02/01/2005 12:00 AM
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Ischemic Colitis: A Clinical Review
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Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
(C) 2005 Southern Medical Association
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03/01/2007 12:00 AM
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Four Cases of Patients with Gastrointestinal Granular Cell Tumors
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We present four cases of gastrointestinal granular cell tumors (GCT) with a literature review. Gastrointestinal granular cell tumors, a benign neural tumor thought to arise from Schwann cells, can occur in several areas, including the gastrointestinal tract. Studies suggest that endoscopic ultrasound and endoscopic removal is the treatment of choice for esophageal GCTs if they are small in size (<2 cm) and do not involve the muscularis propria. GCTs are malignant less than 2% of the time. Although most GCTs are benign and can be followed endoscopically without resection, the malignant potential warrants evaluation with endoscopic ultrasound for possible endoscopic or surgical resection.
(C) 2007 Southern Medical Association
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05/01/2006 12:00 AM
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Massive Fecal Impaction Presenting with Megarectum and Perforation of a Stercoral Ulcer at the Rectosigmoid Junction
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A 25-year-old male with lifelong constipation presented to the emergency department with an acute abdomen. Initial resuscitation was performed, and the patient underwent urgent laparotomy. He was found to have feculent peritonitis with megabowel involving the rectum and sigmoid colon and a stercoral ulcer with full thickness erosion, and perforation was also identified on the anti-mesocolic surface at the rectosigmoid junction. Abdominal irrigation and subtotal colectomy with proximal fecal diversion was performed. This case illustrates that recognition of severe, chronic constipation should lead to interventions including disimpaction and aggressive medical management. When indicated, megabowel can be managed surgically in an elective setting based on anatomic findings and physiologic studies. Peritonitis is an ominous late finding in patients with severe constipation.
(C) 2006 Southern Medical Association
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04/01/1999 12:00 AM
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Retrorectal Carcinoid Tumor
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colon; Retrorectal masses comprise a varied group of rarely encountered tumors. We present the case of a 42-year-old white woman with a retrorectal carcinoid tumor treated by abdominosacral resection. Diagnostic and therapeutic strategies are discussed.
(C) 1999 Southern Medical Association
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01/01/1987 12:00 AM
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Transsphincteric Approach to Lesions of the Rectum
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colon; Transsphincteric posterior resection of villous adenomas and small carcinomas restored gastrointestinal continuity and preserved continence in 25 of 26 patients in this study. No patient had local recurrence. This procedure is suitable for villous tumors that are too high for transanal or too low for transabdominal resection, and for small mobile malignancies of the lower 5 cm of the rectum.
(C) 1987 Southern Medical Association
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08/01/2000 12:00 AM
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Obstructing Giant Colonic Diverticulum
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We report the second case of an obstructing true colonic diverticulum. Of the 103 cases of giant sigmoid diverticulum found in the literature, 13% have been reported as true giant sigmoid diverticulum, ie, containing all layers of the colonic wall. Our 75-year-old patient had clinical symptoms for only 6 months, and endoscopy revealed an almost totally obstructing mass 20 cm from the anus. Surgical resection of the sigmoid colon with a primary anastomosis resolved all of the patient's obstructive symptoms. A flap-valve mechanism was the cause of this true giant colonic diverticulum. Microscopic examination of the diverticulum wall revealed all normal layers of colon wall.
(C) 2000 Southern Medical Association
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11/01/2008 12:00 AM
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Gastric Carcinoid Tumor in Association with Hepatocellular Carcinoma: A Case Report
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A second primary malignancy (SPM) can occur in patients with gastrointestinal carcinoids. A patient underwent endoscopic resection of a gastric carcinoid. Repeat gastroscopy revealed recurrence of the lesion and multiple nodular gastric lesions, while an abdominal computed tomography scan revealed a small solid lesion in the left hepatic lobe. The patient underwent total gastrectomy and wedge resection of what proved to be a hepatocellular carcinoma. This case illustrates the significance of considering SPM in every patient with gastrointestinal carcinoids. SPMs are more aggressive than carcinoids, and awareness and early resection of these tumors may improve prognosis.
(C) 2008 Southern Medical Association
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11/01/1994 12:00 AM
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Facial Arteriovenous Malformation Managed With Ablative Surgery and Dual Rotational Flap Reconstruction
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colon; A 34-year-old man had previously had partial resection of a left facial hemangioma or arteriovenous malformation which included partial mandibulectomy and external carotid arterial ligation for treatment of recurrent bleeding. Because of recurrent intraoral bleeding with aspiration and profound anemia and angiographic analysis showing large tortuous abnormal vessels feeding the lesion from the cranial base, the patient had tracheostomy for airway control, radical left facial resection, completion hemimandibulectomy, and subtotal maxillectomy. He required 20 units of blood components intraoperatively. Oral reconstruction was done with a pedicled pectoralis major myocutaneous flap, and left facial reconstruction was done with a rotational transaxillary latissimus dorsi myocutaneous flap supplemented with skin grafts as appropriate for coverage of the rotated muscles. Postoperatively, the patient has had no further oral bleeding. This case illustrates the multiple difficulties involved in the surgical management of a high-flow arteriovenous malformation.
(C) 1994 Southern Medical Association
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04/01/1987 12:00 AM
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Incidence of Serum Acid Phosphatase Elevation After Transurethral Prostatectomy
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colon; Serum acid phosphatase levels were measured in 402 patients after transurethral resection of the prostate for benign adenoma. All patients had normal preoperative serum acid phosphatase levels (< 0.8 IU/L) and the tissue specimen was histologically benign in all patients. Ninety-three patients (23%) showed normal postoperative serum acid phosphatase levels, while 309 (77%) showed postoperative elevation of serum acid phosphatase. One hundred forty-eight patients (37%) had postoperative levels higher than 5 IU/L. Significant elevation of serum acid phosphatase may follow transurethral prostate resection in patients having no evidence of malignancy.
(C) 1987 Southern Medical Association
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04/01/2009 12:00 AM
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Duodenal Mantle Cell Lymphoma in a Patient with Advanced Sigmoid Adenocarcinoma
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While colorectal cancer is one of the most commonly encountered gastrointestinal malignancies, primary lymphoma is an uncommon neoplasm of the gastrointestinal tract. The duodenum is not a common location for the recurrence of colon cancer or of primary gastrointestinal lymphoma. Studies regarding mantle cell lymphoma (MCL) as a secondary synchronous or metachronous malignancy are limited. Here we report a patient who received concurrent chemoradiotherapy for his advanced sigmoid adenocarcinoma and developed MCL in the duodenal bulb 20 months later. Suspected lesions should be biopsied and examined for a secondary neoplasm, especially when they appear in an uncommon location for metastasis or direct invasion.
(C) 2009 Southern Medical Association
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01/01/2003 12:00 AM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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09/01/2006 12:00 AM
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Gastrocolic Fistula: A Rare Complication of a Benign Gastric Ulcer: A Case Report and Review of the Literature
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Small bowel follow through confirmed a large fistula between the stomach and transverse colon . prior to en-bloc resection with primary anastomosis. and en-bloc resection with primary anastomosis.
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04/01/1979 12:00 AM
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Clinical Study of 81 Gastrointestinal Carcinoid Tumors
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The behavior and treatment of gastrointestinal carcinoid tumors have been the subject of much discussion. Size, location, and histologic invasiveness have been shown to correlate with regional and remote metastasis in previous series. We reviewed 81 patients with gastrointestinal carcinoids seen at the Medical University of South Carolina Teaching Hospitals since 1950. An unusual case of a 0.5 cm primary ileal carcinoid with widespread intra-abdominal and hepatic metastases is documented. In this series carcinoids were found (in order of decreasing frequency) in the ileum, appendix, rectum, right colon, duodenum, jejunum, stomach, ampulla of Vater, sigmoid colon, and pancreas. Metastases were found in 17% of the overall group. Two carcinoids presented with intussusception, while one was found within a Meckel's diverticulum. In addition to the small metastatic ileal carcinoid, one patient with a rectal carcinoid measuring 0.4 cm was found to have metastases after low anterior resection. Because all extra-appendiceal gastrointestinal carcinoids are potentially metastatic, it is stressed that regional lymphadenectomy en bloc with primary excision is the treatment of choice wherever feasible. If the lesion is small or has not invaded deeply, local excision with close follow-up may be an acceptable alternative.
(C) 1979 Southern Medical Association
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04/01/1991 12:00 AM
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Endoscopic Palliative Management of Rectal Cancer
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colon; Laser ablation and bipolar coagulation have been used to palliate rectal cancer and avoid surgery. Indications are distal metastatic disease, extensive local invasion, obstruction and bleeding from nonresectable rectal tumor, or refusal of surgery. From Jan 1, 1986, to Jan 1, 1989, I saw 26 patients who met those criteria; 19 already had metastatic disease and three repeatedly refused abdominoperineal resection. A two-laser approach using both CO2 and Nd:YAG lasers was used in patients with low-lying lesions; others were treated by the Nd:YAG laser only. For rectal tumors, bipolar esophageal tumor probes were used via the rigid sigmoidoscope. The number of laser sessions averaged three per patient, and the number of bipolar coagulation sessions averaged five per patient. Bleeding followed bipolar coagulation in one patient. There were no perforations in either treatment group, and no patient has required colostomy. Of the 19 patients who already had metastatic disease, 12 are still alive, the longest survival being 20 months. Of those medically unfit for surgery, three have died of coincidental disease, and one is alive with controlled rectal cancer after 16 months. All three patients who refused surgery are alive; the longest survival is 13 months.
(C) 1991 Southern Medical Association
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09/01/1997 12:00 AM
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Squamous Cell Carcinoma Arising in an Unhealed Wound in Crohn's Disease
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colon; A 49-year-old black woman with a 23-year history of Crohn's disease came to our clinic; she had a squamous cell carcinoma arising in an unhealed perineal wound 16 years after abdominoperineal resection (APR). We report this case to show the potential for malignant degeneration in such wounds. This patient had had multiple procedures for fistulotomies and incision and drainage of abscesses and, ultimately, an APR. After the APR, she had a persistent perineal wound, which did not fully heal despite extensive local and systemic therapy. Our examination revealed a chronic wound involving the entire perineum and vagina, including the labia, both inguinal folds, and the intergluteal cleft. Biopsies showed moderately differentiated squamous cell carcinoma throughout. We believe healing may be impaired in patients who have Crohn's disease, with a significant risk of unhealed perineal wounds after APR. Chronic unhealing wounds may progress to carcinoma, and this propensity toward transformation may be increased by immunosuppression. Complaints of persistent pain and unhealing wounds in the absence of infection in patients with Crohn's disease suggest the possibility of malignancy and biopsy is recommended.
(C) 1997 Southern Medical Association
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05/01/2000 12:00 AM
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Acute Abdomen With Colonic Necrosis Induced by Kayexalate-Sorbitol
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: Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration. Prompt surgical resection of the necrotic transverse colon permitted rapid recovery of bowel function. Although SPS crystals are seen microscopically in the necrotic bowel, experimental evidence implicates the sorbitol component of the SPS-sorbitol in the pathogenesis of colonic necrosis. A high index of suspicion for the unusual complication of colonic necrosis after oral or rectal administration of SPS-sorbitol may allow prompt recognition and surgical cure.
(C) 2000 Southern Medical Association
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10/01/1995 12:00 AM
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Cardiopulmonary Complications During Laparoscopy: Two Case Reports
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colon; Laparoscopic surgery is growing in popularity. As a result, laparoscopic procedures are being done on a broader and older patient population. These patients may have underlying cardiopulmonary disease that predisposes them to complications not seen in younger patients. Anesthesiologists should be aware of this possibility and of the problems inherent to the pneumoperitoneum necessary for laparoscopy. We present two cases involving elderly patients to illustrate cardiopulmonary complications that can occur during establishment or maintenance of the increased intra-abdominal pressures required for laparoscopic surgery. The first case describes a patient who developed bradycardia and asystole during insufflation for a laparoscopic hernia repair. The second case involves severe hypercarbia and a pneumothorax due to massive subcutaneous emphysema that developed during a laparoscopic colon resection.
(C) 1995 Southern Medical Association
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02/01/1985 12:00 AM
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Carcinoma of the Duodenum
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colon; Primary duodenal carcinoma is an uncommon tumor that tends to be diagnosed late in its course because of a symptom complex compatible with many benign diseases. We reviewed the cases of five patients with duodenal adenocarcinoma treated at Norfolk General Hospital from 1973 to 1983. Periampullary tumors were excluded. The most common symptom, nausea and vomiting, was present in four patients, all of whom had microcytic anemia; in three, tests showed blood in stool specimens. The upper gastrointestinal series was suggestive of carcinoma in all patients. One of the lesions was proximal to the ampulla, while the other four were in the third and fourth portions of the duodenum. Only three of the lesions could be seen on upper GI endoscopy, and in only one of the three was the biopsy specimen positive for malignancy. At laparotomy, two patients had resectable lesions, but only segmental resection was done. Three patients had unresectable disease because of liver metastases and/or involvement of the root of the small bowel mesentery. Because delay in diagnosis of duodenal carcinoma may prevent successful resection, greater awareness of the possibility of these uncommon lesions, along with aggressive diagnostic work-up, may result in a higher percentage of cures.
(C) 1985 Southern Medical Association
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06/01/1995 12:00 AM
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Epilepsy Surgery: Removing the Thorn From the Lion's Paw
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colon; In the United States, 10,000 to 20,000 patients have epilepsy uncontrolled by medication. The addition of a second-line drug to the primary regimen has a 2% to 11% chance of controlling the seizures. We present a series of 35 patients with intractable epilepsy who had surgical resection of their seizure focus. Seventy-five percent of the patients with temporal lobe epilepsy were made seizure free, with an additional 14% sustaining a greater than 90% reduction in seizures (decrease in number and frequency). Seventy-one percent of the patients with extratemporal lobe epilepsy (seizures originating outside the temporal lobe) had a worthwhile reduction (>90%) in their seizures. Two patients sustained permanent clinically significant deficits as a result of their presurgical evaluation or resection. There were no deaths. Epilepsy surgery offers a cure for the "incurable" patient with a morbidity of 5% to 6%.
(C) 1995 Southern Medical Association
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04/01/1993 12:00 AM
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Conservative Alternatives in the Management of Early Adenocarcinoma of the Rectum
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colon; The majority of patients with adenocarcinoma of the rectum are treated with radical surgical procedures. Lesions located in the distal third of the rectum are usually treated by abdominoperineal resection, and those situated in the proximal portion of the rectum are treated by low-anterior resection. Relatively small, moderately or well differentiated lesions have a low risk of lymph node metastasis, and are therefore amenable to conservative (ie, rectum-sparing) procedures. Conservative management options consist of transrectal excision, transrectal excision and preoperative or postoperative radiotherapy, endocavitary contact radiotherapy, and interstitial therapy. Discussion of these options, the experience at the University of Florida with two of these options, and review of the literature follow.
(C) 1993 Southern Medical Association
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10/01/2006 12:00 AM
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Cutaneous Metastases of Signet Cell Carcinoma of the Rectum Without Accompanying Visceral Involvement
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Cutaneous metastasis of rectal carcinoma is a rare event. It occurs in fewer than 4% of all patients with rectal cancer. Although skin metastasis of rectal cancer is usually detected around surgical scars or on the abdominal wall, especially in the periumbilical region, it rarely presents at other sites. The early diagnosis of skin metastases in these patients is very important because it can alter treatment. A case of signet cell carcinoma of the rectum with cutaneous metastases without accompanying visceral involvement is presented, occurring 14 months after completion of adjuvant therapy.
(C) 2006 Southern Medical Association
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02/01/2010 12:00 AM
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Desmoid Tumor Arising in the Site of Previous Surgery in the Left Lower Quadrant of the Abdomen
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A desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic structures. The pathogenesis is still not clear. A 79-year-old woman who developed a desmoid tumor in the left lower abdomen after surgical resection of an abdominal lipoma seven years previously is presented. Preoperative computed tomography showed a large left lower abdominal mass. Pathology showed the spindle fibroblastic cell pattern typical of desmoids.
(C) 2010 Southern Medical Association
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10/01/2005 12:00 AM
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Paradoxical Inflammatory Reaction to Seprafilm: Case Report and Review of the Literature
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This report describes a paradoxical inflammatory reaction to Seprafilm caused by extensive adhesion formation early in the postoperative period. A female patient had development of small bowel obstruction immediately after an uneventful low anterior resection for rectal carcinoma with placement of Seprafilm. The obstruction did not improve with nonoperative therapy. At laparotomy, extensive adhesions necessitating bowel resection and ileostomy were noted. Pathology results showed a giant cell foreign body reaction to Seprafilm. A literature search yielded only two other instances of adverse reactions to Seprafilm. The information provided by this and other atypical reports suggests that further studies aimed at identifying the incidence and pathophysiological mechanisms for such paradoxical reactions are needed.
(C) 2005 Southern Medical Association
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11/01/1991 12:00 AM
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Postoperative Intussuception: Increasing Frequency or Increasing Awareness?
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colon; Postoperative intussusception in children is a rare but well recognized phenomenon. The diagnosis is often delayed due to the protean manifestations of the disorder (ileus, distention, and nausea and vomiting) which, when encountered shortly after an abdominal operation, usually result in a low index of suspicion because they are common after laparotomy. Experience with two cases of postoperative intussusception within 24 hours heightened our index of suspicion. Review of our records indicated we had diagnosed and treated postoperative intussusception in 14 children during the preceding 4 years. Patient ages ranged from 4 months to 12 years (mean 39 months, median 20 months), and symptoms appeared on postoperative days 3 to 36 (mean 10 days, median 6 days). Initial operations included excision of a retroperitoneal or abdominal tumor (five cases), Nissen fundoplication and gastrostomy (three), ileal resection (two), Ladd procedure (one), Duhamel operation (one), and operative reduction of ileocolic intussusception (the two most recent cases). Eleven patients had appendectomy (five by the inversion technique), and three had placement of a transgastric small bowel feeding tube. Nine children had had either barium enema or upper gastrointestinal studies because of the postoperative suspicion of obstruction; one patient had both. Diagnostic studies were not done in four patients. Operative reduction was successful in all but one child, who required bowel resection.
(C) 1991 Southern Medical Association
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08/01/1978 12:00 AM
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Pancreatic Injury
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colon; During the ten-year period from 1967 to 1977, 50 cases of pancreatic trauma were reviewed. There were 40 gunshot wounds, six stab wounds, and four cases of blunt abdominal trauma. Ten of the patients died, a mortality of 20%. The overall complication rate was 57%, but only 27% had complications attributable to the pancreatic injury. As has been reported by most authors, there is a high incidence of associated injuries. In our series only one patient had isolated pancreatic injury, while 30% had a major vascular injury, and the mortality for this group was 50%. Several methods of treatment were used, but the majority (36 patients) had drainage alone. The others had either resection (five) or Roux-en-Y pancreaticojejunostomy (five). Of particular interest were results of treatment of severe injuries to the head of the pancreas. Early in the series two patients were treated by pancreaticoduodenectomy and both died within 24 hours. During the last year we have treated five similar injuries using a Puestow type of Roux-en-Y pancreaticojejunostomy, with one death and no pancreatic complications. At present we advocate sump tube drainage for most injuries but rely on a Roux-en-Y pancreaticojejunostomy for severe injury to the head of the pancreas rather than resection.
(C) 1978 Southern Medical Association
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03/01/1974 12:00 AM
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Analysis of Pancreatoduodenectomy
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colon; Thirty-three pancreaticoduodenectomies were performed at the Medical University of South Carolina between 1956 and 1970. Seventeen resections were for adenocarcinoma of the head of the pancreas. Eleven Whipple procedures were performed for cancer arising in the extrahepatic biliary ducts and duodenum. Cancer of the stomach accounted for three pancreaticoduodenectomies. The remaining two procedures were for cystadenocarcinoma of the pancreas and chronic pancreatitis. Twelve resections were performed on clinical evidence alone. Carcinoma was found in every specimen. Biopsy and frozen section were used in the other 21 resections. Resection was undertaken only when there was no gross evidence of lymph node metastases. Still, the pathologic analyses of the specimen revealed nodal metastases in 39% of the pancreatic carcinomas. None of these patients with positive nodes were long-term survivors. There were 14 major complications from the 33 pancreaticoduodenectomies. Failure of the pancreaticojejunostomy was the most frequent complication. Seven patients were operative mortalities. In each surgical mortality, the preoperative bilirubin was markedly elevated. At this writing, eight patients (25%) are alive and free of disease. Carcinoma of the ampulla of Voter had the best survival rate. The worst survival rate was found in carcinoma of the duodenum and carcinoma of the common bile duct. The history and current controversies over this extensive surgical resection are reviewed.
(C) 1974 Southern Medical Association
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03/01/2009 12:00 AM
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The Water Jet Deformation Sign: A Novel Provocative Colonoscopic Maneuver to Help Diagnose an Inverted Colonic Diverticulum
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Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert an inverted diverticulum include probing it with a closed biopsy forceps or intraluminal air insufflation during colonoscopy. On colonoscopy, a 59-year-old female had two intraluminal colonic projections. Probing these projections and using air insufflation failed to indent or evert them. Spraying these lesions with a water jet, however, flattened or partly everted them. This novel maneuver provided conclusive evidence that these intraluminal projections represented inverted diverticula. The proposed pathophysiology is that water pressure causes an inverted diverticulum to indent or evert due to its thin wall. The currently reported maneuver may be easier and safer than probing an inverted diverticulum with biopsy forceps and may prove a more reliable diagnostic maneuver than air insufflation.
(C) 2009 Southern Medical Association
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09/01/1963 12:00 AM
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The Diagnosis and Surgical Treatment of Abscess Complicating Diverticulitis
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The diagnosis of an abscess complicating diverticulitis may be difficult or impossible. However, drainage of the abscess found at laparotomy and resection of the affected segment of the colon have proven most successful in the author's cases.
(C) 1963 Southern Medical Association
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12/01/2009 12:00 AM
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Rectal Stents as an Alternative to Surgery
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No abstract available
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09/01/2006 12:00 AM
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An Uncommon but Potentially Life-Threatening Cause of Chest Pain
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Resection of the stomach was not needed. the spleen or colon migrates into the chest cavity through the normal esophageal hiatus or a defect decompression and resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundopl
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05/01/1986 12:00 AM
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Cystosarcoma Phyllodes
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colon; We present four cases of cystosarcoma phyllodes in which mammograms revealed a small or large lobulated mass occupying the entire breast. Preoperative diagnosis was a benign lesion with a low probability of nodular carcinoma. Histologically, all tumors were classified as malignant. Although uncommon, cystosarcoma should be considered in the differential diagnosis of these masses, since local recurrence is frequent unless wide wedge resection or simple mastectomy is done.
(C) 1986 Southern Medical Association
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07/01/1999 12:00 AM
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Hydrosalpinx Due to Asymptomatic Bilateral Tubal Pregnancies Associated With Metaplastic Papillary Tumor of the Fallopian Tube
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colon; The patient described in this report had bilateral hydrosalpinx due to pregnancies in both fallopian tubes, treated by laparoscopic resection. Histologically, both fallopian tubes revealed intratubal occlusion by degenerated, partially calcified chorionic tissue. An incidental finding was an intraluminal papillary epithelial tumor in one of the fallopian tubes. The clinical significance and complications of asymptomatic tubal ectopic pregnancy and the pathogenesis and biologic behavior of papillary epithelial tumors of the fallopian tube are briefly discussed.
(C) 1999 Southern Medical Association
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09/01/2000 12:00 AM
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Cutaneous Nephrocolonic Fistula as a Consequence of a Kidney Stone
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We report an unusual case of cutaneous nephrocolonic fistula caused by a renal calculus with perirenal infection. The diagnosis was made by fistulography and computed tomography, after which nephrectomy and resection of the descending colon were successful. We also review the literature on cutaneous nephrocolonic fistulas.
(C) 2000 Southern Medical Association
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01/01/1986 12:00 AM
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Estimating Blood Supply of the Skin and Intestine With the Fluorescence Camera
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We used fluorescein dye to evaluate the vascularity of flaps in 73 patients and of the left colon in 23 individuals after resection and replacement of the abdominal aorta. Instant photographs of the dye pattern were taken in the light using a specially modified Polaroid camera. All areas of skin and bowel that showed adequate staining with the dye survived, and all but one of ten areas that were nonfluorescent became necrotic unless they were excised or revascularized. The intraoperative use of fluorescein dye with the fluorescence camera is a useful technique for all surgeons who need to evaluate the vascularity of tissue.
(C) 1986 Southern Medical Association
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09/01/1991 12:00 AM
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Pectus Excavatum: A 15-Year Perspective
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colon; Pectus excavatum is relatively uncommon. Our experience with 177 children during a 15-year period produced changes in our surgical technique, which now includes a small transverse incision, minimal subcutaneous flap elevation, a muscle-relaxing incision over the fifth costal cartilage, complete resection of involved cartilage, use of Adkins' strut, suspension of sternum to strut, taut reefing of intercostal muscle, no tubes or drains, epidural analgesia, a patient-controlled analgesia device postoperatively, and eventual strut removal. Use of the evolved technique gives excellent cosmetic results, good functional results with minimal discomfort, and a shorter convalescent period.
(C) 1991 Southern Medical Association
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06/01/1998 12:00 AM
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Endometrial Stromal Sarcoma With Sex Cord-Like Differentiation Associated With Tamoxifen Therapy
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colon; Low-grade endometrial stromal sarcoma with sex cord-like differentiation occurred in two postmenopausal patients who had received tamoxifen for more than 3 years after surgical resection for breast cancer. Uterine sarcomas have been described in association with the use of tamoxifen. Only two cases of endometrial stromal sarcoma with sex cord-like features associated with tamoxifen use have been reported previously. This report adds an additional two cases of this tumor. Immunohistochemical and ultrastructural examinations of the tumor support the concept of smooth muscle differentiation in the sex cord-like areas. This observation proposes that the low-grade endometrial stromal sarcoma with sex cord-like elements may be a consequence of tamoxifen ingestion, but the exact mechanism of tamoxifen in the development of this tumor remains speculative.
(C) 1998 Southern Medical Association
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09/01/1984 12:00 AM
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Impact of Early Recognition on Outcome in Nonpenetrating Wounds of the Small Bowel
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colon; During a recent ten-year period, 20 patients were treated for nonpenetrating, small-bowel trauma requiring resection. Despite the relative infrequency of this injury, jejunoileal trauma must be suspected in all patients sustaining blunt force to the abdomen. Physical signs suggesting major intra-abdominal wounds usually occur at admission or immediately thereafter, provided the patient is alert. Patients with altered sensorium or equivocal findings should undergo diagnostic peritoneal lavage. Laboratory investigation is not helpful in detecting small-bowel wounds. Plain roentgenography is indicated, but was diagnostic in only 20% of patients in this series. The high incidence of associated injuries accounts for the substantial morbidity (70%) in this series. Early operation improves survival.
(C) 1984 Southern Medical Association
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03/01/1987 12:00 AM
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Vertical Rectus Abdominis Musculocutaneous Flap for Breast Reconstruction After Irradiation
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colon; We have used a contralateral vertical rectus abdominis musculocutaneous flap based upon the superior epigastric vessels in six patients to provide coverage after resection of locally recurrent breast carcinoma in irradiated tissues. Primary healing of defects as large as 16 cm x 35 cm has been obtained using this technique. Although there is no evidence to suggest that such a procedure significantly lengthens survival, it was clearly beneficial to the quality of life in these patients. Our results suggest that older patients with relatively indolent disease receive the greatest benefit from this procedure.
(C) 1987 Southern Medical Association
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10/01/1999 12:00 AM
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Biatrial Myxoma Resembling an Interatrial Clot in Transit on Echocardiogram
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colon; A 47-year-old man had an embolic stroke. Transesophageal echocardiography showed biatrial, elongated, mobile masses that appeared interconnected via a patent foramen ovale. Echocardiography did not distinguish between an interatrial clot in transit and an atypical biatrial myxoma. Surgical resection and subsequent histopathologic examination identified the mass as a biatrial myxoma. This case identifies a limitation of echocardiography in the diagnosis of cardiac myxoma.
(C) 1999 Southern Medical Association
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10/01/1994 12:00 AM
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Intrathoracic Desmoid Tumor: CT and MRI Appearance
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colon; Intrathoracic desmoid tumors are extremely rare, only 12 cases having been reported in the literature. In the 14-year-old girl we describe, a desmoid tumor manifested as an intrathoracic mass. Computed tomography of the chest after administration of intravenous contrast medium showed a large intrathoracic heterogeneous mass and lysis of multiple adjacent vertebral bodies. After incomplete resection of the tumor, T1-weighted magnetic resonance imaging showed residual tumor that produced signal intensity equal to that of skeletal muscle. Intense enhancement after intravenous administration of gadolinium allowed improved delineation of adjacent tissue involvement.
(C) 1994 Southern Medical Association
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11/01/1994 12:00 AM
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Intrapericardial Pheochromocytoma Complicated by Massive Intraoperative Hemorrhage
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colon; Middle mediastinal pheochromocytomas are exceedingly rare. Because so few cases have been reported, consensus has not been reached regarding the anesthetic management of patients with these tumors. The use of cardiopulmonary bypass (CPB) for the resection of intrapericardial pheochromocytomas has met with varied success. We report the first documented case of successful anesthetic and surgical management of an acute, massive hemorrhage during the dissection of an intrapericardial pheochromocytoma, which was managed without cardiopulmonary bypass. Perioperative anesthetic considerations, including the risks and benefits of CPB, are discussed.
(C) 1994 Southern Medical Association
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05/01/1987 12:00 AM
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Malignant Salivary Gland Tumors of the Base of the Tongue
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colon; We present a 41-year retrospective study of patients with malignant salivary gland tumors of the base of the tongue treated at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston. This report characterizes the patient group, documents their physical findings, analyzes survival, and draws some conclusions regarding clinical course and treatment options. When feasible, surgical resection is the preferred treatment, with planned postoperative radiotherapy when indicated by pathologic findings.
(C) 1987 Southern Medical Association
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08/01/1997 12:00 AM
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Spontaneous Resolution of Rhodococcal Pulmonary Infection in a Liver Transplant Recipient
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colon; Pulmonary infection by Rhodococcus equi is characterized by indolent infection in an immunocompromised host with a propensity to form cavitary lesions. Mortality can be greater than 50%; treatment involves prolonged therapy with multiple antibiotics and, occasionally, surgical resection. Recurrence is common. We report a case of a liver transplant patient with a pulmonary nodule caused by R equi; the nodule followed a benign clinical course and resolved spontaneously. This case illustrates that the spectrum of disease caused by R equi is not fully appreciated and that significant pitfalls complicate the diagnosis and management of infection by this unusual and probably underrecognized pathogen.
(C) 1997 Southern Medical Association
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11/01/1975 12:00 AM
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Repair of Vesicovaginal Fistulas: Simultaneous Transvaginal-Transvesical Approach
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colon; The records of 91 patients with vesicovaginal fistulas at the Ochsner Clinic between 1942 and 1974 were reviewed. The fistulas were managed in several ways: spontaneous closure, palliative operation, urinary diversion, transvesical repair, transvaginal repair, and a combined transvaginal-transvesical procedure. The latter had a 100% success rate in the eight patients in whom it was used. The technic of this procedure is described and the indications are expanded to include (1) large fistulas, (2) fistulas near the ureteral orifice, (3) if other abdominal or urologic surgery is being done, (4) if transvesical approach is being used, (5) previous failed attempts at correction, (6) difficulty of access by vaginal approach, and (7) fistulas resulting from transurethral resection of the bladder neck.
(C) 1975 Southern Medical Association
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03/01/2004 12:00 AM
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Jaundice Secondary to Isolated Porta Hepatis Metastasis in Colorectal Cancer: Case Report and Review of the Literature
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Colorectal cancer occurs mainly after the age of 50. The liver is the most frequent site of metastases, although isolated metastases to the porta hepatis are rarely reported in the literature. From 1924 to 1993, only 16 cases of periportal lymph nodes metastases were reported. We report a case of jaundice secondary to porta hepatis metastases from primary colorectal cancer. The appearance of symptoms was concurrent with the elevation of carcinoembryonic antigen in our case. This emphasizes the importance of polymerase chain reaction to detect the small amount of carcinoembryonic antigen transcript in blood or in peritoneal fluid before the appearance of symptoms. Polymerase chain reaction allows the prediction of high risk of recurrence and the presence of micrometastases. More trials are needed to assess the outcome after treatment by adjuvant chemotherapy for micrometastases.
(C) 2004 Southern Medical Association
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12/01/2006 12:00 AM
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Primary Mucosa-associated Lymphoid Tissue (MALT) Lymphoma Occurring in the Rectum: A Case Report and Review of the Literature
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The primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical pathologic entity that develops in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast; however, colorectal involvement is rare.
To the best of our knowledge, only 30 cases of primary rectal MALT lymphoma have been published in the English language literature, mostly from Japan. A single case has been reported from the US before this report. The most common symptoms ranged from asymptomatic to occult or gross gastrointestinal bleeding. Simultaneous involvement of the cecum or colon was seen in 20% of the patients. Ninety percent of the patients were classified as low grade, Stage 1 at the time of diagnosis. Polypoid lesions were 10-fold more common than ulcerative lesions. Seven patients were reported to have H pylori in the stomach. The majority of the patients underwent surgical or endoscopic resection as a cure; however, controversy exists with regards to antibiotic treatment or observation alone because of unknown etiopathogenesis. Infection with microorganisms other than H pylori has been postulated in the development of rectal MALT lymphoma; however, this hypothesis remains unproven. The overall prognosis of rectal MALT lymphoma appears favorable; however, long-term follow-up data is lacking. Therefore, periodic clinical monitoring should be done in these patients.
(C) 2006 Southern Medical Association
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11/01/1999 12:00 AM
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Chest Wall Ectopic Synovial Bursa Cyst
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colon; We report an unusual case of chest wall tumor in a 27-year-old patient. A complete resection was accomplished, and the patient had an excellent postoperative course. Histologically, the mass was confirmed to be an ectopic synovial bursa cyst. Although rare, synovial cysts should be considered in any case of a fluctuating chest wall mass. We also discuss the etiology and diagnostic approach of cystic masses of the chest wall.
(C) 1999 Southern Medical Association
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03/01/1994 12:00 AM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
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04/01/1998 12:00 AM
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Diaphragm-like Strictures of the Ileum Associated With NSAID Use: A Rare Complication
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colon; Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for many conditions including arthritis. A rare complication of their use is diaphragm-like strictures of the small and large intestines. A 65-year-old woman with a 12-year history of arthritis came to us with a 35-pound weight loss and anorexia. She had been taking piroxicam for 3 years. Evaluation including enteroclysis revealed multiple mid-ileal diaphragm-like strictures and proximal small bowel dilatation. The symptoms persisted despite discontinuance of the drug. Abdominal exploration with intraoperative enteroscopy revealed five ileal strictures within a short segment of bowel. Resection was done and completion enteroscopy showed no other strictures. The patient recovered uneventfully and had full resolution of the symptoms. We discuss the difficulties in diagnosis and management of this drug complication and briefly review the literature.
(C) 1998 Southern Medical Association
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