1/9. Direct clinical evidence for spinal hyperalgesia in a patient with irritable bowel syndrome.OBJECTIVE: Our objective was to evaluate GI motor and sensory function and spinal cord testing in a patient with severe irritable bowel syndrome. methods: A patient is described who underwent an extensive assessment of GI motor and sensory function including transit studies, colonic and rectal barostat studies, sensory and manometric studies of the small bowel, and colon and anorectal physiology testing. The patient also underwent testing with spinal cord stimulation and spinal drug delivery as part of a pain management assessment. RESULTS: The viscerosomatic referral pain pattern resulting from rectal distention was consistent with spinal hyperalgesia. The patient underwent testing for spinal cord stimulation and spinal drug delivery. CONCLUSION: This novel finding provides direct clinical evidence for the presence of spinal hyperalgesia in a patient with irritable bowel syndrome, consistent with the existing indirect clinical evidence and animal data.- - - - - - - - - - ranking = 1keywords = colonic (Clic here for more details about this article) |
2/9. Total colonic manometry as a guide for surgical management of functional colonic obstruction: Preliminary results.BACKGROUND/PURPOSE: Functional colonic obstruction (pseudo-obstruction) encompasses a broad group of motility disorders. Medical management of colonic pseudo-obstruction is complex and often fails, leading to surgical referral. In most cases (excepting Hirschsprung's disease) the surgeon is unable to precisely localize the area of functional obstruction. Total colonic manometry can directly measure intraluminal pressures and contractile function along the entire length of the colon. The authors propose that total colonic manometry can be used by the pediatric surgeon to guide the timing and extent of surgical therapy in refractory functional colonic obstruction. methods: Four patients were evaluated for functional colonic obstruction. All underwent barium enema and rectal biopsy with a diagnosis of Hirschsprung's disease in one patient. All patients underwent colonoscopy and total colonic manometry. Manometric tracings were obtained while fasting, after feeding, and after pharmacologic stimulation both preoperatively (n = 4) and postoperatively (n = 3). RESULTS: Total colonic manometry identified an abrupt end of normal peristalsis in 2 of the non-Hirschsprung's patients (one in the proximal colon and one in the transverse colon). Medical therapy failed in both of these patients, and they underwent diverting ostomy proximal to the loss of normal peristalsis. The third non-Hirschsprung's patient essentially had normal manometry and was able to have her colon decompressed successfully on a laxative regimen. Repeat manometry after colonic decompression showed return of normal peristalsis in 2 of these patients and continued abnormal peristaltic activity in the third. Definitive surgical intervention based on the results of total colonic manometry was performed on the latter. All 3 patients achieved normal continence. A fourth patient had Hirschsprung's disease confirmed by rectal biopsy and underwent a 1-stage neonatal modified Duhamel procedure, which was complicated by postoperative functional obstruction. manometry showed a lack of peristaltic function beginning in the right colon. An ileostomy was performed, and timing of ileostomy closure was guided by the return of normal colonic peristalsis seen on manometry. CONCLUSIONS: These initial cases show the utility of total colonic manometry in the management of colonic pseudo-obstruction syndromes. In addition to its diagnostic utility, direct measurement of colonic motor activity can be valuable in deciding the need for and timing of diversion, the extent of resection, and the suitability of the patient for restoring bowel continuity. In Hirschsprung's disease, total colonic manometry can potentially be used to determine suitability for primary neonatal pull-through versus a staged approach. J Pediatr Surg 36:1757-1763.- - - - - - - - - - ranking = 23keywords = colonic (Clic here for more details about this article) |
3/9. Case report: persistent colonic spasm concealing a carcinoma--an uncommon diagnostic pitfall of the barium enema examination.Colonic carcinomas may be missed on the barium enema examination for a variety of perceptive, technical, and interpretive reasons. We report an uncommon source of error-persistent bowel spasm resulting in concealment of an underlying carcinoma. awareness of this association is necessary in the effort to minimize diagnostic pitfalls of the barium enema examination.- - - - - - - - - - ranking = 4keywords = colonic (Clic here for more details about this article) |
4/9. Ogilvie's syndrome associated with herpes zoster infection.Acute colonic pseudo-obstruction that occurs in the setting of an underlying medical condition is known as Ogilvie's syndrome. The etiology of Ogilvie's syndrome is unknown, and associated medical illnesses are varied and often extra-abdominal. While herpes zoster infection has been reported to cause constipation and hypomotility, the association with massive colonic distention has not so far been described. We present a patient with Ogilvie's syndrome in the setting of herpes zoster infection. There was no evidence of other active illnesses, and the patient has continued to do well since the resolution of the zoster. We believe that this is the first reported association of Ogilvie's syndrome and herpes zoster infection.- - - - - - - - - - ranking = 2keywords = colonic (Clic here for more details about this article) |
5/9. Acute colonic pseudo-obstruction: a possible role for the colocolonic reflex.In diverse clinical settings, injury or impairment of the peripheral autonomic nervous system may cause acute colonic pseudo-obstruction. The mechanism has remained elusive since Ogilvie's original description. In classic Ogilvie's syndrome, colonic pseudo-obstruction is associated with malignant invasion of the prevertebral ganglia, and may be mediated through the colocolonic reflex, described in a guinea pig model. We have treated three patients with acute colonic pseudo-obstruction due to: 1) malignant invasion of the prevertebral plexus (classic or true Ogilvie's syndrome), 2) clonidine, and 3) herniorrhaphy under epidural anesthesia. In this paper, we discuss the possible role of the colocolonic reflex in the pathophysiology of acute colonic pseudo-obstruction, and the delineation of true Ogilvie's syndrome from the other many causes of acute colonic pseudo-obstruction.- - - - - - - - - - ranking = 15keywords = colonic (Clic here for more details about this article) |
6/9. cytomegalovirus infection of the bowel in infancy: pathogenetic and diagnostic significance.Three infants had cytomegalovirus (CMV) infection of the bowel. Infected enteric ganglion cells were found in two, one of whom had hypoganglionosis and colonic dysmotility. The third infant had classic short segment Hirschsprung's disease and colitis with CMV inclusions in vascular endothelium, a situation wherein viral transformed cells may have led to misinterpretation of the diagnostic biopsy.- - - - - - - - - - ranking = 1keywords = colonic (Clic here for more details about this article) |
7/9. Prolonged ambulatory small intestinal and colonic motility monitoring: potential in irritable bowel syndrome--first report of prolonged ambulatory oesophageal, small intestinal and colonic motility in the same patient.irritable bowel syndrome (IBS), which affects up to 25% of the population in western countries and accounts for up to 50% of referrals to gastroenterologist, remains mainly a diagnosis of exclusion. We have studied, for the first time, prolonged ambulatory motility recordings from the oesophagus, small intestine and colon of a patient who was referred to us with a 12-year history of abdominal pain and a presumptive diagnosis of IBS. The results indicated that the diagnosis was pseudo-obstruction syndrome rather than IBS. Wider clinical use of the new techniques of prolonged ambulatory intestinal motility monitoring in IBS would offer considerable potential not only in achieving a greater understanding of its pathophysiology but also in providing a more precise definition of clinical and therapeutic subgroups.- - - - - - - - - - ranking = 8keywords = colonic (Clic here for more details about this article) |
8/9. Pseudo-obstruction of the colon."Pseudo-obstruction of the colon" refers to a condition in which physical and radiological findings identical to those associated with mechanical obstruction of the large bowel are found but in which no organic cause for the colonic distention is present. These cases may involve progressive proximal large bowel dilatation to the point of cecal perforation or necrosis. We have collected eight cases of our own which will be presented. The various etiologic factors reported in the literature will be discussed and analyzed and we will offer an anatomicophysiologic explanation of a possible mechanism, based on sympathetic-parasympathetic neurostimulatory imbalance.- - - - - - - - - - ranking = 1keywords = colonic (Clic here for more details about this article) |
9/9. colonic pseudo-obstruction following termination of pregnancy and uterine operation.colonic pseudo-obstruction refers to a condition in which physical and radiologic findings identical to those associated with mechanical obstruction of the large bowel are found but in which no organic cause of the colonic distention is present. Cases of this condition have been reported in the world literature, of which 40 per cent have followed the termination of pregnancy or uterine operation. Three cases of this syndrome are presented. One followed normal vaginal delivery; one followed cesarean section, and the third followed elective abdominal hysterectomy. The literature on the subject is reviewed, and a possible anatomicophysiologic explanation, based upon a sympathetic-parasympathetic neurostimulatory imbalance, is put forward.- - - - - - - - - - ranking = 1keywords = colonic (Clic here for more details about this article) |