1/18. Endoscopic preoperative colonic tattooing: a clinical and surgical complication.Endoscopic colonic tattooing is the simplest and most economic technique for identifying small lesions or polypectomy sites during open and laparoscopic surgery. Moreover, it is useful for the endoscopic follow-up of polypectomy sites. india ink is the agent of choice because of its long-lasting stain and the low risk of adverse reaction and toxicity. Very few cases of complications have been reported. We report here the case of a patient in whom colonic tattooing in preparation for surgical resection was followed by clinical complications such as fever and abdominal pain. An abscess-type inflamed pseudotumor was found at laparotomy. Histological examination revealed chronic granulomatous inflammation.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
2/18. The role of chemotherapy and prophylactic bilateral oophorectomy in a case of colorectal adenocarcinoma with ovarian metastases.A 66-year-old female presented with a large abdominal mass and accompanying systemic complaints of abdominal pain, constipation. and fever. On exploratory laparotomy, the mass was found to be a moderately differentiated adenocarcinoma of the sigmoid colon with metastasis to the left ovary. A primary colorectal carcinoma that has metastasized to the ovaries can be difficult to distinguish clinically from an advanced primary ovarian tumor. histology and tumor markers are currently the most useful tools available in making an accurate diagnosis. If the nature of the primary tumor is uncertain and the initial response to chemotherapy is poor, the patient's prognosis will also he poor. Though controversy exists regarding the role of prophylactic bilateral oophorectomy during resection for primary colorectal cancer, later confusion can be avoided by performing this procedure when the colorectal carcinoma is first diagnosed. However the possibility of a concurrent primary ovarian tumor must not be overlooked.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
3/18. Laparoscopic-assisted resection of giant sigmoid lipoma under colonoscopic guidance.Colonic lipomata are rare and mostly asymptomatic lesions; but as they become larger they may produce abdominal pain, constipation, diarrhea, hemorrhage, and intussusception. We report the case of a 75-year-old man who suffered from nonspecific recurrent abdominal pain in the left upper and lower quadrants and had variable episodes of diarrhea and constipation of 4 weeks' duration. During colonoscopy, a giant intraluminal polyp was diagnosed at 35 cm. Abdominal helical computed tomography (CT) revealed a constipating colonic tumor with a diameter of >or=50 mm and density values equal to fat. During laparoscopic surgery in the lithotomy position, the sigmoid and the descending colon were mobilized using a Harmonic scalpel. The origin of the polyp was localized precisely under colonoscopic guidance. The former 12-mm incision in the left lower quadrant was expanded to approximately 70 mm for extracorporal tumor resection. The left and sigmoid colon resections were carried out, and the polyp was removed by full-wall excision. After closure with a single-layer suture, the colon was pushed back into the peritoneal cavity. The patient had an uneventful recovery and was discharged 10 days postoperatively. histology confirmed a benign lipoma of the descending colon. Laparoscopic-assisted resection under endoscopic guidance proved to be suitable for the removal of large colonic polyps without complications.- - - - - - - - - - ranking = 2keywords = abdominal pain (Clic here for more details about this article) |
4/18. carcinosarcoma of the rectosigmoid colon: report of a case.We report an unusual case of carcinosarcoma of the colon. An 80-year-old woman was admitted to our hospital with lower abdominal pain. Computed tomography showed a large pelvic mass, 18cm in maximal diameter, and barium enema and colonoscopy both showed a type-2 tumor in the sigmoid colon. We performed Hartmann's procedure with resection of the ileocolic segment. Immunohistochemical stains of the resected specimen revealed that most of the tumor consisted of spindle cell sarcoma with neural and muscle differentiation, while only the superficial area of an ulcerated lesion contained adenocarcinoma positive for carcinoembryonic antigen. The patient died of a fast-growing recurrent pelvic tumor 6 months postoperatively. Our experience of this case and our review of eight other cases in the English literature indicate that wide resection provides the best chance of cure, but careful postoperative follow-up is essential.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
5/18. Obstructive colitis proximal to partially obstructive colonic carcinoma: a case report and review of the literature.BACKGROUND: Obstructive colitis refers to ulceroinflammatory lesions that occur in the colon proximal to an obstructing lesion. As this condition is not widely appreciated by pathologists or clinicians, we describe herein a case of colonic polyposis and sigmoid colonic carcinoma with obstructive colitis. PATIENT PRESENTATION: A 47-year-old Taiwanese woman presented to Cardinal Tien Hospital with a 3-day history of acute onset of abdominal pain, vomiting, and watery diarrhea. A lower gastrointestinal series using water-soluble contrast medium revealed annular narrowing of the sigmoid colon and showed polyposis at the rectosigmoid colon and regional colitis over the proximal descending colon. She was treated by total colectomy. Microscopic sections showed poorly differentiated adenocarcinoma, tubular adenomas, and a segment of obstructive colitis measuring 25 cm in length 5 cm proximal to the colon tumor. The tumor was also retrieved for simultaneous analyses of replication error and loss of heterozygosity. A total of three instances of loss of heterozygosity were demonstrated at the P53, MET, and D8S254 gene loci. No examples of replication error were detected. CONCLUSION: Obstructive colitis can cause diagnostic and therapeutic problems. colitis areas may be a source for septicemia or may perforate and lead to peritonitis. The frequently normal appearance at surgery may lead to involved segments of colon being used for anastomoses with consequent complications. awareness of the features and incidence of obstructive colitis should help physicians avoid these diagnostic and therapeutic problems.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
6/18. Refractory proctosigmoiditis probably caused by inferior mesenteric vein ligation at sigmoidectomy.A case of refractory proctosigmoiditis is reported in a 65-year-old female post-sigmoidectomy patient. She had bloody diarrhea and abdominal pain 2 years after sigmoidectomy, in which the inferior mesenteric vein was ligated close to the inferior mesenteric artery root during the lymph node dissection, while the inferior mesenteric artery trunk and the last branch of the sigmoid arteries was preserved. The biopsied specimen obtained by a fiber optic colonoscopy was diagnosed as proctitis. antidiarrheals, 5-aminosalicylic acid and steroid enemas showed only limited therapeutic effects. An angiography revealed a mild degree of rectal artery dilatation and tiny venous angiogenesis detected on the delayed phase images. Because the inferior mesenteric vein had been ligated, collateral veins developed to drain the blood on the distal side of the anastomosis to bilateral internal iliac veins. The venous blood of the descending colon (oral side of anastomosis) drained to left colic vein. The cause of rectosigmoiditis was considered to be venous congestion due to the inferior mesenteric vein ligation. A rectosigmoidectomy with reanastomosis using a double-stapling technique was performed, and the patient was discharged without symptoms.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
7/18. Trophoblastic tissue spread to the sigmoid colon after uterine perforation.BACKGROUND: Trophoblastic tissue spread following uterine perforation during dilation and curettage is rare. We present a case of trophoblastic spread to the sigmoid colon following uterine perforation, which was treated by surgical removal of the implants and intramuscular administration of methotrexate. CASE: A woman presented 3 weeks after curettage for a blighted ovum. laparotomy performed for suspected intra-abdominal bleeding revealed bleeding trophoblastic implants in a perforation tract and the anterior uterine wall and on the appendix epiploica of the sigmoid colon. The implants were surgically removed and methotrexate was administered for persistently high beta-hCG levels. The patient fully recovered. CONCLUSION: Extrauterine trophoblastic implants should be considered in women evaluated for abdominal pain whose pregnancy test is positive after uterine perforation. Conservative treatment with methotrexate in nonacute patients may be considered.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
8/18. Rare cause of abdominal pain in childhood: computed tomography findings in a 14-year-old boy with a colonic carcinoma.Carcinoma of the colon during infancy and childhood is a rare disease, and the diagnosis is usually not taken into consideration in a child complaining of abdominal pain. Owing to the lack of awareness of its occurrence and the histological cell type, it generally presents as advanced disease. We report on the case of a 14-year-old patient admitted to hospital with an acute abdomen and a 2-month history of night sweats and weight loss of 10 kg. Ultrasound and computed tomography revealed an unclear mass of the lower abdomen, and colonoscopic histopathologic examination disclosed an obstructing tubular-papillary adenocarcinoma of the sigmoid colon. Colonic carcinoma should be included as a differential diagnosis in young patients with abdominal pain of unknown etiology.- - - - - - - - - - ranking = 6keywords = abdominal pain (Clic here for more details about this article) |
9/18. Pyogenic liver abscesses secondary to carcinoma of the sigmoid colon: a case report and clinical features of 20 cases in japan.We report a case of liver abscesses associated with sigmoid colon cancer in an 81-year-old woman. The patient was referred to our hospital because of a tumorous lesion of the sigmoid colon. Five days before the scheduled operation, she presented abdominal pain, fever and chill. Imaging scans revealed multiple liver abscesses in both lobes, which were successfully treated with intravenously administered antibiotics. Two weeks later, the patient underwent laparoscopic-assisted sigmoidectomy. Nineteen cases of liver abscess associated with colonic cancer have been reported during the past ten years in japan, and we report the clinical features of these cases in this paper. An aggressive search for the underlying cause of pyogenic liver abscess should be an integral part of the definitive treatment of this disease.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
10/18. Sigmoid colonic carcinoma associated with deposited ova of schistosoma japonicum: a case report.We report a case of sigmoid colonic carcinoma associated with deposited ova of schistosoma japonicum. A 57-year old woman presented with a 10-mo history of left lower quadrant abdominal pain and a 2-mo history of bloody stools. She had a significant past medical history of asymptomatic schistosomiasis japonica and constipation. A colonoscopy showed an exophytic fragile neoplasm with an ulcerating surface in the sigmoid colon. During the radical operative procedure, we noted the partially encircling tumor was located in the distal sigmoid colon, and extended into the serosa. Succeeding pathological analysis demonstrated the diagnosis of sigmoid colonic ulcerative tubular adenocarcinoma, and showed deposited ova of schistosoma japonicum in both tumor lesions and mesenteric lymph nodes. Three days after surgery the patient returned to the normal bowel function with one defecation per day. These findings reveal that deposited schistosome ova play a possible role in the carcinogenesis of colorectal cancer.- - - - - - - - - - ranking = 1keywords = abdominal pain (Clic here for more details about this article) |
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