1/20. Unusual 'recurrence' sites for colorectal cancer.Five patients are reported. Four underwent major 'curative' restorative colorectal resections and developed perineal 'recurrence', 2 developed 'recurrence' in the distal ends of previously identified fistulae in ano and 2 developed 'recurrence' at the site of a previously performed haemorrhoidectomy. The fifth patient developed metastasis to a fistula track prior to surgical intervention. The danger of implantation of exfoliated tumour cells in patients with distally situated 'raw' mucosal sites is recognized and anorectal procedures should not be performed prior to resection. Minor anorectal procedures should not be performed at the same time as colorectal resections for carcinoma in these patients either. Some 'recurrences', such as those described in this paper, may be inevitable and in fact really represent preoperative metastases. Routine flexible sigmoidoscopy prior to the performance of any anorectal procedure might identify patients at risk of such 'recurrences' but this may not be cost-effective.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/20. Colorectal adenocarcinoma as a second malignant neoplasm following rhabdomyosarcoma of the urinary bladder: a case report.Following improvements in therapy for childhood malignancies, the striking increase in survival rate over the past 30 years has led to the increase risk of developing second malignant neoplasms (SMNs). We report a case of colorectal carcinoma as a SMN, following treatment for rhabdomyosarcoma. The patient was diagnosed with rhabdomyosarcoma of the urinary bladder at his age of three years, and developed adenocarcinoma in the colon 13 years later. Histologic examination of the surgical specimen revealed adenocarcinoma involving the rectosigmoid area with radiation colitis in its background. The tumor cells showed strong immunoreactivity for p53 protein, suggesting the role of irradiation and p53 mutation in carcinogenesis. This case emphasizes the need for dose observation in survivors of early childhood malignancies treated with radiation and multiagent chemotherapy.- - - - - - - - - - ranking = 1.4923249194869keywords = urinary (Clic here for more details about this article) |
3/20. Tuboovarian abscess mimicking malignancy: report of two cases.Tuboovarian abscess is a well-known sequela of acute or chronic salpingitis. In a small percentage of patients, these inflammatory masses compress or even rupture into the adjacent viscera, thus simulating the condition of pelvic malignancy, particularly when the clinical presentations are indolent. We describe two cases of tuboovarian abscess mimicking malignancy. Case 1: A 39-year-old woman with an intrauterine device had a clinical presentation mimicking an exophytic submucosal colorectal tumor with suspicious mucosal invasion. She complained of tenesmus but did not experience fever or adnexal tenderness. A right tuboovarian abscess with fistula formation into the rectosigmoid colon was noted during laparotomy. Case 2: A 46-year-old woman with an intrauterine device had a preoperative diagnosis of uterine myoma with degeneration. At laparotomy, an omentum cake with dense pelvic adhesions was noted. Malignancy appeared to be present, and debulking surgery was performed. The final pathologic examination revealed bilateral chronic tuboovarian abscesses and focal omental abscess.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
4/20. Colorectal cancer complicating Crohn's disease.Some earlier studies have indicated that patients with inflammatory bowel disease, especially those with long-standing and extensive ulcerative colitis, have an increased risk of colorectal cancer. Moreover, others in tertiary care centres have suggested that patients with Crohn's disease also have a higher risk of colorectal cancer. Canadian data on colorectal cancer in Crohn's disease appear to be limited. For this investigation, a single clinician database of 877 patients with Crohn's disease was used. Altogether, there were six patients with colorectal cancer (ie, overall rate of 0.7%). All of these patients were men with an initial diagnosis of Crohn's disease established at a mean age of approximately 28 years, with either ileocolonic disease or colonic disease alone, but not with ileal disease alone. Although there was a predominance of women in the overall study population (ie, 56.1%), no women developed colorectal cancer. The clinical behaviour of Crohn's disease was classified as nonstricturing in all six patients with colorectal cancer, but in two patients, Crohn's disease was complicated by a perirectal abscess or a fistula. All cancers were located in the rectum and were diagnosed 30 years, 22 years, seven years, 18 years, 20 years and 40 years after Crohn's disease was initially diagnosed. In three patients, the cancer was detected in a residual rectal stump after a partial colon resection at least 10 years earlier. In five patients, localized extension of disease through the serosa, nodal or distant metastases (ie, liver, lung) was found at the time of cancer diagnosis; two patients have since died. The present study confirms that Crohn's disease involving the colon may be a possible risk factor for the development of colorectal cancer, at least in younger men, but, in this study, not in women. However, part of this increased risk in men may have been related to the presence of a rectal stump, rather than to Crohn's disease per se.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
5/20. malacoplakia simulating organ invasion in a rectosigmoid adenocarcinoma: report of a case.malacoplakia is a histiocytic inflammatory response that may be associated with colorectal tumors. We report the case of a 65-year-old male taking steroids for a severe pulmonary disease. He presented with a rectosigmoid tumor that seemed to infiltrate the urinary bladder and the sacrum on the preoperative CT scan and echography and at laparotomy. A low anterior resection en bloc with a partial cystectomy was performed. The pathologic analysis showed a pT3pN0 adenocarcinoma with an extensive malacoplakia infiltrating the bladder and the pericolic and perirectal tissues. This case report emphasizes the overstaging that malacoplakia may induce and underlines a situation the surgeon may possibly confront. Our observation confirms the association of malacoplakia, colorectal carcinoma, and steroid treatment.- - - - - - - - - - ranking = 0.29846498389737keywords = urinary (Clic here for more details about this article) |
6/20. clostridium septicum and malignancy.BACKGROUND: clostridium septicum is known to be associated with malignancy or immunosuppression. It has a variable clinical presentation and is associated with a high mortality. The aim of the present study was to review the experience at St George Hospital, Sydney, over a 10-year period, with particular reference to the association of this condition with colorectal cancer. methods: The records of five patients with blood culture-proven clostridium septicum infection, among a larger group of 31 patients with clostridial infections, presenting to St George Hospital between 1990 and 2000 were reviewed. RESULTS: Associated malignancy was found in four (80%) of the patients with clostridium septicum infection. Two infections were related to colorectal cancer, two to haematological malignancies and one to radiation-induced recto-urethral fistula. Those patients who had colorectal cancer presented with septicaemia and vague abdominal symptoms. CONCLUSIONS: clostridium septicum infections have a strong association with malignancy. When this infection occurs without an obvious underlying aetiology there should be a high index of suspicion about associated malignancy. In the absence of haematological malignancy a colonoscopy is warranted. early diagnosis and aggressive treatment is essential in order to improve prognosis.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
7/20. Palliative treatment of an enterorectal fistula with a covered metallic stent.In patients with recurrent colorectal cancer, the development of fistulae presents a difficult therapeutic problem. The traditional surgical approach of resection and intestinal diversion may not always be appropriate in those with disseminated or terminal disease. We present the successful use of a covered esophageal stent to occlude an enterorectal rectal fistula in a patient with recurrent inoperable colonic carcinoma.- - - - - - - - - - ranking = 3keywords = fistula (Clic here for more details about this article) |
8/20. Lhermitte sign and urinary retention: atypical presentation of oxaliplatin neurotoxicity in four patients.BACKGROUND: Regimens combining oxaliplatin with fluorouracil and folinic acid are standard therapeutic options for patients with metastatic colorectal carcinoma. Oxaliplatin has a good safety profile, although it is responsible for dose-limiting neurotoxicity typically consisting of two distinct clusters of symptoms. Cold-induced distal paresthesiae occur during or shortly after infusion in most patients and are usually transient and mild. A persistent sensory peripheral neuropathy may develop with prolonged treatment, eventually causing superficial and deep sensory loss, sensory ataxia and functional impairment. methods: The authors report four cases of atypical neurotoxicity induced by oxaliplatin in patients treated for metastatic colorectal carcinoma. Two patients were male and two were female, with an age range of 52-59 years. RESULTS: Three patients experienced Lhermitte sign and two experienced urinary retention. In all cases, the cumulative dose of oxaliplatin was higher than 1000 mg (range, 1248-2040 mg). brain and spinal magnetic resonance imaging was performed in two patients and was normal. Somatosensory evoked potentials were recorded in two patients and suggested cervical dorsal column dysfunction. Symptoms resolved a few weeks after discontinuation of oxaliplatin. CONCLUSIONS: Lhermitte sign may be induced via a neurotoxic effect on the ascending axons of these T-shaped neurons. An atonic bladder may be the result of damage to the sensory portion of the sacral reflex arc, either in the dorsal roots, as for example in diabetic neuropathy, or in the posterior columns, as in tabes dorsalis. Alternatively, it may result from a paralysis of the parasympathetic fibers that control the bladder musculature. It is unclear at present whether the micturition difficulties observed in patients in the current series are due to sensory neuropathy or to autonomic neuropathy, event if the former hypothesis seems more likely, as autonomic neuropathy has not been previously observed with oxaliplatin, and its association with cisplatin is exceedingly rare and controversial.- - - - - - - - - - ranking = 1.4923249194869keywords = urinary (Clic here for more details about this article) |
9/20. Does rich fiber diet accelerate the healing process of low-output colorectal fistulas?The occurrence of an anastomotic leakage is a major therapeutic concern in colorectal surgery. Considering the outflow level of the fistula, a defunctioning stoma may be necessary to obtain closure. When the outflow is low and the intestinal transit is not interrupted, a colostomy is not mandatory but the healing process can be long. Here the author presents three consecutive cases of low output fistula treated by feeding with an enriched fiber diet. Closure of the fistulae occurred in a few days. The rationale of this alternative treatment is discussed.- - - - - - - - - - ranking = 3.5keywords = fistula (Clic here for more details about this article) |
10/20. Screening for familial colorectal cancer: the need for continuing education. A case report.A 37 year old female patient was diagnosed with sigmoid colon cancer in our clinic five years ago (January 1998). The family history revealed three deaths due to colorectal cancer (maternal grandmother, mother's sister and patient's sister), and the patient's mother had been diagnosed with adenomatous polyps (endoscopically removed). Histopathological diagnosis was moderate / poorly differentiated adenocarcinoma. Resection of sigmoid colon was performed and adjuvant chemotherapy was carried out, with uneventful evolution. The patient was annually followed-up (colonoscopy, abdominal ultrasound, laboratory tests). The last admission was in January 2003. No recurrence or metastases were found. The patient's mother, who was admitted at the same time, had been diagnosed with urinary bladder tumor. Subjects with a personal or family history of colorectal cancer should routinely have a colonoscopy beginning from age 40 or earlier. It is important for such patients to be followed-up closely not only for recurrence or metastases, but also for detection and treatment of a second primary cancer at an early stage- - - - - - - - - - ranking = 0.29846498389737keywords = urinary (Clic here for more details about this article) |
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