Annals of Coloproctology

Volume 17(6); December 2001

Original Articles

The Usefulness of Colonoscopy in the Management of Right Side Colonic Diverticulitis.: Lee, Eun Kyu , Kim, Hung Dai , Son, Beong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2001;17(6):283-288.

1,109 View
13 Download

Abstract PDF: PURPOSE
Most patients who finally diagnosed as the cecal and ascending colonic diverticulitis would complain pain on right low quadrant of abdomen. So many of them unfortunately would be performed emergency operation for presumed appendicitis. We are purposed to verify the usefulness of colonoscopy for the diagnosis and aimed to treat many patients with this disease conservatively.
METHODS
We reviewed retrospectively the medical records of the 46 patients who diagnosed as the cecal and ascending colonic diverticulitis under admission at general surgery department during 4 years from January, 1997 to December, 2000.
RESULTS
The mean age was 40.1 years and the male to female ratio was 1.2:1. Most common clinical manifestation was abdominal pain (46 cases) and nausea/vomiting (13 cases), fever/chill (4 cases) followed. On physical examination on abdomen, 26 patients had tenderness with rebound tenderness on right low quadrant and 18 patients showed only tenderness on right low quadrant. The mean peripheral WBC count was 10,600.9/mm2. Diagnostic tools were abdominal ultrasonography (34 cases), abdominal CT (13 cases), barium enema (8 cases) and colonoscopy (22 cases). The sensitivities of each modalities were 52.6%, 46.2%, 33.3% and 81.8% respectively. The respective mean hospital days depending on the treatment arms were as follows: 6.0 days of the conservatively treated group, 8.0 days of whom were operated as exploratory laparotomy with incidental appendectomy and 16.9 days of whom were operated as Right-hemicolectomy. 17 patients of 24 colonoscopy-done patients were recovered with conservative treatment, compared with only 7 patients of 22 colonoscopy-undone patients (P=0.0005). 2 cases of the conservatively managed groups were operated later due to recurrences (mean follow up periods=20 months). 2 operated patients had complications of postoperative ileus.
CONCLUSIONS
Based on our study, the indications of colonoscopy are that in whom impressed clinically as acute appendicitis, on physical examination there be obvious tenderness on right low quadrant but obscure rebound tenderness, on peripheral blood smear the WBC counts range from normal to mild increased (<15,000/mm2), and on ultrasonography, appendix couldn't be detected or colonic wall show thickening. In patients who selected fit for indications, colonoscopy is safe and highly sensitive. We would manage these patients more conservatively, and may reduce their hospital stay.

The Significance of Preoperative Stoma Site Marking.: Choi, Pyong Wha , Yu, Chang Sik , Cho, Young Gyu , Hong, Hyoun Kee , Lee, Hae Ok , Kim, Mee Sook , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(6):289-294.

1,017 View
22 Download

Abstract PDF: PURPOSE
The complication after colostomy formation may place undue hardship and emotional trauma on the ostomates. The purpose of this study was to find the effect of preoperative stoma site marking on postoperative stoma related complication.
METHODS
We recruited 127 colostomy patients who underwent sigmoid or descending end colostomy, by elective operation. Transverse colostomy, loop colostomy, and emergency operation were excluded in this study. We divided the patients into two groups according to pre-operative stoma site marking by an enterostomal therapist. Postoperative stoma related complications were compared and analysed prospectively using chi-square test and paired t-test. Significance was assigned to a P value of < 0.05.
RESULTS
Among 127 patients, 49 were marked preoperatively (marking group) while 78 were not marked (non- marking group). Overall stoma related complications were developed in 32 (25%) cases. Major complications including prolapse, parastomal hernia, stenosis were developed in 10 (8%) cases and minor complications including peristomal dermatitis and wound infection were developed in 22 (17%) cases. Stoma related complications were developed in 7 (14%) cases in the marking group and 25 (32%) cases in the non-marking group (P<0.05). Major complications were developed in 2 (4%) cases in the marking group and 8 (10%) cases in the non-marking group. Minor complications were developed in 5 (10%) cases in the marking group and 17 (22%) cases in the non-marking group. However, the difference in major and minor complications between the groups was not statistically significant. Of minor complications in the non-marking group, 9 (53%) cases due solely to postoperative frequent stool leakage caused by inappropriate location of the stoma. However, in the marking group, postoperative stool leakage was not observed.
CONCLUSIONS
Preoperative stoma site marking by an enterostomal therapist may reduce postoperative stoma related complication. All elective procedure that result in stoma formation should be assessed and marked preoperatively.

Is the Level of Anastomosis within the Anal Canal Pertinent to Physiologic and Functional Outcome in the Double-stapled Ileoanal Reservoir?.: Choi, Hong Jo , Choi, Jeong Seok , Saigusa, Naoto , Shin, Eung Jin , Weiss, Eric G , Nogueras, Juan J , Wexner, Steven D; J Korean Soc Coloproctol. 2001;17(6):295-303.

855 View
12 Download

Abstract PDF: PURPOSE
The aims of this investigation were to access the relative ratio of epithelial types within the anal canal after a double-stapled ileoanal reservoir (DSIAR) and to review physiologic and functional differences based on this diversity in epithelial types.
METHODS
According to types of the epithelium present at histologic sections of the distally excised tissue ring ("donut") after the stapling for restorative proctocolectomy with construction of a DSIAR, one hundred thirty-eight patients with ulcerative colitis were stratified into two groups: 40 patients (22 males and 18 females) were categorized to be of lower anastomosis (group I), where squamous, squamous mixed with columnar, or squamocuboidal component was reported to be present, and 98 patients (50 males and 48 females) to be of higher one (group II), which was evidenced by columnar epithelium at the "donut". Physiologic and functional parameters were appraised between 2 groups to define whether this difference in epithelial types is associated with a significant difference in postoperative anorectal functional outcome.
RESULTS
None of preoperative parameters reflecting resting and squeeze pressures showed significant differences between 2 groups. Postoperative mean and maximal resting pressures (MRP and MxRP) were declined to 48.8 16.9 mmHg and 67.1 21.3 mmHg in group I, and 61.1 22.7 mmHg and 90.0 38.6 mmHg in group II, differences of which were significant (P=0.046 and 0.031, respectively). Neither postoperative mean nor maximal squeeze pressure was, however, statistically different between 2 groups. Mean length of the high pressure zone was decreased in both groups postoperatively, but there were no intergroup differences. Rectoanal inhibitory reflex decreased significantly from 97.4% to 50% in group I and from 86.5% to 53.9% in group II, respectively (P<0.0001 in both). However, there was no significant intergroup difference postoperatively. Maximal tolerance volume and compliance of the reservoir were significantly improved postoperatively in both groups; from 52.2 26.1 ml and 2.8 3.3 to 163.3 115.7 ml and 14.7 15.3 in group I (P=0.0001, and <.0001, respectively), and from 77.0 59.5 ml and 4.4 6.8 to 167.3 87.9 ml and 28.7 44.0 in group II (P<0.0001, both). But there was no intergroup difference in either parameters postoperatively. There were no significant differences between groups relative to functional outcome except the diurnal incontinence to solid stool (P<0.011).
CONCLUSIONS
Although epithelial types were shown to be variable at the anal side of the anastomosis after a DSIAR, these differences were not associated with physiologic and functional differences. Therefore, if technically feasible, this procedure can be performed with safety without fear of significant functional derangement.

Etiology and Management for Adult Intussusception.: Park, Sung Won , Kim, Hee Cheol , Cho, Young Kyu , Hong, Hyoun Ki , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(6):304-308.

960 View
16 Download

Abstract PDF: PURPOSE
Intussusceptions occurring in adults are relatively rare, however, surgery is usually recommended since they frequently accompany organic lesions as predisposing factor. The purpose of this study is to analyze clinical manifestations and investigate optimal treatment principles for adult intussusception.
METHODS
Clinicopathogic manifestations of 28 adult intussusception patient were analyzied, retrospectively. The types of adult intussusception were classified as enteric and colonic types. Sex ratio was 15:13 and mean age was 52 (17-80) years.
RESULTS
CT scan was the most accurate tool for diagnosis of adult intussusception and detection of underlying causes. The types of adult intussusception were 4 jejuno-jejunal, 7 ileo-ileal, 15 ileo-cecal, and 2 colo-colic types. The pathologic lesions were identified in 23 out of 28 cases (82%). Malignancy was the cause of adult intussusception in 5 cases (45%) of enteric type and in 6 cases (35%) of colonic type intussusception. Operations were performed in 26 cases (93%) and resection without reduction was performed in 23 cases.
CONCLUSIONS
Surgical exploration without reduction may be the treatment of choice since the majority of cases have organic lesions as the etiology, with relatively frequent association of malignancies.

The Safety of Intraoperative Colonic Irrigation for Single Stage Procedure in Emergency Based Left Colonic Pathology.: Kim, Bum Ryul , Shon, Dae Ho , Jang, Byung Ik , Jung, Moon Kwan , Shim, Min Chul , Kim, Jae Hwang; J Korean Soc Coloproctol. 2001;17(6):309-315.

915 View
13 Download

Abstract PDF: Staged procedures are preferred to single stage procedures in emergency based left colonic obstruction or perforation because of the safety. PURPOSE: To evaluate whether the single stage procedure in emergency based left colonic pathology is not safe.
METHODS
We compared medical records of single stage procedure (SP, n=22 male; 10, mean age: 60+/-17, range: 26-82 Yrs) with Hartmanns procedure (HP, n=23 male; 13, mean age: 58+/-16, range: 18-90 Yrs) and diverting loop colostomy (DC, n=19, male; 12, mean age: 59+/-19, range: 19-80 Yrs) in these 4 years. All the patients were admitted via emergency room. Intraoperative colonic irrigation method with newly developed irrigation device (MITech co., Ltd, Seoul, Korea) was used for SP. APACHE III scoring system was applied to evaluate the physiologic status of the patients. Preoperative data were compared with the 1st and 3rd postoperative day (POD).
RESULTS
There were no statistically significant differences in patient demographics and preoperative APACHE III scores. The improvement of APACHE III score was significant in SP and DC on the 3rd POD from 29.6+/-20.9 to 22.9+/-10.2 and 25.7+/-13.3 to 21.4+/-14.8 (P<0.05). There was also a significant improvement in DC (25.7+/-13.3 to 21.9+/-12.9, P<0.05) on the 1st POD, however, there was only a tendency of improvement in SP (29.6+/-20.9 to 26.1+/-12.3) without statistical significance. The scores in HP showed no improvement on the 1st and 3rd POD. There were 3 operative mortalities in HP and one in DC.
CONCLUSIONS
Our results suggest that the safety of the single stage procedure with newly developed colonic irrigation device is comparable to palliative decompressive loop colostomy and better than Hartmanns procedure in emergency based left colonic pathology.

Thymidylate Synthase Expression Using Immunohistochemical Staining in Colorectal Cancer.: An, Chang Hyeok , Seo, Hak Jun , Kim, Kee Hwan , Oh, Seung Tack , Kim, Jeong Soo , Jeon, Hae Myung , Lim, Keun Woo , Lee, Eun Jung; J Korean Soc Coloproctol. 2001;17(6):316-323.

993 View
6 Download

Abstract PDF: PURPOSE
Thymidylate synthase (TS) is a critical enzyme in the DNA synthesis and an important target of cancer chemotherapeutic agents, such as 5-fluorouracil (5-FU). Recent studies suggest that TS expression is related to the prognosis of various cancers and the mechanism of chmotherapeutic drug resistance. This retrospective study was performed to determine whether TS expressions in primary colorectal tumors influence the overall survival and recurrence for patients with colorectal cancer.
METHODS
Intratumoral TS expression was evaluated by immunohistochemical staining using TS-106 monoclonal antibody in primary colorectal cancers of 64 patients who had undergone surgery from July, 1995 to June, 1999. The relationship between TS expressions and patients' survival was evaluated statistically. The median follow-up period was 25.7 months.
RESULTS
Overall positive TS expression rate was relatively high (54.7%) in colorectal cancers, and overall disease-free survival rate was significantly higher in the TS positive group (P=0.0204). But there was no statistically significant differences in overall survival rates (P=0.249) and tumor recurrence rates (P=0.732) between positive TS group and negative TS group.
CONCLUSIONS
These results suggest that TS expression status in the colorectal cancer tissue is only related to the overall disease-free survival rates, not the overall survival rates and tumor recurrence rates. More objective method and long term follow up study will be required for accurate assessment of clinical importance of TS expression in colorectal cancers.

The Effects and Surgical Morbidity of Preoperative Combined Chemoradiotherapy for Locally Advanced Rectal Cancer.: Chung, Ji Eun , Kim, Kap Tae , Chung, Eul Sam; J Korean Soc Coloproctol. 2001;17(6):324-331.

950 View
24 Download

Abstract PDF: PURPOSE
The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer.
METHODS
Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy.
RESULTS
Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy.
CONCLUSIONS
Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.

Association of Human Papillomavirus with Human Colorectal Cancer.: Min, Byung Wook , Hong, Jeong Hoon , Lee, Kyung Bum , Moon, Hong Young; J Korean Soc Coloproctol. 2001;17(6):332-336.

926 View
13 Download

Abstract PDF: PURPOSE
The aim of this study is to confirm the association of human papillomavirus with colorectal cancer.
METHODS
We studied 44 patients who were received operation for colorectal cancer from 1, Jan. 1997 to 31, Dec. at Korea University Guro Hospital. We used paraffin- embedded tissue sections of colorectal adenocarcinomas and human cervical cell lines as a positive control. We also studied 10 cases of anal canal squamous cell carcinomas. The extracted DNA were analyzed by polymerase chain reaction and enzyme restriction method.
RESULTS
Human papillomavirus DNA was not detected in all specimen of colorectal adenocarcinomas. But in 3 of 10 (30%) of anal canal squamous carcinomas, human papillomavirus DNA was detected. We identified this human papillomvirus DNA as type 16 by enzyme restriction technique.
CONCLUSIONS
Human papillomavirus usually associated with malignant transformation are present in anal canal squamous cell carcinomas. This study also showed same result. But this association was absent from adenocarcinoma of the colon and rectum.

Abdominopelvic Omentopexy to Prevent Postoperative Radiotherapy Complications in Rectal Cancer after Abdominoperineal Resection.: Kim, Woo Jin , Lee, Sang Kuon , Pak, Seong Chul , Oh, Seong Taek , Kim, Se Kyung , Kim, In Chul; J Korean Soc Coloproctol. 2001;17(6):337-341.

1,063 View
19 Download

Abstract PDF: PURPOSE
In rectal cancer, it is known that the postoperative radiotherapy is an effective way for reducing locoregional recurrence, especially if accompanied with concurrent chemotherapy. However, toxicity to small bowel was one of the major limitations to perform full-dose radiotherapy. For overcoming this problem, abdominopelvic omentopexy, which separates the small bowel from the pelvic cavity, was developed. This study analyses the acute and chronic complications related to the partitioning of the pelvic cavity and subsequent postoperative radiotheraphy.
METHODS
From January 1990 to September 1999, medical records of 127 patients with rectal cancer who underwent abdominoperineal resection were retrospectively reviewed. Seventy-one of these patients belonged to stages B2 through D according to the modified Astler-Coller classification and underwent adjuvent chemoradiation therapy, and abdominopelvic omentopexy was performed in thirty- three patients. We compared postoperative radiotherapy complications between abdominopelvic omentopexy group and non-abdominopelvic omentopexy group. After abdominoperineal resection, the greater omentum covers whole small bowel like apron. The lateral edges are attached to both lateral peritoneal wall with continous running suture. The lower margin is sutured to the parietal peritoneum of the posterior abdominal wall at the level of the aortic bifurcation. The pelvic reperitonealization was carried out in whole patients.
RESULTS
In the group of radiotheraphy with abdominopelvic omentopexy, six patients showed signs of acute radiation enteritis, whereas no case of chronic radiation- induced enteropathy was observed. Other complications were postoperative ileus (three patients), urinary problems (four patients), radiation dermatitis (ten patients), and radiation-induced leukopenia (three patients). In the group of radiotheraphy without abdominopelvic omentopexy, 7 out of 38 patient developed symptom and sign of radiation- induced chronic complication. The chronic complication rate is significantly lower in the omentopexy group than in the non-omentopexy group (P=0.0089).
CONCLUSIONS
Abdominopelvic omentopexy is effective for preventing the late sequela of radiation-induced enteritis.

Clinical Characteristics of Inguinal Hernia Following Rectal Cancer Surgery.: Lee, Chang Min , Kim, Hee Cheol , Cho, Young Kyu , Hong, Hyun Kee , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2001;17(6):342-345.

971 View
7 Download

Abstract PDF: PURPOSE
The anatomic and physiologic changes after rectal cancer surgery was suggested to be a cause of inguinal hernia. But, there are only few reported cases about the inguinal hernia following rectal cancer surgery. The aim of this study is to verify risk factors and surgical techniques to prevent inguinal hernia following rectal cancer surgery.
METHODS
Out of 1226 patients who underwent operations at the Department of Surgery, Asan Medical Center, between the period from June 1989 to July 1999, 12 patients who had developed inguinal hernia and their medical records were reviewed retrospectively regarding the clinical characteristics.
RESULTS
The median duration of hernia following rectal cancer surgery was 12 (3-36) months. The median age was 63 (36-74) years with eight of them more than seventh decades of their life. All patients had male sex. Three of them were overweighted. Five cases had hernias on the left side, six on the right, and one case on both side. All patients had indirect inguinal hernia. Three cases had preoperative symptoms of bowel obstruction. The operations for rectal cancer were low anterior resection in eight cases, ultralow anterior resection in three cases, and abdominoperineal resection in one case. The complications in rectal cancer surgery were found in six cases. Six cases had the advanced stage. A postoperative radiation therapy was applied in five cases. Five cases had the coexisting diseases.
CONCLUSIONS
Male sex and old age would be related with occuring inguinal hernia after rectal cancer surgery and, it would be necessary to give a special attention to the patients who have these factors, although the present study could not show the definite correlation between inguinal hernia and rectal cancer surgery due to a small number of cases.

Case Report

A Case of Recurrent Perianal Paget's Disease.: Bang, Sang Young , Kang, Won Kyung , Park, Jong Kyung , Kim, Ji Yeon , Park, Seung Chul , Ahn, Chang Hyuk , Oh, Seong Taek; J Korean Soc Coloproctol. 2001;17(6):346-349.

971 View
3 Download

Abstract PDF: Extramammary Paget's disease is an uncommon intraepithelial carcinoma of the skin and mucosa usually occurring in the anogenital area. Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. Clinical manifestations of perianal Paget's disease include pruritis (most common), irritation, rash, lump sensation and the lesion shows erythematous, crusted or scaly area which may weep clear fluid. Lichenified, leukokeratotic or leukoplakia-like patches may also develop in some patients. These areas may resemble eczema or contact dermatitis. Many authors recommend surgery as the treatment of choice. Extended surgical excision for non-invasive lesion and excision of rectum or abdominoperineal resection for invasive disease is recommended. The prognosis for non-invasive lesion is excellent, but for invasive lesion is poor.We experienced one case of perianal Paget's disease which recurred after wide excision of vulvar area for Paget's disase, and performed secondary abdominoperineal resection. Now, radiation therapy was done for adjuvant therapeutic modality.

First
Prev
Page of 1
Next
Last

Previous issues