Annals of Coloproctology

Volume 21(2); April 2005

Original Articles

Regional Distribution of Peptide YY Concentrations in Human Lower Gastrointestinal Mucosa.: Sin, Jin Yong , Hong, Kwan Hee , Oh, Nahm Gun; J Korean Soc Coloproctol. 2005;21(2):65-70.

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Abstract PDF: PURPOSE
Peptide YY is composed of 36 amino acids, and its functions are suppression of gastric acid secretion, delay of gastric emptying, increase of intestinal motility, inhibition of pancreatic exocrine secretion, and enhanced postprandial colonic absorption of water and electrolyte. PYY is released from PYY cells, which are mainly distributed in the ileum and colon, in response to the presence of intraluminal lipids. This study was designed to determine the regional distribution of PYY in the normal human ileum, colon, rectum, and anal canal by studying mucosal concentrations.
METHODS
Fresh tissues were obtained from specimens of segmental resections of the small bowel, colectomies, ileostomies, and abdominoperineal resections for the management of colonic or rectal carcinomas or benign diseases of the bowel. Only specimens devoid of advanced luminal obstruction were included. Mucosa was separately recruited by microdissection of frozen sections. Radioimmunoassays were performed using the methods of Adrian et al.
RESULTS
The concentration of PYY was highest at 25 cm proximal to the ileocecal valve in the ileum (307.6 pmol/ g) and in the upper rectum at the colon (653.1 pmol/g). The concentration of PYY was 27.3 pmol/g in the anal canal distal to the dentate line. A clear differential distribution of PYY was shown in the ileum and colon.
CONCLUSIONS
This study showed PYY was present in large amounts in the mucosa of the ileum and colon, with high concentrations in locations 25 cm proximal to ileocecal valve and in the upper rectum, respectively. The trend of regional differences in PYY in the colonic mucosa probably reflects local differences in functions, such as absorption and storage. Also, the peak concentration in the ileum at 25 cm proximal to ileocecel valve suggests that this region is the most abundant production site of PYY in the ileum.

The Effect after Intra-dermal Methylene Blue, Hydrocortisone, Lidocaine Injection Therapy for Intractable, Idiopathic Pruritus Ani.: Kim, Joo Hyung , Lee, Yong Pyo; J Korean Soc Coloproctol. 2005;21(2):71-75.

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Abstract PDF: PURPOSE
Idiopathic pruritus ani is a common and embarrassing proctological condition which can be very difficult to treat. In this study, we documented our results with methylene blue intra-dermal injection in patients with intractable idiopathic pruritus ani.
METHODS
5-ml 1% methylene blue, 100-mg hydrocortisone, and 15-ml 1% lidocaine were injected into the perianal skin of 21 patients with idiopathic pruritus ani which had proved refractory to standard care. Clinical follow-up was undertaken.
RESULTS
After one injection of the above solution, 15 (71.4%) of the patients were rendered symptom free. Repeat injection in the initial non- responders ultimately rendered another four. 19 (total: 90.5 %) of the patrents symptom free. Morbidity was 0%.
CONCLUSION
This study has shown that intra-dermal methylene blue injection is a safe, simple, and efficient method of treating intractable, idiopathic pruritus ani.

The Effect of Hyaluronate Membrane on Prevention of Adhesion after Rectal Cancer Surgery: a Prospective Study.: Yu, Chang Sik , Kim, Hee Cheol , Park, In Ja , Lee, Kang Hong , Kim, Jin Cheon; J Korean Soc Coloproctol. 2005;21(2):76-81.

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Abstract PDF: PURPOSE
The aim of this study was to evaluate the efficacy of using a Hyaluronate (HA) bioresorbable membrane (SeprafilmTM, Genzyme Corp., Cambridge, MA) to prevent adhesion after rectal cancer surgery.
METHODS
We recruited 362 rectal cancer patients who underwent a curative resection between April 2001 and December 2002. We excluded patients with a previous operation history, a stoma procedure, a multivisceral resection, an extended lymphadenectomy, a total colectomy, or a pouch procedure. An adhesive ileus was defined as a symptomatic, radiological intestinal obstruction without evidence of recurrence.
RESULTS
We placed the HA membrane under the midline incision in 153 patients. There was no difference between the groups regarding demographic findings and clinicopathological findings, including locations of the tumors, surgery performed, AJCC stage, and adjuvant treatment. While only 1 (0.7%) patient of the HA group experienced an adhesive ileus, 13 (6.2%) cases of adhesion were identified in the control group (P=0.008). Every patient, except 1 in the control group, underwent conservative management.
CONCLUSIONS
A Hyaluronate membrane may be effective in preventing an adhesive ileus after rectal cancer surgery. However, a prospective, randomized, double-blind study is needed.

Local Pelvic Recurrence after Curative Resection of the Rectal Cancer: Classification and Prognosis.: Park, Jea Kun , Kim, Nam Kyu , Baik, Seung Hyuk , Lee, Kang Young , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2005;21(2):82-88.

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Abstract PDF: PURPOSE
The management of local recurrence after curative surgery of the rectal cancer remains difficult clinical problems to surgeons. This study was performed to analyze the outcomes of patients with local pelvic recurrence according to its recurrence type.
METHODS
A total 109 patients with local recurrence were evaluated. Among the 109 patients 62 were local recurrence alone and 47 were both local and systemic recurrence. The recurrence type was classified as Central, Anterior, Posterior, Lateral and Perineal recurrence according to the relation of the tumor location and either intra pelvic organ and/or fixed pelvic structure.
RESULTS
Only 26 (23.9%) of the 109 patients had curative resection and the remaining 83 (76.1%) patients had palliative exploration or nonsurgical procedure. The resectability according to the recurrence type showed that the Central and Anterior type was higher than other type of recurrences (P=0.001). When the primary operation was Abdominoperineal Resection (APR) the resectability was poorer than Low Anterior Resection (LAR) (P=0.0001). When comparing the patients with local recurrence alone, the 5 year survival rate was significantly higher patients treated by curative resection than palliative or non-resection group (P=0.002). Mean follow up period was 44.2+/-30.0 months and mean recurrence time between primary operation and recurrence was 26.0+/-22.7 months.
CONCLUSIONS
Resection for central type of the recurrent is potentially curative, however treatment failure was common when the recurrence invaded fixed pelvic structure. Our data suggest that local pelvic recurrence should be treated with radical resection as can as possible.

The Effect of Preoperative Concurrent Chemoradiation in Locally Advanced Rectal Cancer.: Cho, Hyeon Min , Kim, Jun Gi , Jung, Hun , Heo, Youn Jung , Won, Yong Sung , Chun, Kyung Hwa , Chin, Hyung Min , Park, Woo Bae , Chun, Chung Soo; J Korean Soc Coloproctol. 2005;21(2):89-99.

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Abstract PDF: PURPOSE
Tumor downstaging from preoperative chemoradiation has been associated with an increased probability of a sphincter-saving procedure and with improved local control and survival rate. We observed the effect and the prognostic value of pathologic tumor downstaging, including complete pathologic response to preoperative concurrent chemoradiation, resectability, sphincter-saving rate, disease- free survival, and overall survival in locally advanced rectal cancer patients.
METHODS
From January 2000 to December 2003, we recruited a total 78 patients with computed tomography stages II and III rectal cancer which was treated by using preoperative concurrent chemoradiation; all patients had a radical resection with total mesorectal excision. Surgical resection was performed 6 to 8 weeks after completing the radiation therapy. The average follow up was 25.40+/-13.64 months.
RESULTS
The number of patients according to CT stage before preoperative chemoradiation was 39 (II) and 39 (III). Tumor downstaging occurred in 51 (65.4%) patients, including 11 (14.1%) patients who had a complete pathologic response. Tumor size, radiation dose, and clinical stage were associated with tumor downstaging in the univariate analysis. None of the clinical or pathologic variables was associated with a complete pathologic response. The overall resectibality was 100%. The number of sphincter-saving procedures were 61 (78.2%). Recurrence occurred in 17 (21.8%) patients: local recurrence in 4 (5.1%) and distant metastasis in 13 (16.7%). None of the patients with a complete pathologic response recurred. Recurrences were 3 (17.6%)/7 (22.6%)/7 (36.8%) for pathologic stages I/II/III. Recurrence was more common among younger patients (P <0.05). Patients in the complete pathologic response group had more favorable disease-free survival compared with other group (yp stage I, II, III) (P=0.026).
CONCLUSION
Preoperative concurrent chemoradiation for locally advanced rectal cancer seems to afford some potential advantages: high tumor response, resectability, and feasible sphincter preservation, and even a complete pathologic response. A complete pathologic response to preoperative chemoradiation is associated with an improved disease-free survival.

Case Reports

Colorectal Cancer during Pregnancy or Postpartum: A Review of 7 Cases.: Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2005;21(2):100-104.

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Abstract PDF: Colorectal cancer during pregnancy is a very rare condition with a reported incidence between 0.001% and 0.1%. Delayed diagnosis is common because of the similarity between the early signs and symptoms of colon cancer and the gastrointestinal symptoms related to pregnancy, which results in a poor prognosis. Only two cases, related with pregnancy were reported in Korea prior to 2004. We report seven cases of colorectal cancer during pregnancy or postpartum, as well as a literature review. We experienced 7 cases of colorectal cancer which were discovered during pregnancy or 2 weeks after delivery. The chief complaints were abdominal pain, discomfort, and hematochezia. The locations were the rectum in two cases, the right-side colon in two cases, the splenic flexure in two cases, and the sigmoid colon in one case. The stages of the disease were advanced in two cases: one with ovarian metastasis and the other with breast metastasis. There were four stage II patients who survived for 70, 34, 47, and 15 months, respectively. one patient had intra-mucosal cancer, which was identified incidentally during examination. The patient with ovarian metastasis died at 57 months postoperatively and the patient with breast metastasis died at 3 months.

A Case of a Tailgut Cyst.: Kim, Sin Sun , Kim, Ji Yeon , Lee, Hye Kyung , Hwangbo, Seal , Kim, Jeong Gu , Lee, Dong Ho , You, Young Kyoung , Ahn, Chang Joon; J Korean Soc Coloproctol. 2005;21(2):105-108.

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Abstract PDF: The tailgut is a blind extension of the hindgut into the tail fold just distal to the cloacal membrane. Remnants of this structure may form a tailgut cyst. This is prone to infection and chronic fistula formation and has a long-term risk of malignancy. Non-recognition and incomplete treatment leads to morbidity. A twenty one year-old female patient visited our hospital with repeated perianal pain and discharge. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal cyst suggestive of a tailgut cyst. She underwent a complete excision of the retrorectal mass through a presacral approach. She recovered uneventfully. This report includes the case and a brief review of tailgut cysts.

Cecal Intramural Hematoma after Acupuncture in a Patient Taking Anticoagulant Drug.: Lee, Yoon Suk , Kim, Jin Jo , Lee, Keun Ho , Oh, Se Jung , Park, Seung Man , Kim, Young Ha; J Korean Soc Coloproctol. 2005;21(2):109-111.

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Abstract PDF: The most common causes of an intramural hematoma of the bowel are blunt trauma and complications from an anticoagulant drug. The duodenum is the most common site of an intramural hematoma caused by blunt trauma. An intramural hematoma caused by the use of an anticoagulant drug commonly involves the small bowel and can be conservatively treated with good prognosis. However, an intramural hematoma caused by trauma or injury in a patient who is taking an anticogulant drug has rarely been reported. We report the case of 75-year-old woman with an intramural hematoma who took cumadin after acupuncture and who presented with acute abdominal pain, especially on the RLQ area. Abdominal CT showed a cecal wall enlargment and enhancement. We performed an emergency operation under the impression of peritonitis. During the opertion, we found the cecal intramural hematoma, so a right hemicolectomy was done. An Intramural hematoma after a focal injury, such as acupuncture, in a patient who is taking an anticoagulant drug can take place in Korea. We think that proper treatment should be studied. Also education patients taking an anticoagulant drug should be addressed.

Review

Current Status of Laparoscopic Colectomy for Colon Cancer.: Lee, Woo Yong; J Korean Soc Coloproctol. 2005;21(2):112-119.

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Abstract PDF: Although laparoscopic colon resection is a widely accepted treatment for benign colon disease, many questions have been raised about its value in management of colorectal cancer. The short-term benefits of this operation, such as decreased incidence of pulmonary complications, faster return of the bowel function, decreased narcotic requirements, shortened hospital stay, and faster recovery time, are now well established. However, there are many controversies for this method as a treatment of cancer. The main issues are adequacy of oncologic resection, recurrence rates and patterns, and long-term survival. Considering the results so far reported, laparoscopic colectomy seems to be feasible and safe. Modest benefits in the quality of life are observed. Same oncologic resection can be performed laparoscopically with no adverse influence on the recurrence rate. At least, equivalent survival is obtained by laparoscopic colectomy. Even the early results of laparoscopic colectomy for cancer are encouraging, the fate of this procedure rests with the long term analysis of number of trials currently underway.

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