Annals of Coloproctology

Case Report

Colorectal cancer

Melanocytic nevus of the anal canal and granular cell tumor of the cecum: a case report and literature review of 2 coincidentally co-occurring neurocristopathies: Victoria Sandoval, Jorge Lara-Endara, Javier Rodríguez-Suárez, Williams Arias Garzón, Ligia Redrobán, Nelson Montalvo; Ann Coloproctol. 2024;40(Suppl 1):S23-S26. Published online January 12, 2023; DOI: https://doi.org/10.3393/ac.2022.00444.0063

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Abstract PDF: Granular cell tumors are predominantly benign soft tissue tumors originating from Schwann cells, whereas melanocytic nevi are benign proliferations of melanocytes. We present the case of a patient with the presence of both entities located in the cecum and anal canal, respectively, constituting an extremely rare coincidental finding. A 43-year-old woman was evaluated by colonoscopy for iron-deficiency microcytic anemia that had lasted for 1 year. Colonoscopy demonstrated a macular lesion of 0.3 cm with a melanocytic appearance in the anal canal; at the cecum level, a subepithelial, yellowish, and partially mobile firm nodular lesion measuring 1.3 cm was observed. A histopathological study showed a melanocytic nevus in the anal canal and a granular cell tumor in the cecum. This is the first reported case of a patient with the extremely rare coincidental-incidental finding of these 2 entities at the same time.

Review

Benign GI diease,Benign diesease & IBD,Epidemiology & etiology

The Epidemiology and Etiology of Right-Sided Colonic Diverticulosis: A Review: Greg A. Turner, Michael J. O’Grady, Rachel V. Purcell, Frank A. Frizelle; Ann Coloproctol. 2021;37(4):196-203. Published online July 21, 2021; DOI: https://doi.org/10.3393/ac.2021.00192.0027

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Abstract PDF

Diverticulosis of the colon is a common condition in Western countries and most patients will remain asymptomatic, but some will present with symptoms of acute diverticulitis or bleeding. Our understanding of diverticulosis is evolving but is mostly derived from diverticulosis affecting the left-sided colon. In contrast, right-sided colonic diverticulosis (RCD) is more commonly seen in Asian countries but is much less common overall. Based on the marked differences in epidemiology, it is commonly thought that these are 2 distinct disease processes. A review of the literature describing the epidemiology and etiology of RCD was performed, with a comparison to the current understanding of left-sided diverticulosis. RCD is becoming increasingly common. The epidemiology of RCD shows it to be a mostly acquired condition, and not congenital as previously thought. Many factors in the etiology of RCD are similar to that seen in left-sided diverticulosis, with a few variations. It is therefore likely that most cases of RCD represent the same disease process that is seen in the left colon.

Citations

Citations to this article as recorded by

Right‐sided colonic diverticulitis. Short and long‐term surgical outcomes and 2‐year quality of life
Sara Lauricella, Francesco Brucchi, Dario Palmisano, Gianandrea Baldazzi, Luca Bottero, Diletta Cassini, Giuseppe Faillace
World Journal of Surgery.2024; 48(2): 484. CrossRef
49-jährige Patientin mit Unterbauchschmerz rechts
Achim Jatkowski, Arne Dehling, Wolfram Zoller
Zeitschrift für Gastroenterologie.2024; 62(02): 171. CrossRef
Features of colonic diverticulitis in children and adolescents: A multicenter study
Ji-Won Han, Joonhyuk Son, Chaeyoun Oh
Asian Journal of Surgery.2024; 47(5): 2195. CrossRef
Right Upper Quadrant Pain: A Rare Presentation of Diverticulitis
Rediet Tefera Atalay, Oluwapelumi Kolawole, Girma M Ayele, Abay A Gobezie, Angesom Kibreab, Miriam B Michael
Cureus.2024;[Epub] CrossRef
Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates
Emeka Ray-Offor, Stella-Maris Egboh, Rex F.O.A. Ijah, Sameh Hany Emile, Steven D. Wexner
Digestive Surgery.2024; 41(2): 63. CrossRef
Genetic, epigenetic and environmental factors in diverticular disease: systematic review
Hannah N Humphrey, Pauline Sibley, Eleanor T Walker, Deborah S Keller, Francesco Pata, Dale Vimalachandran, Ian R Daniels, Frank D McDermott
BJS Open.2024;[Epub] CrossRef
Beyond the Norm: Acute Multifocal Diverticulitis
Bianca Thakkar, Jasmine Tidwell, Minh Thu T. Nguyen, Gengsheng Yu, Neil Parikh
ACG Case Reports Journal.2024; 11(9): e01505. CrossRef
Right-Sided Diverticulitis: A Rare Cause of Right-Sided Abdominal Pain
Athanasios Papatriantafyllou, Paraskevi Dedopoulou, Konstantina Soukouli, Ioannis Karioris, Stylianos Tsochatzis
Cureus.2023;[Epub] CrossRef
Diverticulosis and Diverticulitis: Epidemiology, Pathophysiology, and Current Treatment Trends
Mohit Bhatia, Aastha Mattoo
Cureus.2023;[Epub] CrossRef
Diagnosis and Treatment of Colonic Diverticular Disease
You Sun Kim
The Korean Journal of Gastroenterology.2022; 79(6): 233. CrossRef
When to Perform a Colonoscopy in Diverticular Disease and Why: A Personalized Approach
Antonio Tursi, Valerio Papa, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Antonio Gasbarrini, Alfredo Papa
Journal of Personalized Medicine.2022; 12(10): 1713. CrossRef
Right-sided colopleural fistula secondary to diverticular disease: a case report
Summer Hassan, Primal Singh
Journal of Medical Case Reports.2022;[Epub] CrossRef
Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?
Lucas Faraco Sobrado, Tarsila Gomes Caldas, Carolina Graciolli Facanali, Leonardo Bustamente-Lopez, Carlos Walter Sobrado
Journal of Coloproctology.2022; 42(04): 302. CrossRef

Case Reports

Mucosa-Associated Lymphoid-Tissue Lymphoma of the Cecum and Rectum: A Case Report: Myung Jin Nam, Byung Chang Kim, Sung Chan Park, Chang Won Hong, Kyung Su Han, Dae Kyung Sohn, Weon Seo Park, Hee Jin Chang, Jae Hwan Oh; Ann Coloproctol. 2017;33(1):35-38. Published online February 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.1.35

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Abstract PDF

A colonic mucosa-associated lymphoid-tissue (MALT) lymphoma is relatively rare compared to lymphomas of the stomach or small intestine. We present a case of a MALT lymphoma in the cecum and rectum found during screening colonoscopy. A 54-year-old female, who had undergone right-breast-conserving surgery with axillary dissection due to an invasive ductal carcinoma and a left-breast excisional biopsy due to microcalcification following adjuvant chemoradiation therapy 3 years earlier, was found to have 3-mm-sized smooth elevated lesions in both the cecum and rectum. No pathologic lesion or lymphadenopathy was found at any other site, but chronic gastritis negative for Helicobacter pylori infection was found. The polyps were removed by using an endoscopic biopsy and revealed an extra nodal marginal zone B-cell MALT lymphoma, showing positive for CD3 and CD20 by immunohistochemical staining. The patient underwent close observation without any additional treatment and has shown no evidence of recurrence as of her last visit.

Citations

Citations to this article as recorded by

Changes in Incidence and Survival by Decade of Patients With Primary Colorectal Lymphoma: A SEER Analysis
Qingguo Li, Shaobo Mo, Weixing Dai, Yaqi Li, Ye Xu, Xinxiang Li, Guoxiang Cai, Sanjun Cai
Frontiers in Public Health.2020;[Epub] CrossRef
Successful Endoscopic Resection of Mucosa-Associated Lymphoid Tissue Lymphoma of the Colon
Brian L. Schwartz, Robert C. Lowe
ACG Case Reports Journal.2019; 6(10): e00228. CrossRef
Synchronous MALT lymphoma of the colon and stomach and regression after eradication ofStrongyloides stercoralisandHelicobacter pylori
Kevin Singh, Soren Gandhi, Behzad Doratotaj
BMJ Case Reports.2018; : bcr-2018-224795. CrossRef
Mucosal leishmaniasis mimicking T-cell lymphoma in a patient receiving monoclonal antibody against TNFα
Antonio Carlos Nicodemo, Daniel Fernandes Duailibi, Diego Feriani, Maria Irma Seixas Duarte, Valdir Sabbaga Amato, Zvi Bentwich
PLOS Neglected Tropical Diseases.2017; 11(9): e0005807. CrossRef

Epidermoid Cyst of the Cecum: Jae-Young Park, Youn Wha Kim, Kil Yeon Lee, Ji-Youn Sung; Ann Coloproctol. 2015;31(1):37-39. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.37

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7 Citations

Abstract PDF

An epidermoid cyst of the cecum is extremely rare; only eight cases have been reported in the literature. A 63-year-old woman was admitted to Kyung Hee University Medical Center with a colonic mass that had been discovered incidentally during a regular health check-up. The radiographic impression was that this mass was a gastrointestinal stromal tumor. During surgery, an exophytic mass in the cecal wall was resected by using an ileocecectomy. Based on the macroscopic and the microscopic findings, this case was identified as an epidermoid cyst of the cecal wall. We report this case to discuss the origin of this entity and the unusual nature of our case.

Citations

Citations to this article as recorded by

Epidermoid Cyst in the Appendix: A Rare Entity
Yu Ya Nway, Raj Shah, Jignesh Parikh, Ernesto Robalino Gonzaga
Cureus.2022;[Epub] CrossRef
Epidermoid cyst of the cecum resected by single-incision laparoscopic colectomy: a case report
Tetsuro Tominaga, Takashi Nonaka, Akiko Fukuda, Masaaki Moriyama, Shosaburo Oyama, Mitsuhisa Ishii, Terumitsu Sawai, Nozomi Ueki, Takeshi Nagayasu
Surgical Case Reports.2021;[Epub] CrossRef
A rare case of epidermoid cyst of the cecum
Giovanni Tonelli, Emanuele Soricelli, Margherita Vannucchi, Marcello Lucchese
Clinical Journal of Gastroenterology.2021; 14(6): 1746. CrossRef
Cecal epidermoid cyst: a neonatal case with clinicopathological consideration
Joo-Young Na, Soo-Hong Kim, Narae Lee
BMC Pediatrics.2021;[Epub] CrossRef
Multifocal Epidermoid Cysts Accompanied with Ruminal Tympany in a 36-Month-Old Holstein Cow
Sinya TOKUTAKE, Satomi DOAI, Daiki KAWASHIMA, Hirotaka MORITA, Tomoyuki SHIBAHARA
Journal of the Japan Veterinary Medical Association.2021; 74(9): 558. CrossRef
A Case of Epidermoid Cyst of the Cecum Treated by Laparoscopic Resection
Ryoji Kaizaki, Toru Inoue, Satoshi Takatsuka, Tadashi Tsukamoto
Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons).2020; 45(6): 800. CrossRef
An Unusual Cecal Mass in an Otherwise Healthy Young Woman
Lisa Lutz, Philipp Holzner, Hannes Neeff
Gastroenterology.2016; 150(5): e5. CrossRef

Solitary Polypoid Ganglioneuroma of the Cecum.: Park, Ji young , Kang, Yu Na , Park, Kyung Sik , Choe, Misun; J Korean Soc Coloproctol. 2009;25(4):264-267.; DOI: https://doi.org/10.3393/jksc.2009.25.4.264

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Abstract PDF

A ganglioneuroma is a very rare neoplasm in the gastrointestinal tract and consists of ganglion cells, nerve fibers, and supporting cells. A gastrointestinal ganglioneuroma is occasionally related to inherited diseases, like neurofibromatosis type I and multiple endocrine neoplasm type 2b. We have experienced a case of a solitary polypoid ganglioneuroma in the cecum of a patient with no history of inherited diseases. The patient was a 56-yr-old male who had suffered from dyspepsia for a year. On the colonoscopic examination, a sessile polyp, measuring 0.7 x 0.7 cm in greatest dimensions, was discovered and eliminated. The remaining large intestine was unremarkable. Microscopically, the polyp was composed of isolated or nested ganglion cells admixed with a proliferation of spindle cells in the mucosa and the submucosa. The background showed interspersed cystic glands in an expanded lamina propria. Immunohistochemically, the ganglion cells were positive for NSE and NeuN while the spindle cells demonstrated a positive response to S-100 protein. Since a ganglioneuroma has a benign nature, complete resection is the treatment of choice.

Citations

Citations to this article as recorded by

Diffuse Ganglioneuromatosis of the Colon Presenting as a Large Subepithelial Tumor in Adults: Report of Two Cases
Tae-Jun Kim, Hyun Lim, Ho Suk Kang, Sung Hoon Moon, Jong Hyeok Kim, Choong Kee Park, Mi Jung Kwon, Bong Hwa Lee
The Korean Journal of Gastroenterology.2015; 66(2): 111. CrossRef
A Case of Isolated Ileal Ganglioneuroma
Ju Hyung Song, Byong Duk Ye, Yong Sik Yoon, Mi-Jung Kim, Dong-Hoon Yang, Kee Wook Jung, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
Intestinal Research.2011; 9(1): 46. CrossRef

Original Articles

Difference in Clinical Features between Appendicitis and Right-Sided Colonic Diverticulitis on Initial Diagnosis.: Lee, Eun Kyu , Kim, Hungdai , Son, Beong Ho , Han, Won Kon; J Korean Soc Coloproctol. 2005;21(4):201-206.

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Abstract PDF: PURPOSE
Most patients who are finally diagnosed as having cecal and right-sided colonic diverticulitis complain of pain in the right lower quadrant of the abdomen, many of them unfortunately undergo an emergency operation for presumed appendicitis. Our purpose was to differentiate the diagnosis of right-sided colonic diverticulitis from appendicitis in an emergency setting.
METHODS
We retrospectively reviewed the medical records of 450 patients between January 1997 and July 2003. Among them, 92 patients who had been diagnosed as having right-sided colonic diverticulitis were classified as Group I. In the remaining 358 patients with appendicitis, 268 patients with simple appendicitis were classified as Group II and 90 patients with perforated appendicitis were classified as Group III.
RESULTS
The sex ratios were similar among 3 groups. The mean age of Group I (36.5+/-10.1 years) was significantly different from that of Group II (30.7+/-14.8 years, P=0.002), but not from that of Group III (38.7+/-20.9). Incidences of fever/chill and nausea/vomiting were less common in Group I (P<0.05). The duration of prodromal symptoms in Group I (2.6 days) was longer than that of Group II (1.6 days, P=0.02), but was not significantly different from that of Group III (3.3 days, P=0.83). The mean WBC count was significantly smaller in Group I (10913.8/mm3) than in Group II (13238.3/mm3) and III (15589.3/mm3, P<0.001). The percentage of segment form in differential counts was smaller in Group I (73.6%) than in Group II (79.1%) and III (81.8%, P<0.001). The percentage of lymphocytes in differential counts was larger in Group I (17.7%) than in Group II (13.9%) and Group III (9.4%, P<0.001).
CONCLUSIONS
Among the patients who complain of pain in the right lower quadrant abdomen in an emergency setting, cecum and right-sided colonic diverticulitis must be considered in the following conditions to avoid unnecessary emergency operations, relatively younger patients (20~40 years), infrequent prodromal symptoms, absent rebound tenderness with a laterally deviated maximal tenderness point, and absent or mild leucocytosis with a relatively low fraction of segment forms associated with a higher fraction of lymphocytes in CBC.

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.

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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.

Case Report

Natural Killer (NK) Cell Lymphoma of the Cecum with Perforation:A case of report.: Kim, Ik Yong , Ju, Man Ki , Kim, Jong Seok , Jung, Soon Hee , Kim, Dae Sung , Rhoe, Byoung Seon; J Korean Soc Coloproctol. 2001;17(5):277-282.

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Abstract PDF: Natural Killer cell lymphoma pursued a highly aggressive clinical course, with the aggressiveness and poor prognosis in this biologically distinct primary gastrointestinal lymphoma, a more vigorous systemic therapy should be considered in the addition to surgery. We report an unusual case of aggressive primary Natural Killer cell (NK cell) lymphoma of the cecum. A 38-year old man admitted for intractable fever, diarrhea, and hematochezia. The patient diagnosed as primary NK cell cecal lymphoma with perforation after surgical resection. The primary lesion was deep ulceration with perforation and it revealed metastasis to liver. The immunophenotype of the tumor cell were CD56+, CD3+, UCHL-1+, CD45RO+, polyclonal IGH, TCRr, so confirmed NK cell type lymphoma.

Original Article

Clinical Analysis of Diverticulosis of the Cecum and Ascending Colon.: Kim, Gyu Yeol , Nam, Chang Woo , Ko, Byung Kyun , Cho, Hong Rae , Park, Chan Jin , Choi, Dae Hwan; J Korean Soc Coloproctol. 1998;14(3):595-604.

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Abstract PDF: BACKGROUND
Diverticulosis of the cecum and ascending colon is a rare disease in Western countries, it is more common in the Orient. Making the diagnosis preoperatively could be difficult, and the intraoperative assessment and decision of optimal treatments are difficult.
METHODS
Therefore, we reviewed the patient's charts of diverticulosis of the cecum and ascending colon at our hospital from 1992 to 1997.
RESULTS
During the past 5 years, a total of 53 cases of diverticulosis of the cecum and ascending colon had been treated at this hospital. Mean age was 41.8 years (range 20-70). The male to female ratio was 1.8 : 1. Frequent complaints were abdominal pain (46 cases, 86.8%), followed by diarrhea (5 cases, 9.3%), indigestion (4 cases, 7.5%), and bowel habits change (2 cases, 3.8%). Mean duration of illness was 3.5 days(range 24 hours~15 days). In non-surgical cases, diagnoses were established with barium enema, CT scan, or ultrasonography. The accuracy of these methods was 91%, 75%, and 25%. In surgical cases, the preoperative diagnoses were appendicitis(13 cases, 50.1%), diverticulitis (7 cases, 31.8%), and abscess (2 cases, 9.1%). Treatments of the cecum and ascending colon diverticulitis were conservative management (3 teases,58.5%) and surgical treatment (22 cases,41.5%). The operative procedures were right hemicolectomies (2 cases), ileocecal resections (2 cases), diverticulectomies (6 cases) and appendectomies only (11 cases).
CONCLUSION
These results suggest that correct diagnosis of the diverticulitis of the cecum and ascending colon made before treatment is very important because correct assessment of diverticulitis intraoperatively is difacut. Liberal use of diagnostic modalities could facilitate to make correct diagnosis to set a proper plan for treatment.

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