PURPOSE: This study was designed to determine the outcome of patients with Crohn’ s disease and indeterminate colitis who have an ileal pouch- anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwen...PURPOSE: This study was designed to determine the outcome of patients with Crohn’ s disease and indeterminate colitis who have an ileal pouch- anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn’ s disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35- question survey mailed to all patients with a functioning pouch of at least six months duration. RESULTS: Pouch complications were significantly more common in patients with Crohn’ s disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn’ s disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn’ s disease, multivariate analysis revealed that the pathologist’ s initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn’ s disease were independently associated with pouch failure. The functional results in patients with Crohn’ s disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. CONCLUSIONS: Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one- half of patients with Crohn’ s disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn’ s disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn’ s disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch- anal anastomosis is an acceptable alternative for patients with indeterminate colitis.展开更多
Angiosarcoma is a malignancy that occurs rarely in the gastrointestinal tract. We present a case of a 77-year-old male who had rectal bleeding and obstructive bowel symptoms. A large near-obstructing mass was seen end...Angiosarcoma is a malignancy that occurs rarely in the gastrointestinal tract. We present a case of a 77-year-old male who had rectal bleeding and obstructive bowel symptoms. A large near-obstructing mass was seen endoscopically, but biopsies were inconclusive. A CT scan showed a large sigmoid lesion, and the patient had surgical resection. A large hemorrhagic-appearing tumor was found at operation. Angiosarcoma of the sigmoid colon was diagnosed on histologic examination. After colonic resection, the patient rapidly developed numerous liver metastases and died six months later. A review of the literature reveals only 12 other reported cases of colorectal angiosarcoma; 62 percent of these patients died within one year of surgical resection. The role of adjuvant radiation and/or chemotherapy is unclear. In conclusion, colorectal angiosarcomas are rare tumors that behave very aggressively, and the outcome is generally poor.展开更多
文摘PURPOSE: This study was designed to determine the outcome of patients with Crohn’ s disease and indeterminate colitis who have an ileal pouch- anal anastomosis. METHODS: Between 1982 and 2001, 1,270 patients underwent a restorative proctocolectomy at the Mount Sinai Hospital: 1,135 had ulcerative colitis, 36 had Crohn’ s disease, 21 had indeterminate colitis, and 78 had another diagnosis. Perioperative data were collected prospectively. Functional outcomes were assessed with a 35- question survey mailed to all patients with a functioning pouch of at least six months duration. RESULTS: Pouch complications were significantly more common in patients with Crohn’ s disease (64 percent) and indeterminate colitis (43 percent) compared with patients with ulcerative colitis (22 percent) (P < 0.05). Similarly, 56 percent of patients with Crohn’ s disease had their pouch excised or defunctioned, compared with 10 percent of patients with indeterminate colitis and 6 percent with ulcerative colitis (P < 0.01). In the subgroup of patients with a diagnosis of Crohn’ s disease, multivariate analysis revealed that the pathologist’ s initial designation of ulcerative colitis (based on the colectomy specimen) and an increasing number of pathologic, clinical, and endoscopic features of Crohn’ s disease were independently associated with pouch failure. The functional results in patients with Crohn’ s disease with a successful pouch were not significantly different from those with indeterminate colitis or ulcerative colitis. CONCLUSIONS: Although complication rates may be higher in patients with indeterminate colitis compared with ulcerative colitis, the overall pouch failure rate is similar. On the other hand, more than one- half of patients with Crohn’ s disease will require pouch excision or diversion. Our data suggest that it is difficult to identify patients with Crohn’ s disease who are likely to have a successful outcome after restorative proctocolectomy. Thus, Crohn’ s disease should remain a relative contraindication to restorative proctocolectomy, whereas ileal pouch- anal anastomosis is an acceptable alternative for patients with indeterminate colitis.
文摘Angiosarcoma is a malignancy that occurs rarely in the gastrointestinal tract. We present a case of a 77-year-old male who had rectal bleeding and obstructive bowel symptoms. A large near-obstructing mass was seen endoscopically, but biopsies were inconclusive. A CT scan showed a large sigmoid lesion, and the patient had surgical resection. A large hemorrhagic-appearing tumor was found at operation. Angiosarcoma of the sigmoid colon was diagnosed on histologic examination. After colonic resection, the patient rapidly developed numerous liver metastases and died six months later. A review of the literature reveals only 12 other reported cases of colorectal angiosarcoma; 62 percent of these patients died within one year of surgical resection. The role of adjuvant radiation and/or chemotherapy is unclear. In conclusion, colorectal angiosarcomas are rare tumors that behave very aggressively, and the outcome is generally poor.
