Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Metho...Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Methods: Patients with colon cancer complicated by incomplete intestinal obstruction who were treated in Midi Branch, Pangang Group General Hospital between March 2015 and October 2017 were selected and randomly divided into the nutrition group who accepted nutritional support + FOLFOX4 intravenous chemotherapy and the control group who accepted FOLFOX4 intravenous chemotherapy alone, and they underwent surgery after two cycles of chemotherapy. The contents of immune cells in peripheral blood and the contents of immune cytokines in serum were determined before chemotherapy and two cycles after chemotherapy;the expression levels of proliferation genes in colon cancer lesions were determined after surgical resection.Results:Compared with those of same group before chemotherapy, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were decreased significantly after chemotherapywhereas peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of control group did not change significantly after chemotherapy, and compared with those after chemotherapy between groups, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were significantly lower than those of control group, and CyclinD1, Bcl-2, USP22, VEGF and N-cadherin mRNA expression were not different from those of control group.Conclusion:Nutritional support + intravenous chemotherapy can improve the anti-tumor immune response without affecting the proliferation of cancer cells in the lesion of patients with colon cancer complicated by incomplete intestinal obstruction.展开更多
To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles inve...To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.展开更多
OBJECTIVE To investigate the clinical characteristics of melanosis of the colon (MC) and its correlation with polypus and carcinoma of the large intestine. METHODS Clinical feature and colonoscopic findings of 156 M...OBJECTIVE To investigate the clinical characteristics of melanosis of the colon (MC) and its correlation with polypus and carcinoma of the large intestine. METHODS Clinical feature and colonoscopic findings of 156 MC patients were retrospectively analyzed. Final diagnosis of MC case was made after colonoscopic and pathological examination, and data of the case history was recorded. RESULTS The overall detection rate of MC was 1.12%, with 0.46% in males, 0.66% in females. An 82.69% of the patients suffered various constipations and had a history of taking cathartics. The clinical manifestation of total-colon melanosis occurred in 83.97% of the patients. There was no significant difference between the rate of concomitant polypus (27.56%) in the MC patients and the detection rate of polypus in the patients who underwent a synchronous colonoscopy (χ^2 = 1.205, P = 0.298). Also there was no significant difference between the detection rate of carcinoma of the large intestine (8.97%) in MC patients and the detection rate of the same disease in the patients who underwent synchronous colonoscopy (χ^2 = 0.268, P = 0.604). A logistic regression analysis has shown that the older the age of MC patients is, the more opportunities of MC and the concomitant polypus would occur. CONCLUSION MC may be related to constipations and a long-term administration of cathartics, among which total-colon melanosis ranks first in the cases. There is an earlier age of onset in the females, with a higher detection rate. The older the age of the patients is, the higher the detection rate of MC is, and the more possibility the onset of the concomitant polypus.展开更多
Approximately 7%-29%of patients with colorectal cancer present with colonic obstruction.The concept of self-expandable metal stent(SEMS)insertion as a bridge to surgery(BTS)is appealing.However,concerns on colonic ste...Approximately 7%-29%of patients with colorectal cancer present with colonic obstruction.The concept of self-expandable metal stent(SEMS)insertion as a bridge to surgery(BTS)is appealing.However,concerns on colonic stenting possibly impairing oncologic outcomes have been raised.This study aimed to review current evidence on the short-and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction.For short-term outcomes,colonic stenting facilitates a laparoscopic approach,increases the likelihood of primary anastomosis without a stoma,and may decrease postoperative morbidity.However,SEMS-related perforation also increases local recurrence and impairs overall survival.Moreover,colonic stenting may cause negative oncologic outcomes even without perforation.SEMS can induce shear forces on the tumor,leading to increased circulating cancer cells and aggressive pathological characteristics,including perineural and lymphovascular invasion.The conflicting evidence has led to discordant guidelines.Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research(e.g.,alteration of circulating tumors)are needed to clarify the actual benefit of colonic stenting as BTS.展开更多
Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a ...Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a diagnostic challenge. A computed tomography (CT) scan is recommended in adult cases as the most sensitive diagnostic tool and the pathognomonic finding of outer intussuscepiens and central intussusceptum is diagnostic. A septum of a duplicated colon in a non-intussuscepted segment has been rarely reported in the literature. With advancements in radiological imaging technology and the increased availability of CT scanners, the capacity for a correct pre-operative diagnosis has been significantly enhanced. Our current case report illustrates the importance of considering an uncommon etiology for enteric intussusception and duplication as a differential diagnosis of acute abdomen in an adult patient. Our analyses of this patient also highlight the successful use of CT scanning to make this diagnosis.展开更多
Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency s...Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency surgery has been indicated to treat patients with obstructive colon cancer.However,compared to patients undergoing elective surgery,the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high.With the advancement of colonoscopic techniques and equipment,a self-expandable metal stent(SEMS)was introduced to relieve obstructive symptoms,allowing the patient’s general condition to be restored and for them undergo elective surgery.As the use of SEMS placement is growing,controversies about its application in potentially curable diseases have been raised.In this review,the short-and longterm outcomes of different treatment strategies,particularly emergency surgery vs SEMS placement followed by elective surgery in resectable,locally advanced obstructive colon cancer,are described based on the location of the obstructive cancer lesion.Controversies regarding each treatment strategy are discussed.To overcome current obstacles,a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.展开更多
From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all...From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all the patients, 14 cases were treated by primary resection with anastomosis. Anastomotic leakage occurred in 6 cases, and 5 of them were died. Of 25 cases with the traditional staged management, the tumors were resected only in 20 cases, and not resectable in the other 5 patients. 19 with modified Hartmann's procedure and 26 with extended right hemlcolectomy with ileorectal or low ileosigmoid anastomosis gave satisfactory results. In terms of this series, the five-year survival rate in primary resection group was significantly higher than that in staged resection group (P< 0. 05). It is suggested that extented right hemlcolectomy or modified Hartmann' s procedure in cases of acute cancerous obstruction of the left colon would be favord.展开更多
Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk o...Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.展开更多
AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were...AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. Der Simonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94%(95%CI: 92-96) and 91%(95%CI: 88-93), respectively. Overall complication rate for SEMS was 23%(95%CI: 18-29). Stent migration8%(95%CI: 6-10) and stent obstruction 8%(95%CI: 6-11) were the most common complications, followed by perforation 5%(95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14%(95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8%(95%CI: 6-10), while surgical intervention was needed in 6%(95%CI: 4-8).CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.展开更多
Endoscopic stenting for malignant large bowel obstruction is common nowadays. However, recurrent obstruction secondary to stent occlusion due to tumour ingrowth or overgrowth might occur. We reported a case of a 70-ye...Endoscopic stenting for malignant large bowel obstruction is common nowadays. However, recurrent obstruction secondary to stent occlusion due to tumour ingrowth or overgrowth might occur. We reported a case of a 70-year-old man with large bowel obstruction initially treated with colonic stenting. It was complicated with recurrent intestinal obstruction, with colonoscopy showing stent blockage by tumour ingrowth over distal part of the stent. Successful endoscopic implantation of additional colonic stent over the old stent was achieved and intestinal obstruction was resolved afterwards.展开更多
Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction ...Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction were divided into control group (n=63) and observation group (n=63) from May 2015 to May 2017 in Zhongnan Hospital of Wuhan University and Gezhouba Dam group central hospital, the control group only received parenteral nutrition, while the observation group was treated with parenteral nutrition plus alanine glutamine treatment. The expression levels of nutritional indicators, inflammatory factors, immunity and antioxidant were compared between the two groups.Results:Before and 1 d after treatment, there was no significant difference between the two groups of prealbumin (PA), albumin (ALB), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), interferon-γ (IFN-γ) and immunoglobulin (IgA, IgG, IgM), superoxide dismutase (SOD) and malondialdehyde (MDA). 1 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly lower than before the treatment, and TNF- , CRP and MDA were significantly higher than before the treatment. On the 7 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly increased compared with the 1 d after treatment, while TNF-α, CRP and MDA were significantly lower than the 1 d after the treatment, the PA, ALB, IFN-γ, IgA, IgG, IgM and SOD levels in the observation group were significantly higher than those in the control group, while TNF-α, CRP and MDA were significantly lower than those of the control group, there was no significant difference in IgA, IgG and IgM levels between the observation group and that before treatment. There was no significant difference in MDA and SOD levels between the control group and that before tre atment.Conclusions: Parenteral nutrition support in patients with colon cancer with intestinal obstruction, alamyl glutamine, can significantly improve the nutritional level, reduce the inflammatory response, enhance the immune and antioxidant functions.展开更多
Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis ...Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.展开更多
Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment.Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases.This...Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment.Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases.This“manoeuvre” leads the patient to a percentage of moRality/morbidity and to a bad quality of life due to acceptance of stoma.The introduction of enteral metal stent inserted endoscopically has,in our opinion,provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method.We reported our case-series and we analyzed the current literature and costs of treatments.展开更多
BACKGROUND Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon.We report...BACKGROUND Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon.We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.CASE SUMMARY A 73-year-old male had undergone extended radical resection for rectosigmoid cancer.The invaded ileocecal area and sigmoid colon were removed during the procedure,and the ileum was anastomosed side-to-side with the rectum.The excluded ascending,transverse,and descending colon were sealed at both ends and left in the abdomen.After 7 years,the patient developed persistent abdominal pain and distension.Work-up indicated intestinal obstruction.The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained,but the symptoms persisted;therefore,surgery was planned.Intraoperatively,extensive adhesions were found in the abdominal cavity,and the small intestine and the indwelling colon were widely dilated.The dilated colon was 56 cm long,5 cm wide(diameter),and contained about 1500 mL of viscous liquid.The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue.The bacterial culture of the secretions was negative.The patient recovered after the operation.CONCLUSION Although colonic exclusion is routinely performed,this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.展开更多
BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a hi...BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.展开更多
文摘Objective:To study the effect of nutritional support + intravenous chemotherapy on anti-tumor immunity and cancer cell proliferation in patients with colon cancer complicated by incomplete intestinal obstruction.Methods: Patients with colon cancer complicated by incomplete intestinal obstruction who were treated in Midi Branch, Pangang Group General Hospital between March 2015 and October 2017 were selected and randomly divided into the nutrition group who accepted nutritional support + FOLFOX4 intravenous chemotherapy and the control group who accepted FOLFOX4 intravenous chemotherapy alone, and they underwent surgery after two cycles of chemotherapy. The contents of immune cells in peripheral blood and the contents of immune cytokines in serum were determined before chemotherapy and two cycles after chemotherapy;the expression levels of proliferation genes in colon cancer lesions were determined after surgical resection.Results:Compared with those of same group before chemotherapy, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were decreased significantly after chemotherapywhereas peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of control group did not change significantly after chemotherapy, and compared with those after chemotherapy between groups, peripheral blood Treg, Th9, Th17 and Th22 contents as well as serum IL-4, IL-9, IL-10, TGF-β1, IL-17 and IL-22 contents of nutrition group were significantly lower than those of control group, and CyclinD1, Bcl-2, USP22, VEGF and N-cadherin mRNA expression were not different from those of control group.Conclusion:Nutritional support + intravenous chemotherapy can improve the anti-tumor immune response without affecting the proliferation of cancer cells in the lesion of patients with colon cancer complicated by incomplete intestinal obstruction.
文摘To critically review the literature addressing the definition, epidemiology, aetiology and pathophysiology of acute colonic pseudo-obstruction (ACPO). METHODSA systematic search was performed to identify articles investigating the aetiology and pathophysiology of ACPO. A narrative synthesis of the evidence was undertaken. RESULTSNo consistent approach to the definition or reporting of ACPO has been developed, which has led to overlapping investigation with other conditions. A vast array of risk factors has been identified, supporting a multifactorial aetiology. The pathophysiological mechanisms remain unclear, but are likely related to altered autonomic regulation of colonic motility, in the setting of other predisposing factors. CONCLUSIONFuture research should aim to establish a clear and consistent definition of ACPO, and elucidate the pathophysiological mechanisms leading to altered colonic function. An improved understanding of the aetiology of ACPO may facilitate the development of targeted strategies for its prevention and treatment.
文摘OBJECTIVE To investigate the clinical characteristics of melanosis of the colon (MC) and its correlation with polypus and carcinoma of the large intestine. METHODS Clinical feature and colonoscopic findings of 156 MC patients were retrospectively analyzed. Final diagnosis of MC case was made after colonoscopic and pathological examination, and data of the case history was recorded. RESULTS The overall detection rate of MC was 1.12%, with 0.46% in males, 0.66% in females. An 82.69% of the patients suffered various constipations and had a history of taking cathartics. The clinical manifestation of total-colon melanosis occurred in 83.97% of the patients. There was no significant difference between the rate of concomitant polypus (27.56%) in the MC patients and the detection rate of polypus in the patients who underwent a synchronous colonoscopy (χ^2 = 1.205, P = 0.298). Also there was no significant difference between the detection rate of carcinoma of the large intestine (8.97%) in MC patients and the detection rate of the same disease in the patients who underwent synchronous colonoscopy (χ^2 = 0.268, P = 0.604). A logistic regression analysis has shown that the older the age of MC patients is, the more opportunities of MC and the concomitant polypus would occur. CONCLUSION MC may be related to constipations and a long-term administration of cathartics, among which total-colon melanosis ranks first in the cases. There is an earlier age of onset in the females, with a higher detection rate. The older the age of the patients is, the higher the detection rate of MC is, and the more possibility the onset of the concomitant polypus.
文摘Approximately 7%-29%of patients with colorectal cancer present with colonic obstruction.The concept of self-expandable metal stent(SEMS)insertion as a bridge to surgery(BTS)is appealing.However,concerns on colonic stenting possibly impairing oncologic outcomes have been raised.This study aimed to review current evidence on the short-and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction.For short-term outcomes,colonic stenting facilitates a laparoscopic approach,increases the likelihood of primary anastomosis without a stoma,and may decrease postoperative morbidity.However,SEMS-related perforation also increases local recurrence and impairs overall survival.Moreover,colonic stenting may cause negative oncologic outcomes even without perforation.SEMS can induce shear forces on the tumor,leading to increased circulating cancer cells and aggressive pathological characteristics,including perineural and lymphovascular invasion.The conflicting evidence has led to discordant guidelines.Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research(e.g.,alteration of circulating tumors)are needed to clarify the actual benefit of colonic stenting as BTS.
文摘Colonic intussusception and gastrointestinal duplication are diseases that arise in young children. The clinical presentation of adult cases of intussusception and enteric duplication is non-specific and thus poses a diagnostic challenge. A computed tomography (CT) scan is recommended in adult cases as the most sensitive diagnostic tool and the pathognomonic finding of outer intussuscepiens and central intussusceptum is diagnostic. A septum of a duplicated colon in a non-intussuscepted segment has been rarely reported in the literature. With advancements in radiological imaging technology and the increased availability of CT scanners, the capacity for a correct pre-operative diagnosis has been significantly enhanced. Our current case report illustrates the importance of considering an uncommon etiology for enteric intussusception and duplication as a differential diagnosis of acute abdomen in an adult patient. Our analyses of this patient also highlight the successful use of CT scanning to make this diagnosis.
文摘Approximately 10%–18%of patients with colon cancer present with obstruction at the initial diagnosis.Despite active screening efforts,the incidence of obstructive colon cancer remains stable.Traditionally,emergency surgery has been indicated to treat patients with obstructive colon cancer.However,compared to patients undergoing elective surgery,the morbidity and mortality rates of patients requiring emergency surgery for obstructive colon cancer are high.With the advancement of colonoscopic techniques and equipment,a self-expandable metal stent(SEMS)was introduced to relieve obstructive symptoms,allowing the patient’s general condition to be restored and for them undergo elective surgery.As the use of SEMS placement is growing,controversies about its application in potentially curable diseases have been raised.In this review,the short-and longterm outcomes of different treatment strategies,particularly emergency surgery vs SEMS placement followed by elective surgery in resectable,locally advanced obstructive colon cancer,are described based on the location of the obstructive cancer lesion.Controversies regarding each treatment strategy are discussed.To overcome current obstacles,a potential diagnostic method using circulating tumor DNA and further research directions incorporating neoadjuvant chemotherapy are introduced.
文摘From 1973 to 1989, 90 cases of obstructing carcinoma of the left colon were treated with five different operative procedures, the Incidence of anastomotic leakage was 6.7%, the operative mortality was 7. 8%. Among all the patients, 14 cases were treated by primary resection with anastomosis. Anastomotic leakage occurred in 6 cases, and 5 of them were died. Of 25 cases with the traditional staged management, the tumors were resected only in 20 cases, and not resectable in the other 5 patients. 19 with modified Hartmann's procedure and 26 with extended right hemlcolectomy with ileorectal or low ileosigmoid anastomosis gave satisfactory results. In terms of this series, the five-year survival rate in primary resection group was significantly higher than that in staged resection group (P< 0. 05). It is suggested that extented right hemlcolectomy or modified Hartmann' s procedure in cases of acute cancerous obstruction of the left colon would be favord.
文摘Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.
文摘AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. Der Simonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94%(95%CI: 92-96) and 91%(95%CI: 88-93), respectively. Overall complication rate for SEMS was 23%(95%CI: 18-29). Stent migration8%(95%CI: 6-10) and stent obstruction 8%(95%CI: 6-11) were the most common complications, followed by perforation 5%(95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14%(95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8%(95%CI: 6-10), while surgical intervention was needed in 6%(95%CI: 4-8).CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.
文摘Endoscopic stenting for malignant large bowel obstruction is common nowadays. However, recurrent obstruction secondary to stent occlusion due to tumour ingrowth or overgrowth might occur. We reported a case of a 70-year-old man with large bowel obstruction initially treated with colonic stenting. It was complicated with recurrent intestinal obstruction, with colonoscopy showing stent blockage by tumour ingrowth over distal part of the stent. Successful endoscopic implantation of additional colonic stent over the old stent was achieved and intestinal obstruction was resolved afterwards.
文摘Objective:To explore the effects of alanine glutamine on inflammatory, immune, antioxidant and nutritional indicators in colon cancer patients.Methods: A total of 126 cases of colon cancer with intestinal obstruction were divided into control group (n=63) and observation group (n=63) from May 2015 to May 2017 in Zhongnan Hospital of Wuhan University and Gezhouba Dam group central hospital, the control group only received parenteral nutrition, while the observation group was treated with parenteral nutrition plus alanine glutamine treatment. The expression levels of nutritional indicators, inflammatory factors, immunity and antioxidant were compared between the two groups.Results:Before and 1 d after treatment, there was no significant difference between the two groups of prealbumin (PA), albumin (ALB), tumor necrosis factor-α (TNF-α), C reactive protein (CRP), interferon-γ (IFN-γ) and immunoglobulin (IgA, IgG, IgM), superoxide dismutase (SOD) and malondialdehyde (MDA). 1 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly lower than before the treatment, and TNF- , CRP and MDA were significantly higher than before the treatment. On the 7 d after treatment, the levels of PA, ALB, IFN-γ, IgA, IgG, IgM and SOD in two groups were significantly increased compared with the 1 d after treatment, while TNF-α, CRP and MDA were significantly lower than the 1 d after the treatment, the PA, ALB, IFN-γ, IgA, IgG, IgM and SOD levels in the observation group were significantly higher than those in the control group, while TNF-α, CRP and MDA were significantly lower than those of the control group, there was no significant difference in IgA, IgG and IgM levels between the observation group and that before treatment. There was no significant difference in MDA and SOD levels between the control group and that before tre atment.Conclusions: Parenteral nutrition support in patients with colon cancer with intestinal obstruction, alamyl glutamine, can significantly improve the nutritional level, reduce the inflammatory response, enhance the immune and antioxidant functions.
基金Supported by(Entirely)Thomas Jefferson University HospitalUniversity of Utah through existing intramural funds and salary support
文摘Colorectal cancer (CRC) is the 3<sup>rd</sup> most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient’s quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient’s condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
文摘Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment.Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases.This“manoeuvre” leads the patient to a percentage of moRality/morbidity and to a bad quality of life due to acceptance of stoma.The introduction of enteral metal stent inserted endoscopically has,in our opinion,provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method.We reported our case-series and we analyzed the current literature and costs of treatments.
文摘BACKGROUND Indwelling colon is characterized by an excluded segment of the colon after surgical diversion of the fecal stream with colostomy so that contents are unable to pass through this part of the colon.We report a rare case of purulent colonic necrosis that occurred 7 years after surgical colonic exclusion.CASE SUMMARY A 73-year-old male had undergone extended radical resection for rectosigmoid cancer.The invaded ileocecal area and sigmoid colon were removed during the procedure,and the ileum was anastomosed side-to-side with the rectum.The excluded ascending,transverse,and descending colon were sealed at both ends and left in the abdomen.After 7 years,the patient developed persistent abdominal pain and distension.Work-up indicated intestinal obstruction.The patient underwent ultrasound-guided catheter drainage of the descending colon and a large amount of viscous liquid was drained,but the symptoms persisted;therefore,surgery was planned.Intraoperatively,extensive adhesions were found in the abdominal cavity,and the small intestine and the indwelling colon were widely dilated.The dilated colon was 56 cm long,5 cm wide(diameter),and contained about 1500 mL of viscous liquid.The indwelling colon was surgically removed and its histopathological examination revealed colonic congestion and necrosis with hyperplasia of granulation tissue.The bacterial culture of the secretions was negative.The patient recovered after the operation.CONCLUSION Although colonic exclusion is routinely performed,this report aimed to increase awareness regarding the possible long-term complications of indwelling colon.
文摘BACKGROUND Malignant tumors of the ileocecal region often cause intestinal obstruction.Emergency surgery is the main treatment for patients presenting with an obstruction.However,this procedure is associated with a high mortality rate and frequent complications.The placement of colon stents is commonly performed for obstructions in the distal colon and is a less invasive and safer procedure.However,obstructions in the proximal colon are more challenging to treat by stent placement due to the increased distance from the anus.CASE SUMMARY This case report concerns an 88-year-old man with malignant intestinal obstruction in the ileocecal region.He was contraindicated for general anesthesia and surgical enterostomy.The placement of a self-expandable metallic stent seems an alternative to surgery,although stenting in this area is thought to be difficult and few studies have been reported so far.After three attempts at different interventional approaches,a stent was successfully placed in the obstructed segment under fluoroscopic guidance.After the procedure,the patient's abdominal distension and abdominal pain were significantly better than before.CONCLUSION For patients with proximal colonic obstruction,self-expandable metallic stent placement under fluoroscopic guidance could be considered as a feasible treatment to relieve abdominal distension and pain in patients with acute bowel obstruction.It has the characteristics of high safety and high patient tolerance.However,further study is still needed.