Value of CT scan in the diagnosis of primary large bowel lymphoma

Objective: To study the CT imaging of primary large bowel lymphoma and evaluate the value of CT scan. Methods: CT reports of 8 patients with proven primary large bowel lymphoma were retrospectively reviewed. Plain CT scans were done on all patients, enhanced CT scans simultaneously with 5-10 mm section thickness, and 5-10 mm table increments in 6 cases. Results: Primary involved sites were on the cecum (n=3), the ascending colon (n=2), and the rectum (n=1). The tumor was found in multiple areas of the large bowel in 2 cases. CT appearance fell into 3 typical patterns in our study. The first was focal mass type in 2 cases, with one combined with intussusception and retroperitoneal adenopathy; the second was segmental annular involvement type in 3 cases, with one of them combined with mesenteric adenopathy; the last was diffuse involvement type in 2 cases. Multiple nodules were seen in the rectum in 1 case. Conclusion: CT was found to be accurate in detecting the primary sites and complications of lymphoma, and evaluating invasion of adjacent structures; Focal mass type, segmental annular involvement type and diffuse involvement type are the main patterns of CT features in the primary large bowel lymphoma; The features revealed by CT scan are suggestive of primary large bowel lymphoma in some cases.

METABOLISM PATTERN OF FECAL BILE ACIDS IN PATIENTS WITH LARGE BOWEL CANCER

The feca! bite acids were extracted from 21 patients with large bowel (colonic and rectal) cancer and 21 controls, and the bile acid composition and concentration were measured by gas chromatography. The total bile acid concentration and concentration of individual bile acids were not statistically different between colonic and rectal cancer. Bat the concentration and the percentage composition of secondary bile acids (deoxycholic and lithocholic acids) were significantly higher than that in controls. However the percentage composition of primary bile acids (cholic and chenocholic acids) were significantly lower than that in controls. The results suggest that incidence of large bowel cancer is closely related to the metabolism of fecal bile acids, and the etiology of colonic and rectal cancers may be the same.

Platelet rich plasma effectiveness in bowel anastomoses:A systematic review

BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery.Technical insufficiency,topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage,with detrimental effects on patient postoperative outcomes.Despite the investigation of several factors and the invention of protective materials,the ideal agent to prevent anastomotic leaks is yet to be determined.AIM To study the effect of platelet rich plasma(PRP)on the healing of bowel anastomoses.METHODS A systematic literature search was performed in PubMed,EMBASE,and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.RESULTS Eighteen studies were eligible with a total population of 712 animals including rats(14 studies),rabbits(2 studies)and pigs(2 studies).No postoperative complications were reported following PRP application.Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention,such as intraperitoneal chemotherapy or peritonitis.Similar results were reported by ten studies in terms of tissue hydroxyproline levels.One study reported significant increase in collagen deposition in PRP groups.PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy(6 studies).CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes,especially in animal models having an underlying condition affecting the normal healing process.PRP application seems to augment the normal healing process under these circumstances.However,further studies are needed to investigate the potential role of PRP on bowel anastomosis healing,especially in clinical settings.

Clinical considerations and therapeutic strategy for sigmoid volvulus in the elderly:A study of 33 cases

AIM： To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery. METHODS： A retrospective review of the clinical presentation and imaging characteristics of 33 sigrnoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review. RESULTS： In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigrnoid, Hartmann＇s procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage ＂on table＂ prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay （3 to 8 d after the deflation）. All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigrnoidopexy and one patient underwent a near-total colectomy. Two .patients （sigmoidectomy- sigmoidopexy） had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had only one death （5.9%）, whereas after 15 emergency operations 6 patients died, which means a mortality rate of 40%. CONCLUSION： Although sigmoid volvulus causing intestinal obstruction is frequently successfully encountered by endoscopic decompression, however, the principal therapy of this condition is surgery. Only occasionally in patients with advanced age, lack of bowel symptoms and multiple co-morbidities might surgical repair not be considered.

Colorectal stenting for palliation and as a bridge to surgery:A 5-year follow-up study

AIM: To evaluate the long-term effectiveness of colonic stents in colorectal tumors causing large bowel obstruction.METHODS: We retrospectively analyzed data from 49 patients with colorectal cancer who had undergone colorectal stent placement between January 2008 and January 2013. Patients' symptoms,characteristics and clinicopathological data were obtained by reviewing medical records. The obstruction was diagnosed clinically and radiologically. Histopathological diagnosis was achieved endoscopically. Technical success rate(TSR)was defined as the ratio of patients with correctly placed SEMS upon stent deployment across the entire stricture length to total number of patients. Clinical success rate(CSR) was defined as the ratio of patients with technical success and successful maintenance of stent function before elective surgery(regardless of number of SEMS deployed) to total number of patients. The surgical success rate(SSR) of colorectal stent as a bridge to surgery was defined as the ratio of patients with successful surgical procedures. Unsuccessful surgical outcomes were defined as being due to insufficient colonic decompression. The technical,clinical,surgical success rates and complications after stenting were assessed.RESULTS: The median age of patients was 64(36 to 89). 44.9% of patients were male and 55.1% were female. Eighteen patients had the obstruction located in the rectum,15 patients in the rectosigmoid region,10 patients in the sigmoid region,and 6 patients had a tumor causing obstruction in the proximal colon. Each patient was categorized pathologically as stage 2(32.7%,16 patients) or stage 3(42.9%,21 patients) and 12 patients(24.4%) had metastatic disease. None of the patients received chemotherapy before stenting. Stenting was undertaken in 37 patients as a bridge to surgery,and in 12 patients stents were used for palliation. Median time to surgery after stenting was 30 ± 91.9 d. All surgery was completed in one single operation and thus no colostomy with stoma was needed. The median overall survival rate of patients with stage 2-3 colorectal cancer was 53.1 mo and stage 4 was 37.1 mo(P = 0.04). Metastatic colorectal patients who were treated palliatively with stents had backbone chemotherapy with oxaliplatin and/or irinotecan-based regimens plus antiangiogenic therapies,especially bevacizumab. Resolution of the obstruction and clinical improvement was achieved in all patients. The technical,clinical and surgical success rates were 95.9%,100% and 94.6%,respectively.CONCLUSION: The efficacy and safety of colonic stents was demonstrated both as a bridge to surgery and for palliative decompression. In addition,results emphasize the importance of the skills of the endoscopist in colonic stenting.

Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis

Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder; its localization in the colorectal tract is extremely rare. The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of α1 and α2 proteins and C-reactive protein (17.5 mg/dL; normal value 0-0.5), and a palpable mass, localized in the right lower quadrant of the abdomen. A computed tomography scan showed a large right cecal mass with necrotic areas, local inflammation of retroperitoneal fat, and enlargement of local lymph nodes. Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition, the patient underwent right colectomy after 4 d of antibiotic treatment. Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve. We review the reports of large bowel tract XGI in the international literature.

Intestinal metastasis from breast cancer:Presentation,treatment and survival from a systematic literature review

BACKGROUND Intestinal metastases from breast cancer(BC)arerare;available data depend mainly on case reports and case series.AIM To conduct a review of the literature regarding presentation,diagnosis,treatment and survival of patients with intestinal metastasis from BC.METHODS We identified all articles that described patients with intestinal metastasis(from duodenum to anum)from BC using MEDLINE(1975 to 2020)and EMBASE(1975 to 2020)electronic databases.RESULTS We found 96 cases of intestinal metastasis of BC.Metastasization involved large bowel(cecum,colon,sigmoid,rectum)(51%),small bowel(duodenum,jejunum,ileum)(49%),and anum(<1%).Median age of patients was 61-years.The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma.In more than half of patients,the diagnosis was made after the diagnosis of BC(median:7.2 years)and in many cases of emergency,for bowel obstruction,bleeding or perforation.Diagnosis was achieved through endoscopy,radiological examination or both.In most of the cases,patients underwent surgery with or without systemic therapies.Survival of patients included in this review was available in less than 50%of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.CONCLUSION Although,intestinal metastases of BC are considered a rare condition,clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC,especially in patients with a histology of lobular carcinoma.

Computed tomographic findings of trichuriasis

In this report, we present computed tomographic findings of colonic trichuriasis. The patient was a 75-year-old man who complained of abdominal pain, and weight loss. Diagnosis was achieved by colonoscopic biopsy. Abdominal computed tomography showed irregular and nodular thickening of the wall of the cecum and ascending colon. Although these findings are nonspecific, they may be one of the findings of trichuriasis. These findings, confirmed by pathologic analysis of the biopsied tissue and KatoKatz parasitological stool flotation technique, revealed adult Trichuris. To our knowledge, this is the first report of colonic trichuriasis indicated by computed tomography.

Effect of special Hungarian probiotic kefir on faecal microflora

AIM： To investigate the effect of a four-week consumption of a special Hungarian probiotic agent （Biofir） on the faecal microflora in human healthy subjects.METHODS： The effect of Biofir with 10^6/cm^3 initial germs on the faecal microflora was studied in 120 healthy volunteers （71 females, 49 males）. The traditional Russian type kefir was used as control. The various germ groups and pH values were determined in wk 2, 4 and 6.RESULTS： The number of all microbes increased during the 4-week probiotic treatment. The number of microbes increased 4,3-fold in the control group and 6.8-fold in Biofir-treated group. The probiotic kefir caused multiplication of the probiotic flora, meanwhile the undesired bacteria multiplied in the control group. No significant change of pH values of the faeces was found in both groups.CONCLUSION： The Hungarian probiotic keflr （Biofir） is capable of promoting multiplication of probiotic bacterial flora in the large bowel.

Colonic gallstones:a case report

BACKGROUND:Colonic gallstone is an uncommon entity with high morbidity and mortality due to various reasons. It remains a diagnostic challenge because of delayed and non-specific presentations,especially in the elderly population,often with multiple co-morbidities. METHOD:We present a case of 81-year-old woman who had a large bowel obstruction due to colonic gallstone. RESULTS:Immediately after a cholecysto-colonic fistula was found by laporotomy,she underwent a single stage enterolithotomy,cholecystectomy and fistula closure. CONCLUSIONS:A single stage enterolithotomy,cholecys- tectomy and fistula closure is ideal for this condition. Various other surgical options in the literature are discussed.