Anal Side Research Articles

A YOUNG ADULT CASE OF PRIMARY CARCINOMA OF THE JEJUNUM

Primary adenocarcinoma of the jejunum is extremely rare, despite the fact that the small intestine is much longer than the colon. In addition the anatomy of the small intestine makes us difficult to diagnose the disease preoperatively. A 31-year-old male was admitted to our hospital because of intermittent epigastric pain lasting for 6 months. Gastric endoscopy and the abdominal ultrasonography revealed no abnormalities. Selective contrast radiography indicated primary carcinoma of the small intestine. Partial jejunectomy and resection of Schnitzler's metastasis were carried out. The tumor was located as a whole circumference stricture at the jujunum about 100cm anal side from the Treitz's ligament. Its histrogical diagnosis was well differentiated adenocarcinoma of Borrmann type 2. There was peritoneal dissemination in the Douglas Cul-de-sac, but no regional lymph node metastasis was observed. Resection of the intestine by about 120cm with peritoneal dissemination was performed, and then a reservoir was indwelt in the abdominal cavity. The patient received adjuvant chemotherapy with 100mg/body of CBDCA intraper-itoneally, 3000mg/body of 5-Fu intravenousily and 600mg/body/day of UFT orally. He is doing well without any signs of recurrence as of 2 years after the operation.

A CASE OF CA19-9 PRODUCING CANCER OF THE SMALL INTESTINE WITH PERFORATION

An 87-year-old male was admitted to the hospital because of abdominal pain. Generalized peritonitis was suspected with physical examination. Abdominal plain X-ray film in the upright position showed dilated loops of the small intestine with air fluid levels and free air at the bilateral subphrenic spaces. The patient was diagnosed as perforation of the intestine and emergency operation was performed. Duing operation the perforation of the small intestine caused by strangulation due to the shortened mesenterium was detected at about 3m anal side from the Treitz' ligament and peritoneal dissemination was seen. Large part of the small intestine and ascending colon were cyanotic. A portion from the small intestine about 1.5m anal side from the Treitz' ligament to ascending colon was resected. Pathological examination revealed that the perforation was caused by ischemia due to the strangulation and cancer cell was found on the perforation. And peritonitis cacinomatosa was diagnosed pathologically. Histological findings of the resected specimen showed well differentiated adenocarcinoma of the small intestine. Immunohistochemical stain for CA19-9 was positive in the tumor cells.

ADULT INTUSSUSCEPTION DUE TO A COLONIC CANCER -REPORT OF TWO CASES-

Two cases of intussusception with a colonic cancer at the head are reported. Case 1: An 81-year-old man was admitted to the hospital because of diarrhea. Intussusception of the transvers colon was confirmed by CT and a cancer was found at the head of intussusception by colonofiberscopy. Thereafter lumbago appeared. A curative operation was performed, and perforations of the colon were confirmed. Case 2: A 76-year-old woman was admitted to the hospital because of diarrhea, constipation, and intestinal obstruction. Intussusception was proved by barium enema and CT, and then a cancer was found by colonofiberscopy. Curative operation was carried out and the resected cancer tumor was a 10×10cm Bormann type 1 lesion in the cecum. Moreover mucosal prolapse syndrome was found at the anal side of the intussusception. Adult intussusception of the transvers colon is comparatively rare and we could not find any report of intussusception caused by a Borrmann type 1 lesion with 10cm in diameter. CT and colonofiberscopy are very useful to confirm the intussusception, and operation must be performed without desintussusception because of the risk of metastasis.

A CASE OF COLONIC CANCER ASSOCIATED WITH COLONIC TUBERCULOSIS

A 74-year-old woman was seen at the hospital because of a right lower abdominal pain. Barium enema revealed a narrowing of the hepatic flexure and remarkable shortenig with pseudo diverticula formation of the ascending colon. Colonoscopy demonstrated a whole circumferential stricture in the hepatic flexure and old inflammation in the anal side area from the stricture. Since an biopsy yielded moderated differentiated adenocarcinoma, right hemicolectomy was performed. The resected specimen showed that the tumor was categorized as carcinoma of Borrmann 2 type. A few the scarred area with discoloration was observed in the shortened ascending colon, and so we recognized this change as the old colonic tuberculosis. This case and 51 cases of colonic tuberculosis with a colonic cancer seen in the Japanese literature were reviewed. It took about 30 years to develop colonic cancer in the cases which actually had a previous history of tuberculosis. The causal relation between colonic tuberculosis and colonic cancer is not indisputably interpretated. But it is assessed that colonic cancer affected with tuberculosis may be exist, because macroscopically atypical carcinoma type was frequently observed and “dysplasia” around the cancer was revealed in about 19% of all cases.

A Retrospective Study of 66 Esophageal Reconstructions Using Microvascular Anastomoses

We have studied 66 patients who underwent esophageal reconstruction using microvascular anastomoses. This series comprises 28 patients with reconstruction using a free jejunal interposition between the pharynx and the cervical esophagus following pharyngolaryngoesophagectomy for hypopharyngeal carcinoma and 38 atypical patients in whom other methods of reconstruction were used. Successful transfer was achieved in 98.5 percent (65 of 66). Issues concerning atypical reconstruction and our procedures in these cases are discussed. In order to obtain adequate tension in the jejunum on the anal side, in particular, since the anastomosis is located in a deep or narrow space, autosuture instruments were used. The anastomotic leakage rate was 2.8 percent (1 of 36); the stenosis rate was 2.8 percent (1 of 36). To prevent necrosis in the trachea, a greater omentum flap was used in three patients, a mesenterium flap in two, and a pectoralis major musculocutaneous flap in one. There were no significant complications. In patients with a short gastric pedicle or in those in whom a double cancer occurred in the hypopharynx and thoracic esophagus, a gastric pedicle and a free jejunum flap were used together. As a result of this method, the incidence of any reflux of digestive juice was reduced to 0 percent (0 of 6). To reduce the possibility of an ischemic complication at the oral end of the colonic pedicle, we added a microvascular anastomosis of the colonic pedicle, thereby reducing both leakage [0 percent (0 of 9)] and necrosis [0 percent (0 of 9)]. These procedures involving microvascular anastomoses have reduced the incidence of complications in esophageal reconstructions.

Local neural control of intestinal motility: nerve circuits deduced for the guinea-pig small intestine.

1. Propulsion of digesta along the intestine appears to occur by the action of a series of local reflexes which cause contraction oral to the digesta and relaxation of circular muscle on the anal side. 2. There is now substantial evidence available about the identities of the enteric neurons that mediate these reflexes. 3. The motor neurons and interneurons of the reflex pathways lie within the myenteric plexus. These neurons can be classified electrophysiologically as S-neurons and have distinctive projections and neurochemistries. 4. The sensory neurons may lie in the myenteric plexus, but there is some evidence for sensory neurons in the submucous plexus. A contribution from extrinsic sensory neurons to local motility reflexes cannot be ruled out. Intrinsic sensory neurons are probably AH-neurons and are large multi-axonal cells.

Nitric oxide-mediated inhibitory response of rat proximal colon: independence from changes in membrane potential.

1. We studied the relation of nitric oxide-mediated relaxation of smooth muscle to changes in membrane potential of cells in the proximal colon of rats. 2. The resting membrane potential and electrical field stimulation (EFS)-induced junction potentials were recorded from the circular and longitudinal muscle cells. 3. Localized distension with a small balloon caused relaxation of the circular muscle on the anal side of the distended region (descending relaxation). Relaxation of the longitudinal muscle was also induced by EFS. 4. Inhibitory junction potentials (i.j.ps) were recorded from all circular muscle cells tested, but rarely from the longitudinal muscle cells. 5. The i.j.ps were recorded only in the presence of atropine but relaxations of both muscles were induced even in the absence of atropine. 6. Apamin (100 nM) completely abolished the i.j.ps recorded in both circular and longitudinal muscle cells, but had no significant effect on the relaxations of either. 7. In contrast to apamin, Ng nitro-L-arginine (10 microM) inhibited the relaxations of both muscles, but did not affect the i.j.ps. 8. Exogenously added nitric oxide (0.1-10 microM) induced relaxations of both muscles concentration-dependently, but did not affect the membrane potentials at these concentrations. 9. These data strongly suggest that nitric oxide-mediated relaxation of rat proximal colon is not associated with the i.j.ps of the cell membrane.

Projections of nitric oxide synthase- and peptide-containing neurons in the small and large intestines of the toad ( Bufo marinus)

The projections of galanin (GAL)- and vasoactive intestinal peptide (VIP)-immunoreactive (IR) and nitric oxide synthase (NOS)-containing neurons in the small and large intestines of the amphibian Bufo marinus were investigated by their reactions to surgical interruption (myotomy). In the small intestine, myotomy caused accumulation of GAL- and VIP-IR and of NADPH diaphorase reaction product (revealing NOS) in cut axons on the oral side of the operation site. On the anal side there was loss of GAL-IR axons from the circular muscle and myenteric plexus and long, anally directed processes could be traced from GAL-IR nerve cell bodies. There was no significant loss of VIP-IR or NADPH diaphorase from nerve fibres in the myenteric plexus or circular muscle layer, although anally-directed axons could be traced from nerve cell bodies on the anal side of the operation sites. In the large intestine, myotomy caused accumulation of VIP-IR and of NADPH diaphorase reaction product in cut axons on the oral side of the operation site. Anal to the cut, although there was no significant loss of these fibres from the muscle or myenteric plexus, anally directed axons could be traced from nerve cell bodies. GAL-IR fibres in the large intestine are of two types: a few contain GAL-IR alone and are thought to arise from enteric neurons; many contain both GAL- and SOM-IR and are thought to arise from nerve cell bodies in the hindgut. Myotomy caused an accumulation of GAL/SOM-IR material in fibres on the anal side of the cut and a substantial decrease in the number of fibres on the oral side. There was no detectable effect of myotomy on the GAL-IR fibres, although an abnormally high density of GAL-IR nerve cell bodies was found oral to the cut. These results indicate that VIP-IR and NOS-containing enteric neurons project in an oral to anal direction in the toad small and large intestines. Some of the neurons have short anal projections to the circular muscle. GAL-IR enteric neurons have similar projections in the small intestine, but their projections could not be determined in the large intestine. GAL/SOM-IR axons in the large intestine project from anal to oral. Myotomy in the large intestine appears to induce an increased or de novo expression of GAL-IR in enteric neurons oral to the cut.

A CASE OF PERFORATION OF THE JEJUNAL DIVERTICULUM ASSOCIATING WITH A LEIOMYOSARCOMA

A 63-year-old man had repeated melena of unknown origin from March 10, 1991. On February 7 1992, the patient developed melena followed by abdominal pain in the early morning and was referred to the hospital for admission. There were tenderness with muscular defence and Blumberg sign in the abdomen. Simple X-ray examination of the chest and abdomen showed free air under the diaphragm. From these findings the patient was diagnosed as having a gastrointestinal perforation. Laparotomy was immediately performed and a diverticulum with a perforation 8mm in diameter in the jejunum at 2mm anal side from the Treitz ligament was found. The diverticulum was 8cm in size, was located on the antimesenteric side, and a hard tumor mass with the size of tip of the finger was palpated in a part of the wall. Partial excision of the jejunum including the diverticulum was performed. This case was of true diverticulum of the jejunum associating with an extramural lyomiosarcoma in which tumor cells invaded almost entire the diverticulum and the perforation was formed in its ulcerated part. In this paper a rare case of jejunal diverticulum with a leiomyosarcoma in which hemorrhage was repeated from erosion and ulcer in the lumen probably forming a perforation is described.

Experimental study on intestinal movement after total gastrectomy with jejunal interposition

In order to study the physiological changes in the intestinal movement after total gastrectomy with jejunal interposition, electromyography was taken from different sites of small intestine of the dogs with and without gastrectomy. Both 6 and 12 months after surgery, the frequency of the basic electric rhythm (BER) of interposed jejunum was lower and that of distal jejunum was much lower than that of duodenum. Most of the interdigestive migrating electric complexes (IMEC) was originated in the oral side of the interposed jejunum; the rate of occurrence increased after the operation further and reached to 91.5% one year after the operation. Most of the dogs showed the propagation pattern from interposed jejunum to duodenum and to distal jejunum; this tendency increased after the operation and 80.8% of the dogs showed this pattern one year after the operation. Thus, the IMEC, conducted usual intestinal order disappeared after the operation and those originated from oral to anal side, regardless of their original order. These results suggest that the order of the propagation of IMEC were determined by the order of the portion of intestine after operation and the parietal continuity, rather than extrinsic nerves, is involved in the propagation. It is also suggested that the propagation of IMEC is not always correlated with the gradient in the difference of the BER between the replaced jejunum and duodenum.

A CASE OF PRIMARY UPPER INTRA-THORACIC ESOPHAGEAL ADENOCARCINOMA IN ECTOPIC GASTRIC MUCOSA IN AN ELDERLY PATIENT

A surgical case of primary esophageal adenocarcinoma in ectopic gastric mucosa which was located in the upper intrathoracic region of the eosphagus is described in this report. The patient was an 85-year-old male. He started to suffer from difficulty of swallowing since April of 1991. Endoscopy was performed and a tumor narrowing the entire circumference was observed on the left side of the posterior wall of the esophagus located 20cm from the incisor line. Biopsy diagnosed this case as poorlydifferentiated adenocarcinoma. On May 9, 1991, blunt dissection without thoracotomy was performed, followed by postmediastinum esophagogastrostomy. The surgical findings were A2NxM0Plx. The postoperative course was unevent ful and the patient was discharged from the hospital on the 39th day after surgery. Histopathologically this tumor was adenocarcinoma with a variety of histological patterns such as highly-moderately and poorlydifferentiated and mucinous types. Stratified squamous epithelium was present on the oral and anal sides of the lesion. Columnar epithelium resembling that of gastric mucosa was also found in the tumor. Given these findings, this case was diagnosed as having an adenocarcinoma in ectopic gastric mucosa. Only five cases of malignancy originating from ectopic gastric mucosa have been reported in Japan including the present case. The course of the patient with ectopic gastric mucosa should be carefully observed.

A Case of Rectal Carcinoma in a Part of a Giant Periproctal Abscess

Abstract: A 58‐year‐old male was admitted to our hospital complaining of perineal pain and weight loss. On digital examination, a hard mass with a central depression was palpable in the circumference of the rectum. A barium enema study revealed a giant periproctal abscess formation, and a colonoscopy showed a giant irregular‐shaped ulceration in the circumference of the rectum. Biopsy specimens obtained from the rectal ulcer revealed a well differentiated adenocarcinoma, and this case was diagnosed as being carcinoma of the rectum with periproctal abscess formation. A pelvic exenteration and colostomy were performed. The macroscopic findings of the resected rectal specimen showed a giant abscess formation measuring 13 cm over the anal verge in the circumference of the lower rectum. The abscess, with a thickened wall measuring 50 mm, was accompanied by an ulcerated lesion on its oral and anal side. The tumor was adherent to the bladder and prostate with direct invasion. The post operative diagnosis made was an unclassified type of rectal carcinoma (type 5). Its clinical staging was stage 5 (HIPON1A3) in gross appearance. The histopathological findings of the resected specimen indicated a poorly differentiated adenocarcinoma partly containing signet ring cell carcinoma. The frequency with which a rectal carcinoma with a regional abscess has been reported is less than 1%. It has been assumed that a regional abscess is caused by the perforation of the rectum contributing with the invasion of carcinoma over the proper muscle layer. In this case, it was inferred that the rapid development of this tumor caused secondary, ischemia at its center and then an abscess was formed with tumor necrosis.

A CASE OF HETEROTOPIC PANCREATIC CANCER IN THE JEJUNUM

We experienced a case of synchronous double cancer consisting of gastric cancer and heterotopic pancreatic cancer in the jejunum. A 64-year-old male visited the hospital because of abdominal pain on his right side. On close examination the patient was diagnosed as having a gastric cancer and underwent laparotomy. Laparotomy revealed a tumor in the jejunum 110cm anal side from the Treitz ligament. The jejunum formed a loop about 50cm long with infiltration into the serosa. Total gastrectomy and partial resection of the jejunum were performed. According to pathological diagnosis, the gastric lesion was poorly differentiated adenocarcinoma and the jejunal lesion was Heinrich type I heterotopic pancreatic cancer. Two cases of heterotopic pancreatic cancer in the jejunum have been seen in the Japanese literature so far, and this case may be the third report.

SIGNIFICANCE OF SERUM CEA IN A CASE OF PRIMARY SMALL INTESTINAL CANCER

Among gastrointestinal tumors, small bowel tumors are found in a relatively low incidence. These tumors are hardly detected in an early stage because of lacked specific clinical manifestations, for that, the prognosis is poor. This paper describes a 59-year-old man with this disease presenting with nausea and vomiting. Abdominal simple X-ray film indicated an obstruction of the upper jejunum and barium meal method of the small intestine wascarried out. As a result, the obstruction due to a tumor was found in the jejunum about 25cm anal side from Treitz ligament. Laparotomy was performed under a diagnosis of small bowel tumor. During the operation, a hard mass about 5cm in diameter, in the jejunum and swollen regional lymph nodes were seen, and resection of the jejunum with lymph node dissection was performed. The tumor with ulcer formation occupying the whole-circumference of the tract was seen in the resected specimen. Histologically, it was moderately differentiated adenocarcinoma determined by HE staining. It is known that small bowel cancers can produce CEA. In this case elevated CEA level was shown preoperatively and it was detected by immunoperoxidase staining using anti-CEA antibody. Serum CEA level decreased after the operation. Based on this experience, when we encounter a patient who has some abdominal complaints but dose not show any abnormalities in upper and lower gastrointestinal series, a possible existence of small bowel tumor should be entertained.

A CASE OF TUBERCULOSIS OF THE SMALL INTESTINE WITH REPEATED CHRONIC ILEUS SYMPTOMS WHICH PRESENTED DIFFICULTIES IN DIAGNOSIS

A case of primary tuberculosis of the jejunum which repeated chronic ileus symptoms for a long term and presented difficulties in diagnosis is described. A 64-year-old woman was seen at the hospital because of chronic abdominal distension and abdominal pain. A chest X-ray film revealed no abnormality but abdominal simple X-ray film showed a significant dilatation of the small intestine and fluid level. Barium meal method revealed a cystic and abnormally dilated lesion in a part of the small intestine. Laparotomy findings included a cystic dilated lesion in the jejunum with a narrowing in the anal side, and numerous swelling mesenteric lymph nodes. Excision of the intestine with end-to-end anastomosis was performed. Based on histopathological examination of the excised specimen, a diagnosis of tuberculosis was made. This case was not of lung tuberculosis associating with intestinal tuberculosis, but of so-called primary tuberculosis of the small intestine. It is rare to encounter such a case as presenting abnormal cystic dilatation and repeating ileus symptoms like this case. In this case an elevated serum CA-125 level was noted in the clinical course. For this, some notes are also presented here in terms of literature review.

Key roles of nitric oxide and cyclic GMP in nonadrenergic and noncholinergic inhibition in rat ileum

Nonadrenergic and noncholinergic (NANC) inhibitory responses in circular and longitudinal muscles of the rat ileum were studied separately in vitro. Localized distension with a small balloon caused relaxation of the circular muscle on the anal side of the distended region. Nitro-arginine inhibited the relaxation and L-arginine counteracted the effect of nitro-arginine. Treatment of the preparation with superoxide dismutase (SOD) and methylene blue resulted in enhancement and inhibition, respectively, of the relaxation induced by distension. Nitric oxide caused relaxation of the circular muscle in a dose-dependent manner. 8-Bromo cyclic GMP (cGMP) caused relaxation of the circular muscle. Electrical transmural stimulation caused relaxation followed by a rebound contraction of the longitudinal muscle. Nitro-arginine inhibited the relaxation and L-arginine counteracted this inhibition. Similar results to those in the circular muscle were obtained in the longitudinal muscle with SOD, methylene blue, nitric oxide and 8-bromo cGMP. Electrical field stimulation increased the cGMP content of the longitudinal muscle preparation. Nitric oxide also increased the cGMP content of smooth muscle cells obtained from circular and longitudinal muscles of rat ileum. Preincubation of smooth muscle cells with methylene blue inhibited the effect of nitric oxide on the cGMP content. These results suggest a key role of cGMP in NANC inhibitory responses in rat ileum. The factors mediating the responses are discussed.

小腸平滑筋肉腫により穿孔性腹膜炎を呈した１例

We report a rare case of perforated leiomyosarcoma of the small intestine in a 79-year-old woman who was admitted with acute abdominal pain on October 12, 1990. Physical examination revealed signs of panperitonitis, and emergency exploratory laparotomy was performed. At laparotomy, a mass 4cm in diameter was detected approximately 150cm anal side from Treitz ligament. The tumor and adjacent intestine (25cm) were resected. Histologically, the tumor was diagnosed as leiomyosarcoma arising from the proper muscle layer. The postoperative course was uneventful, and the patient is asymptomatic and free of detectable lesion one year after resection. We also review 47 cases of perforation of leiomyosarcoma of the small intestine reported in Japan. Most tumors were detected during the sixth, seventh or eighth decade of life, and the duration of symptoms in most patients was short, i.e., within 10 days. More than 70% of leiomyosarcomas of the jejunum were located within 50cm from Treitz ligament. The cumulative 5-year survival rate of patients with perforated leiomyosarcoma was 46.0%.

下咽頭・食道癌の治療 Ｂ． 下咽頭癌の治療 ２０年間１７３例の検討

One hundred and thirty eight out of 173 cases of hypopharyngeal carcinoma visiting to our clinic during 1971 to 1990 were radically operated, and resulted in 41% of accumulated 5 year survival rate. Local recurrence occurred in 20 cases, indicating that 20 mm and 25 mm of safety margin are necessary for oral and anal sides, respectively. For NO, the rate of occult lymph-node metastasis in the affected neck was high in T2, T3 and T4 cases. The half of NO cases with metastasis in the affected neck indicated the metastasis in the unaffected one. For N2, the metastasis rate in the unaffected neck was high in any T category. The larynx was conserved in some of the T1 or T2 cases of piriform sinus and posterior wall carcinoma. Deltopectral flap and pectoralis major myocutaneous flap were useful. Among the reconstractive methods after pharyngolaryngectomy, the free jejunum graft was the most reliable although the time of food intake was long.

TWO RESECTED CASES OF LEIMYOSARCOMA OF THE ESOPHAGUS WHICH WERE SUCCESSFULLY DIAGNOSED PREOPERATIVELY

Primary leiomyosarcoma of the esophagus is a rare disease. It is hardly diagnosed preoperatively, because it is a submucosal tumor. Recent experience with 2 cases of leiomyosarcoma of the esophagus, in which we were able to perform radical operation under the definite diagnosis resulting from preoperative examinations, is reported.Case 1 is an 81-year-old woman complaining of dysphagia. An esophagogram revealed a tumor of 6 cm in longer diameter in Ei region. Esophagoscopy showed a protruded lesion lobulating like a polyp, locating at 30 cm from the incisor line. As as result of biopsy, it was diagnosed as leiomyosarcoma. Intrathoracic anastomosis of the esophagus and remnant stomach under left thoracoabdominal incision was performed. The excised tumor was 3.5×6.0cm in size, presenting as protruded type with lobulation. Histopathologically it was leiomyosarcoma of the esophagus with a metastasis in the left cardiac lymph node.Case 2 was a 61-year-old man complaining of dysphagia and hematemesis. An esophagogram revealed a tumor 8 cm in longer diameter in the EiC region, presenting as tumor type with ulceration. Esophagoscopy showed a protruded lesion with a high of about 2.5 cm locating at 40 cm from the incisor line, which was accompanied with deep ulcer on the anal side. As a result of biopsy, it was found a leiomyosarcoma. Jejunal interposition between the esophagus and remnant stomach under left thoracoabdominal incision was performed. Excised specimen was 4.5×6.0×4.0 cm in size. Histopathologically it was a leiomyosarcoma.

An experimental study of the diurnal changes in colonic motility centering on defecation

The following findings have been obtained as a result of making an assessment regarding the diurnal changes in colonic motility by means of continuous measurement of contractile waves by using strain gauge force transducers and roentgenographic observation in conscious dogs. 1. Before defecation, the contractile force of the wave was weak, frequency of its emergence was also small, and transfer of intestinal content was slow, showing decrease of colonic motility. 2. After defecation, the gradually increasing and decreasing contractile wave groups became clear, and the contractile force was intensified concurrently with increase of its emerging frequency. Transfer of intestinal content to the anal side was rapid, and recovery of colonic motility was observed. 3. The recovery of the colonic motility after defecation was observed regardless of digestive or interdigestive state. 4. By intake of food, increase of the colonic motility corresponding to gastrocolic response was observed, but it was due to the increase of emerging frequency of contractile wave, for which no change was observed in contractile force or duration in each individual waves. 5. It was suggested that the contractile motion which undergoes gradual increase and decrease is the basic pattern in the colonic motility and that the colonic motility changes by the differences of amount, shape and hardness of intestinal content, and decreases gradually along with increase of intestinal content, but the basic pattern of contractile motion is restored by inflow of intestinal content into the colon which became empty after defecation. From the above it was considered to be inadequate to use the pattern classification of digestive and interdigestive state for the analysis of colonic motility and that assessments should be made centering on defecation.