Carcinoma Of Transverse Colon Research Articles

How to Do It: Laparoscopic Total Abdominal Colectomy with Complete Mesocolic Excision (CME) for Transverse Colon Cancer in Ulcerative Colitis

BackgroundUlcerative colitis (UC) is a chronic mucosal inflammatory bowel disease of the colon and rectum. After 10 years of having the disease, there is a significant risk of dysplasia or cancer in the affected colon and rectum, and because of the often aggressive biology of these tumors, frequent endoscopic surveillance is warranted. Over a third of patients with UC will ultimately require an operation, and although for specific cases alternative operations can be pursued, most patients prefer an ileal pouch-anal anastomosis (IPAA) with J-pouch construction. CaseA staged IPAA removes the affected colon and rectum treating UC and also restores intestinal continuity. However, the standard colectomy for UC includes low ligations of the main colonic vascular pedicle branches (ileocolic, right colic, middle colic and inferior mesenteric) that does not address a proper oncologic operation. A high ligation of the named vessels as well as a proper resection of the affected colon with its mesentery and lymph node package are needed to treat colon cancer. Analogous to a total mesorectal exicision for rectal cancer, a more radical procedure to remove the tumor and lymph node packet for colon cancer is described as a complete mesocolic exision (CME) in efforts to increase disease free survival. DiscussionWe demonstrate a laparoscopic subtotal colectomy for UC, with an oncologic complete mesocolic excision for a left transverse colon carcinoma in the setting of chronic mucosal inflammation secondary to chronic UC as the first procedure in a 3-staged IPAA. In the video, it is also demonstrated how the lymph node dissection is extended towards the greater gastric curvature and comprising omentum and gastrocolic ligament. There were no postoperative complications in the 44-year old male patient.

P43-9 A 10-year marathon, race against time: Challenges in management of metastatic colon cancer

This poster illustrates the management of initially locally advanced colon carcinoma and followed by metastatic disease over a course of 10 years. It reflects our challenges in managing not only the cancer itself but also the toxicities related to treatment. In the last 10 to 15 years there are major advancements in treatment of metastatic colorectal carcinoma. With 5-Fluorouracil (5-FU) alone, the median survival has been reported as 11 to 12 months. However with more new agents other than 5-FU, for example other new cytotoxic agents, biologic agents targeting angiogenesis and the epidermal growth factor receptor (EGFR), the average median survival is approaching 3 years (Heinemann et al). Past and current treatment history was obtained retrospectively through electronic medical records. Madam L was first diagnosed with Dukes C Transverse Colon Carcinoma pT3N2M0 in 2010. However she developed metastatic disease subsequently in 2011. She failed a total 11 lines of chemotherapy and targeted therapy, including XELOX, XELIRI, FOLFIRI, TS-1, Regarofenib used with combination of Cetuximab, Panitumumab, Aflibercept. She suffered from side effects of both chemotherapy and targeted therapy, which some has been managed medically and some disabling enough to lead to cessation of the agent. She was given multiple chemo-holidays in between treatments. Over the course of 10 years, with advancement in treatment and new laboratory investigations for mutation, this patient has been on newer treatments. She is still undergoing palliative chemotherapy and is asymptomatic now. This patient has beaten the odds, by proper sequencing of chemotherapy and targeted therapy, besides adequate management of treatment related toxicity.

S1647 A Surprising Diagnosis of Lynch Syndrome at Age 86

INTRODUCTION: Lynch syndrome (LS) is the most common inherited colorectal cancer (CRC) syndrome and accounts for up to 6% of all CRCs in the United States. The lifetime risk of CRC is near 75% for individuals with this inheritable highly expressed gene making identification of individuals and at-risk family members important for cancer prevention and management. CASE DESCRIPTION/METHODS: 86-year-old male in excellent physical condition with history of right-sided poorly differentiated invasive stage IIa adenocarcinoma status post right hemicolectomy 12 years ago presented after 6 episodes of painless hematochezia (hemoglobin 11.9 g/dL). He chose not to undergo chemotherapy and never had a follow-up colonoscopy following his initial CRC. He reported a family history of 1 sister who recovered from breast cancer and 2 deceased younger brothers who passed from colon cancer after his original diagnosis of CRC. Both parents experienced early death from cardiovascular disease. He had 6 children. Colonoscopy revealed normal ileocolonic anastomosis but with a 3 cm ulcerated, friable mass in transverse colon, a 2.5 cm mass in rectosigmoid colon, and a large, fungating 4cm ulcerated mass 5 cm from the anal verge. CT chest/abdomen/pelvis scan demonstrated extension of the transverse colonic mass through the colon wall into the mesentery with extensive nodal and hepatic metastatic disease. Pathology revealed invasive moderately differentiated adenocarcinoma positive for MLH1, MHS2, and PMS2 suggestive of Lynch syndrome; absent MSH6 staining was noted. Family members were recommended for genetic testing. The patient ultimately opted against treatment. DISCUSSION: The average age of colon cancer diagnosis for those with LS is 44 as compared to 68 for men without the genetic syndrome. This case demonstrates a particularly unique diagnosis of Lynch syndrome in an elderly male that was not diagnosed until his second bout of CRC. Of note, both cancers occurred after age 70. Strict adherence to the revised Bethesda guidelines can miss 68% of high microsatellite instability CRCs suggesting these guidelines are inadequate for LS screening, particularly if a full multigenerational family cancer history is not available. Multiple studies have demonstrated economic feasibility and advocate for universal LS testing of CRC tumors. This case supports such a paradigm. For identifying those who may be at risk for LS, we would prefer a predictive model without an overreliance on age to determine those appropriate for screening.Figure 1.: Endoscopic view of the 3 cm transverse colon (A), 2.5 cm rectosigmoid colon (B), and 4 cm anal verge (C) masses in an 86-year-old male discovered to have Lynch syndrome.Figure 2.: CT abdomen/pelvis showing transverse colon carcinoma with direct extension through the colon wall (red arrow) and into the mesentery associated with extensive nodal, as well as hepatic (yellow arrows) metastatic disease in an 86-year-old male discovered to have Lynch syndrome.

Acute Large Bowel Obstruction Following Late Sequelae of Traumatic Diaphragmatic Hernia

A 33 years old patient was admitted in a Military Hospital with the features of acute large gut obstruction. Exploratory laparotomy was done and peroperatively the obstruction was seen in the transverse colon and obstruction seemed to be carcinoma of transverse colon with involvement of left hemidiaphragm which was not negotiable. Transverse loop colostomy with decompression of bowel was done. Subsequently the patient was transferred to tertiary level hospital in Dhaka. In the tertiary hospital, the patient developed left sided massive pleural effusion. With relevant investigation the condition was diagnosed as left sided diaphragmatic hernia. Thoracotomy was done and herniorrhophy was performed after reduction of the content. Post-operative management was stormy and eventful but the condition improved gradually and the patient was discharged in proper time. The patient had history of chest trauma due to RTA he met 4 years back and he received hospital indoor management for 3½ months. The patient was asymptomatic and leading normal active military life before 2nd time admission for acute intestinal obstruction. The patient had past history of trauma to left chest wall 4 years back, presented with acute large gut obstruction and there was diagnostic dilemma. There were management difficulties and post operative events were stormy. The aim of this reporting is to highlight all of these.
 Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 119-120

Surgical management of adenocarcinoma of the transverse colon: What should be the extent of resection?

Transverse colon, owing its origin to midgut and hindgut and harbouring a flexure at both ends, continues to pose a surgical challenge. When compared to the rest of the colon, transverse colon adenocarcinoma is relatively uncommon. These cancers usually present late and lie in close proximity to the stomach, omentum, and pancreas. Adequate lymphadenectomy entails dissection around and ligation of the middle colic vessels. Hence, resectional surgery for transverse colon carcinoma is considered difficult. This is more so because of the variation of arterial and venous anatomy. From this perspective, the surgeon is tempted to perform a more radical operation like extended right or left hemicolectomy to secure an adequate lymphadenectomy. Such a cancer has also been dealt with a more limited transverse colectomy with colo‐colic anastomosis. For all these reasons, patients with transverse colon adenocarcinoma were excluded from randomised trials which compared laparoscopic resection with traditional open operation. Surgical literature is yet to establish a definite operation for transverse colon cancer and the exact procedure is often dictated by surgeon's preference. This is primarily because this is an uncommon cancer. The rapid adoption of laparoscopic operation favoured extended colectomy as transverse colectomy can be difficult by minimally invasive technique. However, in the recent past, cohort studies and meta‐analyses have shown equivalent oncological outcome between transverse colectomy and extended colectomy. It is time to resurrect transverse colectomy and consider it equivalent to its radical counterpart for cancers around the mid‐transverse colon.

PTU-086 Outcomes of all surgery for ulcerative colitis over a 12-month period at a tertiary referral ibd unit

Introduction 1/4 of patients with ulcerative colitis (UC) will require surgery. We describe an audit of indications and outcomes of UC surgery at LTHT a tertiary referral centre for pouch surgery. Method Patients undergoing surgery for UC in 2013 were identified from surgical lists, IBD nurse post-op review and from histopathology database. Data were extracted from electronic records and case notes. Results 42 cases, 38 with complete dataset, 25 (59.5%) males. Mean age 42 (range 18–91), mean age at diagnosis 33 (7–68). 21 (55%) had failed >3 therapies and 15 (39%) taking oral steroids at time of surgery. 0 E1 disease, 15 (39.5%) E2, 15 (39.5%) extensive colitis (E3), 8 (21%) extent unclear. 48 procedures on 38 patients within the 12 months, 32 (67%) were elective, 16 (33%) emergency. Of 16 emergencies 11 were sub-total colectomies for acute severe disease (5 open, 6 laparoscopic), 3 EUAs, 1 rectal stump dehiscence and 1 obstructing tumour. At 12 months 23 (61%) completed pouch surgery. Of 40 colectomies 27 (67.5%) were laparoscopic. Indications: failed medical therapy 78.9% (n = 30, one low grade dysplasia), cancer 7.9% (n = 3, 1 = panproctocolectomy transverse colon carcinoma, 1 = pouch with adenocarcinoma cuff, 1 = sub-total colectomy with tumour in rectal remnant), patient choice 5.3% (n = 2), perforation 2.6% (n = 1), other 5.3% (n = 2) One death from pneumonia following emergency procedure. 11 short-term complications in 7 patients having 2-stage pouch surgery (5 wound infections, 2 anastomotic leaks, 1 ileus, 1 chest infection, 1 failure to restore continuity, 1 ureteric damage). 5 had longer-term complications (1 each for pouch dysfunction, high output stoma, strictured anastomosis, pouchitis, peri-anal pain). 7/16 having 3-stage pouch suffered one or more short-term complications (5 wound infection/dehiscence, 5 intra-abdominal complication (collection/sepsis/bleed), 2 ileus and one each of anastomotic leak, chest sepsis, VTE, rectal stump complication, AKI, confusion, pneumaturia, anterior spinal artery infarct). 7/16 patients suffered one or more longer-term complication (3 high output stoma before reversal ileostomy, anaemia n = 2 and and 1 of rectal discharge, SBO, adrenal insufficiency and retrograde ejaculation) Conclusion Leeds is a high volume surgical unit performing 23 pouch operations in 12 months compared with the median number of 4 (national IBD audit). Most were laparoscopic as recommended by the IBD service standards. Pouch surgery carries significant short and long term risks and these should be addressed carefully. We recommend that all elective UC surgical patients are discussed at the IBD MDT and ideally reviewed in the combined clinic. Disclosure of interest None Declared.

Lymph node metastasis of carcinomas of transverse colon including flexures. Consideration of the extramesocolic lymph node stations.

Complete mesocolic excision (CME) is nowadays state of the art in the treatment of colon cancer. In cases of carcinoma of transverse colon and of both flexures an extramesocolic lymph node metastasis can be found in the infrapancreatic lymph node region (ILR) and across the gastroepiploic arcade (GLR). These direct metastatic routes were not previously systematically considered. In order to validate our hypothesis of these direct metastatic pathways and to obtain evidence of our approach of including dissection of these areas as part of CME, we initiated a prospective study evaluating these lymph node regions during surgery. Forty-five consecutive patients with primary tumour manifestation in transverse colon and both flexures between May 2010 and January 2013 were prospectively analyzed. Patients were followed up for at least 6 months. Mode of surgery, histopathology, morbidity and mortality were evaluated. Twenty-six patients had a carcinoma of transverse colon, 16 patients one of hepatic flexure and four patients one of splenic flexure. The median lymph node yield was 40. Occurrence of lymph node metastasis in ILR was registered in five patients and in GLR in four patients. The mean lymph node ratio was 0.085. Postoperative complications occurred in nine patients, and postoperative mortality was 2 %. We were able to demonstrate this novel metastatic route of carcinomas of the transverse colon and of both flexures in ILR and GLR. These could be considered as regional lymph node regions and have to be included into surgery for cancer of the transverse colon including both flexures.

Management of Pain in Cancer Patients at a South Indian Hospital

The main objectives were to study the incidence of cancer in the locality, pattern of drug prescribed and management of pain in cancer patients. In a total of 30 patients, 18 (60%) were male and 12 (40%) were female. Patients between the age group 51 and 60 were found to be more (n=7; 23.33%) to get hospitalized for the treatment of cancer. Right breast cancer (n=3; 10%) is more predominant in the cancer patients as a past medical history, which is followed by Left breast cancer, Penis cancer, Acute myeloid leukemia in 6.66% (n=2) and Non- Hodgkin lymphoma, B-cell acute lymphoblastic leukemia, T-cell lymphoma, Acute lymphocytic leukemia and airway obstruction, Burkett’s lymphoma, Right lung cancer, Carcinoma of mild transverse colon, etc. Diagnosis in the study population shown that Hodgkin lymphoma (n=4; 13.33%) and Right breast cancer (n=4; 13.33%) were predominant cancer, which is followed by B-cell acute lymphoblastic leukemia, left breast cancer, penis cancer, acute myeloid leukemia in each of 2 (6.66%) patients. The most commonly used pain medications were Tramadol and Diazepam, these drugs are prescribed in 8 patients each (26.66%), and it is followed by Morphine, Phenobarbital and Flurazepamwere found in 4 patients each (13.33%).

Laparoscopic colectomy for transverse colon carcinoma: a surgical challenge but oncologically feasible

The aim of the study was to assess the safety and feasibility of laparoscopic surgery for transverse colon cancer and to compare the clinicopathological outcome with that of conventional open surgery. From March 1998 to December 2009, 1253 patients with colorectal tumours were operated on, 564 laparoscopically. There were 154 cases of transverse colon cancer, 86 of which were included in the study. Details were collected on age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to resume a liquid diet, postoperative length of hospital stay, complications, TNM stage, tumour size, distal resection margin, proximal resection margin, number of nodes harvested and surgical procedure. Laparoscopic and open surgical removal was compared. No significant differences were found between laparoscopic and conventional groups in age, sex, BMI, operation time or postoperative length of hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (105.9± 140.9ml vs 305.7±325.3ml; P=0.05). The time to the first flatus was shorter (2.1±0.3days vs 3.8±3.0days; P=0.043) and diet was started earlier (3.1±1.4days vs 3.4±1.5days) in the laparoscopic group. No significant differences in tumour size, proximal resection margin or number of lymph nodes were observed. The mean distal resection margin was not statistically different (10.3±4.5cm vs 8.8±4.9 cm). At a mean follow up of 33±2.3months, nonport-site metastases occurred in eight patients and locoregional recurrence occurred in three, with no significant difference between the groups. The 3-year cumulative overall survival rate was 78%, and the disease-free survival rate was 69%. There was no difference in the outcome of laparoscopic and open surgery for transverse colon cancer, including the cancer-specific outcome.

拡大切除により長期生存した横行結腸癌十二指腸瘻の1例

症例は64歳，男性．下痢，腹痛を主訴に受診し下部消化管内視鏡で横行結腸に全周性の2型腫瘍を認めた．上部消化管内視鏡で十二指腸下行脚下部に全周性の腫瘍を認め，大腸との間に瘻孔を認めた．腹部CTでは肝彎曲部結腸に5cm大の腫瘍を認め，膵鈎部との境界が一部不明瞭であった．横行結腸癌十二指腸膵浸潤の診断で，結腸右半切除，幽門輪温存膵頭十二指腸切除，肝部分切除術を施行した．病理所見はpSI（Duo），pN1（1/25），pStage IIIaであった．現在術後51カ月を経過し再発なく健在である．結腸癌十二指腸浸潤は比較的少ないが，今回われわれは横行結腸癌十二指腸瘻に対し，拡大手術を行い長期生存を得られた症例を経験した．結腸癌十二指腸浸潤は当科で過去に経験した症例においても，根治度A手術により長期生存が得られており，治癒切除が可能であれば拡大切除を積極的に検討すべきと考えられた．

形態変化のみられたlymphoid stromaを伴う横行結腸癌の1例

形態変化のみられたlymphoid stromaを伴う横行結腸癌の1例

空腸およびS状結腸に瘻孔を形成した横行結腸癌の1例

空腸およびS状結腸に瘻孔を形成した横行結腸癌の1例

Colorectal Carcinoma Masquerading Empyema of the Gallbladder: A Case Report with Literature Review

Colorectal cancers does not exclusively present with the familiar symptoms of change in bowel habit, rectal bleeding, anaemia, weight loss and abdominal pain. Sometimes, colorectal tumours may infiltrate local structures and present in a different manner. We present an interesting case of a 76-year-old Caucasian lady with locally invasive transverse colon carcinoma who presented initially with gallbladder empyema and later with upper gastrointestinal (GI) bleeding. To the best of our knowledge, this is the first case reported in the literature who presented in this way.

横行結腸癌を合併した腸間膜静脈硬化症の１例

症例は82歳，男性．体重減少を主訴に近医を受診し，横行結腸癌の診断を受け，平成21年８月に当科を紹介受診した．術前精査で腸間膜静脈硬化症の所見を認めた． 平成21年９月に右半結腸切除術を施行された．腫瘍は横行結腸肝彎に存在し，肉眼的に腫瘍周囲は暗青色調の浮腫状粘膜を呈していた．病理組織学的にも腸間膜静脈硬化症に合致するもので，横行結腸癌に合併した腸間膜静脈硬化症と診断した． 腸間膜静脈硬化症は静脈硬化に伴う虚血性腸炎で，1991年に小山ら1)により初めて報告された．病理組織学的には腸間膜静脈の著明な線維性肥厚と石灰化，血管周囲への膠原線維の著明な沈着を特徴とする．稀な症例で現在のところ，アジアとりわけ日本からの報告例がある程度である．人種特異性が示唆されるが，成因や治療法，長期予後に関して良くわかっていない．癌の合併に関しては現状ではいわゆるcolitis cancerとは異なり，偶発的なものと考えられている．われわれの症例を含めて３例の癌の合併例が報告されている．成因，予後に関して明らかにするために，今後より多くの症例の蓄積，研究が待たれる． 悪性腫瘍を合併した腸間膜静脈硬化症の１例を経験したので若干の文献的考察を含めて報告する．

Laparoscopic colectomy for transverse colon carcinoma

Laparoscopic resection of transverse colon carcinoma is technically demanding and was excluded from most of the large trials of laparoscopic colectomy. The aim of this study was to assess the safety, feasibility, and outcome of laparoscopic resection of carcinoma of the transverse colon. A retrospective review was performed to identify patients who underwent laparoscopic resection of transverse colon carcinoma. These patients were compared to patients who had laparoscopic resection for right and sigmoid colon carcinoma. In addition, they were compared to a historical series of patients who underwent open resection for transverse colon cancer. A total of 22 patients underwent laparoscopic resection for transverse colon carcinoma. Sixty-eight patients operated for right colon cancer and 64 operated for sigmoid colon cancer served as comparison groups. Twenty-four patients were identified for the historical open group. Intraoperative complications occurred in 4.5% of patients with transverse colon cancer compared to 5.9% (P = 1.0) and 7.8% (P = 1.0) of patients with right and sigmoid colon cancer, respectively. The early postoperative complication rate was 45, 50 (P = 1.0), and 37.5% (P = 0.22) in the three groups, respectively. Conversion was required in 1 (5%) patient in the laparoscopic transverse colon group. The conversion rate and late complications were not significantly different in the three groups. There was no significant difference in the number of lymph nodes harvested in the laparoscopic and open groups. Operative time was significantly longer in the laparoscopic transverse colectomy group when compared to all other groups (P = 0.001, 0.008, and <0.001 compared to right, sigmoid, and open transverse colectomy, respectively). The results of laparoscopic colon resection for transverse colon carcinoma are comparable to the results of laparoscopic resection of right or sigmoid colon cancer and open resection of transverse colon carcinoma. These results suggest that laparoscopic resection of transverse colon carcinoma is safe and feasible.

Synchronous colonic carcinomas presenting as an inguinoscrotal hernial mass: a case report

BackgroundA carcinoma within a hernia in the groin is uncommon, with an incidence of less than 0.5 percent of all excised sacs. This article describes a case of synchronous colonic carcinomas, one of which presented as an inguinoscrotal mass.Case presentationA 69-year old man presented with a large, irreducible left inguinoscrotal hernia and symptoms of obstruction. On examination, there was an 8 cm palpable mass within the hernia sac. CT scan revealed small and proximal large bowel obstruction secondary to a large ingunoscrotal sac and synchronous colonic tumours of the transverse colon and the ascending colon. The former presented as an inguinoscrotal mass. Laparotomy revealed a large tumour mass arising from the transverse colon in the hernia sac. The procedure was followed by an extended right hemicolectomy, during which the second tumour in the ascending colon was also resected.ConclusionThis case demonstrates a rare but interesting occurrence of primary transverse colon carcinoma presenting in a hernia sac, in conjunction with a synchronous tumour of the ascending colon. Prognosis is comparable to patients with a solitary tumour of similar pathological staging when the resection is curative. The presence of an inguinal hernia itself does not signify an increased risk of colorectal malignancy. However, in the presence of obstruction, incarceration, and weight loss, malignancy should be suspected. Thorough clinical examination, flexible sigmoidoscopy or radiographic evaluation is necessary preoperatively in such patients. Surgical resection, with or without adjuvant oncological treatment, should be performed as soon as possible, using established techniques with modifications according to involvement of local structures.

横行結腸癌による成人腸重積症の1例

横行結腸癌による成人腸重積症の1例

A CASE OF AFFERENT LOOP OBSTRUCTION DUE TO INVASION OF CARCINOMA OF THE TRANSVERSE COLON

A case of afferent loop obstruction due to invasion of carcinoma of the transverse colon is reported. A 69-year-old man was admitted to the hospital because of fever, abdominal pain and nausea. There was a previous history of undergoing a Billroth II antecolic gastrectomy for gastric ulcer 25 years before admission. He was diagnosed as having an advanced carcinoma of the transverse colon by a total colonoscopy and Ba-enema study. The temperature rose to 39°C suddenly, and the laboratory studies revealed leukocytosis and an elevation in CRP level. Ultrasonography and computed tomography revealed a large cystic mass adjacent to the pancreas head and a diagnosis of obstruction of the afferent loop was made. Endoscopic drainage of the afferent loop was attempted but failed. Therefore, an emergency operation was performed on the same day and the obstructed afferent loop was drainaged. Thirteen days after the drainage, he underwent a radical operation for the transverse colon carcinoma. However, he died of carcinomatous peritonitis and multiple lung metastasis 2 months after the operation. Afferent loop obstruction is a complication following gastrectomy, though it is rare. The most common causes of obstruction are internal hernia, adhesion, and flexion. According to the literature, only 2 cases of obstruction of afferent loop due to invasion of colonic carcinoma including our case have been reported in Japan.

異時性に両側性腎う外尿漏出をきたした結腸癌再発の１例，および文献的考察

自然腎盂外尿溢流,自然腎盂破裂は稀な疾患である.われわれは,結腸癌再発により異時性に左右の腎盂外尿縊流をきたした症例を経験した.症例は36歳の男性である.1991年8月に横行結腸癌にて横行結腸切除(D3)が施行された.組織所見は粘液癌ss,n1(+),ly2,v2,であった.1991年8月に右背部から右側腹部にかけての疼痛を訴え,諸検査にて右腎盂破裂の診断でカテーテルによる後腹膜ドレナージ術を行った後手術を施行した.手術所見では,ダグラス窩の左右に2個の転移性腫瘍を認め,右の腫瘤は右尿管および直腸壁に浸潤していた,直腸低位前方切除,右尿管部分切除を施行して再発腫瘤を切除した.1994年8月左側腹部痛を訴え,DIP,CT,などの所見より再発腫瘤による左腎盂外尿溢流と診断された.経皮的に左腎瘻を造設したのみで経過を観察した.以上,異時性に左右の腎盂外尿漏出をきたした症例を経験したので文献的考察を加えて報告した.

A CASE OF ADULT TRANSVERSE COLON INTUSSUSCEPTION SUCCESSFULLY DIAGNOSED BY CT PREOPERATIVELY

A case of adult intussusception with a transverse colon carcinoma in the lead is reported. An 84-year-old woman presenting with abdominal pain and melena was reffered to the hospital. Barium enema examination showed typical findings so-called cup-shaped appearance. On abdominal CT examina-tion, the intussusception part was visualized as triple dence tissue layers separated by thin fatty stripe correlating to the intestinal walls and a mass about 3cm in size. The mass was suspected of Borrmann type 1 carcinoma of the transverse colon which led the intussusception. We operated on. Intussusception was easily recovered with milking back. After the preoperative diagnosis was confirmed, transverse colectomy with lymphonode dissection and colostomy was carried out. Adult intussusception is a rare entity and has a variety of organic diseases. Causative diseases for colorectal intussusception are predominantly malignant, and hence, laparotomy and resection of the intestine are principle procedures. Although the propriety of repair of the intussusception prior to resection is controversial, we should select an adaquate operation in comformity with case by case, for general condition and quality of life of the patient.