Colonic Wall Research Articles

Nodular Lymphoid Hyperplasia of the Colon in an Adult Patient after Covid-19 Infection: A Case Report and Literature Review

Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility disorders (diarrhea, constipation). The clinical presentation can also be alarming with rectal bleeding and obstructive symptoms that may be misinterpreted as a neoplastic process. In this paper, we report the case of a 58-year-old female patient with a previous history of appendicetomy. She presented with persistent abdominal pain, chronic constipation and black colored stools, following Covid-19 infection. The physical examination was unremarkable. Colonoscopy examination found a bulging, non-ulcerated mass, measuring 3.5 cm in greatest dimension, located at the right colic angle. Thoraco-abdomino-pelvic computed tomography was performed and showed right colonic wall thickening and enhanced nodule formation. Furthermore, metastatic localization was not detected. After a multidisciplinary meeting, a laparotomy with right hemicolectomy was performed. Histopathological examination of the surgical specimen revealed nodular lymphoid hyperplasia with CD20+, CD5−, CD10+ and BCL2− phenotype on immunohistochemistry. Besides, lymphocytes in interfollicular area are CD3+ T cells. Patient outcome was favorable after surgery and no additional treatment was necessary. Nodular lymphoid hyperplasia of the colon is a benign process whose endoscopic appearance can sometimes raise suspicion of malignancy. The diagnosis can only be established by histological evaluation. Immunohistochemistry is also essential to confirm the diagnosis and to rule out low-grade lymphoma. Clinical evolution is often favorable. However, endoscopic follow-up is necessary in all cases.

The Effect of Supplementation with β-Hydroxy-β-Methylbutyric Acid (HMB) to Pregnant Sows on the Mucosal Structure, Immunolocalization of Intestinal Barrier Proteins, VIP and Leptin in the Large Intestine in their Offspring

Abstract The large intestine epithelium plays an important role in water absorption and participates in fluid, acid-base and electrolyte balance, and the removal of waste products. The large intestine is rich in microorganism-presented enzyme activity. Apart from energy supply, the colon also participates in the synthesis of trophic factors and the modulation of the immune system and the systemic inflammatory response. The current study investigated the effects of dietary HMB administration to pregnant sows on the postnatal development of the colon in their offspring, at weaning. From the 70th to the 90th day of gestation, sows received either a basal diet (n = 12) or the basal diet supplemented with HMB (n = 12) at a dose of 0.2 g/kg of body weight/day. Maternal HMB treatment increased serum IgG and glucose concentrations and decreased serum urea concentration in the piglets. Basal histomorphometric analysis of offspring large intestines showed that prenatal HMB treatment led to a reduction in the thickness of the mucosa, submucosa and both types of myenterons, as well as reduced crypt thickness. The immunoreaction performed to mark T0 lymphocytes and total T lymphocytes in the colon wall showed that prenatal HMB treatment decreased the number of both types of lymphocytes. Greater expression for cadherin was found in the colon of piglets delivered by the HMB-treated sows. The expression of both tight junction proteins (occludin and claudin-3), as well as that of leptin, was stronger in the HMB-treated group. Vasoactive intestinal peptide (VIP) expression was stronger in the submucosal plexuses in the HMB maternal treated piglets, while no changes were observed in the myenteric plexuses. The results obtained indicate that the administration of HMB to pregnant sows significantly influenced the expression of leptin, VIP and some proteins of the intestinal barrier in their offspring, with less influence on large intestine basal morphology.

Ipidacrine therapy in a 1.5-month old child with Hirchprung’s disease at the postoperative period

Introduction. Motor colon dysfunction is seen in most patients after surgical intervention for Hirschsprung’s disease regardless of the pull-through technique and absence of technical errors during surgery. The main cause of motor colon dysfunction are developed dystrophic disorders in the wall of dilated colon which can be manifested as episodes of both fecal incontinence and constipation. Cholinesterase inhibitors are pathogenetic preparations which are prescribed for hypo- and atonic colon conditions. The authors present a clinical case of successful treatment of 1.5 month-old child with Hirschsprung’s disease who was prescribed postoperative cholinesterase inhibitor Ipidacrine.Clinical case. A boy, aged one month and one day, was operated on for Hirschsprung’s disease of the recto-sigmoid form. Agangliosis sized 13 cm. Colon hypotonic dysfunction persisted in the postoperative period. Rehabilitation for 19 days did not give any positive results. So, it was decided to prescribe Ipidacrine (after approval of the Expert Commission because of age restrictions for the given preparation). Ipidacrine effective dose was 2 mg per kg twice a day per os. Therapy lasted for 7 days after which the colon function was normalized. No adverse cholinergic effects were recorded.Conclusion. The authors consider that after sufficient accumulation of clinical data Ipidacrine can be prescribed as pathogenetic preparation in functional hypotonic colon disorders in children including those with Hirschsprung’s disease at their postoperative period.

Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition.

Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety. Data of 24 consecutive patients who met the inclusion criteria from 272 patients with RPS who underwent surgical treatment between April 2015 and April 2022 were retrospectively collected and analyzed. The patients underwent left- or right-sided abdominoinguinal incision. In all patients, the abdominoinguinal approach provided good exposure, and complete resection was achieved. Iliac artery+vein, vein, and artery resection and replacement by graft were performed in 70.8%, 25.0%, and 4.2% of patients, respectively. Additional resected organs mainly included the colon, ureter, bladder, kidney, and abdominal wall. The median number of organs resected was 5. In 37.5% of patients, reconstruction of the lower abdominal wall and inguinal ligament was performed using a mesh. Venous graft thrombosis occurred in 21.7% of patients, while no patient had pulmonary embolism or arterial occlusion. Major complications occurred in 20.8% of patients, and no 30-day mortality was observed. The estimated 5-year local recurrence and distant metastasis rates were 54.4% and 22.1%, respectively, with a median recurrence-free survival of 27 months. En bloc resection of RPS involving iliac vessels with graft interposition using the abdominoinguinal approach is feasible and advantageous. Good complete resection rate and safety can be achieved. The long-term survival benefit of this surgical approach should be verified by further large-scale prospective controlled studies.

Ultrasonography of solitary rectal ulcer syndrome (review and case reports)

Solitary rectal ulcer syndrome (SRUS) is a chronic benign disease with an unclear pathogenesis and a wide range of macroscopic changes of rectal and sigmoid colon wall, without any specific clinical symptoms. Its detection and differential diagnosis with tumors and inflammatory bowel disease often is challenging. The aim was to assess the entire spectrum of SRUS manifestations, as well as to analyze the possibilities of ultrasound and other imaging modalities (barium enema, defecography, MRI, CT) in its diagnostics. Clinical cases showed that every method solves its own tasks, revealing structural and/or functional changes in SRUS, and makes a valuable contribution to the final diagnosis

Mesenteric Inflammatory Veno-Occlusive Disease of the Colon: An Under-Recognized Entity - A Case Report

Isolated nonthrombotic venulitis of the colon with concomitant ischemic injury, also known as mesenteric inflammatory veno-occlusive disease (MIVOD), is a rare inflammatory vascular disorder of unknown etiology. First described in 1994, there are only about 34 cases in the literature. We report a 25-year-old woman who presented with loose stools and abdominal pain of 3-week duration. Investigations revealed eosinophilia. Endoscopy showed erosion and ulcers of the gastrointestinal tract, with mucosal biopsies showing features of ischemic injury. Computed tomography showed an edematous and thickened colonic wall with impending perforation, hence, a subtotal colectomy was performed. The patient, however, had a cardiac arrest and expired despite adequate measures. The resection specimen was consistent with a diagnosis of MIVOD. As the clinical and radiological features of MIVOD are nonspecific and overlap with inflammatory bowel disease or mesenteric ischemic disorders, histopathological examination of the resection specimen is the mainstay for its diagnosis. We believe this is the only other case in the literature of MIVOD with eosinophil predominance.

Protective effect of intraluminal fecal diverting device against colonic wall erosion induced by wrapping bands: A post-hoc pathological analysis.

Materials wrapping the bowel elicits tissue erosion gradually. We experienced several bowel wall erosions with no serious clinical consequences in our two previous animal experiments aimed at the safety and efficacy of the COLO-BT developed for intra-luminal fecal diversion. We tried to find out why the erosion is safe by investigating histologic changes of the tissue. Tissue slides at the COLO-BT fixing area from the subjects which had COLO-BT over three weeks acquired from our two previous animal experiments were reviewed. For the classification of the histologic change, microscopic findings were classified for six stages (from minimal change of stage 1 to severe change of stage 6). A total of 26 slides of 45 subjects were reviewed in this study. Five subjects (19.2%) had stage 6 histological change; three of stage 1 (11.5%), four of stage 2 (15.4%), six of stage 3 (23.1%), three of stage 4 (11.5%), and five of stage 5 (19.2%). All subjects which had a stage 6 histologic change survived. The phenomenon from which the back of the band is passed through is replaced by a relatively stable tissue layer due to fibrosis of the necrotic cells in the stage 6 histologic change. We found that thanks to the sealing effect of the newly replaced layer, no leakage of the intestinal content occurs even if perforation by erosion develops according to this histologic tissue evaluation.

An overview of diverticular pathophysiology and its treatment

Diverticula are protrusions that resemble sacs in the colon's wall. Acute or chronic problems are experienced by 4% of diverticula patients. Diverticulosis development has been linked in large part to the western way of life. Colonic diverticular disease has become more common. Obesity, smoking, and inadequate fibre consumption are risk factors for the illness. Most of the time, surgery is not necessary to treat this; however, if the bleeding is significant, angiography and endovascular intervention may be helpful. Ureteral catheters should be considered when a patient has undergone radiation therapy, resurgery, or preoperative imaging reveals an abnormal anatomy. Oral antibiotics can help prevent surgical site infections after an elective colon resection, according to studies. Using nonabsorbable oral antibiotics like erythromycin, neomycin, and metronidazole reduces surgical site infections overall.

Strongyloides colitis, a rare but important mimic of Crohn’s disease, resulting in coma and multi-organ failure: a case report

BackgroundStrongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn’s disease. Here, we present a case of a patient who was diagnosed with Crohn’s disease and was treated with immunosuppressant therapy which resulted in a poor outcome.Case presentationA middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn’s disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later.DiscussionStrongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient.ConclusionStrongyloid colitis can very harmfully mimic Crohn’s colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.

Current practice for the treatment of obstructive left-sided colon cancer in China: a nationwide cross-sectional survey.

This study surveyed the current practice of surgical treatment of obstructive left-sided colon cancer (OLCC) in China. All colorectal surgery departments at tertiary or secondary hospitals in China were invited to complete a web-based questionnaire between August 27 and September 2, 2020. Overall, completed questionnaire were received from 357 hospitals. Emergency surgery was the mainstay of treatment for OLCC, with the open approach accounting for up to 61.62%. The stoma rate of emergency surgery was up to 80%, mainly due to inadequate bowel preparation and severe edema of colon walls. Hartmann's procedure (61.62%) was the most preferred operation. A total of 243 hospitals (68.7%) reported that they would consider the use of a self-expanding metallic stent (SEMS) as a bridge for elective surgery. More than 50% of the hospitals participating in this study reported the success rate of SEMS placement, as well as the resolution rate of obstruction more than 80%, and the stent-related perforation rate was < 5%. A total of 126 hospitals considered carrying out a strategy ofSEMS followed by neoadjuvant chemotherapy prior to elective surgery and believed that it might further improve treatment outcomes. SEMS is a feasible option for the treatment of OLCC in addition to traditional emergency surgery, and its clinical benefits have been preliminarily recognized.

Cholecystocolonic fistula, a rare complication of cholelithiasis: case presentation

Introduction: Cholecystocolonic fistula is usually a rare and late complication of gallstones and is the second most common cholecystoenteric fistula. Objective: To present the case of a cholecystocolonic fistula, a rare complication of cholelithiasis. Presentation of the case: A 50-year-old female patient who comes to our institution for recurrent abdominal pain. Discussion: Patients with FCC usually have a variable clinical presentation and are more often asymptomatic. When symptomatic, patients generally present with diarrhea, abdominal pain, jaundice, fever, nausea, vomiting, steatorrhea, and weight loss. The combination of pneumobilia, chronic diarrhea, and vitamin K malabsorption has been proposed as a pathognomonic triad for cholecystocolonic fistula. Conclusions: Cholecystocolonic fistula is a rare entity, radiologists should be aware of it and should be carefully informed if it occurs together with other hepatobiliary anomalies. The clinical triad pneumobilia, chronic diarrhea, and prolonged prothrombin time is seen in less than one third. Almost three quarters of the cases are asymptomatic and are diagnosed intraoperatively. Where cholecystectomy and repair of the colon wall is the most used treatment method.

LPNet: A lightweight CNN with discrete wavelet pooling strategies for colon polyps classification

AbstractThe traditional process of disease diagnosis from medical images follows a manual process, which is tedious and arduous. A computer‐aided diagnosis (CADs) system can work as an assistive tool to improve the diagnosis process. In this pursuit, this article introduces a unique architecture LPNet for classifying colon polyps from the colonoscopy video frames. Colon polyps are abnormal growth of cells in the colon wall. Over time, untreated colon polyps may cause colorectal cancer. Different convolutional neural networks (CNNs) based systems have been developed in recent years. However, CNN uses pooling to reduce the number of parameters and expand the receptive field. On the other hand, pooling results in data loss and is deleterious to subsequent processes. Pooling strategies based on discrete wavelet operations have been proposed in our architecture as a solution to this problem, with the promise of achieving a better trade‐off between receptive field size and computing efficiency. The overall performance of this model is superior to the others, according to experimental results on a colonoscopy dataset. LPNet with bio‐orthogonal wavelet achieved the highest performance with an accuracy of 93.55%. It outperforms the other state‐of‐the‐art (SOTA) CNN models for the polyps classification task, and it is lightweight in terms of the number of learnable parameters compared with them, making the model easily deployable in edge devices.

Reduced sodium absorption in the colon under serotonin is a potential factor aggravating secretory diarrhea.

Serotonin is a substance with a propulsive effect on the gastrointestinal tract. It stimulates the intestinal secretion of water and electrolytes, and plays an important role in the pathophysiology of secretory diarrhea. However, the influence of serotonin on intestinal absorption is very poorly understood. This study aimed to evaluate the serotonin and selected antagonists of serotonin receptors, i.e., ondansetron (5-HT3) and GR113808 (5-HT4), on electrogenic sodium ion absorption in the colon. The electrophysiologic method developed by Ussing and modified with a stimulating function on the mucosal side of the isolated colon wall was used. The influence of selected serotonergic compounds on the electrogenic transport of sodium ions under stationary conditions and mechanical stimulation was investigated. For this purpose, experiments were performed on specimens of isolated rabbit colon. Amiloride and bumetanide were used as reagents directly controlling individual ion transport. The data were analyzed using tests for paired samples (paired sample t-test, Wilcoxon signed-rank test and one-sided sign test). Serotonin reduced stationary and stimulated colonic sodium absorption. The 5-HT3 receptor antagonist did not influence the studied phenomenon, while 5-HT4 antagonists acted contrary to serotonin. Serotonin reduces both stationary and stimulated sodium ion absorption, thus playing an important role in the pathophysiology of secretory diarrhea. The described phenomenon depends on serotonin's action on 5-HT4 receptors.

Comparative analysis of the effectiveness of local application of vitamin D3 and 5-aminosalicylic acid in experimental colitis

Introduction. At the moment in the Russian Federation there are no dosage forms with vitamin D3, allowing effective delivery and local effect on the focus of inflammation and the damaged area of the large intestine in inflammatory bowel disease (IBD). Among such dosage forms rectal suppositories are of the greatest interest. The aim of the study was to carry out a comparative analysis of the effectiveness of local administration of vitamin D3 and 5-aminosalicylic acid in experimental colitis. Materials and methods. Experimental colitis (EC) was modeled with oxazolone solution. Suppositories with vitamin D3 and with 5-ASA were applied per rectum every 12 h. Clinical status (DAI), morphometry, colon tissue injury index (TDI), myeloperoxidase (MPO) and TNF-α expression in the lesion were assessed. Results. In EC, DAI is increases, an ulcerative defect is fixed in the lesion of the colon, TDI, neutrophils (NF), lymphocytes (LC), eosinophils (EF), histiocytes (HC), plasma cells (PC), fibroblasts (FB), MPO and TNF-α expression are increased. Vitamin D3 administration reduces DAI, ulcer defect, TDI, MPO and TNF-α expression, the number of NF, EF, LC and PCs, and increases the number of GCs and FBs. Comparison of vitamin D3 and 5-ASA administration revealed comparable efficacy against DAI. Morphometric evaluation of colorectal lesions showed that under the conditions of vitamin D3 administration, in contrast to 5-ASC, less infiltration, edema, signs of healing and repair of ulcerous defects were fixed earlier in EC; MPO expression increased on the 6th day, TNF-α expression on the 4th day. The TDI index on the 4th and 6th days of EC decreased equally under the conditions of vitamin D3 and 5-ASC application. Discussion. The reduction of clinical severity and morphological signs of damage in the large intestine wall at EC against the background of using rectal suppositories with vitamin D3 could be due to pleiotropic effects of vitamin D3. Conclusion. The effect of vitamin D3 in original rectal suppositories is comparable with local application of 5-ASC at EC, it reduces severity of clinical signs, representation of cells involved in tissue destruction, TNF-α and MPO expression in the colon wall and increases representation of cells mediating reparation.

Role of through-the-scope catheter–based EUS in inflammatory bowel disease diagnosis and activity assessment

Distinguishing Crohn's disease (CD) from ulcerative colitis (UC) may be difficult when the disease is limited to the colon. Transmural healing is an important adjunctive measure of inflammatory bowel disease activity. The aim of this study was to examine the role of EUS in differentiating CD versus UC and evaluating transmural disease activity. This prospective cohort study enrolled 20 patients with CD (10 active [aCD], 10 inactive), 20 patients with UC (10 active [aUC], 10 inactive), and 20 control subjects who underwent colonoscopy from 2019 to 2021 at a tertiary care center. Measurements of bowel wall layer thickness from the rectum and cecum were obtained using a through-the-scope US catheter (UM-3R-3; Olympus, Center Valley, Penn, USA) at the time of colonoscopy. Compared with control subjects, patients with aCD had thicker rectal submucosa and total wall layer (submucosa median, 1.80mm [interquartile range {IQR}, 1.40-2.00] vs .60mm [IQR, .40-.70]; total wall median, 3.70mm [IQR, 3.52-4.62] vs 2.10mm [IQR, 1.70-2.40], respectively; P< .01). Similar significant findings were observed for the cecal wall layers. Compared with control subjects, patients with aUC had thicker rectal mucosa and total wall but not submucosa or muscularis propria layers (mucosa median, 1.35mm [IQR, 1.12-1.47] vs .60mm [IQR, .57-.70]; total wall median, 3.45mm [IQR, 2.85-3.75] vs 2.10mm [IQR, 1.70-2.40], respectively; P< .01). Patients with aCD compared with those with aUC had a significantly thicker rectal submucosa layer (median, 1.80mm [IQR, 1.40-2.00] vs .55mm [IQR, .40-.75], respectively, P< .01). Cutoff values of 1.1mm for rectal submucosa in CD (sensitivity, 1.0; specificity, 1.0) and 1.1mm for rectal mucosa in UC (sensitivity, .8; specificity, .9) were found to differentiate active from inactive disease. EUS measurements of colon wall layers can help diagnose aCD versus aUC and assess transmural disease activity. (Clinical trial registration number: NCT03863886.).

Histo- and morphometric changes in the large intestine mucosa in Crohn’s disease depending on the presence of fibrosis

Background. One of the common complications of Crohn’s disease is the development of fibrotic changes in the wall of the large intestine, and, as a result, the risk of strictures. Morphometric study of the cellular composition of large intestine biopsy samples is one of the extended links of the diagnostic criteria for inflammatory bowel diseases, which make it possible to predict the development of the disease. Changes in the number of fibroblasts, as components of mesenchymal cells, can be considered a protective reaction to the intestinal tissue damage. The purpose of the study was to reveal changes in the histo- and morphometric parameters of the large intestine mucosa depending on the development of intestinal fibrosis in Crohn’s disease. Materials and methods. Colon biopsy samples from patients with Crohn’s disease (n=38) were examined histologically and morphometrically. According to morphological studies, patients were divided into two groups: with fibrotic changes in the intestinal wall (n=10) and without fibrosis (n=28). Results. Histologically, changes in the intestinal mucosa were observed in the form of altered integrity of the epithelium (78.3%), crypt architectonics (34.2%), mucosal edema (28.9%), crypt abscesses (47.3%). Fibrotic changes of the intestinal mucosa were found in 26.3% of patients. The inflammatory infiltrate contained neutrophils, eosinophils, lymphocytes, plasma cells, fibrocytes, and macrophages. At the same time, in the group of patients with Crohn’s disease and fibrosis, the number of representatives of the inflammatory infiltrate was higher than in the group of patients with Crohn’s disease without fibrosis. Patients with fibrotic changes in the intestinal wall were characterized by a higher density of inflammatory infiltrate the composition of which was dominated by macrophages and fibroblasts. Thickening of the intestinal mucosa was also observed in patients with fibrosis. The cause for such changes is the activation of the mechanism of fibrosis development against the background of inflammatory processes. Direct correlations were found between the fibrosis of the colon wall and the depth of crypts (r=0.35; p&lt;0.05), the height of the crypt epithelium (r=0.41; p&lt;0.05), cellular density of the infiltrate (r=0.45; p&lt;0.05), the number of neutrophils (r=0.47; p&lt;0.05), eosinophils (r=0.39; p&lt;0.05), fibroblasts (r=0.57; p&lt;0.05). Conclusions. In colon biopsy samples of patients with Crohn’s disease and intestinal fibrosis, a denser and increased level of inflammatory infiltrate is noted. The active development of the fibrotic process is directly related to the high level of fibroblasts in the infiltrate.

Incarcerated Small Bowel inside A Slide Hernia Composed of Colon Wall Triggered by Left Bochdalek Hernia in Adult:An Extremely Rare Etiology of Acute Intestinal Volvulus

Acute abdomen triggered by acute bowel obstruction is common in clinical practice, which may be caused by various reasons such as inflammation, tumors, intussusception and incarcerated hernia,etc. Here by, we describe a young man who was a heavy phsical worker presented with an abdominal pain and a sudden onset for nearly a day duration, accompanied with frequent nausea and vomiting, which could be partially relieved on his standing position. Empty feeling with mild tenderness was palpable on his right lower quadrant abdomen and abnormal bowel sounds were heard in his left chest cavity. Acute abdominal intestinal incarcerated obstruction was demonstrated on computed tomography (CT) of the abdomen. Urgent laparascopic exploration unveiled a Bochdalek hernia with a 3 cm defect in diameter that was subsequently closed by continual suture after the incarcerated reduced. The key to success is early identification of characterized features on images such as chest X-ray and abdominal CT, combined with the abdominal pain attack relieved by standing or semi-recombent position. In addition, the defect of Bodalek hernia is recommended to take a continual suture with a slowly absorbed barbed suture so as to strenthen the firmeness of the diaphragm.

Use of a novel endoscopic overtube with bilateral tool channels for endoscopic resection of experimental lesions and repair of intestinal defects in the right colon: preclinical trial.

Endoscopic tumor resection and intestinal defect repair are technically challenging leading to invasive surgery and colectomy performed for resection of benign polyps. In this study, we evaluated the use of an endoscopic overtube with bilateral tool channels for these procedures. Using a fresh porcine colorectum in a 3D ex vivo model, 3cm lesions at the posterior wall of the transverse colon were removed by two different techniques: standard endoscopic submucosal dissection (ESD) technique (STD, n = 12) and ESD using the overtube with an endoscopic snare and grasper through the bilateral channels (OT, n = 12). Procedure times and the number of muscular injuries were evaluated. Using the same model, 5-10mm full-thickness perforations within a 3cm mucosal defect at the posterior wall of the transverse colon were closed by two different techniques: standard endoscopic closure technique (STD, n = 12) and endoscopic closure using the overtube with two graspers (OT, n = 12). The outcomes measured included bursting pressure and the number of endoscopic clips used for closure. Endoscopic resection of lesions was performed by the OT group in a significantly shorter total procedure time (STD vs. OT = median 38.9min vs. 17.3, p < 0.001) and with fewer muscular injuries (median 0 vs. 2, p = 0.002), compared with the STD group. After repair of intestinal defects, the OT group showed higher median bursting pressures (STD vs. OT = 11.2mmHg vs. 57.1, p = 0.008) despite using fewer clips (median 13 vs. 10, p < 0.001). This study demonstrates a novel traction technique with an endoscopic overtube using multiple instruments to remove lesions and repair intestinal defects in the colon more effectively. This endoscopic platform could provide a safe alternative to invasive surgical treatment.

The possibilities of transabdominal sonographic diagnosis of liver and intestinal lesions in comorbid gastroesophageal reflux disease

Introduction. The spread of gastroesophageal reflux disease (GERD), comorbid with non-alcoholic fatty liver disease, requires modification of methods for non-invasive diagnosis of liver steatosis and fibrosis and concomitant gastrointestinal syndromes. Aim. Substantiation of a modified complex outpatient transabdominal sonographic diagnosis of combined lesions of the liver and intestines in comorbid GERD. Materials and methods. 165 outpatients with GERD (mean age 40.4 ± 2.9 years) underwent clinical and laboratory examinations, ultrasound examination (UE) of the gastrointestinal tract (GIT), liver shear wave elastometry (SWE), esophagogastroduodenoscopy, colonoscopy (CS). Results and discussion. In patients with GERD, a pronounced transsyndromic comorbidity was observed. The degrees of steatosis and fibrosis of the liver according to SWE positively correlated with the biochemical indices APRI and FORNS. ST-index of liver steatosis was statistically significantly associated with the presence of esophagitis, bile sludge, gallbladder polyps and thickening of the colon wall according to ultrasound criteria, sigmoiditis according to CS. Steatosis on ultrasound was associated with male sex, increased waist circumference, lactase deficiency and deficiency of cholecalciferol in the blood, the presence of yeast-like fungi in feces. Liver fibrosis according to the FORNS index directly correlated with the volume of HE-reflux, duodenitis and intestinal damage according to the results of ultrasound, and according to the APRI index, it inversely correlated with the concentration of vitamin D3 in the blood. Fibrosis according to the ESP criteria directly correlated with the presence of hiatal hernia, bile sludge, and the volume of HE-refluxate according to ultrasound criteria; with lactase deficiency, as well as esophagitis and colitis on endoscopic signs. Conclusions. To identify steatosis and liver fibrosis, the SWE methodology can be considered priority, and serum panels of biomarkers – alternative. Ultrasound of the gastrointestinal tract and SWE allow you to identify the degree of steatosis and fibrosis of the liver, the pathology of the esophagus, colon and the biliary system.

The vulnerability of the human taenia coli to alterations in total collagen within the colon of the elderly

The structure of the colonic wall relies on collagen, distributed within the submucosa and the muscularis externa. A recent analysis of total collagen in human ascending colon (AC) suggests that the muscularis externa is more susceptible to age-related increases in collagen among the elderly. However, it is not clear if this change also occurs in the descending colon (DC) or if the circular and longitudinal muscle layers are similarly affected in either region of colon. The aim of this study is to determine the total collagen content in the DC and its distribution between the circular muscle (CM) and taenia coli (TC) of the AC and DC of adults and compare the same with tissue from the elderly. Masson’s trichrome and Picrosirius red were used to assess total collagen content in the AC and DC; aged 22 – 91 years. Macroscopically normal AC from 22 patients (adults: 22–60 years; 6 male, 6 female; elderly: 70 – 91 years; 6 male, 4 female) and DC from 23 patients (adults: 23–63 years; 6 male, 7 female; elderly: 66 – 88 years; 6 male, 4 female) were obtained following surgery for non-obstructed bowel cancer. The total hydroxyproline content in DC samples was also evaluated. In the DC, tinctorial staining demonstrated an increased occurrence of total collagen fibres in the submucosa of the elderly (159.8 ± 9.6 in elderly vs. 126.9 ± 6.1 in the adults; p 0.05) and in the muscularis externa (respectively 37.4 ± 4.1 vs. 18.8 ± 2.4; p 0.01). In the adult AC and DC, there were no statistically significant differences in the amount of collagen within the CM and TC. In the elderly, the total collagen fibres within the TC was greater in the AC (mean grey intensity: 63.4 ± 3.9% in the elderly vs. 36.6 ± 1.6% in adults; p 0.05) and DC (mean grey intensity: respectively, 59.82 ± 2.4 vs. 40.2 ± 0.9%; p 0.05). In both AC and DC of the elderly samples, several thickened collagen fibrils were microscopically identified within the TC infiltrating to the myenteric plexus. In the TC of the elderly AC, the total collagen fibres were increased by approximately 4% compared to that of the DC. The total collagen concentration in the elderly DC assessed by hydroxyproline assay was increased by approximately 15% compared to the adult. Sex related differences were not found when data combined. We concluded that the total collagen content in the muscularis externa particularly of the TC of human colon increases with age. The subtle change in collagen distribution with age between AC and DC may differentially affect the tensile strength of the colon.