Segment Of Transverse Colon Research Articles

S3567 Bowel in the Chest: Clinical Manifestations of a Type IV Hiatal Hernia

Introduction: Hiatal hernias (HH) result from protrusion of intraabdominal organs into the thoracic cavity through the esophageal hiatus and commonly associated with gastroesophageal reflux disease (GERD). Type IV HH are rare, defined by presence of the stomach and/or other abdominal organs into the thoracic cavity. We report a patient with Type IV HH presenting with atypical pulmonary symptoms caused by mass effect that resolved after surgical operation. Case Description/Methods: 55-year-old female with past medical history of cerebral palsy and GERD presented with vomiting, productive cough with yellow sputum, and hoarseness for 3 days. Review of systems revealed fever and shortness of breath. Physical examination revealed respiratory rate of 25 with oxygen saturation of 89%, end expiratory wheezing in the left lower lobes and absent sounds on the right. CBC showed a WBC of 12,500 K/mm3. Chest and abdominal x-ray indicated possible aspiration and large stool burden. She was admitted for aspiration pneumonitis with ileus and received antibiotics, anti-emetics, and laxative medications. CT chest and abdomen (Figure) revealed a large HH with moderate colonic stool burden exerting mass effect over cardio-mediastinal structures. Upper endoscopy and barium enema showed a large Type IV paraesophageal HH containing a long segment of transverse colon with majority of the stomach extending into the posterior right thoracic cavity with mass effect on narrowed colonic loops. She underwent robotic assisted laparoscopic repair with cruroplasty with mesh, esophagopexy and gastropexy. Intra-operatively, colon and stomach were compressing her cardio-mediastinal structures. Postoperative Upper GI study showed successful repair without evidence of leak. CT abdomen showed resolution of HH and small right sided pleural effusions post-operatively. She tolerated a full diet by POD 3 and discharged on POD 4. Postoperative course was complicated by readmission with chylous leak that was controlled by lymphangiographic embolization. Discussion: This patient presented with pulmonary symptoms leading to a workup for respiratory etiologies. Not uncommonly, paraesophageal HH lead to aspiration and pneumonia, in addition to reflux. Large Type IV HH are unique as they predispose additional organs to strangulation and complications as demonstrated by this case. Heightened awareness for consideration of HHs may promote timely detection and treatment.Figure 1.: CT Abdomen and Pelvis of Type IV Hiatal Hernia (Red) Compressing Mediastinal Structures (Stomach= orange, Colon= green, Lung = blue, Heart = black) [Pre-Operative Axial View (A) with Post-Operative Axial View (B) and Pre-Operative Coronal View (C) with Post-Operative Coronal View (D)].

Multi-System Inflammatory Syndrome Presenting as Non-Specific Colitis: A Medical Diagnosis with a Surgical Presentation.

A 20-year-old woman with previous COVID-19 diagnosis presented with abdominal pain and colitis on CT scan. She was admitted in septic shock, with etiology of colitis unclear. After resuscitation, antibiotics, and steroids, she clinically deteriorated. Worsening Clostridioides difficile infection was most likely and she was taken to the operating room. Intraoperatively, only a segment of transverse colon appeared abnormal on gross and endoscopic evaluation. Total colectomy was deferred in favor of segmental resection. Given her unusual disease pattern and recent COVID-19 infection, diagnosis of MIS-C was considered. Steroids were continued and treatment broadened to include heparin and IVIG. The patient returned to the operating room for planned reexploration, endoscopy, and end colostomy. On hospital day three, the patient had an acute mental status change. Computed tomography demonstrated acute cerebral edema with brainstem herniation. The family chose comfort-care measures. Final pathology from the transverse colon demonstrated COVID-19-associated vasculitis.

A multicenter, prospective, inpatient feasibility study to evaluate the use of an intra-colonoscopy cleansing device to optimize colon preparation in hospitalized patients: the REDUCE study

BackgroundHigh quality bowel preparation prior to colonoscopy can be difficult to achieve in the inpatient setting. Hospitalized patients are at risk for extended hospital stays and low diagnostic yield due to inadequate bowel preparation. The Pure-Vu System is a novel device intended to fit over existing colonoscopes to improve intra-colonoscopy bowel preparation. The objective of the REDUCE study was to conduct the first inpatient study to evaluate optimization of bowel preparation quality following overnight preparation when using the Pure-Vu System during colonoscopy.MethodsThis multicenter, prospective feasibility study enrolled hospitalized subjects undergoing colonoscopy. Subjects recorded the clarity of their last bowel movement using a 5-point scale prior to colonoscopy. After one night of preparation, all enrolled subjects underwent colonoscopy utilizing the Pure-Vu System. The primary endpoint was improvement of colon cleanliness from baseline to post-cleansing with the Pure-Vu System as assessed by the improvement in Boston Bowel Preparation Scale (BBPS). An exploratory analysis was conducted to assess whether the clarity of the last bowel movement could predict inadequate bowel preparation.ResultsNinety-four subjects were included. BBPS analyses showed significant improvements in bowel preparation quality across all evaluable colon segments after cleansing with Pure-Vu, including left colon (1.74 vs 2.89; p < 0.0001), transverse colon (1.74 vs 2.91; p < 0.0001), and the right colon (1.41 vs 2.88; p < 0.0001). Prior to Pure-Vu, adequate cleansing (BBPS scores of ≥ 2) were reported in 60%, 62%, and 47% for the left colon, transverse colon, and right colon segments, respectively. After intra-colonoscopy cleansing with the Pure-Vu System, adequate colon preparation was reported in 100%, 99%, and 97% of the left colon, transverse colon, and right colon segments, respectively. Subjects with lower bowel movement clarity scores were more likely to have inadequate bowel preparation prior to cleansing with Pure-Vu.ConclusionsIn this feasibility study, the Pure-Vu System appears to be effective in significantly improving bowel preparation quality in hospitalized subjects undergoing colonoscopy. Clarity of last bowel movement may be useful indicator in predicting poor bowel preparation. Larger studies powered to evaluate clinical outcomes, hospital costs, and blinded BBPS assessments are required to evaluate the significance of these findings.Trial registration Evaluation of the Bowel Cleansing in Hospitalized Patients Using Pure-Vu System (NCT03503162).

1567 A Case of Gastrointestinal Amyloid Causing Colocolic Intussusception in an Adult

INTRODUCTION: Intussusception is very rare in the adult population. It is typically associated with a pathologic lead point, most commonly a malignant lesion. To our knowledge, colocolic intussusception due to gastrointestinal amyloidosis has not been reported. CASE DESCRIPTION/METHODS: This is a case of a 57-year-old man with kappa light-chain (AL) amyloidosis with biopsy-proven myocardial involvement who was initially admitted for congestive heart failure exacerbation and was being managed with ionotrope-assisted diuresis. Five days into his hospitalization, he developed sudden onset abdominal cramping, nausea, non-bloody vomiting, and melena. Physical exam revealed no abdominal tenderness and maroon stool in the rectal vault. Laboratory testing was notable for a hemoglobin decline from 10.2 g/dL to 7.7 g/dL over the course of one day. A CT of the abdomen and pelvis showed a 6 cm segment of distal transverse colon with irregular mural thickening and an apple core lesion, initially concerning for malignancy. A colonoscopy was done, and a protruding, large mass with dusky mucosa was identified in the transverse colon concerning for intussusception. Re-review of CT imaging did suggest a region consistent with intussusception. The patient underwent a laparoscopic extended right colectomy to remove a hemorrhagic transverse colon mass. Pathology of the excised segment showed two foci of hemorrhagic infarction, including a large polypoid lesion, associated with severe perivascular amyloidosis. DISCUSSION: AL amyloidosis rarely involves the gastrointestinal tract, and intussusception secondary to amyloidosis is extremely rare. It has been described as a possible complication in the small bowel, but to our knowledge this is the first report of amyloid causing colocolic intussusception.

Reconstructive Gastroplasty in Postgastrectomy Surgery

Objective. The compensation of digestive disorder in patients who already had gastric operation by using jejuno(colo)gastroplasty at re-reconstruction of the digestive tract.Methods. During 2012-17 in Vishnevsky surgery institute 33 repeated operation were conducted on the patients who had already had resection and antireflux gastric operations. As a repeated operation was conducted jejunogastroplasty in 31 (93,9%) cases, after distal gastrectomy - 8 (24,3%) from them; after gastric stump removal - 7 (21,2%), after еsophagojejuno anastomosis resection - в 2 (6,1%). Also 3 (9,1%) patients were operated on using interposition of the discharge loop into the duodenum: 2 - after gastrectomy with Braun and Roux-en-Y и 1 - after Distal gastrectomy, Hoffmeister. Esophagogastro anastomosis resection; jejunogastroplasty in Merendino-Dillard were conducted on 11 (33,3%) patients. A segment of transverse colon as a plastic material was used on 2 (6,1%) patients: у 1 - after gastric stump removal, у 1 - after еsophagojejuno anastomosis resection.Results. In the early postoperative period 2 (6,1%) patients had surgical complications: one had Partial esophagojejunо anastomosis leakage, the other - under diaphragmatic abscess. One fatal case from progressing multiple organ failure was recorded in the first 24 hours. By the end of the research 28 (84,8%) of 33 patients stayed under the surveillance. The examining of the patients revealed good results after the operation of 21 (75,0%) patients and satisfactory results after the operation of 7 (25,0%) patients. Conclusion. We believe that principles proposed of physiological reconstruction of the digestive tract are universal for primary gastric interventions as well as for repeated ones. It is worth noting that the repeated operations don’t always fully remove clinical manifestations diseases of the operated stomach but significantly decrease their severity by strengthening the patients physically by restoration of physiological passage of food and the expansion of the nutrition.

High-quality Bowel Preparation Is Required for Detection ofSessile Serrated Polyps.

The effect of bowel preparation quality has been well-characterized for detection of adenomas but not for detection of sessile serrated adenomas/polyps (SSPs). We performed a prospective study to determine proportions of patients in whom SSPs were detected at different levels of bowel preparation quality, using common validated scoring systems. Our study enrolled 749 male veterans 50-75 years old undergoing screening or surveillance colonoscopy. Proportions of patients in whom SSP were detected were calculated for each level of preparation quality based on the Aronchick scale (poor= low quality, fair= intermediate quality, and good or excellent= high quality) and the Boston Bowel Preparation Scale (BBPS; scores of 0-3 for right, transverse, and left colon segments). We compared SSP detection among different levels of preparation quality using multivariate logistic regression, adjusting for age, indication, and endoscopist. Our primary hypothesis was that SSP detection would not be significantly lower with intermediate-quality than with high-quality preparations. SSPs were detected in a significantly smaller proportion of patients with intermediate-quality preparation than high-quality preparation, for the entire colon (4.6% vs 12.0%; odds ratio [OR], 0.37; 95% confidence interval [CI], 0.15-0.87) and right colon (1.5% vs 7.9%; OR, 0.19; 95% CI, 0.05-0.81). SSPs were detected in smaller proportions of patients with total colon BBPSscores <7 than in patients with BBPS scores of 7-9 (4.7% vs 12.6%; OR, 0.36; 95% CI,0.19-0.67). SSPs were detected in right colons of a smaller percentage of patients with BBPS scores of 2 than scores of 3 (4.7% vs 9.5%; OR, 0.50; 95% CI, 0.26-0.94). Any bowel preparation quality below high quality is associated with a significant decrease in the detection of SSPs. Although intermediate-quality preparation and BBPS segment scores of 2 seem to be adequate for detection of adenomas, these levels of preparation quality may not be adequate for detection of SSPs.

Quantitative assessment of colorectal morphology: Implications for robotic colonoscopy

This paper presents a method of characterizing the distribution of colorectal morphometrics. It uses three-dimensional region growing and topological thinning algorithms to determine and visualize the luminal volume and centreline of the colon, respectively. Total and segmental lengths, diameters, volumes, and tortuosity angles were then quantified. The effects of body orientations on these parameters were also examined. Variations in total length were predominately due to differences in the transverse colon and sigmoid segments, and did not significantly differ between body orientations. The diameter of the proximal colon was significantly larger than the distal colon, with the largest value at the ascending and cecum segments. The volume of the transverse colon was significantly the largest, while those of the descending colon and rectum were the smallest. The prone position showed a higher frequency of high angles and consequently found to be more torturous than the supine position. This study yielded a method for complete segmental measurements of healthy colorectal anatomy and its tortuosity. The transverse and sigmoid colons were the major determinant in tortuosity and morphometrics between body orientations. Quantitative understanding of these parameters may potentially help to facilitate colonoscopy techniques, accuracy of polyp spatial distribution detection, and design of novel endoscopic devices.

Behçet’lilerde ileokolonik perforasyon riski: Üç olgu sunumu ve literatürün gözden geçirilmesi

Background and Aims:Intestinal Behcet’s disease may cause serious complications, including massive hemorrhage, fistulisation and intestinal perforation, which are encountered in approximately 50% of patients. Currently, there is little data on iatrogenic ileocolonic perforation during colonoscopy in patients with intestinal Behcet’s disease; therefore, our aim is to perform a retrospective review of records of intestinal Behcet’s disease patients who suffered perforation during or after colonoscopy. Materials and Methods: A total of 2615 colonoscopic examinations were performed between May 2002 and December 2007. The main indication for colonoscopy was intestinal Behcet’s disease in 135 of the 2615 patients. Results:135 patients with Behcet’s disease were evaluated by colonoscopy due to presumed ileocolonic involvement. Eight out of 135 (5.9%) patients had ileal and colonic ulcers. 3 patients (2.22%) had iatrogenic perforation; 2 of whom had profound ulcers in proximal colon and ileum. The third case had ulcers in the sigmoid, descending and transverse colon segments. All 3 patients had undergone surgical intervention that included ileal resection and right hemicolectomy. Conclusion:Colonoscopic examination is commonly used in Behcet’s disease not only for diagnostic purposes but also for surveillance of intestinal involvement. Volcano-shaped ulcers are especially prone to perforate. Both clinicians and endoscopists should be alert against barotrauma during colonoscopy since it may cause perforation. Patients should also be followed, and in case of abdominal pain after colonoscopic examination, colonic perforation should be considered.

Physiologic Type Reconstruction in Complicated Corrosive Strictures of Upper Gastrointestinal Segment

Objectives: The main steps for physiologic type reconstruction in 50 complicated corrosive strictures of upper alimentary tract are presented. Methods: In successive developed gastric outlet and esophageal strictures a limited Billroth I resection (in 9) or conversion a prior precolic GEA in such anastomosis (in 5) and middle or total gastrectomies (in 3) were performed. A second stage substernal by-pass with isoperistaltic transverse colon segment was done 6 - 12 weeks later. In all but one instances the graft was implanted high in the gastric stump. In extensive burned and retracted such lesion (in 3) a similar by-pass was carried out but the lower anastomosis was done with the not involved prepyloric segement. In concomittant antropyloric and esophageal strictures in 11 young, good risk patients, a limited Billroth I resction and simultaneous colonic bypass was used. In case of accompanied respiratory fistula (in 4) exclusion by-pass was useful for both lesions. The associated pyloric stricture (in 3) was solved at the same time. Side-to-end pharyngocolostomy was used in 4 high thoracocervical strictures. In 8 previously perforated strictures the by-ass was performed 2 months later. Reults: The overall mortality was 4%. The postoperative morbidity was low (8%). All cervical leaks closed spontaneously. Particular late complications required revisional surgery in 12, 5% of cases. Conclusion: In complicated corrosive strictures (esophageal, gastric, fistulas) limited Billoth I resection, isoperistaltic colon by-pass with high gastrocolic anastomosis, good gastric drainage and maintenance of the duodenum in gastrointestinal continuity are the main factors to achieve the best functional results.

The Risk of Ileocolonic Perforation in Patients with Behçet's Disease: Report of Three Cases and Review of the Literature

Introduction/Purpose: Intestinal Behcet’s disease may cause serious complications. Massive hemorrhage, fistulisation and intestinal perforation are encountered complications in approximately 50% of patients suffering from intestinal Behcet’s disease. Currently, there is not enough data inquiring iatrogenic ileocolonic perforation during colonoscopy in patients with intestinal Behcet’s disease; therefore we aimed to study intestinal Behcet’s disease patients who suffered perforation during or after colonoscopy. Methods: A total of 2615 colonoscopic examinations were performed between May 2002 and December 2007. Of these 2615 patients, main indication for colonoscopy was intestinal Behcet’s disease in 135 patients. Results: In total 135 patients with Behcet’s patients were assessed with colonoscopy due to presumed ileocolonic involvement. 8 out of 135 (5.9%) patients had ileal and colonic ulcers. 3 patients (2.22%) had iatrogenic perforation, 2 of whom had profound ulcers in proximal colon and ileum. The third case had ulcers in sigmoid colon, descending and transverse colon segments. All these 3 patients had undergone surgical intervention including ileal resection and right hemicolectomy. Discussion: Colonoscopic examination is commonly used in Behcet’s disease not only for diagnostic purposes but also for surveillance of intestinal involvement in Behcet’s disease. Volcano-shaped ulcers are specially inclined to perforate. Both clinicians and endoscopists should be alert against barotrauma applied during colonoscopy may cause perforation. Also patients should be followed-up necessarily and in case of abdominal pain after colonoscopic examination, colonic perforation should always be kept in mind.f

A Peterson's hernia and subsequent small bowel volvulus: surgical reconstruction utilizing transverse colon as a new Roux-en-Y limb - 1 case

Peterson's hernia is an internal hernia that can occur after Roux-en-Y anastomosis. It often accompanies small bowel volvulus and is prone to strangulation. Reconstruction of intestinal continuity after massive small bowel resection in a patient who undergoes near total gastrectomy and Roux-en-Y anastomosis can be difficult. A 74-year-old man who had undergone a near total gastrectomy and Roux-en-Y gastrojejunostomy for stomach cancer presented with abdominal pain. The preoperative computed tomography showed strangulated small bowel volvulus. During the emergent laparotomy, we found a strangulated Peterson's hernia with small bowel volvulus. After resection of the necrotized intestine, we made a new Roux-en-Y anastomosis connecting the remnant stomach and the jejunum with a transverse colon segment. We were safely able to connect the remnant stomach and the jejunum by making a new Roux-en-Y anastomosis utilizing a transverse colon segment as a new Roux-limb by two stage operation.

Local resection of gastrointestinal stromal tumor of the second part of duodenum

Gastrointestinal stromal tumors are relatively rare in the duodenum, representing 2-4% of Gastrointestinal stromal tumors of the gastrointestinal tract. We describe a huge Gastrointestinal stromal tumor arising from the second part of the duodenum invading the transverse colon which was removed successfully by local resection of the second part of the duodenum along with a segment of transverse colon.

Enhancement of colonic anastomotic strength in rats by short-chain fatty acids

The present study is aiming at elucidating the effect of intraoperative lavage with short-chain fatty acids (SCFAs) on colonic anastomosis in rats. Forty male Wistar rats were randomized into four groups (10 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. In the 1st group, no intraoperative large bowel lavage was performed; in the 2nd, a lavage with normal saline solution; in the 3rd, the animals received a diet rich in SCFAs pre- and postoperatively, and a lavage with normal saline was performed; and in the 4th group, an intraoperative lavage with SCFAs was carried out. On the 4th postoperative day, the animals were sacrificed. Septic complications, adhesions and anastomoses were graded macroscopically and histologically, and bursting pressure of the anastomoses, CRP, IL-6 and TNF-a was measured. Fewer septic complications (abscesses and minimal ruptures) and adhesions were observed in the 4th group with the intraoperative lavage with SCFAs. The bursting pressure also, in the same group, was higher (73.3 mmHg), followed by the 1st group (67.1 mmHg). Intraoperative lavage with SCFAs increases the bursting pressure of colonic anastomoses, while lavage with saline solution decreases it, in comparison to the group without lavage.

Identification of Epithelial Gaps in Human Small and Large Intestine by Confocal Endomicroscopy

Confocal endomicroscopy is an emerging technology that poses the endoscopist with challenges for identifying epithelial structures in the human intestine. We have shown previously that the murine intestinal epithelium is punctuated by gaps caused by cell shedding. The goals of this study were to determine if confocal endomicroscopy could resolve the presence of human epithelial gaps and whether a proinflammatory cytokine could increase cell shedding. Intestinal mucosa was imaged after staining with acriflavine. Confocal endomicroscopy of 17 patients yielded 6277 images from the human terminal ileum and rectum. Results were validated by parallel studies of anesthetized mice (wild-type and Math1(DeltaIntestine)) using rigid confocal probe microscopy, 2-photon/confocal microscopy, and scanning electron microscopy. Human terminal ileal and rectal epithelium revealed unstained areas with the diameter of an individual epithelial cell, with 2 distinct morphologies. One had a "target" appearance, shown by mouse studies to be goblet cells. The other morphology had no nucleus and was observed by rigid confocal probe microscopy and scanning electron microscopy in the villi of Math1(DeltaIntestine) mice, which lack goblet cells. In the mouse, tumor necrosis factor alpha (0.33 microg/g intraperitoneally) increases cell shedding by 27-fold and caused loss of barrier function across 20% of resultant gaps. Confocal endomicroscopy can distinguish between epithelial discontinuities (gaps) and goblet cells in human intestine. Results suggest that the sealing of epithelial gaps must be considered as a component of the intestinal barrier and has potential implications for intestinal barrier dysfunction in human disease.

Effect of Iloprost on Impaired Anastomotic Healing Caused by 5-Fluorouracil plus Leucovorin

This experimental study was designed to investigate whether iloprost can reverse impaired colonic healing caused by immediate postoperative intraperitoneal administration of 5-fluorouracil plus leucovorin. Eighty Wistar rats were randomized into four groups. After resection of a 1-cm segment of transverse colon, an end-to-end sutured anastomosis was generated. Rats received saline solution (Group 1), 5-fluorouracil plus leucovorin (Group 2), iloprost (Group 3), and 5-fluorouracil plus leucovorin plus iloprost (Group 4) intraperitoneally from the day of operation and once daily until killing. Each group was further randomized into two subgroups. Subjects were killed on the fifth (Subgroup a) and eighth (Subgroup b) postoperative days. After killing, anastomoses were examined macroscopically and graded histologically. Rats were measured for anastomotic bursting pressures and tissue hydroxyproline levels. The leakage rate of the anastomoses was significantly higher in the 5-fluorouracil plus leucovorin group compared with the other groups (P = 0.049). Bursting pressure was significantly lower in 2a subgroup (5-fluorouracil plus leucovorin, postoperative Day 5) than in 4a (5-fluorouracil plus leucovorin plus iloprost, postoperative Day 5; P < 0.001). Adhesion formation was significantly higher in all b subgroups compared with the Control b subgroup. Neoangiogenesis was significantly higher in iloprost and iloprost plus 5-fluorouracil plus leucovorin subgroups compared with the 5-fluorouracil plus leucovorin subgroups. Hydroxyproline levels, collagen deposition, fibroblasts, and white cell count were significantly higher in the iloprost plus 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8) compared with the 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8). The immediate postoperative, intraperitoneal administration of iloprost counteracts and reverses the negative effects of 5-fluorouracil plus leucovorin chemotherapy and protects colonic healing in rats.

The Effect of Insulin-Like Growth Factor I on Healing of Colonic Anastomoses in Cortisone-Treated Rats

This study was designed to investigate whether intraperitoneally injected insulin-like growth factor I is able to protect colonic healing from the adverse effects of hydrocortisone therapy. Eighty female Wistar rats were randomized into four groups (20 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. Hydrocortisone (5 mg/kg body weight) was injected intramuscularly in rats of cortisone (Group B) and insulin-like growth factor I + cortisone (Group D) groups once daily for seven days before and after the operation. Insulin-like growth factor I (2 mg/kg body weight) was intraperitoneally injected in rats of the insulin-like growth factor I (Group C) and the insulin-like growth factor I + Cortisone (Group D) groups immediately after operation and on the second, fourth, and sixth postoperative days. Rats were killed on the seventh postoperative day. Anastomoses were graded macroscopically and histologically, and bursting pressures and anastomotic hydroxyproline levels were recorded. Statistical analyses were performed by using Fisher's exact test for the comparison of proportions and ANOVA for the comparison of means among groups with subsequent post-hoc analysis using Bonferroni correction. Leakage rate was significantly higher in the cortisone (Group B) group. Bursting pressures were significantly lower in the cortisone group, whereas they were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups (Group C and D). Histology revealed a significant decrease of inflammatory cell infiltration, neoangiogenesis, and fibroblast activity in the cortisone group compared with the control group, whereas these parameters were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. Hydroxyproline levels were significantly higher in the insulin-like growth factor I and insulin-like growth factor I + cortisone groups. Hydrocortisone inhibits the healing of colonic anastomoses. However, insulin-like growth factor I given intraperitoneally mediates the deleterious effects of cortisone and protects colonic healing in rats.

The healing of colon anastomosis covered with fibrin glue after early postoperative intraperitoneal chemotherapy

After colon resection for colonic cancer, the administration of antineoplastic agents may prolong survival by killing residual cancer calls and preventing metastasis, but may also slow anastomotic healing. This study was designed to determine the effects of 5-fluorouracil (5-FU) and leucovorin (LEV), injected intraperitoneally, on the healing of colonic anastomoses with or without fibrin glue (FG) covering. Sixty rats were randomized to one of four groups. After resection of a transverse colon segment, an end-to-end sutured anastomosis was performed. Rats in the 5-FU+LEV and the 5- FU+LEV+FG groups received 5-FU+LEV intraperitoneally. The colonic anastomoses of the rats in the FG group and in the 5-FU+LEV+FG group were covered with fibrin glue. All rats were killed on postoperative day 8. Bursting pressure measurements were recorded and the anastomoses were examined macroscopically and histologically. The leakage rate of the anastomoses was significantly different among groups. Specifically, the leakage rate was significantly higher in the 5-FU+LEV group (40%) than in the FG and in the 5-FU+LEV+FG groups where there were no leakages (p=0.017). The mean adhesion formation score was significantly higher in rats of the 5-FU+LEV group, compared to the control (p=0.023), the FG (p=0.006) and the 5-FU+LEV+FG (p=0.006) groups. Bursting pressures were significantly lower in the 5-FU+LEV group than in the other groups (p<0.001). Also, bursting pressures were significantly lower in the control group compared to the FG and 5-FU+LEV+FG groups (p<0.001). Rats in the 5-FU+LEV+FG group had significantly greater neoangiogenesis and fibroblast activity than those in the 5-FU+LEV group (p=0.025). The early intraperitoneal postoperative administration of 5-fluorouracil plus leucovorin impaired colonic wound healing. However, the application of fibrin glue prevented the deleterious effect of chemotherapy.

Augmentation gastroplasty using a segment of transverse colon for corrosive gastric stricture

Diffuse corrosive gastric stricture is a relatively rare entity, and gastric ablative procedures are traditionally recommended for it. We emphasize the importance of preservation of a cicatrized stomach and describe its augmentation using a segment of transverse colon. A young female with a history of corrosive acid ingestion presented to our surgical unit with nonbilious vomiting following meals, consistent weight loss and features of gastric outlet obstruction. A barium study revealed a small-capacity stomach with pyloric stricture. We planned to augment the stomach capacity by using a segment of transverse colon. After documentation of a normal colon by barium examination, a 15-cm segment of transverse colon was harvested based on middle colic artery. This vascularized patch of bowel was united with the stomach that was opened up by a longitudinal incision made along the body. A barium study on the tenth postoperative day revealed a good capacity and contour of the stomach and free entry of Barium into the small intestine. The patient is tolerating a normal meal and has no vomiting. At 3 months follow-up, the patient had a normal stomach radiologically and endoscopically, with a weight gain of 7 kg. Augmentation of corrosive gastric stricture by a segment of transverse colon is an innovative, practical, and useful procedure, although long-term results are awaited.

Absorption of D(+)-xylose, cobalamin, and folic acid after autologic-allotopic ileummucosa transplantation in beagles

Background/purpose Ileummucosa transplantation in a demucosed coloncoat was developed as a new method for small bowel elongation. In an animal model, the authors investigated the absorptive capacity of the transplanted mucosa for D(+)-xylose, cobalamin (vitamin B 12), and folic acid. Methods Ileummucosa was transplanted in a vascularized demucosed segment of transverse colon in 18 beagle dogs. The coloncoat-ileummucosa complex then was integrated in the ileal continuity. Absorptive capacity for D(+)-xylose, cobalamin, and folic acid was measured before and 4 weeks after transplantation. The results were compared and analyzed with the Students’ t test for matched pairs. All determined blood values with P values less than .05 were considered to show a significant reduction in the absorptive capacity of the transplanted ileummucosa. Results Fifteen minutes after application there was no significant difference in the absorption of D(+)-Xylose and cobalamin between normal and transplanted ileummucosa ( P > .1). Absorption of folic acid in the transplanted segment was lower but not significant ( P < .1). After 30 minutes D(+)-xylose and cobalamin again showed no difference between the absorptive capacity of normal and transplanted ileummucosa ( P > .1), whereas folic acid continued with the tendency toward an impaired absorption ( P < .1). However, after 60 minutes, the difference of the absorptive capacity of the transplanted ileummucosa was significant ( P < .05) for folic acid. D(+)-xylose showed a tendency for an impaired uptake ( P < .1), whereas absorption of cobalamin did not differ significantly after transplantation ( P > .1). Conclusions Experimental autologic-allotopic ileummucosa transplantation is a feasible new method for small bowel elongation in an animal model. Examination of the absorptive capacity of the transplanted ileummucosa showed a normal uptake for cobalamin, while there was an impaired absorption of D(+)-xylose and folic acid.

Autologous-allotopic ileum mucosa transplantation for small bowel elongation. A morphological study

Since a standard therapy for short bowel syndrome does not yet exist, every search for new surgical methods would be worthwhile. In previous studies we could show that autologous-allotopic ileum mucosa transplantation is feasible. After a modification of our technique a vascularized colon muscle coat lined completely with transplanted ileum mucosa could be engendered. In 12 young beagles autologous ileum mucosa was transplanted in a demucosed vascularized transverse colon segment. The colon coat-ileum mucosa complex was anastomosed with the small bowel immediately after transplantation, 4 weeks later the animals were sacrificed and histology specimens were harvested from the colon coat-ileum mucosa complex, normal ileum and normal colon. After fixation in 2.5% glutaraldehyde the samples were frozen (-40 degrees C) and 14 micro m sections were stained with hemalaun and eosin. The lumen diameter, the mucosa, submucosa and colon muscle coat thickness, as well as the mucosal crypt depth were evaluated. The diameter of the colon coat-ileum mucosa-complex was smaller than the diameter of normal ileum and colon with no significant stenosis. There were no marked differences in thickness of mucosa and depth of the mucosal crypts compared to the controls, but the transplanted mucosa showed a slightly higher rate of shortened villi. The submucosal layer was thicker following transplantation and showed good neovascularization. The circular muscle layer of the transplanted colon coat was up to 178% thicker and the thickness of the transplanted longitudinal muscle layer differed between 58% and 143% in comparison to normal colon. Only a few histologic differences between transplanted and normal ileum mucosa could be observed after autologous-allotopic ileum mucosa transplantation. Therefore a nearly normal function of the colon coat-ileum mucosa complex has to be expected. Long term experiments of the histologic changes as well as further functional studies are on-going in order to finally apply autologous-allotopic ileum mucosa transplantation clinically.