Sigmoid Lesions Research Articles

A Case of Pneumatosis Cystoides Intestinalis Associated with Trichlor‐oethylene Developing Typical Features during the Follow‐up of Undetermined Sigmoid Lesions

Abstract: A 64‐year‐old male lens grinder with a 43‐year history of occupational exposure to trichloroethylene (TCE) visited Shinshu University Hospital in December 1988 complaining of distention of the lower abdomen. A barium enema study and endoscopic examination showed rosary‐like semilunar folds and edematous mucosa of undetermined etiology in the sigmoid colon. Three months later, the patient visited the hospital again complaining of blood in the stool. An endoscopic examination performed at this time revealed numerous broad‐based, smooth‐surfaced, protruding lesions in the sigmoid colon. A diagnosis of pneumatosis cystoides intestinalis (PCI) associated with TCE was made. After 4‐days treatment with 50% oxygen given by inhalation, the patient's symptoms were completely relieved, and a colonoscopy revealed no evidence of PCI. He returned to his job at the factory which involved dealing with TCE and because of adequate ventilation and a shorter work‐day he has been free of recurrence during a year follow‐up period. The finding of rosary‐like semilunar folds, as demonstrated by the initial endoscopic and barium enema studies in our patient, is a peculiar one in the incipient stage of PCI.

Measurement of degraded fecal hemoglobin-heme to estimate gastrointestinal site of occult bleeding. Appraisal of its clinical utility.

Hemoglobin-heme is variably converted to porphyrin during enterocolic transit. This intestinal converted fraction, as measured by HemoQuant, was elevated as a predictor of the occult bleeding site in 152 patients with discrete lesions. The intestinal converted fraction, expressed as the percentage of total fecal hemoglobin, was similar with upper gastrointestinal and proximal colon lesions. Within the colon, values trended downward with more distal location: means +/- standard deviations were 18 +/- 14 proximal colon, 16 +/- 15 sigmoid, and 10 +/- 10 rectum. The amount of fecal blood also affected the intestinal converted fraction; correcting for hemoglobin concentration improved separation by site. Corrected intestinal converted fraction values were significantly lower with rectal (P less than 0.0005) and sigmoid (P less than 0.02) lesions than with proximal colon lesions. Unfortunately, large within-site variation caused considerable overlap between sites. We conclude that the intestinal converted fraction is influenced by the site and amount of bleeding. However, its clinical utility is compromised by substantial individual differences in luminal hemoglobin metabolism.

Flexible fiberoptic sigmoidoscopy in the practice of a surgeon

The extent to which surgeons participate in surveillance programs depends on their clinical interests, referral patterns, and the needs of the community. The design of surveillance programs, including designation of normal and high risk individuals, and the type and frequency of screening examinations has been studied. The patient's history guides the surgeon in deciding whether and how to implement a surveillance program for a given patient. Sixty-centimeter FFS is clearly superior to 25-cm rigid sigmoidoscopy in screening for rectosigmoid and sigmoid neoplasia. 1-4. 6 The average viewing distance of the rigid sigmoidoscope is less than 20 cm/ whereas in FFS it consistently reaches 40 to 50 cm. The reported diagnostic yield of asymptomatic polyps and cancers is 1.7 to 3 times as great. 4 FFS in sigmoid diverticular disease is very accurate in confirming or ruling out questionable sigmoid lesions noted on barium enema. Some of the logistic and practical deficiencies of FFS include the increased initial expense and maintenance costs, the longer examination and cleaning time, the greater degree of endoscopic skill necessary to use it effectively, and the inadequate cost-effectiveness in small practice settings. Two compelling arguments for FFS screening not often acknowledged are the more dignified examination position, left lateral decubitus rather than knee-chest or jack-knife, and the greater degree of comfort. The value of FFS for neoplasia surveillance is limited. FFS is not a substitute for complete visualization of the colon by colonoscopy or barium contrast enema. The depth of insertion of the FFS is a function of several variables, including endoscopic skill, instrument design, bowel preparation, and the patient's anatomy and cooperation. At what depth another 5cm tube insertion will yield an important increase in percent of lesions detected, or obviate the need for total colonoscopy or barium enema has not been determined. The point of diminishing returns in cancer screening with FFS has yet to be determined. At that point, patient enthusiam or compliance with follow-up examinations may fall off, and the long term effectiveness of a surveillance program is threatened.

Neoplasia and Ureterosigmoidostomy: A Colonoscopy Survey

Patients who have undergone implantation of ureters into the sigmoid colon (ureterosigmoidostomy) are known to be at high risk of developing cancer of the colon many years later. The operation is often performed in infancy for congenital abnormalities of the bladder, thus creating a long term surveillance problem. Six of 34 patients (17.6 per cent) who had undergone ureterosigmoidostomy were found at a screening fibresigmoidoscopy to have adenomas of the left colon or severe dysplasia of the stoma, a mean interval of 22 years after their urinary diversion. Four other patients had previously had a sigmoid adenoma or cancer; thus, 29 per cent overall had developed colonic neoplasms, almost all closely related to their stomas. Another patient who, by error, was excluded from the surveillance, died of metastatic cancer of the sigmoid colon within the study period. Regular surveillance by fibresigmoidoscopy of patients who have had urinary diversion affords the opportunity to detect and remove potentially malignant sigmoid lesions. In addition to its clinical importance, it allows a closer study of this unique model of colon carcinogenesis.

Angiography with epinephrine and beta receptor blocker in diagnosis of sigmoid lesions

Various sigmoid lesions, seen on barium enema of 39 patients, were investigated with angiography of the inferior mesenteric artery using three series. The first was performed with contrast medium only, the second after use of epinephrine, and the third after a beta-blocking agent (propranolol) combined with epinephrine. The patients were followed for more than three years. Eleven carcinomas were detected, all diagnosed angiographically. Carcinoma, radiation fibrosis, and diverticulitis with fibrosis may appear similar on pharmacoangiography, but the inflammatory reaction seen, for example in diverticulitis, is different. These findings are important because they can have an influence on the indications and selection of the most suitable operation to be performed.

Angiodysplasia of the Colon

Angiodysplasia of the colon was diagnosed by arteriography in 33 patients. Approximately one fourth of the lesions were located in the left side of the colon. Three patients with sigmoid lesions had a second lesion elsewhere in the gastrointestinal tract. The lesions on the left involved a more extensive segment of bowel than those on the right. Almost one third of the patients were younger than 60, and 2 were in their thirties. The angiodysplasia is the source of the bleeding in most patients, and its resection results in cure.

Rectocolonic exfoliative cytology. A new approach.

An instrument employing saline lavage with simultaneous suction has been devised. This instrument can assist in a) maintaining optimal visualization free of obscuring debris or hemorrhage and b) obtaining material for cytologic examination from the visualized 25-cm length of rectosigmoid and the more proximal bowel. Experience to date reveals excellent correlation of histologic and cytologic diagnoses for lesions within range of the proctoscope and for strictures in which roentgen and biopsy data are inconclusive. A high degree of accuracy (75%) has been demonstrated for sigmoid and left colon lesions. The technic is suitable for the general population as well as those with a higher risk of malignant degeneration (to facilitate the early diagnosis of cancer). Physician time and patient discomfort can be kept to a minimum, and the technic may be applicable as an office procedure.

Carcinoma or diverticulitis in obstructive sigmoid lesions: an analysis of the problem of recognition and treatment.

Carcinoma or diverticulitis in obstructive sigmoid lesions: an analysis of the problem of recognition and treatment.

Villous Adenoma of the Sigmoid Colon

Villous adenoma of the colon is a somewhat rare benign tumor which has remained unmentioned in the radiological literature. Such a lesion was recently studied in our department and we believe that the history and the unusual roentgenologic manifestations may well be characteristic of this interesting neoplasm. Incidence: These tumors are encountered largely in the later decades, the average age of incidence being in the midfifties, with no apparent familial or sexual tendency. They occur singly and have been stated to constitute from 0.1 to 6.6 per cent of all rectal and sigmoid lesions (10). In one series of 1,144 tumors of the colon and rectum, villous adenomas were said to represent 2.3 per cent of the total (2). Pathology: The term “villous tumor” was originated by Holmes, a British pathologist, in 1860. At various times, and by various authors, these neoplasms have been called papillomas, mucous or columnar papillomas, villous papillomas, papillary polyps or adenomas, villous adenomas, and villomas. ...