Sigmoid Rectum Research Articles

Therapeutic Strategy for Recurrent Ulcerative Colitis

Ulcerative Colitis (UC) is a chronic idiopathic inflammation that appears from the rectum and can extend to colon causing diffuse friability and superficiality. In this case report, Woman, 44 years old, admitted to hospital because of bloody diarrhea, frequency of 4-6 times daily with mucous, malaise, and history of weight loss. Patient already had oral sulfasalazine and oral corticosteroid to maintain her condition, but she stopped the medication at will. On physical examination, showed anemic conjunctiva and increasing in bowel sound, fecal examination showed brown to red, porridge-like consistency, blood, mucous, and positive Benzidine test. Colonoscopy examination revealed, normal anus; in the sigmoid rectum, colon descendent found small swellings, an ulcer, and few bloody. On histopathology, epithelial surface with mucin depletiondistortion of crypt architecture, dilatation and elongation of crypt, as well as shortening of the crypt that does not reach muscular mucous and lamina propria contains solid aggregate inflammation cells, dominated by plasma cells. The patient was given combination of 5-aminosalicylates and glucocorticoids. On re-evaluation in week 8 of therapy, frequency of defecation becomes 1-2 times daily with no blood occurring and improvement on colonoscopy, rectal mucous, colon sigmoid improved, no bleeding and clean mucous. 5-aminosalicylates is the first treatment in UC, it also helps to achieve remission and prevent carcinoma development. UC is a disease that also causes extra-intestinal manifestation, so the treatment should be done holistically. Compliance and regular monitoring will help to improve the quality of life.Keywords: Gastrointestinal, irritable bowel syndrome, ulcerative colitis

Digestive system deep infiltrating endometriosis: What do we know.

Digestive system infiltrating endometriosis (DSIE) is an uncommon form of endometriosis in the digestive system. DSIE often occurs in the intestines (especially the sigmoid rectum), liver, gallbladder and pancreas. Clinically, DSIE presents with the same symptoms as endometriosis, including cyclic pain, bleeding and infertility, in addition to specific biliary/intestinal obstruction and gastrointestinal bleeding. Compared to general endometriosis, DSIE has unique biological behaviour and pathophysiological mechanisms. Most DSIEs are deep invasive endometrioses, characterized by metastasis to the lymph nodes and lymphatic vessels, angiogenesis, peripheral nerve recruitment, fibrosis and invasion of surrounding tissues. DSIE-related peripheral angiogenesis is divided into three patterns: angiogenesis, vasculogenesis and inosculation. These patterns are regulated by interactions between multiple hypoxia-hormone cytokines. The nerve growth factors regulate the extensive neurofibril recruitment in DSIE lesions, which accounts for severe symptoms of deep pain. They are also associated with fibrosis and the aggressiveness of DSIE. Cyclic changes in DSIE lesions, recurrent inflammation and oxidative stress promote repeated tissue injury and repair (ReTIAR) mechanisms in the lesions, accelerating fibril formation and cancer-related mutations. Similar to malignant tumours, DSIE can also exhibit aggressiveness derived from collective cell migration mediated by E-cadherin and N-cadherin. This often makes DSIE misdiagnosed as a malignant tumour of the digestive system in clinical practice. In addition to surgery, novel treatments are urgently required to effectively eradicate this lesion.

PEMERIKSAAN RADIOGRAFI COLON IN LOOP PADA BAYI MENGGUNAKAN KONTRAS POSITIF DENGAN KLINIS HIRSCHPRUNG DISEASE

Background: The development of radiology is growing rapidly because radiodiagnostics is a very important diagnostic tool and cannot be separated in a diagnosis. There are two radiodiagnostic examinations in radiology installations, namely without contrast media and radiological examinations with contrast media. One of the radiological examinations with contrast media is a colon in a circle.
 Methods: This research is a qualitative descriptive study conducted in April 2022. The sample in this study were patients who underwent Colon In Loop Examination in Infants Using Positive Contrast with Clinical Hirschsprung's Disease at the Radiology Installation of RSUD A.M Parikesit Tenggarong.
 Results: Insertion of contrast in colon in loop examination In infants using positive contrast with clinical Hirschsprung's disease can already establish a doctor's diagnosis. And from the results of the expertise with the doctor from the results of the picture the catheter was placed at the end of the baby's anus, the contrast was injected and it looked smooth closing the sigmoid rectum and descending colon, it looked like the distal rectum was narrowed and it looked like proximal rectal dilatation, an impression of hisprung disease.
 Conclusion: Colon in loop examination technique in infants to see clinically Hirschsprung's disease would be better to use positive contrast because it can be excreted through micturition and sweat and more thoroughly see narrowing, easier, better to see other abnormalities

Rapid establishment of murine gastrointestinal organoids using mechanical isolation method

Gastrointestinal (GI) diseases, including pathological dysplasia, inflammation, neoplasia and injury, suffer millions of patients globally per year. Organoids, three-dimensional cell mass structures supported by biomaterials in dishes, are currently used as a research model for diseases of the small intestine. However, the traditional enzymatic-digestion method for establishing small-intestinal organoids (EnzyOs) is time consuming and often loses the bulk of crypts, a more efficient and reliable method needs to be developed. In this study, using mouse GI organoids as a model, we formulated a rapid mechanical isolation method that could efficiently isolate and culture villi-crypts into small intestinal organoids (MechOs). Primary duodenum organoids generated by MechOs displayed three types of morphology: spheroid, semi-budding and budding, while EnzyOs produced much less budding. Moreover, primary duodenum organoids from MechOs could be subcultured and presented similar gene expression profiles of small intestine specific markers as that from EnzyOs. Importantly, the MechOs method could also be used to generate other types of organoids derived from the stomach, jejunum–ileum, sigmoid–rectum and bile cysts. Taken together, the results show that MechOs could efficiently and economically generate digestive system organoids, providing a potential basis of epithelial organoids for the clinical treatment of gastroenterological diseases.

High urinary diversion after irradiation to the lesser pelvis

As useful and necessary as radiotherapy may be, it is associated with irreversible long-term adverse effects including loss of bladder function. In the majority of cases the small bowel, sigmoid rectum and ureter are also affected. The extent of injury depends on the irradiated area, the applied dose and the quality of application. Three factors are essential when choosing a urinary diversion: the length of functional ureter, the position of the bowel outside of the irradiated area and the type of diversion. Acontinent diversion is best performed through aascending-transverse or transverse-descending colon pouch. The efferent segment is diverted through the umbilicus. The simplest technique for an incontinent diversion is aconduit using the ascending colon or the right colon flexure. If the length of the ureter does not suffice for such aconduit, the ideal solution is atransverse conduit, as this conduit can be attached to both renal pelves, while simultaneously allowing free choice of the lateral location of the stoma. In case of an exenteration, adouble stoma on one side of the body should be avoided in order to prevent maintenance issues.

A Case of Rectal Sigmoid Cancer with Anal Skin Metastasis

A Case of Rectal Sigmoid Cancer with Anal Skin Metastasis

2990 Evaluation of the Incidence and Types of Complications in Patients Undergoing for Robot – Assisted Hysterectomy in a Third Level Care Hospital in Mexico

Study Objective To evaluate the incidence and types of complications in patients undergoing Robot-assisted hysterectomy. Design Retrospective study. Setting 3rd level care hospital in Zumpango, State of Mexico. Patients or Participants Women undergoing robotic-assisted laparoscopic hysterectomy. Interventions Robotic-assisted laparoscopic hysterectomy. Interventions A total of 49 patients were included; the main indication for the procedure was uterine myomatosis in 75.5%, abnormal uterine bleeding refractory to treatment in 12.24% and in the rest, endometrial intraepithelial neoplasia, cervical cancer in situ among others. The incidence of complications was 20.40% (10 patients in total), some of them presenting up to two different complications. Complications were classified according to the scale of Claiven and Dindo, finding type I in 58% (most frequent seromas, lesion in the serosa of the sigmoid rectum and a perforation in the posterior cul-de-sac with uterine mobilizer). Type II in 8.3% (one patient with erosive gastritis requiring transfusion) and type III b in 33.3% with two conversions to open surgery (one for hemorrhage and one for non-recoverable equipment failure) and two re interventions (laparotomy due to hemoperitoneum and a laparoscopy for residual abscess drainage) no type IV or V lesions were found. Measurements and Main Results The files of the patients undergoing robotic assisted laparoscopic hysterectomy from May 1, 2014 to April 30, 2019 were analyzed. Conclusion The incidence of complications is similar to that reported in open surgery and discretely larger than laparoscopic, however type I complications were the most frequent. The high incidence of probably due to what we are is a school hospital and surgeons are training period. To evaluate the incidence and types of complications in patients undergoing Robot-assisted hysterectomy. Retrospective study. 3rd level care hospital in Zumpango, State of Mexico. Women undergoing robotic-assisted laparoscopic hysterectomy. Robotic-assisted laparoscopic hysterectomy. A total of 49 patients were included; the main indication for the procedure was uterine myomatosis in 75.5%, abnormal uterine bleeding refractory to treatment in 12.24% and in the rest, endometrial intraepithelial neoplasia, cervical cancer in situ among others. The incidence of complications was 20.40% (10 patients in total), some of them presenting up to two different complications. Complications were classified according to the scale of Claiven and Dindo, finding type I in 58% (most frequent seromas, lesion in the serosa of the sigmoid rectum and a perforation in the posterior cul-de-sac with uterine mobilizer). Type II in 8.3% (one patient with erosive gastritis requiring transfusion) and type III b in 33.3% with two conversions to open surgery (one for hemorrhage and one for non-recoverable equipment failure) and two re interventions (laparotomy due to hemoperitoneum and a laparoscopy for residual abscess drainage) no type IV or V lesions were found. The files of the patients undergoing robotic assisted laparoscopic hysterectomy from May 1, 2014 to April 30, 2019 were analyzed. The incidence of complications is similar to that reported in open surgery and discretely larger than laparoscopic, however type I complications were the most frequent.

Total intracorporeal robot-assisted laparoscopic Mainz II rectosigmoid pouch

Objective To report the surgical techniques and results of robot-assisted laparoscopic radical cystectomy (RRC) with bilateral pelvic lymphadenectomy and the Sigma rectum pouch (Mainz II) performed with an intracorporeal robotic technique at our center. Methods There was 1 female 63 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent completely robot assisted surgery. The procedure included pelvic lymph node dissection, radical cystectomy with uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. A 20 cm segment of the sigmoid was isolated. The posterior wall of the pouch were anastomosed side-to-side. And a nipple was formed by suturing the mucosa over the ureters to accomplish an antireflux mechanism. The F8 mono-pigtail ureteral stents were led out through the rectum, and a F26 Foley catheter was placed transanally for pouch drainage. Finally the anterior wall of the pouch was closed two layers. Results Operating time was 470 min and blood loss was 600 ml. The rectal tube was removal on the 9d postoperative day and the ureteral stents were removed 11 d and 12 d postoperatively. No intraoperative or postoperative complications were observed. The patients were followed up for 2 years, urinating 4-5 times per day and 1-2 times at night, CO2CP is 17.8mmol/L. The patient showed no upper urinary occlusion, reflux or urine incontinence. Conclusion To our knowledge, this is the first robotic radical cystectomy with intracorporeal continent urinary diversion (Mainz Ⅱ), RRC with the Mainz Pouch Ⅱ may become a simple and effective alternative surgical method for treating select patients with localized muscle invasive bladder cancer. Key words: Bladder cancer; Robot-assisted laparoscopic surgery; Radical cystectomy; Controlled urinary diversion

HIV-1 is rarely detected in blood and colon myeloid cells during viral-suppressive antiretroviral therapy.

The aim of this study was to explore the contribution of blood and colon myeloid cells to HIV persistence during antiretroviral therapy (ART). Leukapheresis was collected from HIV-infected individuals with undetectable plasma viral load during ART (HIV + ART; n = 15) and viremics untreated (HIV+; n = 6). Rectal sigmoid biopsies were collected from n = 8 HIV+ART. Myeloid cells (total monocytes (Mo), CD16/CD16 Mo, CD1c dendritic cells) and CD4 T cells were isolated by magnetic-activated cell sorting (MACS) and/or fluorescence-activated cell sorting (FACS) from peripheral blood. Matched myeloid and CCR6CD4 T cells were isolated from blood and rectal biopsies by FACS. Levels of early (RU5 primers), late (Gag primers) and/or integrated HIV-DNA (Alu/HIV primers) were quantified by nested real-time PCR. Replication-competent HIV was amplified by co-culturing cells from HIV-positive individuals with CD3/CD28-activated CD4 T cells from uninfected donors. Early/late but not integrated HIV reverse transcripts were detected in blood myeloid subsets of four out of 10 HIV+ART; in contrast, integrated HIV-DNA was exclusively detected in CD4 T cells. In rectal biopsies, late HIV reverse transcripts were detected in myeloid cells and CCR6CD4 T cells from one out of eight and seven out of eight HIV+ART individuals, respectively. Replication-competent HIV was outgrown from CD4 T cells but not from myeloid of untreated/ART-treated HIV-positive individuals. In contrast to CD4 T cells, blood and colon myeloid cells carry detectable HIV only in a small fraction of HIV+ART individuals. This is consistent with the documented resistance of Mo to HIV infection and the rapid turnover of Mo-derived macrophages in the colon. Future assessment of multiple lymphoid and nonlymphoid tissues is required to include/exclude myeloid cells as relevant HIV reservoirs during ART.

Uterine leiomyoma mimicking a gastrointestinal stromal tumor with chronic spontaneous hemorrhage: A case report.

Uterine leiomyomas are the most common tumors to affect women. Cases of uterine leiomyoma mimicking a gastrointestinal stromal tumor with chronic spontaneous hemorrhage are extremely rare, and similar cases to that of the present study are yet to be reported. In the current study, a 48-year-old female presented with symptoms of lower abdominal pain after menses that had persisted for 4 months. The patient was initially diagnosed with uterine leiomyoma. However, according to the results of the gross and auxiliary examinations, a diagnosis of a gastrointestinal stromal tumor could not be excluded. Therefore, the patient underwent a rectal sigmoid bowel resection, subtotal hysterectomy and bilateral salpingectomy. Subsequent to surgery, the immunohistochemical examinations confirmed the initial diagnosis of uterine leiomyoma. The surgery had therefore involved an unnecessary organ resection.

Assessment of verbascoside absorption in human colonic tissues using the Ussing chamber model

The intestinal absorption of verbascoside (VB), a phenylpropanoid glycoside, extracted and purified from olive mill waste water (OMWW), was investigated using viable and healthy human colonic tissues, mounted in an Ussing chamber. Additionally, VB absorption and transport through the intestinal mucosa were quantified using permeability coefficients. VB absorption was time-dependent and varied in relation to the specific colonic segments considered. In particular, major uptake/absorption (0.50μg/cm2) occurred between 5 and 15min in the proximal tract of the colon, followed by descending colon (0.38μg/cm2) between 30 and 60min, and sigmoid–rectum colon (0.34μg/cm2) at 60min. Overall, VB was absorbed rapidly, with an average uptake of 0.29μg VB per cm2, corresponding to a total accumulation efficiency of ~0.12%. Moreover, the presence of the VB in the basolateral side supported the hypothesis of its bioavailability in the extent of 0.1%. In addition, the permeability coefficient calculation has contributed in a deeper understanding of VB absorption and transport across the human intestinal barrier and could be utilized for other polyphenols present in food and in dietary supplements.

Double rectal perforation after stapled haemorrhoidectomy

Dear Editor: In the last 10 years, in addition to the conventional haemorrhoid-resection techniques (Milligan & Morgan, Ferguson, Parks, etc.) the technique described by Longo rapidly spread into surgical practice, thanks to the reported advantages of less postoperative pain, reduced need of analgesics, earlier return to work or normal activity, shorter recovery and operative time and earlier pain-free first defecation. This treatment is based on the concept that haemorrhoidal prolapse is not just a venous disease but a disease of the whole haemorrhoidal complex, including the connective tissue, the rectal wall, the Treitz muscle and all other muscles involved in the structure, very important for anal continence. Many studies have compared Longo’s stapled anopexy with conventional methods and some complications were reported. The most common described early complication was bleeding (5–8%), followed by severe anal pain, thrombosis, urinary retention (anaesthesia could be involved) and suture dehiscence. After 1 week from the intervention, later complications noted were: recurrence of haemorrhoids, residual prolapse or persistence of symptoms(the most common), occurring in about 5% of the patients, chronic anal pain (2%), stenosis, anal fissure, faecal urgency, incontinence and anal sepsis (fistulas and abscesses). Rectal perforation was rarely reported. We treated a female patient, 27 years old, who came to our attention from a local hospital with an acute abdomen condition and a CT diagnosis of a rectal perforation. She had been previously treated for third-degree prolapsed haemorrhoids in the same hospital, where she received a Longo’s stapled haemorrhoidopexy using the Ethicon Endo Surgery PPH set. She was discharged on the second day after intervention, and she complained of diffused abdominal pain, she has no passed gas and mild temperature. Before the discharge, an enema was performed. The woman had a negative general and gynaecological anamnesis. She was nulliparous and never previously operated or hospitalised. She performed a colonoscopy before the intervention that was negative. No defecography or other diagnostic exams were performed before the intervention. On a fifth postoperative day, she was readmitted; a CT was performed and she was transferred to the emergency room of our hospital. CT examination showed a double rectal perforation, the first at the staple line level and the second further up in the rectum, with a faecal peritonitis and pneumoperitoneum. She presented tachycardia, high temperature (>38°C) and 100/60 of blood pressure. At physical examination, a severe diffuse abdominal pain was found. At rectal digital exploration a small dehiscence of the staple line was noted, about 5 cm above the anal verge, with no external signs of abscess. The exploration caused intense pain, but no stenosis of faecal impact was detected. No other endoanal procedures were performed. Laboratory data showed a white blood cell count of 20,300/mm. An emergency intervention was performed. At laparotomy, generalised faecal peritonitis was found and a rectal posterior perforation at the rectal–sigmoid junction was noted. The hole was closed with a discontinue suture and a left colostomy was performed. Her recto-sigmoid tract was not redundant and there were no diverticula or something else notable. Two suction drains were put in place. No specimens were sent to pathology. The patient was Int J Colorectal Dis (2009) 24:1113–1114 DOI 10.1007/s00384-009-0665-7

Correlations among total colonoscopic findings, clinical symptoms, and laboratory markers in ulcerative colitis

Colonoscopy plays an integral role in the diagnosis, management and surveillance of ulcerative colitis (UC). In the present study we assessed the relationship between endoscopic and histological findings, clinical symptoms, and laboratory data. We performed total colonoscopy examinations in 54 consecutive patients with UC. Seven segments (appendiceal region, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum) were scored for endoscopic and histological activity. The patients were also evaluated using a symptom-activity index and laboratory markers: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) and platelet (plt) counts. There was a significant positive correlation between endoscopic and histological scores (r(s)=0.738), and between symptom activity score, endoscopic score (r(s)=0.444), and histological score (r(s)=0.557). Although the endoscopic and histological scores of distal colonic lesions (rectum-sigmoid, endoscopic: r(s)=0.515, histological: r(s)=0.624) correlated with clinical symptoms, there was no similar correlation for the proximal colon (appendiceal region-descending; endoscopic, r(s)=0.268, histological, r(s)=0.329). CRP, ESR, and WBC count also correlated with the sum of endoscopic and histological scores (CRP, r(s)=0.447, r(s)=0.369; ESR, r(s)=0.483, r(s)=0.589; WBC, r(s)=0.338, r(s)=0.330), whereas platelet count did not (r(s)=0.171, r(s)=0.210). In particular, CRP and ESR were well correlated with the activity of proximal colonic lesions (CRP, r(s) = 0.474, r(s)=0.480; ESR, r(s) = 0.423, r(s)=0.529) rather than with that of distal lesions (CRP, r(s)=0.236, r(s)=0.212; ESR, r(s)=0.368, r(s)=0.497). In this study, clinical symptoms reflected the activity of distal colonic lesions, whereas CRP and ESR reflected the activity of proximal lesions. Therefore, total colonoscopy may be indicated when CRP or ESR is elevated in UC patients in clinical remission.

Intraoperative Colonoscopy for Anastomosis Assessment in Laparoscopically Assisted Left-Sided Colon Resection: Is It Worthwhile?

The aim of our study was to evaluate the use of intraoperative colonoscopy in laparoscopically assisted left-sided colon resection for the assessment of anastomosis. All consecutive laparoscopically assisted left-sided colon resections performed at our department between May 2001 and February 2006 were included in this study. After colon resection and reanastomosis, an intraoperative colonoscopy was performed to detect anastomosis risk. A total of 122 patients were enrolled in this study. In 73 patients (59.84%), the anastomosis was checked via colonoscopy (the study group, (SG), whereas the control group (CG) consisted of 49 (40.16%) patients without colonoscopy. Of the 122 patients, 65 (53.28%) underwent a laparoscopically assisted sigmoid resection, 45 (36.89%) a laparoscopically assisted sigmoid rectum resection, 4 (3.28%) a laparoscopically assisted anterior rectum resection, and 8 (6.56%) a laparoscopically assisted left hemicolectomy. In the study group, 5 (6.85%) anastomotic leakages were intraoperatively detected and oversewn. A total of 6 (4.92%) anastomotic leakages occurred in the early postoperative period (SG: 4 [5.47%] vs. CG: 2 [4.08%]; P = 0.541). Intraoperative evaluation of anastomosis prevents early anastomotic insufficiency because intraoperative identification of leaks allows for repair during surgery. Nevertheless, a certain rate of anastomotic dehiscence occurs in every kind of colon resection. The sometimes increased rate of dehiscence in laparoscopic-assisted colon resection can be reduced by intraoperative colonoscopy.

Tuberculosis of the Colon: Endoscopic Features with Prospective Follow-Up After Anti-Tuberculosis Treatment

Introduction: Tuberculosis (TB) of the colon can present with non-specific symptoms and signs and the diagnosis is frequently missed. Very few studies have prospectively evaluated endoscopic features of colon tuberculosis pre and post anti-TB treatment. Aim: The aim of this study was to prospectively study the colonoscopic features of tuberculosis of the colon. Method: Consecutive patients with tuberculosis of the colon were prospectively enrolled. Only patients who fulfilled the following were considered to have tuberculosis: positive TB bacillus on biopsy and/or positive TB PCR and/or response to anti-TB treatment and/or resected specimen showing TB. Colonoscopy was performed within 4 weeks prior to treatment and repeated 12 months later. Baseline clinical data and endoscopic features of pre- and post anti-TB treatment colonoscopy were prospectively collected. Results: Fifty-two patients were enrolled. Fifteen of these patients are currently on treatment and awaiting follow-up colonoscopy. Hence data is presented on the remaining 37 patients (age 40 ± 17SD, male 20, female 17). Some of the presenting clinical features included weight loss 86%, abdominal pain 84%, fever 46%, diarrhea/constipation 30%, diarrhea 24%, blood per rectum 22%, abdominal mass 14%, and lymphadenopathy 3%. Macroscopic lesions on endoscopy were predominantly right-sided and primarily ulcers (Tables). Except for strictures, majority of the lesions resolved with treatment. Conclusions: Tuberculosis of the colon predominantly affects the cecum and the ascending colon. Ulceration, nodularity and stricture are the most commonly seen endoscopic lesions. Majority of the lesions resolve with anti-TB treatment. Tabled 1Tuberculosis colon: frequency of sites involved T. Ileum Cecum Asc. Colon Tr.Colon Des. Colon Sigmoid Rectum 38% 51% 35% 16% 8% 8% 5% Open table in a new tab Tabled 1Tuberculosis colon: endoscopic lesions seen ∗ Resolved after treatment Ulcer ∗ Resolved after treatment Nodule @ partial resolution Stricture Polyp # Surgery Obst. Mass Fibrous band 92% 54% 43% 16% 8% 3% ∗ Resolved after treatment @ partial resolution # Surgery Open table in a new tab

Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases.

We present our experience with the first 5 patients who underwent radical cystectomy with bilateral pelvic lymphadenectomy and continent urinary diversion (rectal sigmoid pouch) performed with an intracorporeal laparoscopic technique at our center. There were 3 males and 2 females 59 to 65 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent surgery. The procedure included pelvic lymph node dissection, radical cystectomy with prostate or uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. Freehand laparoscopic suturing and in situ knot tying techniques were used exclusively. The mobilized specimens were removed in an endoscopy bag via the rectum or vagina. Laparotomy was not required. Operating time was 6.9 to 7.9 hours (median 7.4) and blood loss was 190 to 300 ml. (median 245). None of the 5 patients none needed blood transfusion. Oral intake was started on hospital day 3, ureteral stents were removed on day 8 and the pouch catheter was removed on day 9. The hospital stay was 10 days for all cases. Histopathological examination of the specimens revealed stage pT1 G3 urothelial carcinoma in case 1, pT2b G2 in cases 2 and 3, pT3a G2 in case 4 and pT3aG3 in case 5. The lymph nodes and resection margins were tumor-free. No intraoperative or postoperative complications were observed. To our knowledge, this is the first series of laparoscopic radical cystectomy with intracorporeal continent urinary diversion (rectal sigmoid pouch), and our results are promising. With more experience and improvement of the surgical technique, laparoscopic radical cystectomy with continent urinary diversion may become an alternative surgical method for treating select patients with localized muscle invasive bladder cancer.

LAPAROSCOPIC RADICAL CYSTECTOMY WITH CONTINENT URINARY DIVERSION (RECTAL SIGMOID POUCH) PERFORMED COMPLETELY INTRACORPOREALLY: THE INITIAL 5 CASES

Purpose: We present our experience with the first 5 patients who underwent radical cystectomy with bilateral pelvic lymphadenectomy and continent urinary diversion (rectal sigmoid pouch) performed with an intracorporeal laparoscopic technique at our center.Materials and Methods: There were 3 males and 2 females 59 to 65 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent surgery. The procedure included pelvic lymph node dissection, radical cystectomy with prostate or uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. Freehand laparoscopic suturing and in situ knot tying techniques were used exclusively. The mobilized specimens were removed in an endoscopy bag via the rectum or vagina. Laparotomy was not required.Results: Operating time was 6.9 to 7.9 hours (median 7.4) and blood loss was 190 to 300 ml. (median 245). None of the 5 patients none needed blood transfu...

Severe imbalance of cell proliferation and apoptosis in the left colon and in the rectosigmoid tract in subjects with a history of large adenomas

BACKGROUNDAlterations in epithelial proliferation and apoptosis in colonic mucosa are associated with an increased risk of colon cancer. It is unclear if these alterations represent a generalised “field defect”.AIMSTo analyse...

Prevalence and clinical significance of proximal colorectal adenomas in asymptomatic, average-risk subjects

Background. Current recommendations for colorectal cancer screening in people at average risk (asymptomatic, age > 50, no other risk factors) are yearly fecal occult blood test (FOBT) and flexible sigmoidoscopy every five years starting at age 50. However, FOBT often fail to detect polyps, and flexible sigmoidoscopy, although effective in reducing colorectal cancer mortality, only examines the distal portion of the colon. The use of colonoscopy for colorectal cancer screening in average-risk subjects is still controversial. Aim. To determine the prevalence and the clinical significance of proximal colonic polyps in a group of asymptomatic, average risk patients according to presence or absence of rectosigmoid adenomas (sentinel lesions), commonly believed to be markers of neoplastic changes throughout the colon warranting colonoscopy. Methods. Among 961 consecutive subjects referred to our center, we identified all those with a successful total colonoscopy. Two hundred and seventy-one subjects had at least one adenomatous polyp: of these, 79 were excluded from this analysis because of reported signs or symptoms (positive FOBT, change in bowel habit, hematochezia), prior history of colon polyps or cancer, prior colon evaluation, or positive family history. The remaining 192 patients constituted the study group. All polyps were removed and pathological evaluation was obtained. Adenoma number, size and location were determined at colonoscopy. Advanced adenomas were defined as tubulo-villous, villous or large (> 10 mm in diameter). Results. Among the 192 asymptomatic, average risk patients (males 63%; mean age-+ SD: 58.8 ± 7.2) 136 (70.8%) had adenomas in the sigmoid rectum, while 56 patients (29.2 %) had only proximal polyps in the absence of sentinel lesions in the sigmoid rectum. Among patients with adenomas in the sigmoid rectum, the prevalence of additional proximal adenomas was 17.6 % (24/136). Sentinel lesions were distinguished on the basis of their size as follows: diminutive, 10 ram. We found that 1 of the 4 patients with diminutive index polyps had proximal advanced adenomas, as did 7/12 patients with small index lesions and 7/8 patients with large index lesions. The prevalence of advanced adenomas among the 56 patients who harbored only proximal polyps was 50% (28/56); ten of these patients had multiple polyps. Conclusions. In our study, asymptomatic subjects at average risk of developing coloreetal cancer showed a high prevalence of proximal adenomas in the absence of sentinel lesions in the sigmoid rectum. Half of these lesions were of a type considered at high risk for the development of further adenomatous polyps or cancer. Since these patients would be missed with the current screening strategies, we believe that these findings support the use of colonoscopy for colorectal cancer screening.

Antagonistic effects of sulfide and butyrate on proliferation of colonic mucosa: a potential role for these agents in the pathogenesis of ulcerative colitis.

It has been shown that feces of patients with ulcerative colitis uniformly contain sulfate reducing bacteria. Sulfide produced by these bacteria interferes with butyrate-dependent energy metabolism of cultured colonocytes and may be involved in the pathogenesis of ulcerative colitis. Mucosal biopsies from the sigmoid rectum of 10 patients (no caner, polyps, inflammatory bowel disease) were incubated with either NaCl, sodium hydrogen sulfide (1 mmol/L), a combination of both sodium hydrogen sulfide and butyrate (10 mmol/L), or butyrate. Mucosal proliferation was assessed by bromodeoxyuridine labeling of cells in S-phase. Compared to NaCl, sulfide increased the labeling of the entire crypt significantly, by 19% (p < 0.05). This effect was due to an expansion of the proliferative zone to the upper crypt (compartments 3-5), where the increase in proliferation was 54%. Sulfide-induced hyperproliferation was reversed when samples were coincubated with sulfide and butyrate. The study shows that sodium hydrogen sulfide induces mucosal hyperproliferation. Our data support a possible role of sulfide in the pathogenesis of UC and confirm the role of butyrate in the regulation of colonic proliferation and in the treatment of UC.