Transverse Colon Research Articles

Literature Review on Stages of Colorectal Cancer

Colorectal cancer, primarily originating from polyps in the colon or rectum, represents a significant health challenge due to its potential progression to malignancy. Polyps, abnormal tissue growths in the inner lining of the colon or rectum, often start as benign adenomas. Over time, these adenomas may undergo cellular mutations, transforming into cancerous tumors. Early detection and removal of polyps during screening significantly reduce the likelihood of cancer development. If left untreated, colorectal cancer can invade deeper layers of the colon wall, metastasize to nearby lymph nodes, and spread to distant organs, commonly the liver, peritoneum, or lungs. Colon cancer typically originates in the mucosa, the innermost lining of the colon, and progresses through the tissue and muscle layers over a span of approximately 10 years. The anatomy of the colon and rectum, consisting of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum, plays a critical role in understanding the disease's progression. Advances in screening methods and treatments have significantly improved outcomes, emphasizing the importance of early intervention in reducing colorectal cancer mortality.

Mid-transversal hepatectomy: breaking new ground in parenchymal sparing hepatectomies.

We, herein, describe a case of complex parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases (CRLMs). A 61-year-old woman, previously operated for an occlusive adenocarcinoma of the transverse colon and undergoing adjuvant chemotherapy, developed metachronous bilobar CRLMs. After administration of a II line chemotherapy with partial response, she was referred to our hospital. The pre- and post-treatment imaging recognized seven liver lesions, with a bilobar distribution involving segments 3, 4, 5, 8, and 7. After multidisciplinary team evaluation, the surgical strategy was planned by means of three-dimensional reconstruction and simulation software. The planned and executed procedure consisted of a unique transection plane comprising partial resection of segments 3-4-5-8-7, thus removing the central transversal portion of the liver. Accurate preoperative planning and intraoperative ultrasound for resection guidance allowed us to achieve a complex parenchymal sparing procedure in an advanced disease that would be usually candidate for major resection and staged hepatectomy.

Mesocolic schwannoma mimicking gastrointestinal stromal tumor: A case report and review of literature.

Schwannomas are common peripheral nerve tumors originating from Schwann cells, primarily occurring in the head and neck, limbs, and trunk. Schwannomas occurring in the mesocolon are rare and often have no specific manifestations. Abdominal schwannomas need to be differentiated from common abdominal tumors such as gastrointestinal stromal tumors. We report a case of a mesocolic schwannoma in a 59-year-old female presenting with gastrointestinal symptoms of acid reflux. At an outside hospital, gastroscopy, colonoscopy, and abdominal computed tomography scans revealed a soft tissue mass adjacent to the greater curvature of the stomach, leading to a suspicion of a gastric mesenchymal tumor. Mesocolic schwannoma. Laparoscopy was performed at our hospital. Intraoperatively, the tumor was found to be closely related to the transverse colon and was initially diagnosed as a mass originating from the transverse colon. Consequently, a resection of the mass along with the adherent portion of the transverse colon was performed. Postoperative pathology and immunohistochemistry confirmed that the tumor was a schwannoma of the mesentery and did not originate from the transverse colon. Schwannomas can be distinguished from gastrointestinal stromal tumors by immunohistochemical staining, and surgical treatment is effective for benign schwannomas.

Simplified magnetic resonance index of activity score versus simple endoscopic score in Crohn's disease: prospective study

BackgroundTo evaluate the correlation between simplified MR index of activity (sMaRIA) score and simple endoscopic score (SES-CD) in Crohn's disease activity assessment. A prospective study was done on established Crohn's disease patients referred to our institution. Magnetic resonance enterography and colonoscopy were performed as an activity assessment protocol searching for activity signs through calculation of sMaRIA score and SES-CD score and correlation between them. One hundred patients were enrolled in the study in period from July 2021 to July 2022. Patients with isolated upper gastrointestinal Crohn's disease (n = 4) or performed surgery before completion of activity assessment protocol (n = 9) or dropout (n = 18) were excluded. Patients with any age group, with ileal or colonic or ileo-colonic Crohn's disease and completed the protocol were eligible for the study (n = 69).ResultsSixty-nine patients with 345 bowel segments (five segments for each patient: ileum, right colon, transverse colon, left colon/sigmoid and rectum) were completely evaluated: 33 males and 36 females with mean age 29.16 ± 11.37 years. sMaRIA and SES-CD scores were calculated for each patient (global), and each bowel segment showed 97.50% sensitivity and 79.31% specificity at the level of global scores as well as significant positive correlation between the two scores at patient level/overall segments (rs = 0.816, p < 0.001), at ileal segments (rs = 0.704, p < 0.001) and colonic segments (right colon rs = 0.661, p ≤ 0.001, transverse colon rs = 0.586, p ≤ 0.001, left colon rs = 0.731, p < 0.001 and rectum rs = 0.786, p < 0.001). There were good inter-rater agreement between the two radiologists for the three parameters (wall thickness > 3 mm, mural edema and fat stranding) and moderate for mucosal ulcer detection with k value 0.666, 0.712, 0.712 and 0.565, respectively.ConclusionssMaRIA score is considered to be a reliable tool for Crohn's disease activity evaluation as compared to SES-CD.

052. Surgical Management of a Tumor Adhering to Ileum and Posterior Stomach: A Case Report

Background: Tumors in the transverse colon that invade adjacent organs, such as the ileum and posterior stomach, present complex surgical challenges. Resection and reconstruction are often required to achieve optimal outcomes. We present a case of a large transverse colon tumor adherent to the ileum and posterior gastric wall, managed with extensive surgical resection and reconstruction. Case: A 54-year-old male presented with abdominal pain, bloating, and weight loss. Imaging studies revealed a large mass originating from the transverse colon, adherent to the ileum and posterior gastric wall. Intraoperative findings confirmed the tumor’s adherence to the ileum, approximately 220 cm distal to the ligament of Treitz, as well as its invasion of the posterior gastric wall. The surgical team performed a multi-organ resection. The segment of ileum involved, located 220 cm from the ligament of Treitz, was resected, and an ileo-ileal anastomosis was performed. The primary tumor, located in the middle of the transverse colon, necessitated a total resection of the transverse colon, with subsequent anastomosis between the ascending and descending colon. Additionally, the portion of the posterior stomach adherent to the tumor was removed through subtotal gastrectomy, followed by a Billroth I reconstruction. Postoperatively, the patient recovered well, with no significant complications. Histopathology confirmed the tumor to be a moderately differentiated adenocarcinoma. The patient is currently undergoing adjuvant chemotherapy. Conclusion: This case highlights the complexity of managing tumors with multi-organ involvement. Comprehensive surgical resection, combined with appropriate reconstruction techniques, can result in favorable outcomes. Early detection and aggressive surgical management are essential in cases involving locally advanced tumors with invasion into adjacent structures.

Endoluminal Approaches for Colorectal Neoplasia in Inflammatory Bowel Disease, A Viable Alternative for Colectomy?

IntroductionEndoscopic resection of visible dysplastic lesions in patients with inflammatory bowel disease (IBD) provides an alternative to colectomy for management. Endoscopic techniques that can be used include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and a combined hybrid approach of ESD and EMR. These endoscopic treatments may allow organ preservation in patients with IBD. The aim of this study was to evaluate outcomes of endoscopic resection, including EMR, ESD and hybrid ESD/EMR, for the treatment of colorectal dysplasia in patients with IBD. MethodsWe performed a retrospective review of IBD patients who underwent endoscopic resection for colorectal dysplasia at our tertiary care center between 2014 to 2023. Patients were identified through a search of our endoscopy database. Medical records were reviewed to collect data on patient demographics, IBD history, details of endoscopic technique, procedural factors, final pathology results, and outcomes including recurrence of dysplasia. ResultsA total of 50 IBD patients underwent endoscopic resection, including 38 ESD, 11 hybrid ESD/EMR, and 1 EMR. Median age was 62 (IQR: 54-68) years and 34 (68%) were male. Median BMI was 27.6 (IQR: 24.8-31.7). Underlying diagnosis was ulcerative colitis in 33 (66%) and Crohn's disease in 17 (33%). Median disease duration was 27.5 years (IQR 8-30). Polyp locations were distributed as follows: right colon, rectum, left colon, transverse colon, and cecum, with 9 (18%) in each area. Median procedure time was 47.5minutes (IQR: 31.2-73.7). En bloc resection was achieved in 34 (68%) and piecemeal resection in 16 (32%). On pathology, median lesion size was 23.5 (IQR: 20.2-40) mm. High-grade dysplasia was found in 7 (14%) and low-grade dysplasia in 15 (30%). During a median follow-up period of 7.2 years, 18% of patients experienced recurrence. No significant difference in recurrence rates was observed between the ESD and ESD/EMR groups. ConclusionEndoscopic resection, including EMR, ESD and hybrid techniques, enables effective treatment of visible dysplastic lesions as an alternative to colectomy in patients with IBD. In this cohort, favorable short-term outcomes were demonstrated after endoscopic resection.

A rare incidence of signet ring cell carcinoma of the rectosigmoid junction: a case report

Introduction and importance: Signet ring cell carcinoma (SRCC) is a rare type of adenocarcinoma. SRCC comprises 1.0% of all colon cancer and 0.7% of all rectal cancer. The SRCC spreads both hematologically and through lymph nodes making it highly invasive. The pathophysiology of the colorectal SRCC involves an alteration in the function of the RNF43, CDH-1, and SMAD4 genes as well as TGF-B signaling pathways, which are responsible for epithelial-mesenchymal transitions and stem cell properties. This also shows a higher rate of BRAF mutation, microsatellite instability-high (MSI-H) and CpG island methylator phenotype positivity Case presentation: A 17-year-old female patient with no known comorbidities presented with copious, bright red colored per rectal bleeding along with painful defecation. Colonoscopy revealed an eccentric growth that led to luminal narrowing. Multiple biopsies confirmed a 4 cm × 6 cm neoplastic lesion with locoregional lymphadenopathy, but no metastasis. The patient underwent anterior resection of the rectum, colostomy, and rectal stump closure. The sigmoid colon was resected up to the middle up to the third mesorectum followed by multiple re-explorations. Discussion: SRCC presents at an advanced stage with a poor prognosis because signet ring cells infiltrate the mucosa without forming a significant mass, hindering early diagnosis of this carcinoma. Among the previously published large-scale studies, SRCC involves the proximal colon, i.e., the cecum, ascending, and transverse colon. However, our case presents a less common left-sided presentation in a less-commonly presented demographic, a 17-year-old girl. The patient’s non-specific symptoms contributed to a delayed diagnosis. Despite this, the absence of metastasis in our late-diagnosed case is atypical of SRCC. Conclusion: SRCC should be considered as a differential diagnosis for young adults presenting with per-rectal bleeding and other common symptoms often seen in frequently diagnosed conditions. Therefore, early diagnosis along with appropriate surgical intervention combined with supportive treatment are important for better patient outcomes.

Nationwide multicenter prospective study on the usefulness, safety, and acceptability of colon capsule endoscopy in Japan

We determined the factors influencing total capsule colonoscopy, adequate cleansing, and detectability of second-generation colon capsule endoscopy (CCE) for colorectal polyps or tumors (CRTs), adverse events, and acceptability. Among 44 Japanese hospitals, 1,006 patients with suspected or documented colorectal diseases who underwent CCE were enrolled prospectively. The total capsule colonoscopy rate was 86.1%. Age younger than 63 years (adjusted odds ratio [aOR], 1.525), male sex (aOR, 1.496), inflammatory bowel disease (aOR, 1.889), lavage intake on Day -1 (aOR, 1.625), ≥1800 mL lavage intake on Day 0 (aOR, 0.595), prokinetics on Day 0 (aOR, 0.608), and ≥30 mL castor oil booster on Day 0 (aOR, 1.734) were significant independent predictors. The overall adequate cleansing rate was 65.5%. Constipation (aOR, 0.527), lavage intake on Day -1 (aOR, 1.822), laxative intake on Day -1 (aOR, 2.616), and ≥1900 mL lavage intake on Day 0 (aOR, 1.449) were significant independent predictors. The detection rates (95% confidence intervals) for patients with CRTs ≥6 mm and ≥10 mm were 92 (84-97) % and 89 (78-96) %, respectively. Inadequate cleansing in the ascending colon (aOR, 0.184), ≥6 mm CRT in the transverse colon (aOR, 4.703), and ≥6 mm CRT in the left-sided colon (aOR, 32.013) were significant independent predictors. CCE retention occurred in two patients (0.20%) requiring endoscopic and surgical interventions. In total, 63% of patients desired CCE for their next colonoscopy. CCE was relatively safe, well tolerated, and useful for detecting colorectal lesions when adequate bowel preparation was made.

The microbiota comparative analysis of the characteristics between colorectal adenomatous polyps and normal mucosal intestinal.

The aim of this study is to systematically examine and compare the characteristics distinguishing colorectal adenomatous polyps from normal mucosal intestinal microbiota. A total of 30 specimens were obtained from patients diagnosed with colorectal adenomatous polyps (adenoma group) who underwent endoscopic removal at Wenzhou People's Hospital between September 2021 and November 2021. Concurrently, 30 normal mucosal specimens were collected from patients without adenomatous polyps (control group). Subsequently, microbiome total DNA extraction was carried out, followed by PCR amplification targeting the V3-V4 region of the 16S rDNA. High-throughput sequencing was conducted using the Illumina MiSeq platform. Subsequent to sequencing, bioinformatics analysis was used to assess the diversity, composition, and functional aspects of the intestinal microbiota in both study groups. A notable dissimilarity in the microbiota structure was identified, specifically within the transverse colon, between these two groups ( P < 0.05). Species composition analysis revealed that Escherichia , Fusobacterium , and Bacteroides were predominant bacteria in both groups, with Escherichia and Enterobacter displaying significant differences at the genera level between the control group and the adenoma group ( P < 0.05). Correlation analysis and functional prediction demonstrated substantial disparities in interactions among dominant intestinal microbial genera within patients from both groups. Additionally, it was discovered that the intestinal microbiomes in patients in the adenoma group exhibited a significantly higher pathogenic potential. Upon conducting a comprehensive analysis, it was discerned that the microbiota present in the transverse colon of the control group exhibited distinctive characteristics that may contribute to the maintenance of intestinal health.

061. A Rare Finding; Severe Intra Abdominal Infection and Colonic Necrosis in Geriatric Crohn’s Disease Patient

Background: Crohn's disease (CD) is an immune-mediated inflammatory bowel disease (IBD) marked by segments of transmural inflammation in the gastrointestinal tract. Only 10% to 15% of IBD cases occur in those over 65. In a retrospective study of 281 surgeries, 43 were in colitis patients and 242 in Crohn's patients. The mortality rate was 5.7%, with 9 deaths due to sepsis, mainly linked to emergency procedures and corticosteroid use. CD symptoms include fatigue, prolonged diarrhea, weight loss, and fever, with or without bleeding. Case: A 69-year-old female with a 15-day history of abdominal pain. Patient referred to our hospital after laparotomy and ileostomy 15-days ago. Patient condition worsened, sepsis condition. Upon arrival, the patient exhibited mild hypotension, abdominal distension with midline incision, intra abdominal drain, and an active ileostomy on the right lumbal region. Laboratory tests shows anemia, electrolyte imbalances, and hypoglycemia. A CT scan abdomen revealed pneumoperitoneum and intestinal inflammation. During relaparotomy operation, ileal perforation was found near the stoma, with full-thickness necrosis of the ascending colon extending into part of the transverse colon, and colitis with mucosal necrosis from part of the transverse colon to the rectum. So, we performed a total colectomy, and ileostomy relocation. Pathology confirmed Crohn's disease with granulomatous inflammation. The patient received intravenous fluids and antibiotics. She was subsequently admitted to the intensive care unit for further management. Conclusion: Crohn's disease with severe intra abdominal infected ec perforated colon in patients over 65 is a rare case. Timely diagnosis through detailed anamnesis and examination is crucial. Surgical options should be taken if there are signs of peritonitis.

Morphometric analysis and tortuosity typing of the large intestine segments on computed tomography colonography with artificial intelligence

Background:Morphological properties such as length and tortuosity of the large intestine segments play important roles, especially in interventional procedures like colonoscopy. Objective:Using computed tomography (CT) colonoscopy images, this study aimed to examine the morphological features of the colon's anatomical sections and investigate the relationship of these sections with each other or with age groups. The shapes of the transverse colon were analyzed using artificial intelligence. Materials and Methods:The study was conducted as a two- and three-dimensional examination of CT colonography images of people between 40 and 80 years old, which were obtained retrospectively. An artificial intelligence algorithm (YOLOv8) was used for shape detection on 3D colon images. Results:160 people with a mean age of 89 men and 71 women included in the study was 57.79±8.55 and 56.55±6.60, respectively, and there was no statistically significant difference (p=0.24). The total colon length was 166.11±25.07 cm for men and 158.73±21.92 cm for women, with no significant difference between groups (p=0.12). As a result of the training of the model Precision, Recall, and mAP were found to be 0.8578, 0.7940, and 0.9142, respectively. Conclusion:The study highlights the importance of understanding the type and morphology of the large intestine for accurate interpretation of CT colonography results and effective clinical management of patients with suspected large intestine abnormalities. Furthermore, this study showed that 88.57% of the images in the test data set were detected correctly and that AI can play an important role in colon typing.

Impenetrable Abdomen: A Case Report of Endoscopic Sleeve Gastroplasty Performed in Patient with Huge Paramedian Laparocele.

Bariatric surgical techniques have demonstrated scientific efficacy and interventional safety; however, these approaches are not universally appropriate for all patients. The term "impenetrable abdomen" refers to the inability to achieve surgical access to the abdominal cavity, a condition that may arise from several underlying factors. Endoscopic sleeve gastroplasty (ESG) is proposed as a safe and effective technique in this subgroup of patients with obesity. A 56-year-old Caucasian woman with an impenetrable abdomen due to the presence of a large left paramedian laparocele underwent ESG (Fig. 1) to our unit. An abdominal computed tomography (CT) scan revealed a substantial laparocele in the left paramedian region, involving the tenuous loops, mesentery, and part of the transverse colon. The patient body mass index (BMI) at presentation was 47.15 kg/m2 (116 kg per 1.57 m). Comorbidities included obstructive sleep apnea syndrome (OSAS), requiring nocturnal continuous positive airway pressure (CPAP) therapy, hepatic steatosis, hypertension, hypertriglyceridemia, and hypovitaminosis D. The case was discussed with our multidisciplinary board team (MDT), who agreed to proceed with the ESG. The endoscopic procedure was performed in the supine position, using the Overstitch device and lasted 58 min. No intraprocedural or post-procedural complications/adverse events have been observed. The patient resumed a liquid diet on the first postoperative day and was discharged from the hospital 24 h after the procedure in good clinical condition. Regular outpatient follow-up visits showed significant reduction of the BMI at 6 months post-procedure with a value of 34.9 kg/m2 compared with the initial value of 47.1 kg/m2. Additionally, the patient's use of nocturnal CPAP for OSAS was successfully discontinued suggesting an improvement in her respiratory condition as a result of weight loss. Moreover, there was a notable reduction in the pharmacological management required for arterial hypertension. These outcomes underscore the positive impact of selecting the most appropriate therapeutic strategy for each patient with obesity through a multidisciplinary team approach. In our experience, we confirm that endoscopic sleeve gastroplasty is both feasible and safe in patients presenting with an impenetrable abdomen. Despite the minimally invasive approach, this technique has proven effective in terms of body weight loss and reduction of obesity related compared with bariatric surgery.

Genetic Testing of Japanese Patients with Serrated Polyposis Syndrome: A Multicentric Study.

Serrated polyposis syndrome (SPS) is a rare condition associated with an increased risk of colorectal cancer. However, the genetic basis of SPS in Japanese patients remains unclear. The present study therefore aimed to address this omission by identifying candidate causative genes of SPS in Japanese patients. The present study performed next-generation sequencing using a multigene panel to identify the causative genes in SPS. Whenever a candidate gene was detected, whole exome sequencing of the tumor tissue was performed. An analysis of 11 patients with SPS identified a germline pathogenic variant of BUB1 (c.1543G>T/p.Gly515Ter) in a 47-year-old, female patient with transverse colon cancer with more than 50 serrated polyps. She had no history of smoking. None of the canonical, causative genes in common colorectal cancer, such as APC, KRAS and TP53, were detected in her lesion. Most of the somatic variants detected in the cancer were transition substitutions (C>T). BUB1 was identified as a candidate causative gene in SPS in a non-smoker with the disease. These findings will hopefully contribute to understanding the genetic basis of SPS.

Feculent Drainage from Percutaneous Endoscopic Gastrostomy Tube due to Gastrocolocutaneous Fistula Found in Emergency Department: A Case Report

Introduction Percutaneous endoscopic gastrostomy (PEG) placement is a common procedure for patients requiring non-oral feeding. One rare complication of PEG placement is the formation of a gastrocolocutaneous fistula that develops when bowel is caught between the stomach and abdominal wall during placement. This report explores an elderly patient's gastrocolocutaneous fistula development months post-PEG placement who presented with malodorous leakage from the gastrostomy tube to the Emergency Department (ED). Case Report A 73-year-old male on hospice presented to the ED with malodorous leakage from his PEG tube. He had received the PEG tube four months prior to this presentation and had it replaced once at an outside hospital due to blockages. In the ED, his PEG tube was found to have a deflated balloon stopper. The PEG tube was replaced, but the feculent discharge persisted. Imaging showed the tube's position in the transverse colon. The patient underwent non-surgical management, with PEG tube removal and nutritional support via nasogastric tube. He was discharged with improvement of PEG site. Conclusion Gastrocolocutaneous fistula should be considered in patients experiencing unexpected PEG tube drainage or feeding-related complications such as diarrhea. Careful replacement techniques after dislodgement or blockage are important. Radiologic confirmation should be considered after replacement of tubes with feculent drainage. The rarity of gastrocolocutaneous fistula cases in literature explains the lack of standardized management approaches. Clinical signs such as feculent leakage through PEG tube site should prompt recognition and diagnosis by the ED clinician.

An aggressive gastric CIC-DUX4 sarcoma surgically resected with multivisceral organs: a case report

BackgroundCapicua transcriptional repressor-double homeobox 4 sarcoma (CDS) is a rare and aggressive malignant soft tissue tumor that typically arises within the soft tissues. We report an exceptionally rare case of a gastric CDS successfully resected despite its extensive invasion into surrounding organs.Case presentationA 48-year-old male presented with a progressively enlarging abdominal mass. Upper gastrointestinal endoscopy revealed a large ulcerative tumor on the posterior gastric wall. Biopsy results initially suggested a neuroendocrine cell carcinoma. Contrast-enhanced computed tomography showed a 20 cm tumor protruding from the posterior stomach wall, directly invading the pancreas and colon. We performed a multivisceral resection (stomach, pancreatic tail, spleen, and transverse colon) achieving an R0 resection. Pathological examination of the permanent specimen revealed small round cells with high nuclear-to-cytoplasmic ratios. Immunohistochemical staining confirmed the diagnosis of CDS. The patient recovered well and was discharged on postoperative day 33.ConclusionsThis case report describes the first detailed account of a surgically resected aggressive CDS originating from the stomach.

Short- and long-term outcomes of laparoscopic right hemicolectomy with D3 resection for right colon cancer in elderly patients.

Laparoscopic right hemicolectomy (RHC) with D3 resection, similar to complete mesocolic excision, is an oncologically satisfying procedure; however, it remains controversial in elderly patients. There are no reports of the procedure for tumors fed by middle colic vessels because it is a difficult procedure. We evaluated the feasibility and oncological outcomes of the procedure in elderly patients. We retrospectively evaluated 336 consecutive patients undergoing laparoscopic right hemicolectomy with D3 resection for Stage I-III ascending and transverse colon cancer between 2010 and 2021. Patients were divided into the EP (age ≥ 75 years) and nEP (age < 75 years) groups, and short- and long-term outcomes were analyzed using propensity score matching. The median follow-up period was 60.7 months. After matching, we enrolled 129 patients. The surgery time, estimated blood loss, postoperative complication rate, number of harvested lymph nodes, and recurrence rate did not differ significantly between the groups; however, the adjuvant chemotherapy rate was significantly lower in the EP group. The EP group had significantly shorter overall survival (OS) (p < 0.01) than the nEP group; however, the cancer-specific (p = 0.15) and recurrence-free (p = 0.36) survivals did not differ significantly from those in the nEP group. In multivariate analyses, age ≥ 75 years, ASA ≥ 3, and pT4 were independent prognostic factors for OS (p = 0.02, < 0.01, < 0.01, respectively); however, only pT4 was an independent prognostic factor for CSS and RFS (p < 0.01 for both). This procedure offers safe, feasible, and satisfactory oncological outcomes for elderly patients.

A Rare Transverse Colon Hiatal Herniation as a Complication of an Esophagectomy

A Rare Transverse Colon Hiatal Herniation as a Complication of an Esophagectomy

Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures.

Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications. Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center. Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded. PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.

Transverse Colon Penetration by Migrated Intrauterine Device: A Rare Complication.

Transverse Colon Penetration by Migrated Intrauterine Device: A Rare Complication.

Solitary Loss of PMS2 in a patient with Colon carcinoma

Abstract Introduction/Objective In the United States, there are about 150,000 new cases of Colorectal cancer (CRC) and about 50,000 CRC related deaths each year. Hereditary nonpolyposis colorectal cancer (Lynch Syndrome) accounts for 2% - 4% of CRC. It is characterized by germline mutations in mismatch repair (MMR) genes - MLH1, MSH2, MSH6 and PMS2. Patients with Lynch syndrome have up to an 80% lifetime risk (LTR) of CRC and up to 60% LTR of endometrial cancer. Lynch syndrome patients also have an associated LTR of ovarian cancer (38%), upper urologic tract cancer (18%), gastric cancer (13%), small bowel cancer (6%), hepatobiliary tract cancer (4%), and brain tumors (3% - usually glioblastoma). Methods/Case Report A 76-year-old man with history of moderately differentiated colorectal adenosarcoma involving the transverse colon and a recently diagnosed grade group 5 (Gleason 4 + 5) prostate adenocarcinoma, currently being managed at an outside hospital. The case was sent to UAB for DNA MMR/microsatellite instability (MSI) status evaluation testing. Immunostaining showed loss of PMS2 and intact expression of MLH1, MSH2 and MSH6. These results were confirmed by the IdyIIa MSI assay which detected microsatellite instability in 5 of 7 markers and negative for BRAF V600E variant confirming microsatellite instable tumor. Results (if a Case Study enter NA) NA Conclusion Solitary loss of PMS2 in colonic adenocarcinoma is uncommon and may be caused by an underlying germline mutation of MLH-1 or PMS2, thus could represent Lynch Syndrome. Our patient’s age doesn’t favor Lynch syndrome. Next step would be to perform MLH-1 promoter methylation to confirm sporadic nature of carcinoma. Somatic methylation of the MLH1 promoter occurs in approximately 80% of CRC with defective MMR. Prostate cancer is not currently considered a part of Lynch syndrome.