Wall Of Sigmoid Colon Research Articles

Эффективность трансабдоминальной ультразвуковой диагностики состояния толстой кишки для оценки эндоскопической активности язвенного колита у детей

Transabdominal ultrasound examination of the colon is an informative research method that does not require special training, which is vital in pediatric practice. The purpose of the study was to compare the informativeness of transabdominal ultrasound of the colon vs the colonoscopy using the clinical and laboratory data of pediatric patients with ulcerative colitis (UC). Materials and methods used: a single-center retrospective cohort study was conducted at the Gastroenterology Department of the National Medical Research Center for Children’s Health (Moscow, Russia) in 2021-2023, which included 119 children 7 to 17 years and 11 months old with an established UC diagnosis. All children have undergone clinical and laboratory tests, ultrasound and ileocolonoscopy. The UCEIS scale and the PMI index of clinical activity were used to assess the endoscopic activity. The study of fecal calprotectin was carried out with immunochromatographic method. During transabdominal ultrasound, the thickness of the intestinal wall and blood flow were assessed using the Color Doppler imaging mode. Results: statistically significant increase in the thickness of the intestinal wall against the background of the growth of UCEIS (Rs=0.654; p<0.001), PUCAI (Rs=0.642; p<0.001) and the level of fecal calprotectin (Rs=0.463; p<0.001) was detected. Statistically significant differences in increased blood flow in the intestinal wall of the sigmoid colon were found with the UCEIS, PUCAI index (p<0.001, for both indices) and the level of fecal calprotectin (p=0.014). The area under the ROC curve corresponding to the relationship between the prognosis of the development of ulcerative colitis and the thickness of the sigmoid colon was 0.850±0.054 with 95% CI: 0.745-0.955. The resulting model was statistically significant (p<0.001). The threshold value of the sigmoid colon thickness was 2.05 mm, in case of an increase in this value, a high risk of exacerbation of ulcerative colitis was predicted. The sensitivity and specificity of the method were 84.3% and 72.7%, respectively. When comparing the PUCAI index, the UCEIS index and the level of fecal calprotectin based on the blood flow in the sigmoid colon wall, the statistically significant differences were found (p<0.001, for both indices, and p=0.014 for fecal calprotectin, respectively). Conclusion: transabdominal ultrasound diagnostics showed good correlation with colonoscopy, clinical activity of the disease and the level of fecal calprotectin, as a result of which ultrasound of the colon should be considered as a useful imaging method for assessing inflammatory activity in the colon and follow-up of patients with UC.

Successful management of malignant colovesical fistula using covered colonic self-expanding metallic stent: a case report

BackgroundA colovesical fistula (CVF) is commonly treated by resection of the intestine containing the fistula or creation of a defunctioning stoma. We herein report a case of successful fistula closure and avoidance of colostomy after placement of a covered colonic self-expanding metallic stent (SEMS) as a palliative treatment for a malignant CVF.Case presentationA 75-year-old man undergoing infusional 5-fluorouracil and irinotecan chemotherapy plus bevacizumab for recurrent peritoneal dissemination of rectal cancer was admitted to our hospital because of fecaluria with a high-grade fever. Blood tests showed a moderate inflammatory reaction (white blood cell count, 9200/mm3; C-reactive protein, 11.03 mg/dL; procalcitonin, 1.33 ng/mL). Urinary sediment examination showed severe bacteriuria. Abdominal contrast-enhanced computed tomography showed intravesical gas, thickening of the posterior wall of the bladder, and irregular thickening of the sigmoid colon wall contiguous with the posterior bladder wall. Magnetic resonance imaging (MRI) clearly showed a fistula between the bladder and sigmoid colon. Colonoscopy revealed a circumferential malignant stricture 15 cm from the anal verge, and a fistula to the bladder was identified by water-soluble contrast medium. We diagnosed a complicated urinary tract infection (UTI) associated with a CVF due to peritoneal dissemination and started empirical treatment with sulbactam/ampicillin. Given the absence of active inflammatory findings around the fistula on MRI and the patient’s physical frailty, we decided to place a covered SEMS to close the fistula. Under fluoroscopic and endoscopic guidance, a covered colonic SEMS of 80-mm length and 20-mm diameter was successfully deployed, and the fistula was sealed immediately after placement. Urine culture on day 3 after stenting was negative for bacteria, and a contrast study on day 5 showed no fistula. The patient was discharged home on day 6 with no complications. The UTI did not recur for 4 months after discharge.ConclusionsA covered colonic SEMS was useful for sealing a malignant CVF in a patient unfit for surgery, and MRI was valuable to determine the status of the fistula. A covered colonic SEMS could be an alternative to surgical treatment for CVFs in patients who require palliative care.

Retrieval of Lost IUCD from Sigmoid Colon by Colonoscopy: A Case Report

IUCDs are easy to use and effective. It has somewhat greater failure rates than oral contraceptives but is otherwise safe. IUCD is used by 85 million women worldwide. A missing device may indicate unrecognised string expulsion or retraction into the cervix/uterus or IUCD perforation at an extra uterine region. Many problems are observed with IUCD. If IUCD perforates the uterine wall and enters the peritoneal cavity, consequences may be asymptomatic or severe. We report a case of a lost IUCD found trapped in the sigmoid colon wall 4 years after insertion and presenting with chronic constipation in a 23-year-old woman. A CT scan of the abdomen was performed to identify constipation and chronic backache. The IUCD was collected during colonoscopy after bowel preparation. The patient recovered without difficulties. Due to its peculiar presentation, missing IUCD may not require extensive workup. In this rare case, the endoscopic method of retrieving IUCD saved the patient from a main laparotomy. J Bangladesh Coll Phys Surg 2023; 41(4): 315-319

Castleman’s Disease. Association with System Scleroderma

The article presents an observation of a rare benign lymphoproliferative disease — Castleman’s disease, with pronounced systemic symptoms. The clinical case is of interest not only for the rarity of pathology, but also for the peculiarities of clinical manifestations, including paraneoplastic pseudosclerodermic clinical and immunological syndrome, which was not previously described in the context of Castleman’s disease, Raynaud’s syndrome, severe pulmonary hypertension and a suspected (not proven morphologically) variant of extranodal lesion with its previously also notobserved localization in the sigmoid colon wall.

Association Between Bowel Wall Thickening and Long-Term Outcomes in Decompensated Liver Cirrhosis.

Bowel wall thickening is commonly observed in liver cirrhosis, but few studies have explored its impact on the long-term outcomes of patients with cirrhosis. Overall, 118 patients with decompensated cirrhosis were retrospectively enrolled, in whom maximum wall thickness of small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum could be measured in computed tomography (CT) images. X-tile software was employed to determine the best cut-off values of each segment of bowel wall thickness for predicting the risk of further decompensation and death. Cumulative rates of further decompensation and death were calculated by Nelson-Aalen cumulative risk curve analyses. Predictors of further decompensation and death were evaluated by competing risk analyses. Sub-distribution hazard ratios (sHRs) were calculated. Cumulative rates of further decompensation were significantly higher in patients with wall thickness of ascending colon ≥ 11.7mm (P=0.014), transverse colon ≥ 3.2mm (P=0.043), descending colon≥9.8mm (P=0.035), and rectum ≥ 7.2mm (P=0.045), but not those with wall thickness of small bowel ≥ 8.5mm (P=0.312) or sigmoid colon≥7.1mm (P=0.237). Wall thickness of ascending colon≥11.7mm (sHR=1.70, P=0.030), transverse colon ≥ 3.2mm (sHR=2.15, P=0.038), and rectum≥7.2mm (sHR=2.38, P=0.045) were independent predictors of further decompensation, but not wall thickness of small bowel≥8.5mm (sHR=1.19, P=0.490), descending colon ≥ 9.8mm (sHR=1.53, P=0.093) or sigmoid colon≥7.1mm (sHR=0.63, P=0.076). Small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum wall thickness were not significantly associated with death. Colorectal wall thickening, but not small bowel wall, may be considered for the prediction of further decompensation in cirrhosis.

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

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

Minute Colon Perforation by a Nonabsorbable Suture Knot after Uterine Myomectomy

We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)

Effect of bladder volume on radiation doses to organs at risk and tumor in cervical cancer during image-guided adaptive brachytherapy and treatment outcome analysis.

There is no consensus in clinical practice on the optimal bladder volume during brachytherapy. The present study aimed to assess the effect of bladder volume on radiation dose to organs at risk and tumor in cervical cancer during image-guided adaptive brachytherapy and clinical outcome. The retrospective study included patients treated at University of Hong Kong-Shenzhen Hospital between January 2015 and July 2019. Patients with International Federation of Gynecology and Obstetrics (2009) stage IB1-IVB (retroperitoneal lymph nodes metastasis only) cervical cancer treated by external beam radiotherapy with concurrent cisplatin followed by brachytherapy were assessed. A total of 421 brachytherapy insertions were analyzed. Every 83 and 90 cm3 (cc) increase in bladder volume led to an incremental raise of 1 Gy in bladder wall minimum dose received by the most irradiated 1 and 2 cc volumes (D1 and D2cc) of the bladder wall, respectively. An increase in bladder volume was associated with increased D1 and D2cc of bladder (both P<0.001, respectively) and rectal wall (P=0.150 and P=0.084, respectively), and decreased D1cc (P=0.003) and D2cc (P=0.001) of sigmoid wall, the maximum doses to the most minimally exposed 90 (D90) and 95% (D95) of the high risk-clinical target volume (HR-CTV; D90, P=0.010; D95, P=0.006). Patients with cumulative HR-CTV D90≤89.6 Gy had shorter median overall survival (OS) than those with cumulative HR-CTV D90>89.6 Gy (42.1 months vs. not reached, P=0.001). Patients with grade 2 acute urinary toxicity had significantly higher cumulative bladder wall D2cc than those with acute urinary toxicity<grade 2 (86.7±3.7 vs. 78.5±7.9 Gy; P=0.001). As the bladder volume increased, the dose to the bladder and rectal wall increase and dose to the sigmoid colon wall and HR-CTV decrease based on intracavitary brachytherapy. The higher dose of HR-CTV predicted better OS and the higher dose received by the bladder wall was associated with more grade 2 acute urinary toxicity.

S1831 A Case of a Foreign Body Embedded in the Sigmoid Colon

Introduction: Foreign body (FB) ingestion is a common occurrence, with most expected to pass spontaneously once in the lower gastrointestinal (GI) tract, distal to the ileocecal (IC) valve with no currently established management guidelines. Case Description/Methods: A 76-year-old female had 2 days of intermittent left lower quadrant pain and diarrhea. Abdominal exam was without peritoneal signs. She tested positive for COVID 19 with mild upper respiratory symptoms. Patient had history of bowel obstruction requiring surgery more than 20 years ago. CT abdomen showed a 5 cm linear, hyperattenuating FB in the sigmoid colon, without inflammation or perforation (Figure 1A). She denied swallowing a FB. Conservative management with Miralax, docusate, and clear liquid diet for 3 days failed as her abdominal pain persisted and daily X-rays were unchanged despite daily bowel movements. Repeat CT showed unchanged location of the FB, which was now embedded in the sigmoid wall, with local inflammation. Sigmoidoscopy revealed a 4 cm linear bone fragment embedded in the sigmoid colon wall, which was retrieved with rat-tooth forceps (Figure 1B). Her pain resolved within 24 hours. Discussion: Boney fragments are common sources of accidental FB ingestion. Iatrogenic sources are also reported, such as needles lost during dental procedures. Such sharp objects have a greater association with complications, including perforation and bleeding which can be life threatening. Size, shape, or number of objects are not always predictive of ability to transit the GI tract. Approximately 80% of objects pass spontaneously and are almost always expected to pass once they have advanced beyond the IC valve. Objects found within the upper GI tract are of common concern, with existing management guidelines, however there are currently no established management guidelines for ingested FBs within the lower GI tract. In our case, the object was expected to pass without endoscopic intervention, but failed to progress over 72 hours, and was instead embedded within the sigmoid colon wall. Although signs of complications, such as perforation typically present themselves clinically, there are sometimes cases of clinically “silent perforation” with sharp objects in the GI tract, which could be missed with conservative management. This case highlights the need for clearly established guidelines for the management of ingested FBs within the lower GI tract, with interval imaging and defined threshold for endoscopic intervention of particular importance.

Transmigration Of An Intrauterine Device Which Presents Abscess In Sigmoid Mesocolon

The intrauterine device (IUD) is an effective, reversible, widely used contraception method. After RIA placement, rare, serious complications such as migration to abdominopelvic viscera, pelvis, bladder, rectum and colon can be observed. A 33-year-old female had a previous history of IUD insertion in an external center presented emergency service with abdominal pain. Due to the presence of acute abdominal findings, explorative laparotomy was performed. The exploration revealed a RIA with a limited abscess formation migrated to the sigmoid colon wall and mesocolon. IUD was excised with limited mesocolon of sigmoid and primary suturing was performed. The patient was discharged uneventfully on the 7th postoperative day. Transmigration of IUD to sigmoid colon is a rare condition. Physicians should keep in mind that patients with a history of IUD who had changes in bowel habits and chronic pelvic pain symptoms may be a sign of colonic migration of IUD.

S1725 Case Report: Prostate Cancer Diagnosed on Rectosigmoid Biopsies in a Patient Presenting With Diarrhea

INTRODUCTION: Prostate cancer is the second most commonly diagnosed cancer in men worldwide. Despite the anatomic proximity, rectosigmoid involvement of prostate adenocarcinoma is rare. We present a case of metastatic prostate cancer diagnosed on rectosigmoid biopsies in a patient presenting with diarrhea and fecal urgency. CASE DESCRIPTION/METHODS: A 76-year-old male presented to clinic for evaluation of non-bloody diarrhea with associated fecal urgency. His medical history was significant for prostate adenocarcinoma diagnosed and treated nine years ago with prostatectomy, radiation, and androgen deprivation therapy (ADT). On current presentation, labs showed a normal complete blood cell count, TSH, and tissue transglutaminase IgA. Stool studies were negative for gastrointestinal pathogens. A colonoscopy was performed which demonstrated a normal terminal ileum, sigmoid diverticulosis, and mild radiation proctitis. Random colon biopsies showed changes consistent with collagenous colitis. Treatment for collagenous colitis was initiated, however, three months later the patient continued to have diarrhea as well as new onset abdominal pain, nausea, vomiting, and weight loss. Imaging showed sigmoid colon wall thickening, an ill-defined soft tissue mass in the pelvis, and lymphadenopathy. Flexible sigmoidoscopy revealed congested and erythematous mucosa beginning at 10cm from the anal verge with multiple clean based ulcerations. Targeted biopsies revealed a population of keratin positive cells with limited differentiation and positive PSA staining consistent with poorly differentiated adenocarcinoma of prostate origin, likely from lymphangitic spread. The patient was diagnosed with metastatic castrate-resistant prostate adenocarcinoma and started on ADT. DISCUSSION: Rectosigmoid involvement by prostate adenocarcinoma is rare and review of available literature suggests at least three potential routes of involvement including direct invasion through Denonvilliers’ fascia, lymphatic metastasis, and implantation after transrectal biopsy. Rectosigmoid involvement of prostate adenocarcinoma may present with symptoms including change in bowel habits, rectal urgency, lower gastrointestinal bleeding, and pelvic pain. The case presented here emphasizes the importance of including prostate adenocarcinoma on the differential diagnosis in men presenting with lower gastrointestinal symptoms and abnormal rectosigmoid mucosa on colonoscopy, especially in patients older than 65 years or with a history of prostate adenocarcinoma.Figure 1.: Congested and erythematous mucosa starting approximately 10 cm from the anal verge.Figure 2.: Rectosigmoid ulcerations with surrounding erythematous mucosa.Figure 3.: Ill-defined soft tissue mass in the peri-rectal region with lymphadenopathy.

Basics of vascular damage and progress of diagnosis and treatment in radiation intestinal injury

Radiation intestinal injury is one of the most common complications after abdominal pelvic radiotherapy, which seriously affects the quality of life for patients. According to the site of occurrence, it is divided into radiation enteritis, colitis and proctitis. The pathological characteristics of radiation intestinal injury mainly include interstitial fibrosis, mucosal edema, ulcers, and inflammatory cell infiltration, and significant vascular lesions as well. It showed telangiectasia and hemorrhage under endoscopy. Under ultrasound examination, it showed diffusive thickening of the intestinal wall and increased blood flow signals. In addition, it also has other features such as increased thickness of the distal sigmoid colon and rectal wall, and increased width of the presacral space. The key factors in the incidence and development of radiation intestinal injury include angiostatin, PDGF, CXCL16, etc. The mechanisms to be clarified include abnormally heightened angiostatin through which signal pathways specifically affect vascular endothelial cells and inhibit angiogenesis and vascular homeostasis, how CXCL16 expressed by macrophages interacting with receptor promotes the transformation of fibroblasts and vascular smooth muscle cells into myofibroblasts, etc. Therapy targeted on basics of vascular damage will be a promising field of radiation intestinal injury research.

Ureteric mapping with Indocyanine green: A new tool to prevent ureteral injury in complex gynecological surgery

Introduction: The aim of this video is to show that ureteric injection of Indocyanine green dye in difficult gynecological operations is a useful tool to identify and safeguard ureters. Case description: A 56-year-old lady with a large 10.5 × 14.5 × 13 cm3 multiloculated endometriotic cyst in the right adnexa was scheduled for robotic-assisted hysterectomy with bilateral salphingooophorectomy. She had undergone a laparotomy and three laparoscopic surgeries for endometriosis and fibroid uterus. Before starting surgery, cystoscopy was performed and with 6 Fr ureteral catheter inserted into ureteral orifice, 5 mL of 0.5% Indocyanine green dye (Aurolab, Madurai, India) was injected into both ureters. Intraoperatively bilateral adnexal cysts were seen densely adherent to omentum, sigmoid colon, sigmoid mesocolon, bladder, and lateral pelvic wall. Bladder and rectosigmoid were pulled up both anteriorly and posteriorly, respectively, and densely adherent to uterus and to adnexal cysts. During surgery, the course of ureter was identified by the green fluorescence emitted by the Indocyanine green dye under near-infrared light on da Vinci Xi camera. During this difficult surgery, the real-time visualization of ureteric course helped to identify and safeguard ureter during adhesiolysis and surgery could be completed without any injury to ureter. Patient did not experience any side effects due to the ureteric Indocyanine green injection. Conclusion: Endometriosis can distort the pelvic anatomy making surgery very challenging. Identifying the course of ureter during surgery can help in avoiding injuries and reduce surgical morbidity.

Pneumatosis Intestinalis in COVID-19

A 72-year-old man with multiple comorbidities presented with diffuse abdominal pain and bleeding per rectum for 1 day. He denied any respiratory symptoms; however, he did test positive for coronavirus disease 2019 (COVID-19) during screening in his nursing home recently. On arrival, he was febrile (104℉) but hemodynamically stable. Physical examination revealed a distended and diffusely tender abdomen without guarding. Computed tomography of abdomen showed descending and sigmoid colon wall thickening and mid-ascending colon pneumatosis without portal venous gas. This was suggestive of COVID-19–induced ischemic colitis with partial bowel obstruction in the absence of other provoking factors. Patient was treated conservatively with bowel rest, adequate hydration, and intravenous antibiotics. Although his gastrointestinal symptoms improved, his condition was subsequently complicated by sepsis, cardiac ischemia, renal insufficiency, and respiratory failure related to severe COVID-19 infection. Pneumatosis intestinalis is an uncommon condition identified by multiple gas-filled cysts in the intestinal submucosa/serosa on imaging. Rupture of these cysts causes pneumoperitoneum, which mandates emergent surgical intervention. The pathophysiology of this condition is still under speculation; however, it has been associated with many gastrointestinal and pulmonary conditions. Because of this patient’s absence of initial respiratory symptoms, the hypercoagulability and thromboinflammation associated with COVID-19 may be the culprit leading to bowel ischemia.

Mycosis fungoïde with CD30 large cell transformation accompanied by hidden adenocarcinoma of the colon: a case report

Mycosis fungoides is the most common subtype of primary cutaneous T-cell lymphoma, its evolution is indolent, except in the case of transformation into large T-cell lymphoma. A 63-year-old patient, he has a stage IB mycosis fungoid for 4 years treated by topical corticosteroids associated with methotrexate. Then he had progressed to stage IIb, treated by PUVA (photochemotherapy) and acitretin with complete remission and then relapsed, with the appearance of tumors, and adenopathy, the extension assessment had objectified a transformed CD30 mycosis fungoid, with a lymph node localization of T lymphoma, the patient is classified as stage IIIB. Thoracic-abdomino-pelvic CT had shown a thickening of the sigmoid colon wall, completed by colonoscopy, whose colon biopsy had objectified a colonic adenocarcinoma. The association of colonic adenocarcinoma and a mycosis fongoide is rare, a pathophysiology is poorly understood, suggests a probably genetic predisposition.

1652 Missing Intrauterine Device Rediscovered in a Sigmoid Colon Polyp Nearly a Decade After Insertion

INTRODUCTION: Intrauterine devices (IUD) are a popular form of contraception with an overall low risk of complications. We report a patient with an IUD placed 8 years ago with the rare incidence of asymptomatic migration into a sigmoid polyp discovered with colonic rectal ultrasound requiring surgical removal. CASE DESCRIPTION/METHODS: A 50-year-old gravida 5 para 5 female presented with right lower quadrant pain for 1 week. Pain described as intermittent and radiating to her right flank. Last menstrual period was 3 weeks prior to presentation. She denied any fever, nausea, vomiting, vaginal bleeding, hematochezia or melena. History included IUD placement 8 years ago, nevertheless became pregnant. At that time, patient was informed her IUD had fallen out and proceeded with tubal ligation postpartum. Labs were within normal limits with a negative urine analysis and pregnancy test. Computed tomography of the abdomen/pelvis demonstrated translocation of IUD to the sigmoid colon wall. Gastroenterology performed a colonoscopy with rectal ultrasound that confirmed a metallic object in a sigmoid colonic polypoid lesion. Subsequently, general surgery performed a robotic assisted laparoscopic sigmoid colon resection. Her abdominal pain subsidized and patient was discharged home in stable condition. DISCUSSION: Uterine perforation and migration into abdominopelvic structures is a known, but rare complication to IUD usage, at a rate of less than 1 per 1000 applications. Perforation generally occurs during IUD insertion and risk factors include anatomically flexed uterus, clinician inexperience, and placement postpartum when the uterus is relatively thin walled. Many cases of perforation are asymptomatic and not discovered until years later. However, relatively few cases in the literature describe perforation with migration into the sigmoid colon. Reported cases describe IUDs placed postpartum becoming embedded in the uterus, with subsequent pregnancy, and uterine contractions forcing the IUD through the uterine wall and into the pelvic cavity. Treatment typically involves endoscopic foreign body retrieval. However, cases at high risk for bleeding or endoscopic limitations require surgical laparoscopy for safe removal. We highlight the utility of colonic ultrasound as safe and minimally invasive procedure to establish the diagnosis. While typically asymptomatic, migrated IUDs are a serious complication that can be diagnosed through computed tomography or colonic ultrasound requiring prompt foreign body removal.

IMPACT OF BLADDER DISTENSION ON ORGANS AT RISK IN 3D INTRACAVITARY BRACHYTHERAPY FOR CERVICAL CANCER

Objectives:&#x0D; To determine the effects of bladder distension on organs at risk (OAR) during ICBT for cervical cancer with 3D Imaging based Planning. &#x0D; Materials and methods:&#x0D; Twenty-eight patients with cervical cancer who received high-dose radiation (HDR) brachytherapy using 7Gy x 4 fractions, were included in the study. For three-dimensional (3D) analysis, pelvic CT scans were obtained with indwelling catheters in place (defined as empty bladder) and repeated scans with 200-cc of sterile water in their bladders (defined as full bladder). To compare the International Commission on Radiation Units and Measurements (ICRU) point doses with 3D-volume doses, the volume dose was defined by using two different criteria, D2cc (the minimum dose value in a 2.0-cm3 volume receiving the highest dose) and D50% (the dose received by 50% of the volume of the OAR) for OARs. &#x0D; Results:&#x0D; For patients with a full bladder, the mean bladder D2cc increased from 395 to 558.4 cGy (41%, p &lt; 0.001). However, the bowel D2cc and sigmoid colon D2cc decreased from 477.4 to 216.1 cGy (55.0%, p &lt; 0.001) and 450.8 to 350.8 cGy (22%, p= 0.001), respectively. The mean D50% values of both the bladder and the bowel decreased from 301.6 to 227.3 cGy (25%, p &lt; 0.001) and from 116.5 to 74.3 cGy (36%, p &lt; 0.001) with a full bladder, respectively. The mean D50% for sigmoid colon also decreased from 148 cGy to 119.3 cGy (19%, p&lt; 0.001) with bladder distension. However, there was no significant difference in rectal D2cc and D50% values. &#x0D; Conclusion:&#x0D; Full bladder technique reduces sigmoid colon and bowel wall radiation exposure. The bladder gets a higher point dose and rectum remains unaffected.

A case of multiple parasitic leiomyomas as complication of incomplete myomectomy

Uterine leiomyoma is the most common neoplastic process affecting the female gynaecological tract, with an incidence of approximately 30% of women over 35.1 It is an entity that is easy to identify, diagnose and manage when it presents in the uterus. However as an extra-uterine presentation, it can become a diagnostic dilemma. Extra-uterine leiomyomas are known as parasitic leiomyomas. They were first identified in 1909 by Kelly and Cullen, however there has been an rise in the incidence since the increasing use of laparoscopic myomectomies with power morcellators.2 It is postulated that small fragments of leiomyoma implant themselves into the pelvic organs, like parasites, if not removed in its entirety. This case study presents a patient with multiple parasitic leiomyomas in the bladder, sigmoid colon, omentum, left adnexa, right adnexa and abdominal wall following 6 myomectomies over 5 years, the second with a power morcellator. This case study attempts to increase the awareness of this rare variant of uterine leiomyoma.

Invasive Moderately-Differentiated Mucinous Adenocarcinoma Incidentally Identified in Perforated Acute Diverticulitis With Abscess Formation

Colonic adenocarcinoma rarely arises within a diverticulum. As illustrated in this case report, such an occurrence presents difficulties in diagnosis, posed by the overlap of radiological findings in diverticulitis and adenocarcinoma and the potential absence of luminal lesion. Here we present a 77-year-old male with acute left lower abdominal pain, fever and leukocytosis. Computarized tomography (CT) imaging revealed extensive colonic diverticulosis, with sigmoid colon wall thickening, extraluminal air and a pericolic abscess. No enlarged lymph nodes were detected. The clinical diagnosis was acute sigmoid diverticulitis with micro-perforation and abscess formation. Partial sigmoidectomy was performed and diverticulitis confirmed; no tumor was identified in the resected colon. However, fragments of mucinous adenocarcinoma were incidentally recognized in the pericolic abscess contents. Immunohistochemical (IHC) studies supported a primary colonic adenocarcinoma, warranting further clinical workup. A subsequent distal sigmoidectomy revealed moderately-differentiated mucinous adenocarcinoma invading through the visceral peritoneum, and arising in a low-grade mucinous neoplasm within a diverticulum. The case illustrates that in a patient with diverticulitis and no evidence of a luminal neoplasm, the unexpected finding of adenocarcinoma in the resected bowel may be attributable to adenocarcinoma arising within a diverticulum.

The Effect of Scattering from Leg Region on Organ Doses in Prostate Brachytherapy for 103Pd, 125I and 131Cs Seeds

Introduction Dose calculation of tumor and surrounding tissues is essential during prostate brachytherapy. Three radioisotopes, namely, 125I, 103Pd, and 131Cs, are extensively used in this method. In this study, we aimed to calculate the received doses by the prostate and critical organs using the aforementioned radioactive seeds and to investigate the effect of scattering contribution for the legs on dose calculations. Materials and Methods The doses to organs of interest were calculated using MCNPX code and ORNL (Oak Ridge National Laboratory) phantom. Results Doses to the prostate as a source of radiation for 125I, 103Pd, and 131Cs were approximately 108.9, 97.7, and 81.5 Gy, respectively. Bladder, sigmoid colon, and testes received higher doses than other organs due to proximity to the prostate. Differences between the doses when tallying with the legs intact and with the legs voided were significant for testes, sigmoid colon contents, and sigmoid colon wall because of their proximity to the prostate. There was also a good consistency between our results and the data published by Montefiore Medical Center and Albert Einstein College of Medicine for the prostate. Conclusion Scattering from leg region had a significant effect on doses to testes, sigmoid colon contents, and sigmoid colon wall in the pelvic region, and prostate and the other organs were unaffected. Brachytherapy treatment plans using 131Cs seeds allow for better sparing of critical tissues, with a comparable number of, or fewer, seeds required, compared to 125I seeds.