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Gastric outlet obstruction due to an incarcerated stomach in a parastomal hernia is extremely rare. Here, we present the management of such a case with a review of the literature. A 79-year-old woman presented with a 3-week history of postprandial vomiting and associated parastomal and epigastric pain. She had a loop colostomy created for severe fecal incontinence secondary to anal stenosis. Imaging revealed a large parastomal hernia with an incarcerated gastric antrum. She was initially managed nonoperatively with a nasogastric tube. She underwent a semi-elective open Sugarbaker mesh repair of the parastomal hernia with good results. Gastric outlet obstruction secondary to incarceration of the stomach in a parastomal hernia is uncommon. A conservative approach with nasogastric tube decompression is a reasonable initial approach in a patient who is not critically unwell, which allows time for consideration of different parastomal hernia repair techniques. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic performance of a proposed new CT observation in cecal volvulus, marked hook-like curvature of ileocolic vessels termed "ileocolic vascular curvature." Methods: Contrast-enhanced CT scans of 14 patients with diagnoses of cecal volvulus on original CT reports were compared with scans of 40 control patients with dilated cecum but no cecal volvulus on original CT reports, accrued consecutively from January, 2006 through July, 2017. Two independent blinded readers retrospectively evaluated scans for cecal dilatation, ileocolic vascular curvature and seven previously reported CT features of cecal volvulus. Statistical methods included the exact binomial distribution to define 95% confidence intervals (95% CIs), logistic regression, receiver operating characteristic analysis, and the exact McNemar test. Pathology reports and clinical records served as reference standards. Results: All patients had abdominal pain and cecal distension. All 14 patients with CT diagnoses of cecal volvulus, and no control patients, had cecal volvulus by reference standards. Ileocolic vascular curvature and ectopic cecal location were the only features independently and significantly associated with cecal volvulus in multivariable regression (odds ratio 178, p = 0.014, and 63, p = 0.013, respectively) and also the only features with both sensitivity (12/14 [85.7%, 95% CI 57.2–98.2%] and 13/14 [92.9%, 95% CI 66.1–99.8%], respectively) and specificity (40/40 [100.0%, 95% CI 91.2–100.0%] and 38/40 [95.0%, 95% CI 83.1–99.4%], respectively) that differed significantly from 50.0%. Conclusions: Ileocolic vascular curvature was independently and significantly associated with cecal volvulus and exhibited both substantial sensitivity and substantial specificity for cecal volvulus, and thus is potentially a valuable new CT finding of cecal volvulus. [ABSTRACT FROM AUTHOR]

A lady in her 70s presented to hospital with sudden onset nausea and excessive vomiting. She had a constant and worsening abdominal pain that radiated to the back but was focused on her stoma in the left iliac fossa. The patient had bilateral hernias and colostomy following a Hartman's procedure for perforated diverticulosis in 2018 and had presented twice before in the last 6 months with similar symptoms. CT abdomen pelvis showed a large portion of the stomach in the parastomal hernia leading to a narrowing of the stomach at the hernia neck but no ischaemic changes. She was diagnosed with bowel obstruction and successfully treated with fluid resuscitation, proton pump inhibitors, analgesia, antiemetics and decompression of the stomach using large bore nasogastric tube. A total of 2600 ml fluid was aspirated in 24 h and her stoma restarted normal output. After 10 days she was discharged home. [ABSTRACT FROM AUTHOR]

Colo-salpingeal fistulae due to acute diverticulitis are rare entities. A 65-year-old female with a 5-day history of left iliac fossa pain, fevers and diarrhoea was seen in a metropolitan hospital. Initial computed tomography of the abdomen and pelvis characterized a left tubular adnexal structure with an air fluid level and normal-appearing colon and was reported as pyosalpingitis. Worsening sepsis despite antibiotics prompted further imaging where thickening of the sigmoid colon was noted, and the provisional diagnosis was revised to complicated acute diverticulitis with perforation into the left fallopian tube/ovary. This was managed with a laparoscopic anterior resection and en bloc left salpingo-oopherectomy, and was followed by an uneventful recovery. The presence of a gas-containing collection remains a sensitive imaging sign for the presence of an enteric fistula and a high index of suspicion should be maintained when this is encountered. [ABSTRACT FROM AUTHOR]

Introduction: Bone metastasis is a rare site of metastasis, seen in only 3.7-11% of clinical cases. Isolated bone involvement has been reported very rarely in literature. Moreover, the patients who have bone metastasis at presentation are even rare.Objectives: To discuss the demographic characteristics, carcinoembryonic antigen (CEA) levels, pattern of bone involvement, and their correlation with survival in patients of colorectal cancer that have bone metastasis at the time of presentation.Materials and Methods: Retrospectively, tumor registry was analyzed for the cases of colorectal cancer presenting with bone metastasis between 2008 and 2013. Survival curves were generated by Kaplan-Meier method and analyzed using the log-rank test.Results: Ten such patients were identified (male:female = 7:3) of the total 410 patients. Median age was 41 years (22-50 years). All patients were Conclusions: In this study, the patients of colorectal cancer presenting with bone metastasis were of male sex and younger age. The factors that were associated with reduced survival were extraosseous and liver involvement. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical features and prognoses of patients with diagnosed bone metastases from colorectal cancer (CRC). Methods: This was a 16-year retrospective study of 32 patients with bone metastases secondary to CRC, who were seen at National Kokura Hospital between 1993 and 2008. The influence of clinical and pathologic variables on survival was assessed by univariate and multivariate analyses. Results: The bone most commonly involved was the spinal column. The mean disease-free interval was 17.6 months and mean survival from the diagnosis of bone metastases was 9.3 months. On univariate analysis, the serum CEA level at the time of diagnosis of bone metastases ( p = 0.020) and history of pulmonary metastases ( p = 0.013) were significant. On multivariate analysis, a history of bone metastases in the ribs (hazard ratio 3.669, p = 0.025) and a history of pulmonary metastases (hazard ratio 3.854, p = 0.022) significantly affected survival. Conclusions: It is important to investigate for bone metastases in patients who complain of back pain and lumbago after CRC surgery. [ABSTRACT FROM AUTHOR]

A comprehensive review of intraluminal duodenal diverticulum (IDD) is presented, along with a report of a completely laparoscopic excision of this duodenal abnormality as well as a report of magnetic resonance cholangiopancreatography demonstrating the classic fluoroscopic 'wind sock sign' pathognomonic appearance of IDD. IDD may easily be missed unless one specifically considers this entity in patients presenting with symptoms of foregut disease. Patients with IDD typically present in the fourth decade of life with duration of symptoms less than 5 years that typically include pain, nausea and vomiting, pancreatitis, and gastrointestinal bleeding. Diagnosis usually requires imaging studies and upper gastrointestinal endoscopy. Laparoscopic excision is recommended because of superior visualization of significant intestinal anatomic abnormalities, the need for accurate ampullary localization, and the ability to facilitate complete diverticular excision while maintaining biliary and pancreatic ductal integrity. Review of surgical literature suggests that IDD results from congenital duodenal developmental abnormalities matured by long-term duodenal peristalsis. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to characterize formally the mesocolic anatomy during and following total mesocolic excision. Total mesocolic excision may improve survival in patients with colon cancer. Although this requires a detailed knowledge of normal and variant mesocolic anatomy, the latter is poorly characterized. No studies have prospectively characterized the anatomy of the entire mesocolon. Method Total mesocolic excision was performed in 109 patients undergoing total abdominal colectomy. The mesocolon was maintained intact thereby permitting a precise anatomical characterization from ileocaecal to mesorectal levels. Two- and three-dimensional schematic reconstructions were generated to illustrate in situ conformation. Results Several previously undocumented findings emerged, including: (i) the mesocolon was continuous from ileocaecal to rectosigmoid level; (ii) a mesenteric confluence occurred at the ileocaecal and rectosigmoid junction as well as at the hepatic and splenic flexures; (iii) each flexure (and ileocaecal junction) was a complex of peritoneal and omental attachments to the colon centred on a mesenteric confluence; (iv) the proximal rectum originated at the confluence of the mesorectum and mesosigmoid; and (v) a plane occupied by Toldt's fascia separated the entire apposed mesocolon from the retroperitoneum. Conclusion When the mesocolon is fully mobilized during a total mesocolic excision of the colon, several anatomical findings that have not been previously documented emerge. These findings provide a rationalization of the surgical, embryological and anatomical approaches to the mesocolon. This has implications for all related sciences. [ABSTRACT FROM AUTHOR]

Background: Colocolic intussusception is rare in children and most cases in adolescents are produced by a lead-point. A review of the English-written literature revealed only three cases of colocolic intussusception without lead point. Case presentation: A seven year-old boy with chief complaint of colicky abdominal pain and vomiting for five days, dysentery for 4 days, and no response to antibiotic therapy, increasing pain and abdominal distension was referred to pediatric gastroenterologist. Abdominal x-ray revealed multiple air-fluid levels and gasless colon. Pseudo-kidney appearance was reported in abdominal ultrasound at splenic flexure. Colocolic intussusception diagnosis without any lead point was confirmed in laparotomy and reduced with milk-out procedure. Conclusion: In children with dysentery especially in presence of colicky abdominal pain, abdominal distention and no response to antibiotic therapy, abdominal ultrasound to rule out I intussusception is recommended. [ABSTRACT FROM AUTHOR]

Background: Large-bowel volvulus is a rare cause of bowel obstruction in the industrialized world. We analyzed the presentation and outcome of 49 patients at the Princess Alexandra Hospital, Brisbane, Australia, who received a diagnosis of colonic volvulus from 1991 to 2001. Methods: A retrospective chart study was carried out. Results: Twenty-nine patients had sigmoid volvulus (59%), 19 patients had cecal volvulus (39%) and 1 patient had a transverse colon volvulus (2%). The diagnosis of sigmoid volvulus was made accurately on plain abdominal radiography or contrast enema in 90% of cases (n = 26), compared with only 42% of cases (n = 8) of cecal volvulus. Twenty-two patients with sigmoid volvulus were treated initially with endoscopic decompression. The success rate was 64% (n = 14). There was a high early recurrence rate of sigmoid volvulus for those treated by endoscopic decompression alone (43%) during a mean period of 32 days. Of the 14 patients with cecal volvulus who were treated with right hemicolectomy, 12 had primary anastomosis and 2 had end ileostomy with mucous fistula formation. There was no anastomotic leak following right hemicolectomy with primary anastomosis, even though 6 of these patients had an ischemic cecum. Conclusions: Endoscopic decompression of the sigmoid volvulus was safe and effective as an initial treatment but has a high early recurrence rate. Any patient who is fit enough to undergo operation should have a definitive procedure during the same admission to avoid recurrence. Cecal volvulus is associated with a higher incidence of gangrene and is treated effectively by right hemicolectomy with or without anastomosis. The need for swift operative intervention is emphasized. [ABSTRACT FROM AUTHOR]

The article presents a medical study examining the advantage of colonoscopy colorectal cancer screening in very elderly patients. The purpose of the study was to evaluate the approximate number of years saved with screening colonoscopy in very elderly patients versus younger patients. The article discusses the prevalence of colon neoplasia, the progression of adenomas to colorectal cancer, life expectancy, potential benefits and risks of screening colonoscopy in very elderly patients, and patient preferences.

Diseases of the large bowel are common in older patients and many of these, notably polyps, cancer, diverticular disease and ischemia, increase in incidence with age. A variety of imaging modalities are available in clinical practice but the choice of investigation should take into consideration not only its diagnostic yield but also the ability of the older patient to undergo the procedure with minimal discomfort. Perhaps more important is whether that investigation is likely to have an effect on the overall management of the patient. [ABSTRACT FROM AUTHOR]

PURPOSE: There are very few studies on the development of early colorectal cancers, although we have previously reported growth speeds of early colorectal cancer in a radiographic retrospective study. The aim of this study was to estimate a statistical curve for cancer growth from mucosal cancer. METHODS: Subjects of the study were 31 patients with cancer in which initial lesions were diagnosed as mucosal cancer. These lesions were overlooked in the first or second investigations, but were detected later. Initial radiographic features were as follows: 4 pedunculated lesions, 1 semipedunculated lesion, 6 sessile lesions, 9 superficially elevated lesions, and 11 superficially depressed lesions. The diameters of the initial lesions were 12.1 ± 6.1 mm. The final depths of invasion were 6 mucosal cancers, 12 submucosal cancers, 6 muscularis propria cancers, and 7 serosal cancers. The observation period between the initial and final examination was 41.5 ± 25.8 months. The growth curve was estimated by an exponential curve with the natural logarithm of d = e(a + b x c), where a is the intercept (initial tumor size) and b is the regression coefficient (growth speed). RESULTS: A growth curve was obtained as follows: diameter = 12.5 x 2(t/77) (r = 0.448, P < 0.0001) and 95 percent confidence interval of time = 53 to 173 months. Subsequently, volume = 1 x 10³ x 2(t/26), and the 95 percent confidence interval of time = 18 to 58 months. CONCLUSION: Growth speed of early colorectal cancer was estimated through a statistically significant growth curve. Estimated doubling time of the volume of early colorectal cancer was 26 (95 percent confidence interval, 18-58) months. From these results we could obtain a rational cancer surveillance program using appropriate procedures with different sensitivities. [ABSTRACT FROM AUTHOR]

We describe herein an extremely rare case of clear cell type ovarian carcinoma resulting in fistula formation into the colon and intestine. The patient was a 61-year-old woman in whom a large tumor with extravasation from the sigmoid colon was found by barium enema examination. The tumor was preoperatively diagnosed as left ovarian cancer by angiography which showed the tumor feeder arising from the left ovarian and uterine arteries. [ABSTRACT FROM AUTHOR]

A 42-year-old male patient presented with a history of persistent pain in the right femur without trauma of 2 months, duration and an episode of bloody stools 3 months earlier with no clinical findings upon examination. X-rays and CT scan revealed a circumscribed lesion with sclerosis and periostal reaction in the right proximal femur. A three-phase bone scan showed a massive hot spot in this area. Primarily differential diagnoses included a Brodie's abscess and/or a tumor. An excisonal biopsy of the area was performed and revealed the coexistence of a bone infarction and the metastasis of an adenocarcinoma of unknown origin. The lesion in the bone was resected, filled with autogenous cancellous bone and stabilized with a plate. Further intensive screening with CT of the abdomen, gastroscopy and colonoscopy led to the primary tumor, an adenocarcinoma at the rectosigmoidal junction. No other metastases were detected. This patient presented with severe pain an radiologically divergent findings: a presumably benign process on radiography, but a massive hot spot on scintigraphy. Further procedures such as a CT scan and/or MRI had to be undertaken. If the analysis includes the differential diagnosis of a malignant process, a biopsy must be obtained, and if this reveals a metastasis, the primary tumor must be sought. [ABSTRACT FROM AUTHOR]

A case of sigmoid colon fistula complicating ovarian cystadenocarcinoma is reported. The entity demonstrated a large air-filled, thin-walled cystic lesion during barium enema examination. The differential diagnosis of distended air-filled cystic lesions is discussed and expanded to include colonic fistula complicating ovarian neoplasms. [ABSTRACT FROM AUTHOR]

Defective fixation during embryologic development is responsible for a variety of segmental colonic malpositions seen during barium enema examinations. A review of the normal development process of fixation is presented, together with the most common and significant aberrations. On the right side clinical entities such as axial torsion, cecal bascule, retrocolic sigmoid, and pericolic bands are discussed and illustrated. On the left side, the configuration and clinical implications of the malposition of the splenic flexure are analyzed. It is pointed out that reversed configurations of the splenic flexure associated with failure of fixation of the entire descending colon may occur as an isolated congenital abnormality and may not necessarily be associated with renal anomalies. The characteristic radiographic appearance of the persistent descending mesocolon and its potential for complications is in addition emphasized. Familiarization with the radiographic appearance and clinical implications of these common abnormalities is essential in the daily interpretation of barium enema examinations. [ABSTRACT FROM AUTHOR]

The incidence of bone metastasis from colorectal cancer is reported to be 10.7% in autopsy cases. However, the characteristics of the primary cancers, as well as the patterns of bone metastasis, remain unclear. We analyzed the clinical and autopsy records of 118 patients with primary colorectal cancer treated either surgically or conservatively and eventually autopsied between 1970 and 1987 at Toranomon Hospital in Tokyo. Bone metastasis was detected in 23.7% (28/118). The average age of patients with bone metastasis was lower than that in patients without bone metastasis (P < 0.02). Cancers to the rectum and cecum were accompanied by bone metastasis more frequently than cancers of other portions of the colon. Signet-ring cell carcinoma showed a high incidence of bone metastasis (P = 0.041). Bone metastasis from colorectal cancer was associated with liver or lung metastases (P < 0.0001). These results indicated that bone metastasis from colorectal cancer is not as infrequent as previously described. [ABSTRACT FROM AUTHOR]

With the development of colonoscopy and double-contrast barium enema, detection of minute sessile coIonic adenomas has increased. We evaluated progression of these lesions radiologically and attempted to clarify the natural history.A total of 125 minute sessile adenomas (≤5 mm in size) with histologic confirmation were examined by double-contrast barium enema at an interval of more than one year. The average follow-up period was 24 (range, 12-36; standard deviation, 9-4) months. To allow for differences in magnification, adenomas increasing in size by 2 mm or more were defined as growing, and the other lesions were defined as unchanged.Eighty-six adenomas showed no interval change in size. Four adenomas decreased 1 mm in size, and 27 adenomas increased 1 mm in size. The remaining eight adenomas (6 percent) increased by 2 or 3 mm in size. None of the adenomas showed any morphologic changes. There was also no difference in degree of histologic atypia between growing and unchanged adenomas. None of the adenomas developed into carcinomas during the follow-up period.These data show that most minute sessile adenomas remain unchanged in size and morphology over the long term. Accordingly, these adenomas probably should be followed up radiologically or endoscopically to avoid excessive polypectomy. [ABSTRACT FROM AUTHOR]

A review of 561 cases of cecal volvulus that were published between 1959 and 1989 along with 7 new cases, was performed to characterize the clinical and laboratory profile and to evaluate the various surgical options in treating this life-threatening condition. The age and sex distribution of these patients have changed over the years and shifted toward older patients (mean, 53 years) and female predominance (female:male ratio, 1.4:1). The clinical presentation was usually of distal closed-loop small bowel obstruction. Forty-six percent of the plain abdominal radiographs were suspected for cecal volvulus, but only 17 percent were diagnostic. Barium enema had a high rate of accuracy (88 percent) and was associated with minimal complications. True volvulus was 6 times more common than bascule, and gangrenous cecum was found in 20 percent of cases. Detorsion alone and cecopexy had almost similar complications, mortality, and recurrence rates (15, 10, and 13 percent, respectively), whereas, resection, which was performed primarily for gangrenous cecum, had higher rates. However, the highest rates of complications (52 percent), mortality (22 percent), and recurrence (14 percent) were noticed after cecostomy. These data suggest that resection should be reserved for patients with necrotic cecum and that detorsion is sufficient for patients with viable cecum. Cecostomy should be abandoned. [ABSTRACT FROM AUTHOR]

The management of cecal volvulus is controversial. From 1971 to 1986, 26 patients with cecal volvulus were treated at Malmö General Hospital. Treatment and patient follow-up are presented, together with a review of 350 patients reported in the literature during the past 15 years. Anatomic background and types of volvulus are described. Simple detorsion is an alternative in high-risk patients without gangrene, but resection is the method of choice also when there is no gangrene present. [ABSTRACT FROM AUTHOR]

Volvulus of the transverse colon is rare. Sixty-six cases have been reported in the English medical literature, and three new cases are presented herein. The causative factors, classical clinical presentation, radiologic findings, and management have been addressed. It is believed that colonoscopy will have an increasing role in the diagnosis and treatment of this condition in the future. [ABSTRACT FROM AUTHOR]

Motor complications are uncommon manifestations of herpes zoster. This report describes two cases of gastrointestinal visceral motor manifestations associated with dermatomal herpes zoster and reviews the English-language literature since 1900. The 17 cases reviewed were divided clinically into two groups: colonic pseudo-obstruction and localized colonic spasm. Characteristics of the patients, radiographic study results, endoscopic findings, proposed pathogenesis, and management options are discussed. It is important to recognize this manifestation in order to institute proper management and avoid unnecessary surgery, given the complete resolution with conservative management in most cases. [ABSTRACT FROM PUBLISHER]

Examines the roentgenogram signs of obstructive cecal volvulus. Basic abnormality in cecal volvulus; Roentgen features of a dilated cecum; Significance of the ileocecal valve in locating a displaced cecum.

Discusses concepts and controversies concerning the management of patients with polypoid lesions of the colon. Reasons for removing the lesions; Patients who may be at higher risk to develop adenomas and carcinoma of the colon; Significance of follow-up colonoscopy and double contrast barium air enema in patients with multiple benign polyps.

A case of gallstone obturation of the duodenal bulb is presented. The general topic of gallstone ileus is briefly discussed and a review of the reported eases of Bouveret's syndrome is presented. The radiographic criteria for diagnosis of these entities are emphasized. [ABSTRACT FROM AUTHOR]

Cholecystoenteric fistulas, not associated with gallstone ileus syndrome, are relatively common complications occurring during the natural history of cholelithiasis and cholecystitis. The etiology, pathogenesis as well as common and uncommon forms of gallbladder fistulas are presented and discussed. The roentgenographic findings are reviewed and a simple classification into two major groups is offered. The majority are acute, transitory, short-lived fistulas, which are self-limiting and relatively common events that usually remain undiagnosed. A minority fail to heal, become chronic and permanent fistulas and are associated with obstruction of the common duct. [ABSTRACT FROM AUTHOR]

Presents the case of a 69-year old white male who experienced paralytic distention of the small intestine simulating small bowel obstruction following diphenoxylate hydrochloride intoxication. Dosage of demerol tablet taken by the patient prior to hospitalization; Laboratory findings at the time of admission; Reason for the radiologist's decision to recommend barium enema examination; Findings of the film studies done to the patient.

The article presents a case study of a 85-year-old woman taken to the emergency department due to acute incarceration of a known left-sided parastomal hernia, linked with severe pain localized to the hernia site and profuse vomiting. The patient underwent laparoscopy, revealing a reduced parastomal hernia containing omentum, and later on was converted to laparotomy due to the size of the defect and uncertain hernia contents.

Primary carcinoma of the gastrointestinal tract rarely presents with osseous metastases. The lumbar and thoracic spines are the most commonly reported sites of metastases. Cervical metastasis is rarely reported, but, when it occurs, is a late manifestation of the disease. We present a patient with an unusual case of colorectal cancer and cervical spine metastasis, who presented initially with neck pain. A vigilant approach to treatment is warranted to reduce the risk of neurological sequelae and to improve quality of life. [ABSTRACT FROM AUTHOR]

It has been frequently stated that barium enema has no value in the treatment of cecal volvulus. We present a patient with cecal volvulus who was effectively treated by barium enema; however, multiple studies were required to achieve optimal results. In a subset of patients with cecal volvulus, laparotomy may be avoided by the use of barium enema. [ABSTRACT FROM AUTHOR]

Comments on a case study wherein enterolithiasis was associated with ileal perforation in Crohn's disease. Information on Crohn's disease; Results of the patient's medical tests; Types of enteroliths; Requirements in the formation of radiopaque enteroliths.

An 69-year-old obese woman was submitted to an abdominoperineal resection (APR) with left side end colostomy to treat a synchronic sigmoid and middle rectum cancer. Six months after APR, she develop a PH with a progressive increase of the size. The patient refused the surgical indication. Thirteen years after APR she presenting with abdominal pain, hematemesis, bilious vomiting and non-functioning of the stoma in the last 2 days. She had a distended and painful abdomen without signs of peritoneal irritation and a large incarcerated PH. CT showed a PH with incarcerated gastric herniation. Endoscopy showed a 4 cm ulcerated lesion in the lesser curvature of the stomach whose posteriorly histopathological study revealed that it was an ischemic ulcer. She was submitted a correction of PH using an onlay polypropylene mesh put around of the previous stoma. The patient has an uneventful recovery and was discharged 3 days later. [ABSTRACT FROM AUTHOR]

A image quiz about crampy abdominal pain is presented.