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Background Iatrogenic ureteral injury (UI) is a potentially serious complication of colorectal cancer surgery. Performing perioperative placement of ureteral stents or intraoperative fluorescence navigation surgery for the ureter using indocyanine green (ICG) has been employed as a method of preventing UI. However, transileal conduit stent placement has been considered challenging because it is difficult to identify the ureteral orifice due to the anatomical changes caused by a previous surgery. We report a case in which laparoscopic colectomy was safely performed using a combination of prophylactic transileal conduit ureteral catheter placement and intraoperative ICG fluorescence navigation surgery. Case presentation A 75-year-old man presented to our hospital complaining of vomiting and abdominal distension. He had a history of open total cystectomy and ileal conduit urinary diversion 11 years prior to admission. Computed tomography confirmed colon dilation with fecal impaction from the ascending colon to the sigmoid colon and wall thickening in the sigmoid colon. Colonoscopy during the transanal ileus tube insertion revealed a Borrmann type II tumor with circumferential stenosis 10 cm distal to the junction between the descending colon and the sigmoid colon. The patient was diagnosed with colorectal ileus due to obstructive sigmoid colon cancer and underwent transanal ileus tube insertion. Severe intra-abdominal adhesions were expected due to the previous total cystectomy, and the left ureter was near the sigmoid colon tumor; therefore, prophylactic retrograde transileal conduit ureteral catheter placement was performed one day before the elective surgery. During the operation, 20 ml (5.0 × 10–2 mg/ml) ICG was administered from the transileal conduit ureteral catheter, and ICG fluorescence of the ureter was observed in the retroperitoneum. Laparoscopic Hartmann's operation was successfully performed, confirming ureter fluorescence. The operation time was 231 min, with 5 mL of intraoperative bleeding. The ureteral catheter was removed 3 days after the operation. The patient’s postoperative course was good with no complications, and he was discharged on postoperative day 7. Conclusions Prophylactic transileal conduit ureteral catheter placement and ICG fluorescence navigation surgery were effective in performing laparoscopic colorectal surgery with severe adhesions after urinary diversion.

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

Giant bilateral Krukenberg tumors are rarely seen, especially causing complications due to their size. We present a 35-year-old female, diagnosed with carcinoma rectum one year back, now presented to us with intestinal obstruction features. Imaging was suggestive of features of acute intestinal obstruction. Intraoperatively, we found that the patient had bilateral giant ovarian cysts, which compressed the proximal part of the descending colon, causing the obstruction. The patient underwent bilateral excision of the ovarian cyst with diversion sigmoid colostomy. Postoperatively the patient was started on palliative chemotherapy.

Lung carcinoma is the leading cause of death worldwide, with almost 50% of the patients presenting with distant metastases at the moment of diagnosis. The most common metastases sites are the lymph nodes, the liver, the adrenal glands, the bones, and the brain. The gastrointestinal tract was considered an unusual site for lung metastases, and due to the asymptomatic progress of the disease, they are usually diagnosed at a late stage. In the present case study, the clinical presentation, the treatment, and outcome of a rare case of descending colon and liver metastases from a lung squamous cell carcinoma in a 72-year-old female, two years after the presentation of her primary tumor are reported. The present study aims to increase the awareness for early diagnosis and treatment of metastatic lung cancer to the gastrointestinal tract.

Cattle have been suggested as the primary reservoirs of E. coli O157 mainly as a result of colonization of the recto-anal junction (RAJ) and subsequent shedding into the environment. Although a recent study reported different gene expression at RAJ between super-shedders (SS) and non-shedders (NS), the regulatory mechanisms of altered gene expression is unknown. This study aimed to investigate whether bovine non-coding RNAs play a role in regulating the differentially expressed (DE) genes between SS and NS, thus further influencing E. coli O157 shedding behavior in the animals through studying miRNAomes of the whole gastrointestinal tract including duodenum, proximal jejunum, distal jejunum, cecum, spiral colon, descending colon and rectum. The number of miRNAs detected in each intestinal region ranged from 390 ± 13 (duodenum) to 413 ± 49 (descending colon). Comparison between SS and NS revealed the number of differentially expressed (DE) miRNAs ranged from one (in descending colon) to eight (in distal jejunum), and through the whole gut, seven miRNAs were up-regulated and seven were down-regulated in SS. The distal jejunum and rectum were the regions where the most DE miRNAs were identified (eight and seven, respectively). The miRNAs, bta-miR-378b, bta-miR-2284j, and bta-miR-2284d were down-regulated in both distal jejunum and rectum of SS (log2fold-change: −2.7 to −3.8), bta-miR-2887 was down-regulated in the rectum of SS (log2fold-change: −3.2), and bta-miR-211 and bta-miR-29d-3p were up-regulated in the rectum of SS (log2fold-change: 4.5 and 2.2). Functional analysis of these miRNAs indicated their potential regulatory role in host immune functions, including hematological system development and immune cell trafficking. Our findings suggest that altered expression of miRNA in the gut of SS may lead to differential regulation of immune functions involved in E. coli O157 super-shedding in cattle.

The outcome of surgery in patients who have recovered from severe coronavirus disease 2019 (COVID-19) is unknown. Herein, we present a case of an emergency operation for acute pan-peritonitis due to perforation of the descending colon diverticulum in a patient who recovered from severe COVID-19 pneumonia. A 59-year-old man, who had recovered from severe COVID-19 pneumonia ~6 months previously, developed acute pan-peritonitis due to perforation of a diverticulum in the descending colon. Emergency surgery was performed, and the perforation was sutured and closed. He was discharged from the hospital 13 days postoperatively. There was no relapse of COVID-19 during the perioperative period of peritonitis surgery. General perioperative management may, therefore, be sufficient in patients who have recovered from COVID-19.

Background and Aims: Colonoscopy surveillance depends on effective bowel preparation. Inadequate bowel preparation can lead to inaccurate clinical diagnosis, insufficient visualization of the colon and increased risk of missed diagnosis. This study aimed to compare the efficacy and safety of a novel Capsule Bowel Preparation (RitePrep), high-volume (2L) polyethylene glycol electrolyte solution (MoviPrep®) and low-volume (1L) polyethylene glycol electrolyte solution (Plenvu™).Methods: Patients (n = 120) were divided into three groups and were administered either RitePrep, MoviPrep® or Plenvu™ as a pre-colonoscopy bowel preparation followed by a colonoscopy at a single center. Validated Boston Bowel Preparation Score (BBPS) and bubble score were used to evaluate bowel cleanliness. Blood tests were also evaluated. The scores and the blood results were analyzed using Kruskal-Wallis and Chi-squared tests.Results: A total of 120 patients (median age of 55; 57 males) [RitePrep (n = 40), MoviPrep® (n = 40) and Plenvu™ (n = 40)] were included in the study. RitePrep was the most effective method for cleansing the bowel, with a significantly higher median BBPS compared to MoviPrep® and Plenvu™ (p = 0.006 and 0.024, respectively). Nearly 50% of the patients in Plenvu™ group showed increased serum osmolality disturbance. Nausea and vomiting were higher in Plenvu™ and MoviPrep® groups than RitePrep group.Conclusions: RitePrep was demonstrated to be a more effective and safe preparation than the other two preparations. RitePrep was not only well-tolerated by all patients; the preparation sufficiently cleared the ascending, transverse, and descending colon, enabling optimal visualization for the clinician. RitePrep was also much safer than the comparators, with no alteration in electrolytes measured. For both the clinician and the patient, RitePrep was the preferred preparation.

Background The optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. Material and methods This study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. Results Baseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786–3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530–2.952, p = 0.609). Conclusion The oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.

Objectives: Colon cancer emerges as a serious health problem in both men and women. Cancers in the colon have different genotypes and phenotypes according to the anatomical region. Tumors in ascending colon are usually diagnosed later, but it is more malignant than the descending and transverse colon, and the survival rates of patients are lower than other regions. The purpose of this study was to determine significantly high or low expressed genes in the ascending colon tumors by comparing all genome information obtained from cancer samples of ascending, transverse and descending colon. In concordance with all this information, another aim of the study was to identify the pathways to which the genes obtained from the colon in the large intestine and to determine their relationship with each other and to correlate them with the characteristics of cancer. Methods: Gene expression values for three subtypes of colon cancer as ascending, transverse, and descending were obtained from GEO (Gene Expression Omnibus) (GSE41258). Data included a total of 47 ascending, 18 transverse and 31 descending colon cancer patient samples. Linear regression analysis was performed to determine differentially expressed genes. Gene Cluster 3.0 was used in order to cluster the genes hierarchically. In addition to linear regression and hierarchical clustering, network analysis with multivariable genes was performed in Cytoscape application 3.8.2 using GeneMANIA. GSEA 4.1.0 (Gene Set Enrichment Analysis) was performed to understand the different genes among the specified groups. Results: As a result of these analyses, it was determined that there were 85 genes with high expression and 139 genes with low expression in the ascending colon tumor samples. It has been shown that these genes can differentiate tumor samples in the ascending colon better than tumor samples in other colon regions. Conclusion: Our findings are important for understanding the genome of ascending colon tumors; if these findings are confirmed in vitro and clinically, it may have potential to be revealed that the identified genes also have biomarker properties for tumors in the ascending colon.

Complete mesocolic excision (CME) was introduced by Hohenberger and it is well standardized for right colonic cancer as well as for cancers of the descending colon and sigma. However, for tumors of distal transverse colon, splenic flexure, and proximal descending colon, the CME remains less homogeneous. This is probably due to the complex anatomy around the splenic flexure, subject to many vascular and lymphatic variations.

Background : Rectal tumors are uncommon in dogs and cats. The clinical signs result from intra- and extraluminal compression. Diagnosis and treatment of rectal tumors are challenging due to their intraplevic location. Owing to considerable bone superposition, computed tomography is the best exam to evaluate the tumor and plan surgery; however, poor availability and high costs may hinder its use. The objective of this case report is to describe the successful use of a combination of diagnostic techniques, namely transrectal ultrasound, transrectal fine-needle aspiration, and colonoscopy, for diagnosis and surgery planning in a case of intrapelvic intestinal leiomyoma in a dog. Case : A 13-year-old female mongrel dog with tenesmus, low stool production, and hematochezia for two months was presented for examination. During this two-month period, a symptomatic treatment was administered, but there was no clinical improvement. In the clinical evaluation revealed a painless mass on the left dorsolateral region, at a depth of around 4 cm, with considerable luminal reduction. Abdominal ultrasound revealed a mass close to the descending colon; however, bone superposition precluded identification of its origin or delimitation of its boundaries. The patient was subjected to transrectal ultrasound imaging, colonoscopy, and cytological examination of fine-needle aspiration biopsy material collected under general anesthesia. The mass was located at the final portion of the descending colon; it was extraluminal, and measured around 7 x 7 cm. The integrity of the intestinal wall was preserved. Next, radiographic examination of the thorax using three projections (ventrodorsal, left lateral, and right lateral) was performed to check for metastases, and no alteration was detected. Cytology suggested presence of leiomyoma. The patient underwent exploratory laparotomy with pubic osteotomy for intrapelvic access. The extraluminal mass was found adhered to the dorsal colorectal surface, whose serosa was compromised. The mass, which occupied around 80 to 90% of the pelvic canal, was completely removed and submitted to histopathological examination, which confirmed presence of proliferative neoplastic mesenchymal cells (intestinal leiomyoma). The patient's clinical picture evolved without intercurrences, and the patient was discharged 40 days after the pubic bone consolidation procedure. Discussion : The occurrence of leiomyomas in the colorectal segment of the intestine is rare in dogs. Neoplasms that develop in such a region of the intestine are usually more frequently found in elderly animals, such as the patient of this report. Leiomyomas are benign (non-invasive) neoplasms with slow growth. Consequently, clinical signs emerge when the mass exhibits a large size, which causes intra- or extraluminal compression, tenesmus, diminished production or absence of defecation, and hematochezia, as observed in the present case. Even though the clinical signs are similar in these cases, they are unspecific; consequently, for reaching a diagnosis, biopsy and histological investigation are required. In spite of the usefulness of these procedures for diagnosis, computed tomography is the exam of choice to investigate neoplasms in intrapelvic intestinal segments because it allows three-dimensional reconstruction of the affected structures and facilitates surgical planning. Unfortunately, computed tomography was not available for this case. Consequently, colonoscopy, transrectal ultrasound, and transrectal fine-needle aspiration biopsy were performed. When combined, these procedures allowed determination of the location, size and type of neoplasm, which were crucial pieces of information for the correct diagnosis and surgical planning, thus contributing for the successful management of the patient.

Background: The human gastrointestinal tract contains a complex and dynamic population of microorganisms, known as the gut microbiota. Critically, although interest in the role that the gut microbiota plays in human health has increased in recent years, there remains no standard sampling protocol for analyzing these organisms. Here, we aimed to characterize the microbial composition of distinct segments of the large intestine and to determine whether rectal swabs are suitable for identifying the colon microbiota. Methods: A total of 100 participants who underwent screening colonoscopy from October 2019 to October 2020 were included in this study. Large intestinal samples (ascending colon, descending colon, sigmoid colon, and rectum) were aspirated by colonoscopy. Rectal swabs were collected before colonoscopy, and stool samples were collected before patients began colonoscopy preparation. All samples were subjected to 16S ribosomal RNA gene sequencing. Findings: We identified differences in the number of phylum-level operational taxonomic units in large intestinal samples, rectal swabs, and stool. Five major phyla were detected in all samples (Firmicutes, Bacteroides, Proteobacteria, Actinobacteria, Fusobacteria), although their relative abundances varied. Notably, we found that the microbial composition of rectal swabs is most similar to those of the sigmoid colon and rectum, whereas the microbiota in stool are relatively different than those from the large intestine and rectal swabs. Interpretation: Our results reveal the existence of microbial heterogeneity within different large intestinal compartments and further suggest that rectal swabs are an acceptable and practical tool for gut microbiota analysis. Funding Information: This study was supported by MediCloud. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study was approved by Yongin Severance Institutional Review Board (IRB No 9-2019-0014) and was performed in compliance with the Declaration of Helsinki. Written consent was obtained from all patients prior to participation.

Modern colorectal surgery has given new impetus to the recognition of colon anatomy [1]. The cornerstone of the anatomical concept is the persisting embryological unit of an intestinal tube and its mesentery during postnatal life. The typical adult anatomy is the result of embryological rotations and secondary adhesions that simulate a loss of the mesentery in the region of the ascending and descending colon. However, the delineation of the colon/mesocolon unit from the retroperitoneum, the duodenum and in part the pancreas is represented by a thin fascial layer called the “mesocolic fascia” in accordance with the terminology of the mesorectum and its mesorectal fascia. The mesocolon, either covered by the mesocolic fascia alone or additionally by the peritoneum, provides the matrix for the blood supply, lymphatic drainage and the autonomic nerves of the bowel wall. There is no direct drainage toward the retroperitoneum as terms such as “partial” or “secondary retroperitoneal” imply; therefore this concept should be abandoned.

Small leucine-rich proteoglycans (SLRPs) regulate different processes and undergo significant alterations in various diseases. Colon carcinomas (CCs) are heterogeneous pathologies with important clinical and molecular differences depending on their location, which makes it interesting to analyze the alterations in SLRPs in right- and left-sided tumors (RS- and LSCCs). SLRP transcription levels were studied in 32 CCs using qPCR compared to healthy colon mucosae samples from the same patients, 20 of them from LSCCs and the remaining 12 from RSCCs. Protein expression of genes with significant differences in their transcriptions was analyzed by immunohistochemistry. The alterations observed were related to survival data. The arrangement of transcription of SLRPs was quite similar in ascending and descending colon, but RS- and LSCCs displayed different patterns of alteration, with a greater number of deregulations occurring in the latter. The analysis of protein expression also indicated changes in the location of these molecules, largely moving to the cell interior. While podocan underexpression showed a trend toward better outcomes, no differences were observed in terms of overall survival. In vitro studies using the HT29 tumor cell line suggest that deregulation of SLRPs could affect cell proliferation. SLRPs constitute new differential markers of RS- and LSCCs, showing differences dependent on the anatomical location of the tumor.

The right colon has many adjacent organs, complicated vasculature, and large anatomical variations. Therefore, NOSES VIII is one of the most difficult techniques in NOSES. Right colon cancer resection with transvaginal specimen extraction is limited to women. Extraction of the right colon specimen through the transverse colon, descending colon, sigmoid colon, rectum, and anus is theoretically feasible, but the actual operation is extremely difficult and impractical. The main operating features of NOSES VIII include complete dissection and transection of the right colon in the abdominal cavity, specimen extraction from the vagina, and totally laparoscopic functional end-to-end anastomosis between the terminal ileum and transverse colon. The main difficulties of this surgical procedure include the technical difficulties in laparoscopic right hemicolectomy and transvaginal specimen extraction. Specifically, the laparoscopic technical difficulties include the correct identification of anatomical landmarks, reasonable surgical approach and complete mesocolon resection, ligation of vessels, and dissection of lymph nodes at the root of the mesentery, and the exposure and protection of important tissues and organs. The NOSES technical difficulties include totally laparoscopic digestive tract reconstruction, which is more difficult than other procedures, and requires the surgeon and assistant to be more skillful. In the process of transvaginal specimen extraction, the application of aseptic and tumor-free techniques is crucial.

Cancer of the sigmoid and descending colon together accounts for about one-third of all colon cancers. For both sites, the lymph nodes along the inferior mesenteric artery are the main draining nodes.

Colonoscopy is a minimally invasive technique used to assess the large intestine through direct inspection of the intestinal mucosa. When associated with histopathological examination of fragments collected from the intestine, the definitive diagnosis can be obtained. This retrospective study evaluated colonoscopy and histopathological exams of the large intestine and ileum of dogs with gastrointestinal disorders admitted at the Veterinary Hospital of the Federal University of Minas Gerais (UFMG) and the Veterinary Hospital São Francisco de Assis to determine the frequency of injuries, their distribution in the intestinal segments, and the relationship of the findings observed in these two analyzes. The colonoscopy and histopathological findings of the case series were described using absolute and relative frequencies, as well as nature and intensity classification of the findings. Cohen’s Kappa coefficient was obtained to assess the concordance of nature and intensity classifications between colonoscopy and histopathology, and its 95% confidence interval constructed. The analyses were performed using the Software SAS University Edition. It was observed a moderate agreement between the classification of the nature of the findings by endoscopy and histopathology (Kappa coefficient = 0.39, CI = 0.20-0.59). This can also be observed when assessing the frequency of similar diagnoses between the methods, since only 39 (72.22%) were consistent, i.e., 15 (22.78%) diagnoses differed depending on the nature of the finding, which could have a great influence on the final diagnosis if histopathology was disregarded. For the intensity of the injuries, little agreement was observed between the methods (Kappa coefficient = 0.1243, C = -0.05-0.30). This was even more evident in the frequency of similar diagnoses in terms of intensity, of which 20 (37.04%) were similar and 34 (62.96%) were different. Inflammatory affections are the most frequently observed alterations in the large intestine and ileum of dogs. The most common finding that reveals inflammatory changes is the lymphoplasmacytic infiltrate. As for the proliferative and neoplastic lesions, adenomatous polyps and lymphoma were common. The most affected sites of the large intestine were the descending colon and the rectum. Findings such as edema and reddening of the mucosa were frequent by macroscopy. Although the changes observed by colonoscopy and histopathology may not be similar, these techniques are complementary, which makes biopsies mandatory for a diagnostic conclusion.

It is a novel technique of laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) colectomy whereby laparoscopic colonic mobilization, transection, and anastomosis are performed intracorporeally. The specimen is then delivered through the rectum using the Cai Tube (Homemade Invention: CN201420203735.X, Fig. 41.1), precluding the need for mini-laparotomy. Left-sided colonic carcinomas are defined as carcinomas located in the middle rectum, upper rectum, sigmoid colon, descending colon, and the splenic flexure of the colon.

Introduction Pyomyositis has been described in association with hematological malignancies. It is rarely associated with solid cancers, particularly colorectal carcinoma. Colorectal carcinoma can present with local or systemic abscesses by causing perforation of the colonic mucosa, followed by local or hematogenous spread of infection. Case presentation A 68-year-old male with a history of hypertension and type II diabetes mellitus presented to the emergency department with a 3-day history of left thigh pain. Magnetic resonance imaging of the thigh showed extensive intramuscular edema in the left thigh adductor and psoas muscles consistent with pyomyositis. An urgent debridement and irrigation of the left thigh revealed pan-sensitive Escherichia coli and Streptococcus viridans. Due to the suspicion of a gastrointestinal or genitourinary source of infection, computed tomography of the abdomen and pelvis showed an apple-core lesion along the mid-distal segment of the descending colon. Colonoscopy and biopsy confirmed the diagnosis of colonic adenocarcinoma. The patient underwent a laparoscopic left hemicolectomy with an end colostomy and was started on an adjuvant chemotherapy regimen with no significant side effects. Conclusion Colorectal carcinoma can be associated with local or systemic abscess formation. When cultures from an abscess show enteric pathogens, it is essential to look to gastrointestinal or genitourinary tracts for the source of infection. Although rare, the diagnosis of pyomyositis should warrant further investigations to unmask the possible underlying cause.

A 53‐year‐old man presented to a rural hospital with a sudden onset of severe epigastric pain, associated with vomiting and abdominal bloating. He reported his bowels had not opened in the previous 30 days. The computed tomography images of the abdomen demonstrated a large amount of free gas and fluid in the abdomen with an unclear site of perforation. Marked faecal loading of the large bowel was present from the rectum to descending colon, displacing other intra‐abdominal organs (Fig. 1). The patient rapidly deteriorated into septic shock, requiring intubation and inotropic support prior to regional hospital transfer.

Colonic lipomas are rare benign, non-epithelial tumors of mesenchymal origin. They are often solitary lesions of submucosal origin found in the proximal colon and typically measure less than 2 cm in size. Giant colonic lipomas are greater than 4 cm and present with non-specific gastrointestinal symptoms such as abdominal pain, abdominal distention, constipation, or gastrointestinal bleeding. Traditionally, giant colonic lipomas have been surgically rather than endoscopically resected due to concerns for bowel wall perforation and life-threatening hemorrhage. However, in recent years, advances in endoscopic tools and hemostatic techniques have lessened these risks. The following case details the successful endoscopic resection of an intermittently obstructing giant colonic lipoma (6 cm) located in the descending colon utilizing the loop-assisted-snare resection technique.

Author(s): Warner, Matthew; Durrani, Muhammad | Abstract: Case Presentation: A 48-year-old-female presented to the emergency department with dislodgement of her percutaneous endoscopic gastrostomy (PEG) tube, necessitating bedside replacement. Replacement was done without difficulty and gastrografin radiography was obtained to confirm positioning. Radiography revealed contrast filling the colon at the splenic flexure and proximal descending colon suggestive of colocutaneous fistula formation.Discussion: The patient required hospitalization with surgical consultation, initiation of parenteral nutrition, and conservative management of the fistula with surgical replacement of the PEG tube. Although rare, it is paramount for the emergency physician to be aware of this complication when undertaking bedside replacement of PEG tubes.

Colorectal anatomy includes the area from the ileocecal valve to the anus. Parts of the colon are cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. A major part of the transverse and sigmoid colon is intraperitoneal. The blood perfusion of colon is supplied by superior and inferior mesenteric arteries. The branches coming from the internal iliac artery provide the perfusion of the rectum and the anal canal. Venous circulation follows the arteries and drains into the portal system through superior and inferior mesenteric vein. Middle and inferior rectal vein which provides the venous drainage of the distal rectum and anal canal drains to the systemic circulation through internal iliac vein. The lymphatics of the colon follow the vessels and are divided into four groups. Epicolic and paracolic lymph nodes are located along the intermediate and marginal arteries. Innervation is provided through the sympathetic and parasympathetic autonomic nerves. Distal part of the anal canal contains motor and sensory nerves. A good knowledge of the anatomy of this area is extremely important for the diagnosis and planning of the treatment.

Intussusception is a common cause of intestinal obstruction and colicky abdominal pain in the children, particularly infants, the commonest being the ileocolic variety with colocolic variety being a very rare entity. We present a case of colocolic intussusception in a 1-year-old girl. A 1-year-old girl presented with history of colicky abdominal pain since 6 hours and non-passage of stools and flatus since 8 hours.The parents also gave history of 4 episodes of vomiting, vomitus contained food particles. Vomitus was not blood stained, foul smelling or bilious. Intraoperative findings included a polypoidal growth in the descending colon as the leading point with the formation of a colo-colic intussusception. The child was taken up for emergency laparotomy. Intraoperatively ilio-ileal intussception was noted at 2 levels with multiple enlarged mesenteric lymph nodes. The intussceptions were reduced manually. On further exploration of the distal end of bowel, appendix was found to be elongated and inflamed. Appendectomy was done, and the sample sent for histopathological examination.

A six-year-old, 4.14-kg, female spayed domestic shorthair cat was referred for vomiting, obstipation, tenesmus and stranguria for five days. On abdominal radiographs, a soft tissue mass effect was visible at the pelvic inlet. During abdominal ultrasound, a tube-like structure filled with hyperechogenic fluid was identified dorsal to the urinary bladder displacing the colon. A presumptive diagnosis of pyometra was made. Exploratory laparotomy revealed the presence of a tubular antimesenteric colonic and rectal mass causing almost complete compression of the urethra, descending colon and rectum. The mass was surgically resected. Histology confirmed a colonic duplication. There was no recurrence of clinical signs for six months. This report emphasises that colonic duplication is a possible differential diagnosis for prepelvic and intrapelvic masses in feline patients. Surgical excision of the duplication is a viable treatment option, alleviating clinical signs and offering good long-term outcome.

We report the case of a 59-year-old male who underwent a screening colonoscopy after a positive fecal occult blood test. Several polyps were removed during the colonoscopy: two pedunculated tubular adenomas of 7 mm, a tubular adenoma with high-grade dysplasia of 25 mm and a pedunculated polyp of 20 mm in the descending colon. Histopathological analysis of the pedunculated polyp revealed a well-differentiated adenocarcinoma (G1) with a mucinous component that invaded the submucosa (T1). The resection margins were less than 1 mm, lymphovascular invasion was present and high budding (10 or more) with an invasive component of 8 mm.

Canine inflammatory bowel disease (IBD) is a group of enteropathies with nonspecific chronic symptoms and poorly understood etiology. Many aspects connected with IBD are not understood. One of them is the participation of the intestinal nervous system in the development of pathological processes. Thus, this study aimed to demonstrate changes in the density of intramucosal nerve fibers containing vasoactive intestinal polypeptide (VIP)&mdash, one of the most important intestinal nervous factors caused by the various stages of IBD development. Mucosal biopsy specimens collected from the duodenum, jejunum and descending colon of healthy dogs and dogs with varied severity of IBD were included in the experiment. The density of VIP-like immunoreactive (VIP-LI) nerves was determined by a single immunofluorescence technique and a semi-quantitative method consisting in VIP-LI fiber counts in the field of view (0.1 mm2). The obtained results indicate that IBD induces changes in the density of mucosal VIP-LI nerve fibers in the canine gastrointestinal tract. The initial decrease is followed by an increase in VIP-like immunoreactivity in successive stages of the disease. These observations show that VIP is a neuronal factor that participates in the pathological processes connected with canine IBD. The observed changes probably result from the neuroprotective and/or adaptive properties of VIP. Protective and adaptive reactions induced by inflammation aim to protect the GI tract against damage by proinflammatory factors and ensure the homeostasis in the enteric nervous system (ENS) under the conditions changed by the disease process.

Diverticulosis involving the entire colon is rare in Western society. During a routine dissection of a 74-year-old Caucasian female cadaver, who died from vascular disease complications, diverticula were observed in the ascending, transverse, and descending colon. A total of 413 diverticula were manually counted. The majority of diverticula arose from the right and transverse colon, which is atypical of the disease in Western society. Histological examination of sections from sample diverticula reveals morphology consistent with pseudodiverticula, suggestive of acquired disease. Pancolonic diverticulosis may be associated with systemic diseases such as collagen disorders, vascular complications, and increased risk of recurrent diverticulitis. This case is an example of a rare manifestation of diverticular disease that is important for clinicians to recognize when evaluating and treating patients with gastrointestinal symptoms.

Objective To assess overall (OS), time to progression (TTP), and disease-free survival (DFS) at 3 years after treatment, comparing stenting as bridge-to-surgery (SBTS) versus emergency surgery (ES) in neoplastic left colon obstruction, secondary endpoints of the previously published randomized controlled trial. Background While SBTS in neoplastic colon obstruction may reduce morbidity and need for a stoma compared with ES, concern has been raised, about long-term survival. Methods Individuals affected by left-sided malignant large-bowel obstruction were enrolled from 5 European hospitals and randomly assigned (1:1 ratio) to receive SBTS or ES. The computer-generated randomization sequence was stratified by center on cT and concealed by the use of a web-based application. Investigators and participants were unmasked to treatment assignment. The secondary outcomes analyzed here were OS, TTP, and DFS. Analysis was by intention to treat. This study is registered, ID-code NCT00591695. Results Between March 2008 and November 2015, 144 patients were randomly assigned to undergo either SBTS or ES; 115 (SBTS n = 56, ES n = 59) were eligible for analysis, while 20 participants were excluded for a benign disease, 1 for unavailability of the endoscopist while 8 withdrew from the trial. With a median follow-up of 37 months (range 1-62), no difference was observed in the SBTS group compared with ES in terms of OS (HR 0.93 (95% CI 0.49-1.76), P = 0.822), TTP (HR 0.81 (95% CI 0.42-1.54), P = 0.512), and DFS (HR 1.01 (95% CI 0.56-1.81), P = 0.972). Planned subgroup analysis showed no difference in respect to age, sex, American Society for Anesthesiology score, body mass index, and pT between SBTS and ES groups. Those participants randomized for the SBTS group whose obstruction was located in the descending colon had a better TTP compared with ES group (HR 0.44 (95% CI 0.20-0.97), P = 0.042), but no difference was observed in terms of OS (HR 0.73 (95% CI 0.33-1.63), P = 0.442) and DFS (HR 0.68 (95% CI 0.34-1.34), P = 0.261) in the same individuals. Conclusions This randomized controlled trial shows that, although not powered for these seconday outcomes, OS, TTP, and DFS did not differ between groups at a minimum follow-up of 36 months.

Summary Paneth cells are the primary source of C-type lysozyme, a β-1,4-N-acetylmuramoylhydrolase that enzymatically processes bacterial cell walls. Paneth cells are normally present in human cecum and ascending colon, but are rarely found in descending colon and rectum; Paneth cell metaplasia in this region and aberrant lysozyme production are hallmarks of inflammatory bowel disease (IBD) pathology. Here, we examined the impact of aberrant lysozyme production in colonic inflammation. Targeted disruption of Paneth cell lysozyme (Lyz1) protected mice from experimental colitis. Lyz1-deficiency diminished intestinal immune responses to bacterial molecular patterns and resulted in the expansion of lysozyme-sensitive mucolytic bacteria, including Ruminococcus gnavus, a Crohn’s disease-associated pathobiont. Ectopic lysozyme production in colonic epithelium suppressed lysozyme-sensitive bacteria and exacerbated colitis. Transfer of R. gnavus into Lyz1−/− hosts elicited a type 2 immune response, causing epithelial reprograming and enhanced anti-colitogenic capacity. In contrast, in lysozyme-intact hosts, processed R. gnavus drove pro-inflammatory responses. Thus, Paneth cell lysozyme balances intestinal anti- and pro-inflammatory responses, with implications for IBD.

Background/purpose Enemas have become a common practice for treating fecal incontinence and severe constipation. Several patients receiving enemas complained of severe, colicky, abdominal pain during enema administration and complained that the duration for fluid to pass was progressively increasing. Contrast studies showed a startling picture of severe right colon dilatation and a spastic, narrow, left colon. An investigation was started to seek the origin and possible management of this condition. Methods Medical and radiologic records were reviewed retrospectively, with emphasis on the type and ingredients of enemas used, the duration the patients had been receiving enemas, and their original diagnosis. A literature review was done on previous reports of this condition and publications related to long-term use of enemas. Results This series included 22 patients (average age, 19.6 years; range, 8–54) with fecal incontinence due to anorectal malformations (10 cases), myelomeningocele (5), cloaca (2), severe colonic dysmotility (2), Hirschsprung's disease (2), and sacrococcygeal teratoma (1). The average duration of enema use was 13.7 years (range, 4–45). The composition of the enemas included saline/glycerin (six cases), only saline solution (five), saline/glycerin/soap (four), plain water (three), and one case each of molasses/milk, saline/glycerin/soap/phosphate, saline/phosphate, and only phosphate. The enemas were performed in an antegrade fashion in 21 cases and rectally in 1. All patients had a dilated right colon and a narrow, spastic, left, transverse, and descending colon. Four patients underwent colonoscopy, colonic manometry, and mucosal biopsies, which did not help in explaining the etiology of the problem. In the literature, 43 reports mentioned a “long-term follow-up” for the administration of enemas, but we could not find a description of symptoms, such as in our cases. Conclusions An intriguing and, to our knowledge, previously unreported complication of chronic enema use is presented. We call attention to an overly concerning complication and report our findings in the hope that they will aid and stimulate more investigations into this condition. Several hypotheses to explain the cause are presented, as well as potential treatment options.

New findings What is the central question of this study? What is the localization and distribution pattern of adenomatous polyposis coli (APC) in intestinal epithelial cells? Does this distribution change in different regions of the colon or in the condition of inflammation? What is the main finding and its importance? Colonic epithelia from mice and humans contain a subset of goblet cells displaying high APC levels. The number of APChigh goblet cells increases in inflamed tissue, which also displays increased GRP78, indicating potential stress from mucin production. In cultured human colon cells, expression of interleukin 1 pathway components (inducers of MUC2 expression) is reduced upon APC depletion raising the potential for APC participation in an inflammatory response. Abstract Adenomatous polyposis coli (APC) serves as a gatekeeper of intestinal homeostasis by promoting cellular differentiation and maintaining crypt architecture. Although appreciated as a critical colon tumour suppressor, roles for APC in disease states such as inflammation have yet to be fully delineated. This study aimed to characterize the localization of APC protein in gastrointestinal tissues from human patients with active inflammatory bowel disease and mice with dextran sodium sulfate (DSS)-induced colitis. Fluorescence immunohistochemistry revealed a subset of goblet cells with elevated Apc staining intensity in the small intestines and proximal/medial colons of mice. Upon induction of colitis with DSS, these 'APChigh ' goblet cells remained in the proximal and medial colon, but now were also observed in the distal colon. This phenotype was recapitulated in humans, with APChigh goblet cells observed only in the descending colons of patients with active ulcerative colitis. In cultured human colon cells derived from normal tissue, APC depletion reduced expression of mRNAs encoding the interleukin 1 (IL1) signalling pathway components IL1β and interleukin-1 receptor (IL1R), known regulators of Muc2 expression. Treating cancer cells lacking wild-type APC with IL1β, or induction of full-length APC in these cells led to increases in IL1R and MUC2 expression. Combining IL1β treatment with APC induction led to an increase of MUC2 expression greater than expected for additive affects, suggesting that APC sensitizes cells to IL1 signalling. These findings suggest that APC has novel roles in maintaining proper goblet cell function, thus providing further evidence for APC as an important factor in intestinal tissue homeostasis and disease.

Both mucosal inflammation and psychologic dysfunction have been implicated in irritable bowel syndrome (IBS). While some relationships between inflammation (mast cells and eosinophils) and depression have been reported in adults with IBS, relationships between inflammation and psychologic function have not been studied in children and adolescents. The aims of the current study were to: (1) assess densities of colonic mast cells, eosinophils, and TH17 cells in youth with IBS; and, (2) explore relationships between these cells and specific IBS symptoms and psychologic functioning. Utilizing previously obtained biopsies from the descending and rectosigmoid colons, densities were determined for mast cells, eosinophils, and TH17 cells, respectively, in 37 youth with IBS and 10 controls. In IBS patients, densities were assessed in relation to specific IBS symptoms and in relation to self-report anxiety and depression scores. In both the descending and rectosigmoid colons, densities of mast cells, eosinophils, and TH17 cells were higher in IBS patients as compared to controls. In IBS patients, rectosigmoid mast cell density was higher in those reporting pain relief with defecation. Also, in IBS patients, rectosigmoid eosinophilia was associated with higher anxiety scores and eosinophil density correlated with depression scores. In the descending colon, eosinophil and mast cell densities both correlated with depression scores. In conclusion, mucosal inflammation (mast cells and eosinophils) is associated with pain relief with defecation and with anxiety and depression in youth with IBS.

Background Lynch syndrome (LS), which is known as a hereditary cancer syndrome, is distinguished by microsatellite instability, represented by the altered number of repetitive sequences in the coding and/or non-coding region. Immunohistochemical staining (IHC) of DNA mismatch repair (MMR) proteins (e.g., MLH1, MSH2, MSH6, and PMS2) has been recognized as an useful technique for screening of LS. Previous study has shown that the assessment of IHC, however, requires specific caution due to variable staining patterns even without germline mutations in MMR genes. Case presentation A 48-year-old man, who had been treated for anaplastic astrocytoma, was referred to our department for the precise examination of progressing anemia. Whole-body examination revealed two advanced carcinomas in descending colon and stomach. A hypo-vascular mass lesion was detected in liver as well. Pathological diagnosis (on surgical specimens) was poorly differentiated adenocarcinoma in descending colon, moderately differentiated tubular adenocarcinoma in stomach, and liver metastasis, which is possibly from colon. It was suspected that this case would be Turcot’s syndrome-type-1 due to its specific family history having two cases of colon cancer within the second relatives. Pathogenic frameshift mutations in codon 618 of MLH1 gene was identified. Immunohistochemical analyses (IHC) demonstrated complete loss of MLH1 immuno-expression as well as of PMS2 except for those in brain tumor. Although frameshift mutation was not found in MSH6 gene, histological expression of MSH6 was patchy in primary colon carcinoma and was completely lost in the metastatic site in liver. MSH6 expression in gastric carcinoma, a coincidental cancer in this case, was intact. An abnormal (C)8 region was identified by the cloned PCR of colon and liver tumors but not from gastric cancer. Frameshift mutation in a (C)8 tract in exon 5 of the MSH6 gene was also detected in liver metastasis. Conclusion This case supports a plausible mechanism, proposed by a previous literature, for the reduced expression of MSH6 in a somatic mutation manner, which might preferentially happen in colon cancer rather than in stomach carcinoma in MLH1/PMS2-deficient type of Turcot’s syndrome type 1.

The diagnosis of paediatric colorectal cancer is an unusual finding often diagnosed at an advanced stage with associated poor survival. Paediatric colorectal cancer warrants investigation for hereditary cancer predisposition syndromes, including Lynch syndrome. Here we describe a 16-year-old girl who presented with a stage IIA mucinous adenocarcinoma of the descending colon (T3 N0 M0) treated by resection alone that was associated with a pathogenic germline mutation of MSH2 (c.1786_1788delAAT (p.Asn596del)). This previously described mutation was not found in either parent or her three siblings. To our knowledge, this is the earliest reported case of paediatric Lynch syndrome-associated colorectal cancer by de novo mutation of MSH2. This case illustrates that although Lynch syndrome is typically described as an adult-onset cancer syndrome, Lynch syndrome-associated colorectal cancer can be found in children and adolescents. Genetic testing should be considered as a part of the initial evaluation in these patients.

Left-sided inferior vena cava (IVC) is a rare congenital malformation, as is persistent descending mesocolon, a developmental anomaly in which the colonic mesentery does not fuse with the dorsal abdominal wall. Although these anomalies are mostly asymptomatic, they should be identified preoperatively to avoid iatrogenic injury. We report a case of sigmoid colon cancer in a patient with both anomalies. The patient was an 80-year-old man whose preoperative computed tomography (CT) scan showed that the IVC ascended vertically along the left side of the abdominal aorta, and the descending colon was at the abdominal midline. Coronal CT was particularly useful for visualizing these anomalies. With this better understanding of the malpositioned anatomy, we successfully performed laparoscopic sigmoidectomy with lymph node dissection. Careful evaluation of preoperative CT imaging based on a clear understanding of such anatomical anomalies is particularly important for performing safe laparoscopic surgery.

Recently, the sidedness of the primary tumor (right versus left) has been investigated for its ability to prognosticate and predict outcomes. We evaluated the effect of regorafenib based on KRAS mutation status and the sidedness of the primary tumor in patients with metastatic colorectal cancer (mCRC). We analyzed 135 patients with refractory metastatic colorectal cancer (mCRC) being treated with regorafenib at Samsung Medical Center, between January 2014 and January 2018. Primary tumors originating in the splenic flexure, descending colon, sigmoid colon, rectum, or proximal third of the transverse colon were defined as left-sided CRC (LC). Primary tumors originating in the appendix, cecum, ascending colon, hepatic flexure, or distal two-thirds of the transverse colon were defined as right-sided CRC (RC). Among all 135 patients, 100 (74.1%) had left sided colon cancer and 35 (25.9%) had right-sided colon cancer. No patients achieved a complete response, but four achieved a partial response, revealing a response rate (RR) of 3.0%. Thirty-seven patients had stable disease, yielding a disease control rate (DCR) of 30.4%. There was no difference in RR or DCR according to the location of the primary tumor (LC vs. RC). A significant difference in progression free survival (PFS) with regorafenib was observed between the LC and RC groups (2.6 months; 95% CI, 2.0 to 3.1 vs. 1.9 months; 95% CI, 1.6 to 2.3; P = 0.04, respectively). In a subpopulation with wild type KRAS, PFS with regorafenib was also significantly different between the LC and RC groups (2.9 months; 95% CI, 1.5 to 4.3 vs. 2.1 months; 95% CI, 0.6 to 3.6; P = 0.04). On multivariate analysis, the sidedness of the primary tumor (LC vs. RC) and the number of metastatic sites (≤1 vs. 2>) had a prognostic effect on PFS (P = 0.01 and P = 0.01, respectively). Regorafenib is a current standard treatment for CRC, but treatment outcomes may be improved if regorafenib is administered based on the appropriate biomarker.

Patient: Female, 29-year-old Final Diagnosis: Synchronous gastrointestinal carcinoid tumor and colon adenocarcinoma Symptoms: Abdominal distension • abdominal pain • obstipation Medication:— Clinical Procedure: Colectomy • laparoscopic colectomy • total colectomy Specialty: Gastroenterology and Hepatology • Surgery Objective: Unusual clinical course Background: Synchronous primary tumors are defined as 2 or more different histological tumors discovered in one patient at the same time or within a period of 6 months. Colorectal cancer is one of the most common cancers in the United States. Inversely, synchronous colorectal cancer and carcinoid tumors are rare. Carcinoid tumors can be classified into functioning and non-functioning tumors. Carcinoid tumors are steadily increasing in incidence. There is only 1 case reported in the literature as synchronous colorectal cancer and appendicular carcinoid. The difficulty is to manage 2 different types of malignancies at the same time. An optimal medical or chemo-therapy strategy is needed. Case Report: A 29-year-old woman presented to the emergency room carrying with her computerized tomography (CT) abdomen and pelvic images showing bowel obstruction. Investigations confirmed an obstructing descending colon mass. She underwent colonoscopic stenting as emergency treatment with multiple biopsies. The pathology report came back positive for adenocarcinoma, and we planned to proceed with surgery. Intraoperatively, she was found to have an appendicular mass. The surgical team decided to proceed with laparoscopic-assisted subtotal colectomy. The postoperative course was uneventful, with no complications. The patient was discharged on postoperative day 6 in stable condition. Conclusions: Synchronous colorectal cancer and carcinoid tumors are rare malignancies. The challenge is to find an optimal medical or chemotherapy strategy to manage both malignancies.

Colonic squamous cell carcinoma is extremely rare, with no clear pathogenesis. It usually presents as an emergency. We present the surgical management of a descending colon squamous cell carcinoma, together with a review of the available cases of colonic squamous cell carcinoma in the literature. A 69-year-old woman presented with a palpable mass and abdominal pain. She underwent ultrasound and colonoscopy, which revealed a large obstructing mass at the descending colon, the biopsies of which were not diagnostic. Unfortunately, she was readmitted with bowel obstruction and underwent extended right hemicolectomy with en-bloc excision of attached small bowel and omentum because of local mass expansion. Histopathological analysis demonstrated squamous cell carcinoma with lymph node metastases. Palliative chemotherapy followed, owing to liver and peritoneal deposits. Sixty-six cases of colonic squamous cell carcinoma have been reported in the literature. The most common location is the right colon. Most cases present at a late stage. Several theories for the pathogenesis of colonic squamous cell carcinoma have been reported; the most popular is the squamous transformation of a pluripotent stem cell.

Primary squamous cell carcinoma (SCC) of the colon is a rare malignancy. The most reported anatomic location is the rectosigmoid colon. In this paper, we report a case of a 74-year-old man with primary SCC of the descending colon treated by surgery and adjuvant chemotherapy. We diagnosed primary SCC of the descending colon because except in the colon, no malignant lesions were found by systemic CT. The role of chemoradiation regimen and duration remains unclear due to the rarity of this entity.

The purpose of this video is to show a minimally invasive approach following oncological principles of a left colectomy with intracorporeal anastomosis and preservation of the inferior mesenteric vein (IMV) for an adenocarcinoma of the descending colon. This procedure may theoretically provide better functional results and lower anastomotic leaks. The patient was a 68 years old male, ASA II, with previous kidney transplantation. The colonoscopy showed a 6 cm, sessile, villous lesion in the descending colon and the biopsy confirmed a mucinous adenocarcinoma. CT scan identified a 5,5 cm wall thickening of the descending colon and the patient was referred for surgery. The Surgery starts with an intraoperative colonoscopy and the lesion site is marked with a hem-o-lok, The medial-to-lateral dissection over the Gerota fascia and under the inferior mesenteric vein is performed up to the left abdominal wall to mobilize the descending colon.The inferior mesenteric artery and the left colic artery are dissected and the left colic artery is ligated with an hem-o-lok. The next step is to dissect along the inferior mesenteric vein, providing a complete mesocolic excision with preservation of the vein up to the Treitz ligament and the head of the pancreas.

Purpose Although some studies have reported differences in clinicopathological features between left- and right-sided advanced colorectal cancer (CRC), there are few reports regarding early-stage disease. In this study, we aimed to compare the clinicopathological features of left- and right-sided T1 CRC. Methods Subjects were 1142 cases with T1 CRC undergoing surgical or endoscopic resection between 2001 and 2018 at Showa University Northern Yokohama Hospital. Of these, 776 cases were left-sided (descending colon to rectum) and 366 cases were right-sided (cecum to transverse colon). We compared clinical (patients age, sex, tumor size, morphology, initial treatment) and pathological features (invasion depth, histological grade, lymphatic invasion, vascular invasion, tumor budding) including lymph node metastasis (LNM). Results Left-sided T1 CRC showed significantly higher rates of LNM (left-sided 12.0% vs. right-sided 5.4%, P P P P Conclusion Left-sided T1 CRC, especially in the sigmoid colon and rectum, exhibited higher rates of LNM than right-sided T1 CRC, followed by higher rates of lymphatic invasion. These results suggest that tumor location should be considered in decisions regarding additional surgery after endoscopic resection. Trial registration This study was registered with the University Hospital Medical Network Clinical Trials Registry (UMIN 000032733).

A lamb presented with recurrent prolapse of the descending colon. On clinical examination, intussusception of the descending colon with the prolapse of a segment was verified. The external anal sphincter had a rupture, extending to the lacerated wound in the anus. The lamb underwent colopexy with the two-portal video-assisted incisional technique and was discharged 6 days after the surgical procedure with a satisfactory clinical outcome. There were no recurrences or complications for at least 9 months. Video-assisted colopexy is an alternative treatment for intussusception and recurrent colon prolapse in sheep, even in the presence of an external anal sphincter rupture.

The recent ban of the antimicrobial compound triclosan from use in consumer soaps followed research that showcased the risk it poses to the environment and to human health. Triclosan has been found in human plasma, urine and milk, demonstrating that it is present in human tissues. Previous work has also demonstrated that consumption of triclosan disrupts the gut microbial community of mice and zebrafish. Due to the widespread use of triclosan and ubiquity in the environment, it is imperative to understand the impact this chemical has on the human body and its symbiotic resident microbes. To that end, this study is the first to explore how triclosan impacts the human gut microbial communityin vitroboth during and after treatment. Through ourin vitrosystem simulating three regions of the human gut; the ascending colon, transverse colon, and descending colon regions, we found that treatment with triclosan significantly impacted the community structure in terms of reduced population, diversity, and metabolite production, most notably in the ascending colon region. Given a 2 week recovery period, most of the population levels, community structure, and diversity levels were recovered for all colon regions. Our results demonstrate that the human gut microbial community diversity and population size is significantly impacted by triclosan at a high dosein vitro, and that the community is recoverable within this system. US Congress This work was supported by funds from the US Congress. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Public domain – authored by a U.S. government employee