RESUMEN
BACKGROUND: Minimally invasive colectomy has become the standard for treatment of colonic disease in many centers. Restoration of bowel continuity following resection can be achieved by intracorporeal (IC) or extracorporeal (EC) anastomosis. The aim of this systematic review was to assess the outcomes of IC compared to EC anastomosis in minimally invasive right colectomy. METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic literature search for studies assessing the outcome of IC and EC anastomosis in laparoscopic and robot-assisted right colectomy was conducted. The primary outcome of this review was postoperative complications. Secondary outcomes included operative time, blood loss, length of stay, conversion to open surgery, and bowel recovery. RESULTS: Twenty-five studies including 4450 patients were evaluated. 47.7% of patients had IC anastomosis and 52.3% had EC anastomosis. The weighted mean length of extraction site incision in the IC group was shorter than the EC group. The EC group had significantly higher odds of conversion to open surgery (OR 1.87, 95% CI 1-3.45, p = 0.046), total complications (OR 1.54, 95% CI 1.05-2.11, p = 0.007), anastomotic leakage (AL) (OR 1.95, 95% CI 1.4-2.7, p = 0.003), surgical site infection (SSI) (OR 1.69, 95% CI 1.4-2.6, p = 0.002), and incisional hernia (OR 3.14, 95% CI 1.85-5.33, p < 0.001) compared to the IC group. Both groups had similar rates of ileus, small bowel obstruction, bleeding, and intra-abdominal infection. CONCLUSION: IC anastomosis was associated with significantly shorter extraction site incisions, earlier bowel recovery, fewer complications, and lower rates of conversion, AL, SSI, and incisional hernia than has the EC anastomosis.
Asunto(s)
Colectomía/métodos , Colon Ascendente/cirugía , Colon Transverso/cirugía , Complicaciones Posoperatorias/etiología , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Fuga Anastomótica/etiología , Colectomía/efectos adversos , Colectomía/estadística & datos numéricos , Colon Ascendente/fisiopatología , Colon Transverso/fisiopatología , Enfermedades del Colon/cirugía , Conversión a Cirugía Abierta/estadística & datos numéricos , Humanos , Hernia Incisional/etiología , Tiempo de Internación , Procedimientos Quirúrgicos Mínimamente Invasivos , Recuperación de la Función , Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/etiologíaRESUMEN
OBJECTIVE: To determine if human colonic neuromuscular functions decline with increasing age. DESIGN: Looking for non-specific changes in neuromuscular function, a standard burst of electrical field stimulation (EFS) was used to evoke neuronally mediated (cholinergic/nitrergic) contractions/relaxations in ex vivomuscle strips of human ascending and descending colon, aged 35-91 years (macroscopically normal tissue; 239 patients undergoing cancer resection). Then, to understand mechanisms of change, numbers and phenotype of myenteric neurons (30 306 neurons stained with different markers), densities of intramuscular nerve fibres (51 patients in total) and pathways involved in functional changes were systematically investigated (by immunohistochemistry and use of pharmacological tools) in elderly (≥70 years) and adult (35-60 years) groups. RESULTS: With increasing age, EFS was more likely to evoke muscle relaxation in ascending colon instead of contraction (linear regression: n=109, slope 0.49%±0.21%/year, 95% CI), generally uninfluenced by comorbidity or use of medications. Similar changes were absent in descending colon. In the elderly, overall numbers of myenteric and neuronal nitric oxide synthase-immunoreactive neurons and intramuscular nerve densities were unchanged in ascending and descending colon, compared with adults. In elderly ascending, not descending, colon numbers of cell bodies exhibiting choline acetyltransferase immunoreactivity increased compared with adults (5.0±0.6 vs 2.4±0.3 neurons/mm myenteric plexus, p=0.04). Cholinergically mediated contractions were smaller in elderly ascending colon compared with adults (2.1±0.4 and 4.1±1.1 g-tension/g-tissue during EFS; n=25/14; p=0.04); there were no changes in nitrergic function or in ability of the muscle to contract/relax. Similar changes were absent in descending colon. CONCLUSION: In ascending not descending colon, ageing impairs cholinergic function.
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Colon Ascendente/patología , Colon Ascendente/fisiopatología , Colon Descendente/patología , Colon Descendente/fisiopatología , Contracción Muscular/fisiología , Fibras Nerviosas/patología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Colon Ascendente/inervación , Colon Descendente/inervación , Estimulación Eléctrica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fibras Nerviosas/fisiología , Vías Nerviosas/patología , Vías Nerviosas/fisiopatología , Unión Neuromuscular/patología , Unión Neuromuscular/fisiopatología , Técnicas de Cultivo de TejidosRESUMEN
Non-steroidal anti-inflammatory drugs influence the electromyogram of smooth muscle of ileum, the cecum and the ascending portion of the colon in rats during ulcerative colitis was investigated. It was shown that COX-2 inhibitors normalized the electromotor activity of ileo-ascendo complex, lowered infiltration of round cells in mucous-submucosal tissue and blood flow.
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Antiinflamatorios no Esteroideos/uso terapéutico , Ciego/efectos de los fármacos , Colitis Ulcerosa/tratamiento farmacológico , Colon Ascendente/efectos de los fármacos , Íleon/efectos de los fármacos , Animales , Antiinflamatorios no Esteroideos/administración & dosificación , Ciego/irrigación sanguínea , Ciego/fisiopatología , Colitis Ulcerosa/inmunología , Colitis Ulcerosa/fisiopatología , Colon Ascendente/irrigación sanguínea , Colon Ascendente/fisiopatología , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Electromiografía , Íleon/irrigación sanguínea , Íleon/fisiopatología , Músculo Liso/efectos de los fármacos , Músculo Liso/fisiopatología , RatasRESUMEN
OBJECTIVES: Studies on the characterization of ascending colonic fluids are scarce, limited to physicochemical characterization of their composition, and little is known for the morphology of the produced colloidal phases. In an attempt to gain insights for their structure at the ultrastructural level, samples from the lumen of ascending colon were collected from patients with ulcerative colitis in remission. METHODS: After ultracentrifugation, the supernatants of two samples (one with high and one with low cholesterol level) were visualized by means of cryogenic transmission electron microscopy. KEY FINDINGS: In the supernatants with high cholesterol content, micellar-like structures, bilayer fragments, open vesicles, and uni-, bi- and trilamellar vesicles were abundant. In addition, crystals of cholesterol were frequently observed. In contrast, in the sample with low cholesterol content, oily solids, plates of cholesterol monohydrate and elongated structures were present. Few unilamellar vesicles were occasionally visualized. CONCLUSIONS: The current study gives direct evidence, for the first time, of the existence of 'remnants' of lipolytic products in the fasted ascending colon. The impact of these structures to colonic absorption of drugs is an open question.
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Líquidos Corporales/química , Colitis Ulcerosa/patología , Colon Ascendente/patología , Contenido Digestivo/ultraestructura , Fenómenos Químicos , Colesterol/química , Coloides , Colon Ascendente/fisiopatología , Microscopía por Crioelectrón , Contenido Digestivo/química , Humanos , Microscopía Electrónica de Transmisión , SolubilidadRESUMEN
INTRODUCTION: Patients with open spinal dysraphism (OSD) frequently present constipation and incontinence requiring treatment. AIM: Evaluation of colon transit time (CTT) in patients with OSD, in relation to neural lesion, mobility, bowel habits, and continence status. METHODS: OSD patients aged between 6 and 20 years, who did not use antegrade enemas, were invited to participate in the study. Data from the medical file and information retrieved by questionnaires for constipation and incontinence were collected. The control group consisted of 13 healthy age-matched children. CTT was measured using the 6-day pellet method with an abdominal X-ray on day 7. Laxatives were continued and retrograde colon enemas were stopped 48h prior the X-ray. RESULTS: Thirty of the 33 patients who met the inclusion criteria agreed to participate. Twelve (40%) patients were constipated (Rome III criteria) despite treatment. Fifteen (50%) were continent, with or without treatment. Total CTT was significantly longer in OSD patients (median CTT: 86.4h vs. 43.2h controls). Constipated OSD patients had a significantly prolonged CTT compared to non-constipated patients (CTT: 125.4h vs. 51.6h). Spontaneous continent OSD patients had a normal CTT (CTT: 33.6h). An abnormal CTT predicted the necessity of treatment to achieve continence (P<0.006). CONCLUSION: CTT in OSD patients is significantly prolonged, indicating a neurogenic involvement of the bowel and a slow transit constipation. An abnormal CTT predicts the necessity of therapy to achieve fecal continence.
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Colon/fisiopatología , Tránsito Gastrointestinal/fisiología , Espina Bífida Quística/fisiopatología , Adolescente , Niño , Colon Ascendente/fisiopatología , Colon Descendente/fisiopatología , Colon Sigmoide/fisiopatología , Estreñimiento/fisiopatología , Defecación/fisiología , Enema , Impactación Fecal/fisiopatología , Incontinencia Fecal/fisiopatología , Femenino , Humanos , Laxativos/uso terapéutico , Masculino , Estudios Prospectivos , Factores de Tiempo , Adulto JovenRESUMEN
AIM: Diaphragmatic disease is rare. This review aims to increase awareness of this condition and its management. METHOD: A literature search was conducted using the key terms 'colon' or 'colonic' in combination with 'diaphragm' or 'diaphragm disease' for publications until August 2012. All cases of colonic diaphragm syndrome were identified and the required data were collected. RESULTS: Forty-five cases of colon diaphragm disease were included. The highest incidence was in the seventh decade of life, with a female preponderance (40F:5M). Most patients presented with chronic (median 3 months) and multiple symptoms. The median use of nonsteroidal anti-inflammatory drugs (NSAIDs) was 5 years including diclofenac as the most commonly used NSAID. Colonoscopy was the most informative investigation and the ascending colon was the most common site of diaphragm disease. Nearly two-thirds of the patients were treated by discontinuing NSAID treatment combined with other forms of treatment, mostly surgery. CONCLUSION: Diaphragm disease of the colon is a rare condition associated with long-term use of NSAIDs with a range of presentations and symptoms. Based on this review, when colon diaphragm disease is diagnosed we would recommend a trial cessation of NSAIDs. Therapeutic endoscopic techniques should be considered but surgery may be required for definitive treatment.
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Antiinflamatorios no Esteroideos/efectos adversos , Enfermedades del Colon/inducido químicamente , Distribución por Edad , Anciano , Anciano de 80 o más Años , Animales , Colon Ascendente/fisiopatología , Enfermedades del Colon/epidemiología , Enfermedades del Colon/fisiopatología , Colonoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Distribución por Sexo , SíndromeRESUMEN
OBJECTIVE: The aim of our study was to investigate systemic lupus erythematosus (SLE) related protein-losing enteropathy (PLE) in the following areas: clinical features, laboratory, endoscopic and imaging characteristics, treatment and outcome. METHOD: A retrospective analysis was performed. RESULTS: From 2001 to 2010, 48 patients had SLE related PLE and their clinical characteristics were: age 40.8 ± 14.3 years, male-to-female ratio 1:8.6, mean symptom duration 4.3 ± 3.4 weeks, initial presentation and concomitant activity of SLE in 21(43.8%) and 37 (77.1%) patients, <20% patients developed gastrointestinal (GI) symptoms, mean serum albumin level 24.4 ± 5 g/L. Thirty (62.5%) patients had diffuse non-erosive erythematous GI mucosa with chronic inflammatory cells in lamina propria. Protein leakage was at the small bowel in 15 (31.3%) patients, terminal ileum/caecum in 16 (33.3%) patients and ascending colon in 11 (22.9%) patients. Thirty (62.5%) patients responded initially well to a combination of prednisolone and azathioprine (AZA) and 33 (68.8%) patients were maintained well by the above therapy. Higher potent induction and maintenance therapy were required in patients with: proteinuria (p < 0.01), history of previous immunosuppressive therapy (p < 0.02) and requirement of higher potent induction therapy (p < 0.01). PLE as initial SLE presentation was associated with better prognosis. Four reversible adverse events were reported: one had AZA-induced pancreatitis, two developed AZA-induced hypoplastic anemia and one developed steroid psychosis. One patient developed shingles in the fourth month and responded to oral acyclovir. No thromboembolic events were reported and one patient died of SLE nephropathy. CONCLUSION: There appears to be increasing prevalence of SLE related PLE. A diagnosis can be made using 99m Tc-labeled HSA scintigraphy. PLE generally responds well to immunosuppressive therapy.
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Antiinflamatorios/uso terapéutico , Azatioprina/uso terapéutico , Inmunosupresores/uso terapéutico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Prednisolona/uso terapéutico , Enteropatías Perdedoras de Proteínas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Análisis de Varianza , Antiinflamatorios/efectos adversos , Azatioprina/efectos adversos , Sedimentación Sanguínea , Proteína C-Reactiva , Ciego/patología , Ciego/fisiopatología , Distribución de Chi-Cuadrado , Colon Ascendente/patología , Colon Ascendente/fisiopatología , Endoscopía Gastrointestinal , Femenino , Hong Kong , Humanos , Inmunosupresores/efectos adversos , Quimioterapia de Inducción , Intestino Delgado/patología , Intestino Delgado/fisiopatología , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Prednisolona/efectos adversos , Enteropatías Perdedoras de Proteínas/sangre , Enteropatías Perdedoras de Proteínas/complicaciones , Enteropatías Perdedoras de Proteínas/diagnóstico por imagen , Cintigrafía , Estudios Retrospectivos , Albúmina Sérica/metabolismo , Estadísticas no Paramétricas , Tecnecio , Adulto JovenRESUMEN
Although adenocarcinoma represents the vast majority of neoplasms of the large intestine, small cell undifferentiated carcinoma (SCUC) also arises from the colorectum. SCUC of the colorectum is highly malignant and shares the similarities in histologic characteristics, behavior, and histochemistry with SCUC of the lung. We report herein a case of SCUC in the ascending colon with rapid enlargement after resection. A 70-year-old male, who presented to a nearby physician with chief complaints of pain in the right lower quadrant, was referred to our hospital. We found a tumor mass that was approximately 15 cm in size in the right lower quadrant. Computed tomography (CT) images showed an irregularly shaped tumor, located inferior to the lower border of the right kidney and in the area of the ascending colon. By colonoscopy, we found a circumferential tumor of the ascending colon. A biopsy indicated it to be SCUC. The patient underwent right hemicolectomy. Two weeks after the resection, we palpated a tumor mass in the same area. The abdominal CT images showed a tumor mass that was approximately 10 cm in size. The tumor rapidly enlarged, and the patient died of multiple organ failure. SCUC is a tumor with a high malignant potential. Radical treatment cannot be achieved by surgical therapy alone and hence further studies of effective adjuvant therapy would be required.
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Carcinoma de Células Pequeñas/fisiopatología , Colon Ascendente/fisiopatología , Neoplasias del Colon/fisiopatología , Anciano , Carcinoma de Células Pequeñas/diagnóstico por imagen , Carcinoma de Células Pequeñas/cirugía , Colon Ascendente/diagnóstico por imagen , Colon Ascendente/cirugía , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/cirugía , Humanos , Masculino , RadiografíaRESUMEN
BACKGROUND/AIMS: The cecum is described as differing anatomically from the ascending colon (AC); yet their similarity or difference in terms of motile activity has not been studied sufficiently. The cecum is separated from the AC by the cecocolonic junction (CCJ) which contains a cecocolonic sphincter. We assumed that the motile activity of the AC is different from that of the cecum and hypothesized that both the AC and the cecum might have different pacemakers which initiate the motile activity. This hypothesis was investigated in the current study. METHODS: The study was performed in 10 subjects (mean age 41.6 +/- 12.8 SD years; 7 women) during the repair of huge abdominal incisional hernias. The electric activity was recorded from 2 monopolar electrodes applied each to the cecum, CCJ and AC. The CCJ was then anesthetized by xylocaine and the electric waves of the cecum, CCJ and AC were registered after 10 and 90 min. The test was repeated using normal saline instead of xylocaine. RESULTS: Electric waves were recorded from the cecum, CCJ and AC in the form of monophasic pacesetter (PPs) and action potentials (APs). The PPs occurred regularly and the APs randomly. The frequency, amplitude and conduction velocity of the waves recorded from the CCJ and AC had higher readings than those from the cecum (p < 0.05). The CCJ and AC showed similar frequency and conduction velocity (p > 0.05). Ten minutes after CCJ anesthetization, electric waves were recorded from the cecum but not from the CCJ or AC; however, electric activity returned after 90 min. Saline injection did not affect the electric activity of the cecum, CCJ and AC. CONCLUSION: The electric wave parameters of the cecum differed from those of the CCJ and AC, suggesting that the motile activity of the CCJ and AC is not a continuation of the motile activity of the cecum and that it might be evoked by 2 different pacemakers. The similarity in frequency and conduction velocity of electric waves of the CCJ and AC, however, most likely denotes that the AC waves are a continuation of those of the CCJ, and that both are evoked by the same pacemaker probably located in the CCJ. The higher amplitude of cecal waves might be due to the thicker cecal musculature compared to that of the AC.