Annals of Coloproctology

Volume 23(4); August 2007

Original Articles

Diverticulitis of the Right Colon: Tips for Preoperative Diagnosis and Treatment Strategy.: Lee, In Kyu , Kim, Su Hong , Lee, Yoon Suk , Kim, Hyung Jin , Lee, Sang Kuon , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek , Jeon, Hae Myung , Kim, Jun Gi , Kim, Eung Kook , Chang, Suk Kyun; J Korean Soc Coloproctol. 2007;23(4):223-231.; DOI: https://doi.org/10.3393/jksc.2007.23.4.223

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PURPOSE
The planned therapy of right colonic diverticulitis is very difficult because preoperative diagnosis is uncommon and the method of treatment is usually decided at the time of laparotomy. We retrospectively analyzed the clinical characteristics of right colonic diverticulitis, the clinical distinctions between preoperatively and postoperatively diagnosed patients, the recurrence rate, and the hospital stay by treatment modality.
METHODS
Among 104 patients who were treated for right colonic diverticulitis from January 1997 to May 2005, we enrolled 90 patients who had been diagnosed by the operation or a barium enema study (BE), and who had not been lost to follow-up. Patients were divided into three groups based on treatment modality: Group 1 (n=28), conservative management with intravenous antibiotics; Group 2 (n=46), aggressive resection; Group 3 (n=16), appendectomy with intravenous antibiotics.
RESULTS
Ultrasound and computed tomography (CT) detected 12 (22.6%) and 21 (87.5%) cases of right colonic diverticulitis, respectively. BE was applied to 45 patients, 28 (62.2%) of them with multiple diverticula. Right colonic diverticulitis was the preoperative diagnosis in 39 patients (43.3%). The length of hospital stay was significantly different between the groups (P<0.001): 4.9+/-3.1 days in Group 1, 7.5+/-3.7 days in Group 2, and 3.8+/-0.9 days in Group 3. Two patients (7.1%) in Group 1, 2 patients (4.3%) in Group 2, and 5 patients (31.3%) in Group 3 had recurrent diverticulitis during the follow-up period (P=0.007). The Kaplan-Meier estimated recurrence rates for Groups 1, 2, and 3 were statistically significantly different (P=0.0086).
CONCLUSIONS
To differentiate right colonic diverticulitis from appendicitis, focusing on the peculiar feature in contrast to appendicitis and appropriate utilization of CT are important. If diagnosed preoperatively, uncomplicated right colonic diverticulitis can be managed by conservative management with intravenous antibiotics. If diagnosed intraoperatively, aggressive resection is advocated as the most effective method for decreasing the recurrence rate.

Citations

Citations to this article as recorded by

Right‐sided acute diverticulitis in a North African country: Presentation and management in one surgical center
Laila Jedidi, Aymen Mabrouk, Hela Ghali, Anis Ben Dhaou, Senda Ben Lahouel, Sami Daldoul, Houyem Said Latiri, Mounir Ben Moussa
World Journal of Surgery.2024; 48(6): 1509. CrossRef
Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina
René M. Palacios Huatuco, Diana A. Pantoja Pachajoa, Julian E. Liaño, Héctor A. Picón Molina, Rafael Palencia, Alejandro M. Doniquian, Matías Parodi
Annals of Coloproctology.2023; 39(2): 123. CrossRef
Caecal diverticulitis can be misdiagnosed as acute appendicitis: a systematic review of the literature
Isabelle Uhe, Jeremy Meyer, Manuela Viviano, Surrennaidoo Naiken, Christian Toso, Frédéric Ris, Nicolas C. Buchs
Colorectal Disease.2021; 23(10): 2515. CrossRef
Laparoscopic diverticulectomy versus non-operative treatment for uncomplicated right colonic diverticulitis
Le Huy Luu, Nguyen Lam Vuong, Vo Thi Hong Yen, Do Thi Thu Phuong, Bui Khac Vu, Nguyen Viet Thanh, Nguyen Thien Khanh, Nguyen Van Hai
Surgical Endoscopy.2020; 34(5): 2019. CrossRef
Clinical differentiation of acute appendicitis and right colonic diverticulitis: A case-control study
Yosuke Sasaki, Fumiya Komatsu, Naoyasu Kashima, Takahiro Sato, Ikutaka Takemoto, Sho Kijima, Tadashi Maeda, Takamasa Ishii, Taito Miyazaki, Yoshiko Honda, Nagato Shimada, Yoshihisa Urita
World Journal of Clinical Cases.2019; 7(12): 1393. CrossRef
Right-sided acute diverticulitis: A single Western center experience
Francesco Monari, Maurizio Cervellera, Basilio Pirrera, Umberto D'Errico, Samuele Vaccari, Laura Alberici, Valeria Tonini
International Journal of Surgery.2017; 44: 128. CrossRef
Diagnosis and Management of Right Colonic Diverticular Disease: A Review
Francesco Ferrara, Jesús Bollo, Letizia V. Vanni, Eduardo M. Targarona
Cirugía Española (English Edition).2016; 94(10): 553. CrossRef
Diagnóstico y tratamiento de la enfermedad diverticular del colon derecho: revisión de conjunto
Francesco Ferrara, Jesús Bollo, Letizia V Vanni, Eduardo M Targarona
Cirugía Española.2016; 94(10): 553. CrossRef
Intraoperative diagnosis of solitary cecal diverticulum not requiring surgery: is appendectomy indicated?
Renol M. Koshy, Abdelrahman Abusabeib, Saif Al-Mudares, Mohamed Khairat, Adriana Toro, Isidoro Di Carlo
World Journal of Emergency Surgery.2016;[Epub] CrossRef
Risk factors for recurrence of right colonic uncomplicated diverticulitis after first attack
Hyoung-Chul Park, Byung Seup Kim, Kwanseop Lee, Min Jeong Kim, Bong Hwa Lee
International Journal of Colorectal Disease.2014; 29(10): 1217. CrossRef
Surgical management of colonic diverticular disease: Discrepancy between right- and left-sided diseases
Heung-Kwon Oh
World Journal of Gastroenterology.2014; 20(29): 10115. CrossRef
Is Conservative Treatment with Antibiotics the Correct Strategy for Management of Right Colonic Diverticulitis?: A Prospective Study
Tae Jung Kim, In Kyu Lee, Jong Kyung Park, Yoon Suk Lee, Youn Si, Hun Jung, Hyung Jin Kim, Sang Chul Lee, Dae Young Cheung, Lee D. Gorden, Seung Taek Oh
Journal of the Korean Society of Coloproctology.2011; 27(4): 188. CrossRef
Management of Right Colon Diverticulitis
Jong Ik Jang, Yang Soo Lim, Jong Woo Choi, Yoon Sik Lee
Journal of the Korean Society of Coloproctology.2010; 26(1): 22. CrossRef
Treatment of Right Colonic Diverticulitis: The Role of Nonoperative Treatment
Ma Ru Kim, Bong-Hyeon Kye, Hyung Jin Kim, Hyeon-Min Cho, Seong Taek Oh, Jun-Gi Kim
Journal of the Korean Society of Coloproctology.2010; 26(6): 402. CrossRef
Right Colonic Diverticulitis
In Kyu Lee
Journal of the Korean Society of Coloproctology.2010; 26(4): 241. CrossRef
A Case of Ascending Colon Diverticulitis with Perforation in a Child
Joon Woo Baek, Jae Young Shin, Jee Hyun Lee, So Young Jung, Ah Young Jung, Jeong Won Kim, Kon Hee Lee
Korean Journal of Pediatric Gastroenterology and Nutrition.2010; 13(2): 193. CrossRef
Laparoscopic and Open Surgery for Right Colonic Diverticulitis
In Kyu Lee, Yoon Suk Lee, Sung Jip Kim, D. Lee Gorden, Dae Youn Won, Hyeung Jin Kim, Hyeun Min Cho, Hae Myung Jeon, Jun-Gi Kim, Seong Taek Oh
The American Surgeon.2010; 76(5): 486. CrossRef

Effect of Electrical Stimulation and Biofeedback Therapy for Constipated Patients with Impaired Rectal Sensation.: Kim, Young Kyu , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2007;23(4):232-236.; DOI: https://doi.org/10.3393/jksc.2007.23.4.232

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Abstract PDF: PURPOSE
Biofeedback therapy is widely used for the management of constipation associated with pelvic outlet obstruction. Some patients have shown poor outcome after biofeedback alone. A subgroup of patients complains of absence of desire to defecate. The main pathophysiology of constipation may be impaired rectal sensation or compliance. This study evaluated the effect of electrical stimulation and biofeedback therapy (EST-BF) for this subgroup of constipated patients with impaired rectal sensation.
METHODS
Of the 37 patients diagnosed with pelvic outlet obstruction by using cinedefecography, 9 patients (M:F=2:7, age=22~77 years, median=57 years) who had impaired rectal sensation (rectal desire threshold > or =100 ml) on anorectal manometry were selected. These patients were treated with EST-BF therapy 2~6 (median: 5) sessions, Kontinece, Multichannel system, HMT, Inc, Seoul, Korea). Treatment consisted of 20 minutes of variant-mode electrical stimulation and 20 minutes of EMG biofeedback therapy per week administered by a specialized colorectal surgeon. All patients were evaluated by using a standardized questionnaire and a threshold for rectal sensation based on balloon distention before and after treatment.
RESULTS
At post EST-BF, six (67%) patients had experienced an improvement in symptoms, including five (56%) patients with complete symptom relief. Significant improvement in rectal sensation, especially the rectal defecation desire threshold (pre-EST-BF vs. post- EST-BF: 181.0+/-38.7 vs. 88.3+/-29.1) was achieved.
CONCLUSIONS
EST- BF may be an effective option for use in the treatment of functional constipation with impaired rectal sensation.

Clinical Characteristics of Synchronous Adenomas Designated as Risk Factors of Metachronous Malignancy in Colorectal Cancer.: Jung, Sang Hun , Kim, Hee Cheol , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(4):237-244.; DOI: https://doi.org/10.3393/jksc.2007.23.4.237

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Abstract PDF

PURPOSE
More than 80% of colorectal cancers are known to occur from adenomas, but only a subset of adenomas undergoes malignant transformation. The aim of this retrospective study was to assess clinicopathologic characteristics of synchronous adenomas associated with metachronous malignant neoplasms in colorectal cancer patients.
METHODS
Three hundred sixty-eight colorectal cancer patients with synchronous adenomas who underwent a complete polypectomy were consecutively enrolled between 1995 and 2002. The patients with familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal cancer (HNPCC), and synchronous colorectal cancers with invasion beyond the submucosa, and patients who underwent a total colectomy were excluded.
RESULTS
The mean age were 60 years (range, 27~83), and the male- to-female ratio was 2.6:1. The mean number of synchronous adenomos was 2.4 (1~22). The incidence of metachronous adenomas was 44.3% (163 patients), and that of metachronous malignant neoplasms was 5.2% (19 patients), consisting of 9 carcinomas and 10 malignant polyps (or adenomas with malignant change). In the multivariate analysis, the variables associated a metachronous adenoma were sex (male), location of the primary tumor, and multiple synchronous adenomas. The independent risk factors of metachronous malignant neoplasms were synchronous neoplastic adenomas (OR, 3.8; 95% CI, 1.24~11.83) and large adenomas (OR, 3.64; 95% CI, 1.17~11.27). The mean free-inverval of matachronous malignant neoplasms was 24 months (range, 12~52).
CONCLUSIONS
Colorectal cancer patients with synchronous adenomas are prone to be at risk for recurrent adenomas and malignant tumors. High- risk patients for metachnonous malignant neoplasms should be considered for frequent colonoscopy follow-up.

Citations

Citations to this article as recorded by

Risk factors of advanced metachronous neoplasms in surveillance after colon cancer resection
Kwangwoo Nam, Jeong Eun Shin
The Korean Journal of Internal Medicine.2021; 36(2): 305. CrossRef
Treatment of Multiple Colorectal Cancers
Ok Joo Paek, Seung Yeop Oh, Kwang Wook Suh
Journal of the Korean Society of Coloproctology.2009; 25(1): 34. CrossRef

Treatment Patterns for Colorectal Cancer Patients at the National Cancer Center Korea in 2003.: Kim, Duck Woo , Jeong, Seung Yong , Kim, Dae Yong , Sohn, Dae Kyung , Lim, Seok Byung , Chang, Hee Jin , Jung, Kyung Hae , Jeong, Jun Yong , Choi, Hyo Seong , Park, Jae Gahb; J Korean Soc Coloproctol. 2007;23(4):245-249.; DOI: https://doi.org/10.3393/jksc.2007.23.4.245

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2 Citations

Abstract PDF

PURPOSE
In Korea, colorectal cancer (CRC) is one of the most sharply-increasing malignancies, and the National Colorectal Cancer Screening Program for persons over 50 years of age began in 2004. To determine the effectiveness of the program, comparative data regarding CRCs treated prior to 2004 must be analyzed. The present study assessed CRC status at diagnosis and treatment patterns in 2003.
METHODS
In 2003, 503 patients were newly diagnosed with CRC and were treated at the Center for Colorectal Cancer, National Cancer Center (NCC). Clinical data were retrospectively reviewed.
RESULTS
The 503 patients included 256 colon and 247 rectal cancer patients. Of the 256 colon cancer patients, 5 (2.0%) were diagnosed during screening colonoscopies and were successfully treated using an endoscopic mucosal resection (EMR), and 17 (6.6%) received only palliative chemotherapy because of distant metastases. Forty patients (15.6%) were treated with palliative surgery and chemotherapy, and 194 (75.8%) with curative surgery with or without adjuvant chemotherapy. Of the 247 rectal cancer patients, 9 (3.6%) were treated with an EMR, 20 (8.1%) with palliative chemotherapy with or without radiotherapy, 19 (7.7%) with palliative surgery and chemoradiotherapy, and 199 (80.6%) with curative surgery with or without chemoradiotherapy. Treatment with curative intent was possible in 199 of 256 (77.7%) colon cancer patients and in 208 of 247 (84.2%) rectal cancer patients.
CONCLUSIONS
Only 12.1% of colon and 8.5% of rectal cancer patients were diagnosed early and treated without adjuvant therapies at the NCC in Korea in 2003.

Citations

Citations to this article as recorded by

Lymphovascular Invasion is a Significant Prognosticator in Rectal Cancer Patients Who Receive Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision
Jong Hoon Lee, Hong Seok Jang, Jun-Gi Kim, Hyun Min Cho, Byoung Yong Shim, Seong Taek Oh, Sei-Chul Yoon, Yeon-Sil Kim, Byung Ock Choi, Sung Hwan Kim
Annals of Surgical Oncology.2012; 19(4): 1213. CrossRef
Role of Radiation Therapy as an Adjuvant Treatment in Rectal Cancer Management
Jae Hwan Oh, Dae Yong Kim
Journal of the Korean Society of Coloproctology.2009; 25(4): 273. CrossRef

Disadvantages of Preoperative Chemoradiation in Rectal Cancer.: Lee, Seung Hyun , Ahn, Byung Kwon , Baek, Sung Uhn; J Korean Soc Coloproctol. 2007;23(4):250-256.; DOI: https://doi.org/10.3393/jksc.2007.23.4.250

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Abstract PDF: PURPOSE
Preoperative chemoradiation therapy for rectal cancer seems to improve local control, anal sphincter preservation, resectability, and possibly survival in patients. However, there are several adverse effects, too. The aim of this study is to analyze the disadvantages of preoperative chemoradiation for rectal cancer.
METHODS
We retrospectively reviewed 139 patients who were treated by using preoperative chemoradiation for an adenocarcinoma of the rectum between January 1995 and December 2004. All patients had fixed or locally advanced lesions, as determined by digital rectal examination. No distant metastasis was proven before preoperative chemoradiation. All of the patiedts received the full scheduled dose of radiation (range, 5,000~5,400 rad). Concurrent intravenous chemotherapy with 5-fluorouracil (425 mg/m2/day) and leucovorin (45 mg/day) was administered continuously on days 1~5 and 29~33. The mean interval between chemoradiation and surgery was 4~6 weeks. After preoperative chemoradiation, 117 patients underwent an operation. We reviewed the side effects of preoperative chemoradiation, postoperative complications, and distant metastases detected during the preoperative period after preoperative chemoradiation and during the operation.
RESULTS
The side effects of preoperative chemoradiation were diarrhea (23%), radiation dermatitis (2.2%), fistula (0.7%), sepsis (0.7%), and rectal bleeding (0.7%). Two patients died from sepsis and rectal bleeding. The postoperative complications were bowel obstruction in 9 cases (7.7%), wound seroma in 8 cases (6.8%), wound infection in 5 cases (4.3%), anastomotic leakage in 5 cases (7.1%), rectovaginal fistula in 2 cases (2.8%), an enterocutaneous fistula in 2 cases (1.7%), and a vesicocutaneous fistula in 1 case (0.8%). Distant metastases were detected in 14 patients (10.1%) after preoperative chemoradiation.
CONCLUSIONS
Although preoperative chemoradiation can be performed safely, careful management for the side effects of preoperative chemoradiation and for postoperative complications is necessary. We need a more sensitive study method for detecting distant metastasis of rectal cancer, especially during scheduled preoperative chemoradiation.

Laparoscopic Surgery for Colorectal Cancer in Elderly Patients.: Lee, Yoon Suk , Lee, In Kyu , Kang, Won Kyung , Cho, Hyun Min , Park, Jong Kyung , Oh, Seung Teak , Kim, Jun Gi , Kim, Young Ha; J Korean Soc Coloproctol. 2007;23(4):257-261.; DOI: https://doi.org/10.3393/jksc.2007.23.4.257

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Abstract PDF

PURPOSE
Elderly colorectal cancer patients may have increased surgical morbidity and mortality due to comorbidity and compromised cardiopulmonary reserves. The aim of this study is to compare the safety and the outcomes of laparoscopic surgery for colorectal cancer in patients of 70 years of age and older to those of patients younger than 70 years of age.
METHODS
From August 2004 to April 2006, the authors retrospectively analyzed the medical records of patients who underwent laparoscopic surgery for colorectal cancer.
RESULTS
The elderly group included 35 cases, and the younger group included 67 cases. The mean age of the elderly group was 74.4+/-4.1, and that of the younger group was 58.2+/-9.5. Sixty-three percent (63%) of the elderly group and 27% of the younger group had co- morbidity. The mean operation time in the elderly group was 299.9+/-121.0 minutes, and that in the younger group was 295.1+/-110.8 minutes. The mean number of harvested lymph nodes was 17.7+/-8.6 in the elderly group and 19.4+/-9.8 in the younger group. The day of diet start was the 4.1+/-0.6 postoperative day in the elderly group and the 4.4+/-1.4 day in the younger group. Hospital stay was 16.0+/-7.6 in the elderly group and 15.5+/-4.6 days in the younger group. There were no statistical differences in terms of operation time, number of harvested lymph nodes, blood loss at operation, day of flatus passing, diet start, hospital stay, and complications. There was no surgical mortality in either groups.
CONCLUSIONS
Laparoscopic surgery for colorectal cancer is a safe and effective treatment option in elderly patients.

Citations

Citations to this article as recorded by

Effects of Heated-Humidified Anesthetic Gas in the Elderly Patients with Colorectal Cancer during Laparoscopic Surgery: Randomized Controlled Trial
Hyo-Sun Park, Younhee Kang
Korean Journal of Adult Nursing.2018; 30(2): 206. CrossRef
Can Elderly Patients Older than 75 Years with Colorectal Cancer Tolerate Planned Laparoscopic Surgery?
Kang San Lee, Young Wan Kim, Joo Hee Kim, Hyun Jun Kwon, Ik Yong Kim
The Journal of Minimally Invasive Surgery.2012; 15(4): 126. CrossRef

Multicenter Study

Long-term Follow-up of Patients with Curatively Resected Colorectal Cancer; May Long-term Follow-up of More than 5 Years be Warranted?.: Moon, Sun Mi , Park, Jae Woo , Hwang, Dae Yong; J Korean Soc Coloproctol. 2007;23(4):262-269.; DOI: https://doi.org/10.3393/jksc.2007.23.4.262

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Abstract PDF

PURPOSE
The data and the recommendations for the postoperative follow-up period after curative surgery for colorectal cancer are unclear, although postoperative follow-up for at least 5 years is generally recommended. The Department of Surgery, Korea Cancer Center Hospital, has a policy of lifetime follow-up. The aim of this study is to investigate the long-term outcome of patients with colorectal cancer with curative treatment and the significance of long-term follow-up.
METHODS
Between January 1993 and December 2002, 1,100 consecutive patients underwent curative surgery for a colorectal adenocarcinoma in the Department of Surgery, Korea Cancer Center Hospital. They were followed, and local or systemic recurrence was recorded. The analysis was performed on 962 of the 1,100 (87%) patients who had undergone curative surgery.
RESULTS
With a median follow-up of 143 months, the 10-year overall survival (OS) was 67% and the 10-year recurrence-free survival (RFS) was 72%. The 5-year OS was 78%, and the 5-year RFS was 78%. Two hundred ninety-nine (31.5%) patients had recurrences. Of the recurrences, 278 (93.0%) became evident within 5 years and 21 (7.0%) presented after 5 years. Twenty-four (2.5%) patients had local recurrences alone, 17 had (1.8%) local plus systemic recurrences, and 258 (26.8%) had systemic recurrences alone. Of the local recurrences, 33 (80%) became evident within 5 years, and 8 (20%) presented after 5 years. Of the systemic recurrences, 258 (94%) became evident within 5 years and 17 (6%) presented after 5 years.
CONCLUSIONS
The long-term surveillance of patients undergoing a curative resection for colorectal cancer demonstrates that most local recurrences and distant metastases occur within 5 years after a 5-year follow-up, most local and systemic recurrences following curative surgery had occurred. However, our data suggest that the postoperative follow-up of more than 5 years may be warranted. Large, multicenter trials are required to define the patterns of disease recurrence after 5 years of follow-up.

Citations

Citations to this article as recorded by

Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer
Jeong-Eun Lee, Yong-Geul Joh, Sang-hwa Yoo, Geu-Young Jeong, Sung-Han Kim, Choon-Sik Chung, Dong-Gun Lee, Seon Hahn Kim
Journal of the Korean Society of Coloproctology.2011; 27(2): 64. CrossRef

Case Reports

Ulcerofungating Rectal Mass Caused by Cytomegalovirus Infection in a Patient with AIDS.: Lee, Sang Il , Park, Jun Seok , Lee, Taek Gu , Kim, Hong Bin , Park, Young Soo , Lee, Kyung Ho , Kang, Sung Bum; J Korean Soc Coloproctol. 2007;23(4):270-273.; DOI: https://doi.org/10.3393/jksc.2007.23.4.270

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Abstract PDF: Cytomegalovirus infection is a common complication in patients suffering from advanced acquired immunodeficiency syndrome. Cytomegalovirus infections of the gastrointestinal tract in human immunodeficiency-virus-positive patients tend to manifest as ulcerative lesions rather than as mass lesions. In this study, we describe a case of a mass lesion identified as cytomegalovirus proctitis in a human immunodeficiency-virus-positive patient, which had initially been thought to have an adenocarcinoma or a lymphoma. A 60-year-old man had an ulcerofungating mass in the rectum, which was initially detected via palpation. Findings of computerized tomography indicated a malignant mass, which was enhanced in the contrast image. An additional colonoscopy and biopsy were conducted for purposes of diagnosis. The histological examination revealed characteristic inclusion bodies within the nuclei of vascular endothelial cells in the ulcer bed. Immunohistochemical staining with anti-cytomegalovirus antibody confirmed the diagnosis of cytomegalovirus infection. The patient's anorectal lesion had subsided after the initiation antiviral treatments. The diagnosis of cytomegalovirus infection in human immunodeficiency-virus- positive patients occasionally proves rather difficult. Cytomegalovirus infection had induce the formation of mass lesions in immunocompromised patients.

Adenocarcinoma of the Rectum with Choriocarcinomatous Differentiation: A case report.: Jeong, Jae Hong , Cho, Yong Bum , Park, Chi Min , Yun, Hae Ran , Lee, Won Suk , Suh, Yeon Lim , Yun, Seong Hyeon , Lee, Woo Yong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2007;23(4):274-278.; DOI: https://doi.org/10.3393/jksc.2007.23.4.274

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Abstract PDF

A choriocarcinoma of the rectum is extremely rare and has a very poor prognosis. Its rarity and the obscurity of its histogenesis make the entity of disease hard to define. We report a case of a choriocarcinoma of the rectum which showed synchronous liver and lung metastasis. A 52-year- old male patient presented with tenesmus, hematochezia and pain on defecation for 4 months. The preoperative colonoscopy revealed a mass at the rectum, 3 cm proximal to the anal verge. The biopsy revealed a poorly differentiated adenocarcinoma. An abdominoperineal resection was performed, and the pathologic examination confirmed a choriocarcinoma arising from an adenocarcinoma. Immunostain for beta-human chorionic gonadotropin (hCG) was strongly positive for the choriocarcinoma component. Serum hCG checked postoperatively was as high as 4,222 IU/L, but the serum carcinoembryonic antigen (CEA) was normal. Although chemotherapy was begun at the 5th week after the operation, the patient died on the 47th day after the operation. A choriocarcinoma of the colon or the rectum is very rare and is aggressive. Although radical resection and chemotherapy are performed, the clinical outcome is very disappointing. Even though a choriocarcinoma of the colon or the rectum is very rare, it should be included on the list for differential diagnosis of a colorectal carcinoma.

Citations

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Primary Rectal Tumor With Extensive Choriocarcinoma Differentiation in a Woman With Lung, Liver and Disseminated Peritoneal Disease: A Primary Rectal Adenocarcinoma With Extensive Choriocarcinoma Differentiation or Primary Rectal Choriocarcinoma?
Isidro Machado, María del Carmen Martínez La Piedra, Fernando Martínez de Juan, Fernanda-Maia de Alcántara, Reyes Claramunt, José Antonio López-Guerrero, Ana Marhuenda, Marcos Melian
International Journal of Surgical Pathology.2024; 32(5): 976. CrossRef
Histologic transformation of rectal adenocarcinoma to choriocarcinoma after surgery and chemotherapy: A rare case report and review of the literature
Juan Zhong, Lei Yang
International Journal of Surgery Case Reports.2024; 117: 109478. CrossRef
Primary colon adenocarcinoma with choriocarcinoma differentiation: a case report and review of the literature
Jessica Boyce, Karine Tawagi, John T. Cole
Journal of Medical Case Reports.2020;[Epub] CrossRef
A Case of Ascending Colon Choriocarcinoma with Multiple Liver Metastases
Koya YASUKAWA, Shinji NAKATA, Syusei SANO, Kei KUSAMA, Akihito NISHIO, Harutsugu SODEYAMA
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2020; 81(8): 1563. CrossRef
Rare histologic types of rectal cancer: A monocentric cases series report
A. Vallard, P. Diao, M.-A. Garcia, G. Pigné, N. Vial, F. Forest, M. Peoc’h, J. Langrand-Escure, N. Magné
Cancer/Radiothérapie.2019; 23(1): 17. CrossRef
Primary Adenocarcinoma with Focal Choriocarcinomatous Differentiation in the Sigmoid Colon
Sook Kyoung Oh, Hyung Wook Kim, Dae Hwan Kang, Cheol Woong Choi, Yu Yi Choi, Hong Kyu Lim, Ja Jun Goo, Sung Yeol Choi
The Korean Journal of Gastroenterology.2015; 66(5): 291. CrossRef

Review

Open Hemorrhoidectomy.: Kim, Do Sun; J Korean Soc Coloproctol. 2007;23(4):279-285.; DOI: https://doi.org/10.3393/jksc.2007.23.4.279

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Abstract PDF

The open hemorrhoidectomy has been recognized as the treatment of choice for symptomatic prolapsing hemorrhoids. Although the open hemorrhoidectomy is thought to be associated with more postoperative pain and delayed wound healing compared with other conventional procedures such as a closed hemorrhoidectomy, and a semi- closed or submucosal hemorrhoidectomy, it is still unclear which procedure is preferable in terms of postoperative pain, wound healing, hospital stay, and time off work. To address this issue, several studies have been performed. According to randomized controlled studies comparing an open hemorrhoidectomy to a closed hemorrhoidectomy, there are no significant differences in the severity of pain and the hospital stay between the two procedures; however, the healing time in the closed hemorrhoidectomy is faster and the operation time in the open hemorrhoidectomy is shorter. Since there are few randomized controlled studies comparing an open hemorrhoidectomy with a semi-closed hemorrhoidectomy or submucosal hemorrhoidectomy, it is difficult to conclude which procedure is superior to the others. Yet, there seems to be no significant difference between these procedures. In 1998, a novel procedure, a stapled hemorrhoidopexy, was introduced by Longo. Several randomized controlled studies comparing the open hemorrhoidectomy with the stapled hemorrhoidopexy showed that the latter was associated with less pain, shorter hospital stay, and earlier return to work. However, considering the lack of long- term data and the disastrous complications, such as retroperitoneal sepsis and rectal perforation, there is still controversy about its efficacy and safety as a definitive treatment of hemorrhoids. The open hemorrhoidectomy is time-tested and is comparable to other conventional techniques in terms of postoperative pain, hospital stay, and time off work. Further study should be performed to assess the long-term results of a stapled hemorrhoidopexy.

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Long-term follow-up of Starion™ versus Harmonic Scalpel™ hemorrhoidectomy for grade III and IV hemorrhoids
Joo Hyung Kim, Dae Hyun Kim, Yong Pyo Lee, Kwang Wook Suh
Asian Journal of Surgery.2019; 42(1): 367. CrossRef
Have Any Changes in Pain Been Noted After a Hemorrhoidectomy Since the Establishment of the Milligan-Morgan Hemorrhoidectomy?
Do Sun Kim
Annals of Coloproctology.2016; 32(3): 90. CrossRef
Randomized Trial Comparing a Starion™ and a Harmonic Scalpel™ Hemorrhoidectomy
Joo Hyung Kim, Yong Pyo Lee
Journal of the Korean Society of Coloproctology.2009; 25(1): 8. CrossRef

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