Annals of Coloproctology

Volume 24(1); February 2008

Original Articles

The Efficacy of the Alvarado Score in the Diagnosis of Acute Appendicitis.: Lee, Sung Min , Chang, In Taik , Kim, Beom Gyu , Cha, Sung Jae , Kim, Yong Seok , Pak, Jun Seok; J Korean Soc Coloproctol. 2008;24(1):1-6.; DOI: https://doi.org/10.3393/jksc.2008.24.1.1

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PURPOSE
Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.

Citations

Citations to this article as recorded by

Ultrasonography of Appendicitis
Dae Hyun Kim
Clinical Ultrasound.2016; 1(1): 19. CrossRef
Diagnostic Efficacy of the Alvarado Score according to Age in Acute Appendicitis
Bo-Young Oh, Kwang-Ho Kim, Ryung-Ah Lee, Soon Sup Chung
Journal of the Korean Surgical Society.2010; 78(2): 100. CrossRef

Clinical Characteristics of a Hand-sewn Circumferential Mucosectomy in Hemorrhoids.: Kang, Jung Gu , Kim, Kang Mi , Ahn, Young Jae; J Korean Soc Coloproctol. 2008;24(1):7-12.; DOI: https://doi.org/10.3393/jksc.2008.24.1.7

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Abstract PDF: PURPOSE
A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids.
METHODS
We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common.
CONCLUSIONS
A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.

Postoperative Complications and Recurrence in Patients with Crohn's Disease.: Hong, Dong Hyun , Yu, Chang Sik , Kim, Dae Dong , Jung, Sang Hun , Choi, Pyong Hwa , Park, In Ja , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(1):13-19.; DOI: https://doi.org/10.3393/jksc.2008.24.1.13

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Abstract PDF

PURPOSE
This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD.
RESULTS
There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age: 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.

Citations

Citations to this article as recorded by

Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection
Yoo Min Han, Ji Won Kim, Seong‐Joon Koh, Byeong Gwan Kim, Kook Lae Lee, Jong Pil Im, Joo Sung Kim, Hyun Chae Jung
Journal of Gastroenterology and Hepatology.2016; 31(8): 1436. CrossRef
Clinical and Endoscopic Recurrence after Surgical Resection in Patients with Crohn's Disease
Yang Woon Lee, Kang-Moon Lee, Woo Chul Chung, Chang Nyol Paik, Hea Jung Sung, You Suk Oh
Intestinal Research.2014; 12(2): 117. CrossRef
The epidemiology and cost of surgical site infections in Korea: a systematic review
Kil Yeon Lee, Kristina Coleman, Dan Paech, Sarah Norris, Jonathan T Tan
Journal of the Korean Surgical Society.2011; 81(5): 295. CrossRef
Long-term Result of Surgical Treatment for Crohn's Enteritis
Sang-Ji Choi, Eun-Kyung Choe, Sung-Chan Park, Kyu-Joo Park
Journal of the Korean Society of Coloproctology.2008; 24(6): 409. CrossRef

Desmoid Tumor in Familial Adenomatous Polyposis (FAP).: Kim, Dae Dong , Yu, Chang Sik , Hong, Dong Hyun , Jung, Sang Hun , Choi, Pyong Wha , Park, In Ja , Kim, Hee Cheol , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(1):20-26.; DOI: https://doi.org/10.3393/jksc.2008.24.1.20

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Abstract PDF

PURPOSE
This research was conducted to assess the incidence, clinical characteristics, and treatment outcomes for desmoid tumors in patients with familial adenomatous polyposis (FAP). METHODS: At Medical Center, we recruited 47 patients who had been diagnosed as having intraabdominal or abdominal wall desmoid tumor between Aug. 1995 and Dec. 2005. We compared FAP-associated desmoid tumors with non-FAP-associated desmoid tumors according to clinical characteristics and treatment outcomes. RESULTS: Desmoid tumors developed 12/46 (26.1%) in FAP, 1/14 (7.1%) in attenuated FAP and 34 in non-FAP associated. Unlike non-FAP-associated desmoid tumors, the occurrence of FAP-associated desmoid tumors in tended to be higher in the earlier age groups (< or =40 yrs, 92.3% vs 67.6%, P=0.082) and no sexual predominancy was observed (male:female ratio of 1.2:1 vs a tumor ratio 1:3.9, P=0.033). Intraabdominal-type desmoid tumors associated for the majority of FAP-associated desmoid tumors (92.3% vs 38.2%, P=0.002), and 70% of the desmoid tumors occurred within 3 years after total proctocolectomy. In the treatment of FAP-associated intraabdominal desmoid tumors, surgery was performed in 7 cases (58.3%), and complete resections were done in only 3 cases (25%), with one recurrence. In non-FAP-associated desmoid tumors, complete resection was possible in 10 cases (76.9%), and there was no recurrence (P=0.036). The medical treatment for unresectable or incompletely resectable cases in cases of non-FAP-associated desmoid tumor was good, but for FAP-associated desmoid tumors, the effectiveness was not good, and further investigation was needed. CONCLUSIONS: Intraabdominal desmoid tumors in FAP patients occurred frequently in the early (< or =3 yrs) postoperative period, and the treatment, outcome including surgery and medication, outcome was not good in patients with FAP-associated desmoid tumors.

Citations

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Clinical Characteristics and Adequate Treatment of Familial Adenomatous Polyposis Combined with Desmoid Tumors
Won Beom Jung, Chan Wook Kim, Jin Cheon Kim
Cancer Research and Treatment.2014; 46(4): 366. CrossRef

Endoscopic Balloon Dilatation for Anastomotic Stricture Developed after Surgery for Colorectal Cancer.: Kim, Byung Nyun , Sohn, Dae Kyung , Hong, Chang Won , Han, Kyung Su , Choi, Dong Hyun , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(1):27-33.; DOI: https://doi.org/10.3393/jksc.2008.24.1.27

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Abstract PDF: PURPOSE
This study was to evaluate the safety and efficacy of endoscopic balloon dilatation for anastomotic strictures that developed after colorectal cancer (CRC) operations.
METHODS
Between Jan. 2001 and Dec. 2006, 18 patients (12 men, 6 women) who underwent endoscopic balloon dilatation for anastomotic strictures that developed after CRC operation at the Center for Colorectal Cancer, National Cancer Center, were enrolled, and their medical records were reviewed retrospectively. The median distance from the anal verge to the stricture was 10 cm (range, 3~40 cm). Dilatations were performed using through-the-scope balloons with diameters of 18 to 20 mm on inflation. RESULTS: The overall success rate of endoscopic balloon dilatation was 94.4% (17 patients). The mean number of treatment sessions per patient was 1.9 (range, 1~7). Of the 17 patients treated successfully, 11 patients (64.7%) required only one dilatation, 4 patients (23.2%) required 2 dilatations, and two patients (11.8%) required 7 dilatations. Failure of balloon dilatation occurred in one patient. No complications occurred. CONCLUSIONS: Endoscopic balloon dilatation of anastomotic strictures after a CRC operation is safe and efficient.

The Role of Preoperative Chest CT in the Evaluation of a Colorectal Adenocarcinoma.: Park, Jae Woo , Moon, Sun Mi , Hwang, Dae Yong; J Korean Soc Coloproctol. 2008;24(1):34-38.; DOI: https://doi.org/10.3393/jksc.2008.24.1.34

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Abstract PDF

PURPOSE
The most common metastatic site of colorectal adenocarcinomas is the liver, and the next common site is the lung. Pulmonary metastasis has been reported to be more common in rectal cancer (esp. lower rectum) than in colon cancer, and for pulmonary survival metastasis, a hepatic metastatectomy results in longer. Likewise, for hepatic metastasis, a pulmonary metastatectomy may prolong survival, and many reports of longer survival after a pulmonary metastatectomy have been published. We compared chest CT to chest PA as a preoperative diagnostic tool for the detection of pulmonary metastasis. METHODS: The retrospective analysis was done for 369 consecutive patients with preoperative chest CT and chest PA who had a histologically-proven adenocarcinoma. RESULTS: The detection rates of pulmonary metastases by preoperative chest PA and preoperative chest CT were 3.5% (13/369) and 8.4% (31/369), respectively. Pulmonary metastases were confirmed by surgical pathology and follow up for over 6 months to have occurred in 22 patients. Chest PA's sensitivity and specificity for metastasis of colorectal cancer were 45% and 99%, respectively, and the positive predictive value was 76.9%. Chest CT had a sensitivity of 86%, a specificity of 96%, and a predictive positive value of 61.2% for pulmonary metastasis. CONCLUSIONS: Chest CT was more sensitive than chest PA in identifying pulmonary metastasis. Also, the detection rate for pulmonary metastasis by using chest CT was higher than that by using chest PA. Chest CT may be more useful in the diagnosis of pulmonary metastasis than chest PA as a preoperative work-up tool. The preoperative chest CT may help surgeons make decisions in the treatment for patients with a colorectal adenocarcinoma.

Citations

Citations to this article as recorded by

Indeterminate pulmonary nodules in colorectal cancer
Eun-Joo Jung
World Journal of Gastroenterology.2015; 21(10): 2967. CrossRef
Clinical Usefulness of Preoperative and Postoperative Chest Computed Tomography for Colorectal Cancer
Jeong Hui Lee, Byung Kyu Ahn, Yung Soo Nam, Kang Hong Lee
Journal of the Korean Society of Coloproctology.2010; 26(5): 359. CrossRef

Ex-vivo Sentinel Lymph-node Mapping in Colorectal Cancer.: Kim, Hyung Jin , Lee, In Kyu , Lee, Yoon Suk , Kang, Won Kyung , Ahn, Chang Hyeok , Oh, Seong Taek; J Korean Soc Coloproctol. 2008;24(1):39-44.; DOI: https://doi.org/10.3393/jksc.2008.24.1.39

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Abstract PDF: PURPOSE
The presence of lymph-node metastases is one of the most important prognostic factors for patients with a colorectal carcinoma. The sentinel lymph node is the first lymph node that receives afferent lymphatic drainage from a primary tumor, and thus has the highest risk of harboring metastatic disease. METHODS: Twenty-eight patients with an adenocarcinoma of the colon or the rectum were investigated. After resection of the specimen in standard oncologic fashion, the specimen was dissected longitudinally along the antimesenteric border, and methylene blue was injected around the tumor submucosally. After 5 minutes, the mesentery was meticulously examined, and blue-stained lymphatics and lymph nodes were carefully dissected and harvested. RESULTS: Sentinel lymph nodes were identified in all cases. The average number of sentinel nodes identified was 3 (range, 1~6), and the average number of lymph nodes retrieved was 20.8 (range, 6~42). Of the fifteen patients (53.6%) identified to be positive for lymph-node metastasis 10 showed nonsentinel nodal metastasis without sentinel nodal involvement. No additional isolated tumor cells were found by immunohistochemical staining in 13 patients who had no lymph-node metastasis on conventional pathologic examination. CONCLUSIONS: In colorectal cancer, the sentinel-lymph-node sampling method is easy and can be performed for the purpose of finding lymph nodes easily. However, applying the sentinel-lymph-node sampling method for the purpose of minimizing lymph node dissection, as in breast cancer, is not recommended because of the high probability of missing metastasis.

Case Reports

Management of Traumatic Injury to the Lower Rectum and Anal Sphincter Muscle Combined with Deep Perineal Laceration.: Jung, Mi Ran , Kim, Ho Kun , Park, Min Ho , Ju, Jae Kyun , Ryu, Seong Yeob , Park, Young Kyu , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin; J Korean Soc Coloproctol. 2008;24(1):45-50.; DOI: https://doi.org/10.3393/jksc.2008.24.1.45

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Abstract PDF: Although rare, traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration present substantial diagnostic and management challenges for surgeons. Between February 2004 and February 2006, six patients were treated for traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration at the Department of Surgery, Chonnam National University Hospital. All six patients underwent a diverting colostomy, primary repair, and presacral a drainage, but only three cases underwentva a sphincteroplasty. Three patients who underwent a sphincteroplasty had normal findings on anorectal manometry. Traumatic injuries to the lower rectum and anal sphincter muscle combined with deep perineal laceration have a high morbidity rate and a great influence on the quality of life. Thus, such injuries require aggressive management, and treatment modalities should be tailored to the individual case.

Acute Anal Pain due to Ingested Bone Fragments.: Choi, Dong Ha; J Korean Soc Coloproctol. 2008;24(1):51-57.; DOI: https://doi.org/10.3393/jksc.2008.24.1.51

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Abstract PDF

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.

Citations

Citations to this article as recorded by

Ingested Chicken Bone (Xiphoid Process) in the Anal Canal: A Case Report and Literature Review
Ahmed F Alkandari, Husain M Alsarraf, Mohammed F Alkandari
Cureus.2023;[Epub] CrossRef
Operative Treatment with a Laparotomy for Anorectal Problems Arising from a Self-Inserted Foreign Body
Seung-Bum Ryoo, Heung-Kwon Oh, Heon-Kyun Ha, Eun Kyung Choe, Sang Hui Moon, Kyu Joo Park
Journal of the Korean Society of Coloproctology.2012; 28(1): 56. CrossRef
Anal Diseases from Ingested Foreign Bodies
Hansuk Kim, Seungbum Ryoo, Eun Kyung Choe, Dosun Kim, Doohan Lee, Kyu Joo Park
Journal of the Korean Society of Coloproctology.2009; 25(6): 387. CrossRef

Original Article

An Incidental Asymptomatic Dieulafoy's Lesion in the Colon: A Case Report.: Moon, Gyoo , Park, Jong Beom , Chang, Hee Chul , Huh, Chang , Paik, Chang Hee , Kim, Hyun Shig; J Korean Soc Coloproctol. 2008;24(1):58-61.; DOI: https://doi.org/10.3393/jksc.2008.24.1.58

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Abstract PDF: A Dieulafoy's lesion is an uncommon, but important, cause of gastrointestinal bleeding. It is associated with massive, life-threatening hemorrhage and is typically difficult to diagnose. Although originally described in the stomach and rarely found below the proximal stomach, identical lesions have been reported in other gastrointestinal organs, including the duodenum, jejunum, colon, and rectum. Most cases occur with bleeding in the gastrointestinal tract. However, we present an incidental asymptomatic Dieulafoy's lesion in the colon, which was treated successfully by using an endoscopic hemoclipping technique.

Case Reports

Management of the Symptoms after a Resection of the Rectum.: Lee, Sang Jeon; J Korean Soc Coloproctol. 2008;24(1):62-71.; DOI: https://doi.org/10.3393/jksc.2008.24.1.62

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Abstract PDF

Many patients have functional disturbances after a traditional restorative rectal resection, complaining of urgency, frequent bowel movements, and occasional fecal incontinence. The rectal reservoir function is disturbed, and this is related to the size of the rectal remnant and the elastic properties of the neorectal wall. A straight anastomosis is recommended when the reservoir capacity of the rectal remnant is sufficient. A side-to-end anastomosis is probably preferable to an end-to-end anastomosis. If a straight anastomosis is considered, the descending colon is much better than the sigmoid colon. If optimal functional results are to be obtained soon after surgery, construction of a pouch is recommended when the rectal remnant is very short. There seems to be a balance between continence without urgency and evacuation ability. For patients with weak sphincter muscles and habitually loose feces, the surgeon should tailor the length of the pouch to be longer whereas it should be made smaller for patients with a pre-operative tendency toward constipation. In the long-term, bowel adaptation may also enable the function after a straight anastomosis to approximate that of a colonic J-pouch anal anastomosis. Where the pelvis is too narrow for a bulky colonic J-pouch anal anastomosis, a coloplasty-anal- anastomosis is an option. The latter results in postoperative bowel function comparable with that of the colonic J-pouch. Traditionally, poor bowel function has been managed expectantly. The colonic adaptation may take one or two years to occur after a low anterior resection. The patient is advised to take adequate soluble fiber in the diet and to avoid foods which aggravate the bowel dysfunction. Those with increased stool frequency are prescribed constipating agents to help control the symptoms. Patients with rectal evacuation problems are prescribed regular laxatives and enemas.

Citations

Citations to this article as recorded by

Quality of Life in Colorectal Cancer Patients according to the Severity of Symptom Clusters Classification
Gyeonghui Jeong, Kyunghee Kim, Yeunhee Kwak
Asian Oncology Nursing.2014; 14(2): 74. CrossRef

Levator Ani Muscle Posterior Midline Incision Method for Diffrentiation of Anal Fistulas Involving Ischioretal and Pelvirectal Spaces.: Lim, Seok Won; J Korean Soc Coloproctol. 2008;24(1):72-74.; DOI: https://doi.org/10.3393/jksc.2008.24.1.72

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Abstract PDF: The difference between anal fistulas involving the ischioretal space and pelvirectal space is that in the former the involvement of the anal fistula is low the levator ani muscle whereas in the latter it is above the levator ani muscle. The levator ani muscle posterior midline incision method, which is introduced here, is thought not to injure the anal sphincter; thus, it does not affect the anal function. The method also allow the surgeon to assess readily and accurately whether or not the fistula has invaded the pelvirectal space.

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