Annals of Coloproctology

Volume 24(4); August 2008

Original Articles

Association of Methylenetetrahydrofolate Reductase C677T, A1298C, and G1793A Polymorphism and the Risk of Colon Cancer.: Kang, Dong Baek , Rhee, Jeong Kyun , Park, Won Cheol; J Korean Soc Coloproctol. 2008;24(4):239-245.; DOI: https://doi.org/10.3393/jksc.2008.24.4.239

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PURPOSE
Methylenetetrahydrofolate reductase (MTHFR) is a critical enzyme regulating folate level, which affects DNA synthesis and methylation. MTHFR is highly polymorphic, and its variant genotypes result in decreased MTHFR enzyme activity and lower plasma folate level. Generally, a low folate level is known to be associated with a gastrointestinal neoplasm. Three common single nucleotide polymorphisms (SNPs) resulting in amino-acid changes (C677T, A1298C and G1793A) have been reported in MTHFR. We studied the relationship of MTHFR C677T, A1298C and G1793A polymorphisms between from colon cancer group and control group of Korean people.
METHODS
We performed a case- control study to examine the relationship between MTHFR C677, A1298C, and G1793A polymorphisms and the risk of colon cancer. Two hundred seven (207) individuals with colon cancer and 288 healthy persons were analyzed. Blood sampling of each group was performed, and (PCR-RFLP) was analyzed; as a result, MTHFR polymorphism genotypes were obtained.
RESULTS
The genotype frequencies of MTHFR C677T polymorphisms were 27.1% (CC), 48.3% (CT), 24.6% (TT), and 72.9% (CT+TT) in the patient group and 39.2% (CC), 36.8% (CT), 24.0% (TT), and 60.8% (CT+TT) in the control group. The genotype frequencies of MTHFR A1298C polymorphisms were 58% (AA), 35.7% (AC), 6.3% (CC), and 42% (AC+CC) in the patient group and 55.6% (AA), 40.3% (AC), 4.2% (CC), and 44.4% (AC+CC) in control group. The genotype frequencies of MTHFR G1793A polymorphisms were 83% (GG), 15.9% (GA), 1% (AA), and 16.9% (GA+AA) in the patient group and 85.8% (GG), 11.8% (GA), 2.4% (AA), and 14.2% (GA+AA) in the control group. The 677CT genotype was associated with a significantly increased risk for colon cancer (adjusted OR=1.90, 95% confidence interval: 1.25~2.90 in CT) than the 677CC genotype. The 1298CC, 1298AC, 1793AA, and 1793GA genotypes were not associated with a significantly increased risk for colon cancer.
CONCLUSIONS
The MTHFR C677T polymorphism may influence colon cancer, but the MTHFR A1298C and G1793A polymorphisms need to be studied further for careful interpretation and confirmation in larger studies.

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APOE, MTHFR, LDLR and ACE Polymorphisms Among Angami and Lotha Naga Populations of Nagaland, India
Benrithung Murry, Neikethono Vakha, Nongthombam Achoubi, M. P. Sachdeva, K. N. Saraswathy
Journal of Community Health.2011; 36(6): 975. CrossRef

Self-pulsed Washable Seton during a Modified Hanley Operation for a Deep Horseshoe Fistula.: Choi, Donghwi , Seo, Hyung Il , Kim, Hyunsung , Oh, Nahmgun; J Korean Soc Coloproctol. 2008;24(4):246-251.; DOI: https://doi.org/10.3393/jksc.2008.24.4.246

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Abstract PDF

PURPOSE
The modified Hanley technique, which is used for treatment of a deep horseshoe fistula, has reduced damage to the external anal sphincter compared to the classic Hanley technique, but its shortcoming is that it causes inconvenience to the patient due to the fact that a drainage tube must be left in place for a long time. To solve this problem, the authors devised a self-pulsed washable seton and then compared the results of its use to determine its clinical usefulness.
METHODS
The subjects of this study were 34 patients who were diagnosed with a deep posterior complex anal fistula and who were operated on by using the modified Hanley technique between January 1999 and December 2004. Twelve patients who were treated with the self-pulsed washable seton were classified as Group A, and 12 patients who were treated by using a conventional loose seton were placed in Group B. These two groups were compared for period of purulent discharge, period of leaving the seton alone, and recurrence rate.
RESULTS
The period of purulent discharge was 18.75 days (15~24) for group Aand 29.75 days (24~37) for group B. The period of leaving the seton was 21.58 days (18~29) for group A and 32.58 days (28~39) for group B. The recurrence rate after surgery was 8.3% in group A and 16.7% in group B.
CONCLUSIONS
The self-pulsed washable seton devised by the authors shortened the treatment period through more effective wound management, so we propose using it as a new method for treating a deep posterior horseshoe fistula.

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Patient-Performed Seton Irrigation for the Treatment of Deep Horseshoe Fistula
Donghwi Choi, Hyun Sung Kim, Hyung-Il Seo, Nahmgun Oh
Diseases of the Colon & Rectum.2010; 53(5): 812. CrossRef

Risk Factors of Pouch Failure after a Restorative Proctocolectomy.: Shin, Ui Sup , Yu, Chang Sik , Kim, Dae Dong , Yoon, Sang Nam , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(4):252-259.; DOI: https://doi.org/10.3393/jksc.2008.24.4.252

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PURPOSE
The aim of this study was to analyze the risk factors of pouch failure after a restorative proctocolectomy.
METHODS
A restorative proctocolectomy was performed in 169 patients between November 1989 and May 2007. A retrospective review was done for postoperative complications and follow-up results of pouch failure, and the risk factors of pouch failure were analyzed. Pouch failure was defined as having occurred when a permanent ileostomy was constructed, regardless of pouch removal. The median follow-up was 48 (3~155) months.
RESULTS
Among the 169 cases, 86 cases involved ulcerative colitis (UC group), 70 cases involved familial adenomatous polyposis or attenuated adenomatous polyposis coli (FAP group), and the remaining 13 involved hereditary nonpolyposis colorectal cancer or synchronous colon and rectal caner (CRC group). The sex ratios and the incidences of comorbidity were not significantly different between the groups, but the mean ages were. Complications occurred in 61 patients (36.1%): pelvic sepsis (28 cases), pouchitis (23 cases), desmoid tumor (12 cases), wound infection (10 cases), and anastomosis stricture (4 cases). The 5-year cumulative rate of pouch failure was 9.8%. Presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture were risk factors of pouch failure.
CONCLUSIONS
The cumulative pouch failure rate after a restorative proctocolectomy was 9.8% for 5 years, and pouch failure was associated with the presence of a desmoid tumor, pelvic sepsis, and anastomosis stricture.

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Factors affecting pouch-related outcomes after restorative proctocolectomy
Gyoung Tae Noh, Jeonghee Han, Min Soo Cho, Hyuk Hur, Byung Soh Min, Kang Young Lee, Nam Kyu Kim, Emiko Mizoguchi
PLOS ONE.2017; 12(10): e0186596. CrossRef

Analysis of Results after Percutaneous Catheter Drainage for Anastomotic Leakage.: Hwang, Sang Il , Kim, Hungdai , Han, Won Kon; J Korean Soc Coloproctol. 2008;24(4):260-264.; DOI: https://doi.org/10.3393/jksc.2008.24.4.260

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Abstract PDF: PURPOSE
Anastomotic leakage is a serious and life- threatening complication after colorectal surgery. The management of clinical anastomotic leakage remains largely operative. The aim of this study was to analyze the clinical characteristics and the natural history of percutaneous catheter drainage (PCD) for anastomotic leakage after colorectal surgery.
METHODS
Twenty patients who were managed by PCD after anastomotic leakage between January 2002 and December 2006 were studied. Charts were reviewed for information on clinical characteristics and biolologic finding prePCD and postPCD.
RESULTS
Anastomotic leakage was managed by using only PCD in 16 of 20 patients (80%), and twenty percent of patients (4/20) were managed by using a loop ileostomy after PCD. Nine patients (45%) had peritoneal drains left in place at diagnosis. Before PCD, the mean of the peak white blood cell (WBC) was 12,800/mm3, and the mean period of fever (>38degrees C) was 3.4 (2~5) days. After PCD, the mean time until the body temperature dropped below 37oC was 3.1 (1~5) days, the mean time until the WBC count dropped below 10,000/mm3 was 3.2 (0~6) days, the mean duration of ileus and diarrhea was 3.3 (0~6) days, the mean total amount of drainage during 6 days was 880 cc, and the mean length of stay after PCD was 14.9 days.
CONCLUSIONS
PCD is a safe and effective method for treating anastomtic leakage in patients without sepsis or diffuse peritonitis and with CT scans that reveal no diffuse fluid collection.

Colorectal Cancer Presenting as an Early Recurrence Within 1 Year after a Curative Resection.: Jung, Sang Hun , Kim, Hee Cheol , Kim, Ah Young , Choi, Pyong Wha , Park, In Ja , Yu, Chang Sik , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(4):265-272.; DOI: https://doi.org/10.3393/jksc.2008.24.4.265

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Abstract PDF

PURPOSE
An individualized surveillance protocol based on stratified prognostic factors is needed for the early detection of recurrent disease. The aim of this study was to determine both the clinicopathological characteristics for early-recurring colorectal cancer and the impact on survival.
METHODS
From January 1996 to September 2000, 1,504 patients with curatively resected colorectal cancer were recruited. The primary goal of this study was to evaluate the time interval until first loco-regional or distant recurrence, and the secondary goal was the last survival status. Early recurrence was defined as recurrence within the first 12 months postoperatively. Clinicopathologic data and preoperative CT records were reviewed. The follow-up period was over 48 months.
RESULTS
The 5-year recurrence rate was 25.4%, and 39.5% of these were detected within the first 12 months postoperatively. In the multivariate analysis, the independent prognostic factors for early recurrence were cell differentiation (PD/MUC/SRC), lymphovascular invasion, and absence of adjuvant chemotherapy in stage III and curatively resected colorectal cancer in stage IV. Inaccurate interpretation by a low-quality CT scan resulted in a stage III cancer being understaged preoperatively. The 5-year overall survival rate according to the recurrent time interval was significantly different (early recurrence: 7.4% vs. late recurrence: 23.6%, P<0.05). The resection rate was similar in both groups (early recurrence: 22.7% vs. late recurrence: 27.6%, P=0.392).
CONCLUSIONS
Colorectal cancer that recurred within 12 months showed more aggressive biologic behaviors and poor survival. Understaging caused by incomplete preoperative evaluation for disease extension may cause treatment failure.

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Predictive factors and the prognosis of recurrence of colorectal cancer within 2 years after curative resection
Jong Pil Ryuk, Gyu-Seog Choi, Jun Seok Park, Hye Jin Kim, Soo Yeun Park, Ghil Suk Yoon, Soo Han Jun, Yong Chul Kwon
Annals of Surgical Treatment and Research.2014; 86(3): 143. CrossRef
Advanced Neoplasm Detection and Its Associated Factors in Colonoscopic Surveillance of Endoscopically Resected Early Colorectal Cancer
Soon Ha Kwon, Jin Woo Choo, Hyun Gun Kim, Seong Ran Jeon, Byung Hoo Lee, Tae Hee Lee, Wan Jung Kim, Bong Min Ko, Jin-Oh Kim, Joo Young Cho, Joon Seong Lee, Moon Sung Lee
The Korean Journal of Gastroenterology.2013; 62(4): 219. CrossRef

Krukenberg Tumor Confirmed by Surgery during the Follow-up after a Primary Resection of Colorectal Cancer.: Choi, Won Ho , Jun, Si Youl; J Korean Soc Coloproctol. 2008;24(4):273-277.; DOI: https://doi.org/10.3393/jksc.2008.24.4.273

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Abstract PDF: PURPOSE
We performed this study to evaluate the clinical presentation of, as well as the surgical intervention for, ovarian metastasis from colorectal cancers identified during postoperative follow-up.
METHODS
Twelve cases (2.4%) of ovarian metastasis were observed among retrospective chart review of 493 females patients who underwent a resection of colorectal cancer between 1981 and 2006. The covariates used for the survival analysis were patient age at the time of ovarian relapse, size of the tumor, initial TMN stage of the colon cancer, the interval to metastasis, and the presence of gross residual disease after treatment for a Krukenberg tumor. The cumulative survival curves for the patient groups were calculated with the Kaplan-Meier method and were compared by means of the Log-Rank test.
RESULTS
The average age of the patients was 48.9 years, ranging from 24 to 71 years, and the average survival time of the 12 patients was 19.6 months (estimated 3-year survival rate was 16.7%), with a range of 3 to 59 months after the diagnosis of a Krukenberg tumor. The survival rate for patients without gross residual disease was longer than that of patients with gross residual disease (P=0.0003). In contrast, patient age, size of the ovarian tumor, initial stage of the colon adenocarcinoma, and interval to metastasis were not prognostic indicators for survival after the development of ovarian metastasis.
CONCLUSIONS
Our results suggest that, in general, most cases with ovarian metastasis have poor prognosis and that the absence of residual disease after treatment is a favorable prognostic factor in cases of a Krukenberg tumor of colon origin.

Prognostic Significance of the Circumferential Resection Margin in Invasive T3 Rectal Cancer.: Joo, In Ho , Jin, Sang Hwa , Bae, Ki Beom , Shin, Jin Yong , Choi, Chang Soo , Choi, Su Im , Hong, Kwan Hee; J Korean Soc Coloproctol. 2008;24(4):278-286.; DOI: https://doi.org/10.3393/jksc.2008.24.4.278

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PURPOSE
Because depth of invasion by T3 rectal cancer can vary according to the extent of mesorectal invasion, the prognosis for invasive T3 rectal cancer is reported to be very different from that for minimal invasive cancer. Recently, with more emphasis on circumferential resection margin (CRM) status, the T stage, rather than the N stage, seems to be a more valuable prognostic marker in rectal cancer. Therefore, the aim of this study is to determine the prognostic significance of the CRM in invasive T3 rectal cancer.
METHODS
Through reviewing 324 consecutive patients with rectal cancer who underwent a curative resection between January 1995 and December 2002 at Busan Paik hospital, 195 patients with invasive T3 rectal cancer, who had not received preoperative neoadjuvant therapy were selected. The patients were classified into a negative CRM group (negative group, n=173) or a positive CRM group (positive group, n=22), and the patients were subgrouped according to the presence of lymph-node (LN) metastasis and CRM status as negative LN and negative CRM (L-/CM-), negative LN and positive CRM (L-/CM+), positive LN and negative CRM (L+/CM-) and positive LN and positive CRM (L+/CM+). All pathological specimens were re-reviewed by a single pathologist, and the distance between the most advanced edge and the outermost aspect of the specimen was re-measured by using a microscope. Local relapse rates, disease free survival, and overall survival were compared using the Kaplan- Meier method. Multivariate analyses to identify independent prognostic factors were performed using the logistic regression model.
RESULTS
Local recurrence rates in the positive group and the negative group were 38.6% and 15.3%, respectively (P=0.004, log-rank test). The multiple logistic regression model demonstrated positive CRM (hazard ratio 4.4, P=0.0007) and N2 nodal status (hazard ratio 2.4, P=0.02) as predictors of local recurrence. In the subgroup analysis, the overall recurrence rates and survival rates were, respectively, 12.3% and 86.5% in the L-/CM- subgroup, 53.1% and 50.3% in the L-/CM+ subgroup, 52.7% and 50.0% in the L+/ CM- subgroup, and 58.7 % and 33.8% in the L+/CM+ subgroup (log rank test for trend; P=0.0001 and P=0.0001, respectively).
CONCLUSIONS
In the event of predicted CRM involvement in invasive T3 rectal cancer, adjuvant therapy should be performed to improve local control. Also, larger prospective studies are needed to clarify the prognostic role of the CRM in invasive T3 rectal cancer because the number of cases in this study was small, especially in the number of CRM positive cases.

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Comparison of short-term oncologic outcomes following laparoscopic versus conventional open surgery for rectal cancer
Nak Jun Choi, Jong Han Yoo, Hong Tae Lee, Jae Ho Shin, Ha Kyoung Park, Min Sung An, Tae Kwun Ha, Kwang Hee Kim, Ki Beom Bae, Tae Hyun Kim, Chang Soo Choi, Sang Hoon Oh, Minkyung Oh, Kwan Hee Hong
Korean Journal of Clinical Oncology.2013; 9(1): 17. CrossRef

Case Reports

Re-anastomosis above a Preceding Anastomosis Made by a Low Anterior Resection.: Shin, Milljae , Yun, Haeran , Lee, Wonseok , Yun, Seonghyeon , Lee, Wooyong , Chun, Ho Kyung; J Korean Soc Coloproctol. 2008;24(4):287-291.; DOI: https://doi.org/10.3393/jksc.2008.24.4.287

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Abstract PDF: Periodic colonoscopic checkup is needed for patients suffering from colorectal cancer, based on the property that a colorectal neoplasm often recurs synchronously or metachronously. Surgical management appropriate to the occasion should be taken in recurrent colorectal cancer. Particularly, recurring colorectal cancer closely above the prior anastomosis for a low anterior resection should be eliminated by using an abdomino-perineal resection, including the preceding anastomotic site or a new anastomotic creation. Under the latter instance, ample possibility exists for postoperative anastomotic stenosis or leakage by reason of insufficient blood supply to the segment between the earlier anastomosis and the later one. The authors report two cases of re-anastomosis for colorectal cancer just above a previous anastomosis taken by a low anterior resection for rectal cancer. In a 52-year-old male with a history of neoadjuvant concomitant chemo-radiotherapy (CCRT) and low anterior resection for rectal cancer located at 6 cm from the anal verge, a new adenocarcinoma was detected 7 cm from the previous anastomotic site and 3 cm from the anal verge. Considering anal sphincter preservation, the re-anastomosis was made at the upper part of the preceding anastomosis. The patient experienced no surgical complications, such as anastomotic stenosis or leakage and functional defecation difficulty. In another patient, a 50-year-old male with a low anterior resection and adjuvant CCRT for rectal cancer 8 cm from anal verge, a new adenocarcinoma was detected in the colon. The new adenocarcinoma was located 10 cm from the anal verge and 8 cm from the previous anastomosis. The same surgical management was applied to this case, with the same postoperative result.

Clinicopathological Features of Retrorectal Tumors in an Adult: A Case Report and Review of the Literatures.: Kwon, Hye Youn , Hur, Hyuk , Min, Byung Soh , Kim, Nam Kyu , Sohn, Seung Kook , Cho, Chang Hwan; J Korean Soc Coloproctol. 2008;24(4):292-297.; DOI: https://doi.org/10.3393/jksc.2008.24.4.292

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Abstract PDF

Retrorectal tumors are particularly rare among the adult population, occurring in 1 of 40,000 hospital admissions. Clinical diagnosis is difficult and is often delayed because of vague symptoms. This study aimed to investigate the clinicopathological features of retrorectal tumors. Between January 1999 and March 2005, 10 patients were diagnosed with retrorectal tumors at the Department of Surgery, Yonsei University Medical Center, and their medical records were reviewed. We analyzed chief complaints, imaging studies, surgical approaches and pathologic examinations. Out of 10 patients, 8 were female and 2 were male. The mean age was 42.8 years. Four patients had no symptoms. Perianal and abdominal pain were the most common presentations. CT and MRI were the most frequently performed imaging studies. Surgery was performed in 9 patients. Postoperative pathologic diagnosis was possible in 9 patients. An epidermal cyst was the most common tumor (4 patients); others included a mature teratoma, an adenocarcinoma from a tail gut cyst, a duplication cyst, a neurogenic tumor, and a smooth muscle cell tumor. Imaging techniques like CT scans, MRI and TRUS are helpful to determine the size and the extent of a tumor and its relationship to the surrounding anatomical structures for the operative approach. A surgical resection is the standard of treatment and demonstrates good results and a good prognosis.

Citations

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Retrorectal Tumors in Adults: A 10-Year Retrospective Study
Abdullah Oguz, Abdullah Böyük, Ahmet Turkoglu, Cemil Goya, Ulas Alabalık, Fatma Teke, Hıdır Budak, Metehan Gumuş
International Surgery.2015; 100(7-8): 1177. CrossRef
Clinicopathological features of retrorectal tumors in adults: 9 years of experience in a single institution
Bong-Hyeon Kye, Hyung-Jin Kim, Hyeon-Min Cho, Hyung-Min Chin, Jun-Gi Kim
Journal of the Korean Surgical Society.2011; 81(2): 122. CrossRef
Clinical Study and Review of Articles (Korean) about Retrorectal Developmental Cysts in Adults
Sung Wook Baek, Haeng Ji Kang, Ji Yong Yoon, Do Youn Whang, Duk Hoon Park, Seo Gue Yoon, Hyun Sik Kim, Jong Kyun Lee, Jung Dal Lee, Kwang Yun Kim
Journal of the Korean Society of Coloproctology.2011; 27(6): 303. CrossRef

Rectal Perforation after Anorectal Manometry Following Preoperative Chemoradiotherapy and Low Anterior Resection: Report of a Cases.: Jeong, Woon Kyung , Chung, Tae Sung , Lim, Sang Woo , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(4):298-301.; DOI: https://doi.org/10.3393/jksc.2008.24.4.298

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Abstract PDF

Anorectal manometry is widely used to evaluate anorectal function. Few reports have described complications resulting from this procedure. A 47-year-old male underwent preoperative chemoradiotherapy and a low anterior resection for rectal cancer. The patient underwent anorectal manometry at postoperative 8 months. A rectal perforation was diagnosed shortly thereafter. The patient was initially managed conservatively using percutaneous drainage and parenteral antibiotics and then discharged on day 60 after the event. One month later, a colo-cutaneous fistula and expanding abdominal fasciitis developed. The patient underwent surgical exploration, drainage, resection of the rectum including the fistula, and redo-coloanal anastomosis with a diverting ileostomy. The patient discharged without complications on postoperative day 25. Anorectal manometry should be performed with particular care in patients who have undergone radiotherapy and anastomosis at the rectum.

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Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: study protocol for a randomised controlled trial
Christine Norton, Anton Emmanuel, Natasha Stevens, S. Mark Scott, Ugo Grossi, Sybil Bannister, Sandra Eldridge, James M. Mason, Charles H. Knowles
Trials.2017;[Epub] CrossRef
Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome
Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
Annals of Coloproctology.2017; 33(4): 146. CrossRef
Perforación rectal tras manometría anorrectal sin enfermedad rectal previa: una complicación excepcional resuelta con tratamiento médico
Jorge Antonio Núñez Otero, Mariano Gómez Rubio, Ángel R. Durán Aguado, José L. Martínez Albares
Gastroenterología y Hepatología.2013; 36(9): 577. CrossRef

Review

Update in the Pathogenesis of Inflammatory Bowel Disease.: Jang, Byung Ik , Lee, Si Hyung; J Korean Soc Coloproctol. 2008;24(4):302-309.; DOI: https://doi.org/10.3393/jksc.2008.24.4.302

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Abstract PDF

Inflammatory bowel disease (IBD) is a multifactorial disease characterized by abnormal immunologic responses to intestinal antigen, and its causes have not yet been clarified. IBD is known to be due to a complexity of environmental, genetic, and abnormal immunological responses. The hygiene hypothesis remains the key hypothesis for explaining the increase in the incidence of IBD, and smoking is the strongest of the known external environmental factors. Since the detection of the NOD2/CARD15 gene in 2001, rapid progress has occurred, and recently, an important relation between the IL23R gene and IBD has been established. Although studies of normal flora in IBD have some difficulties in methodology, the theory that the loss of immune tolerance to normal flora in the bowel results in IBD is still believed. Incomplete adaptation of innate and adaptive immunity is also one of the important pathogenesis. The toll-like receptor family and the NOD-like receptor family have a important role in the pathologic condition. As to adaptive immunity, in Crohn's disease, the Th1 phenotype is known to be involved, and in ulcerative colitis, the Th2 phenotype cytokines are known to be involved. However, recently, the roles of new cytokines and variable phenotypic lymphocytes have attracted interest. We can clarify the relations of inflammatory pathway-specific and molecular classification of the phenotypes of patients in 10~20 years if progress continues at the same rate as during the last 10 years. We also expected to develop a new therapeutic approach based on these efforts.

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A MATHEMATICAL MODEL OF IMMUNE-MEDIATED DISORDER IN INFLAMMATORY BOWEL DISEASE
Anna Park, Il Hyo Jung
East Asian mathematical journal.2016; 32(1): 139. CrossRef
Two Cases of Crohn's Disease Presented with Hematochezia in Patients with Hemophilia
Jae Hyun Park, Hyo Jong Kim, Seong Dong Sohn, Young Hwangbo, Jaejun Shim, Jae Young Jang, Seok Ho Dong, Byung Ho Kim, Young Woon Chang, Rin Chang
Intestinal Research.2011; 9(1): 35. CrossRef

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