Annals of Coloproctology

Volume 25(3); June 2009

Original Articles

Prognostic Factors for Complication and Mortality of Colonic Perforation.: Park, Keon Hwan , Choi, Pyong Wha , Kim, Jae Il , Noh, Tae Ho , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Kim, Chul Nam , Chang, Surk Hyo; J Korean Soc Coloproctol. 2009;25(3):143-149.; DOI: https://doi.org/10.3393/jksc.2009.25.3.143

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PURPOSE
The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality.
METHODS
The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses.
RESULTS
Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9).
CONCLUSION
Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.

Citations

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Ostomy in Nontraumatic Conditions: Our Experience and Review of the Literature
Kenan Büyükaşık, Bünyamin Gürbulak, Emre Özoran, Yiğit Düzköylü, Esin Kabul Gürbulak, Aziz Arı, Hasan Bektaş
Indian Journal of Surgery.2016; 78(6): 471. CrossRef
EVALUATION OF MANNHEIM PERITONITIS INDEX (MPI) SCORING SYSTEM IN PROGNOSIS OF PATIENTS WITH PERITONITIS DUE TO HOLLOW VISCOUS PERFORATION
Mahammad Ali Sutar, Ramakrishna Yaradhimmaiah, Nikhath Ingva Arshi
Journal of Evolution of Medical and Dental Sciences.2016; 5(31): 1626. CrossRef

Malignancy Associated with Inflammatory Bowel Disease.: Shin, Ui Sup , Yu, Chang Sik , Kim, Chan Wook , Park, Jin Seok , Jeong, Kwang Yong , Yoon, Sang Nam , Lim, Seok Byung , Song, Joon Seon , Kim, Jin Cheon; J Korean Soc Coloproctol. 2009;25(3):150-156.; DOI: https://doi.org/10.3393/jksc.2009.25.3.150

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Abstract PDF

PURPOSE
As the number of patients with inflammatory bowel disease (IBD) has steadily increased in Korea, IBD-associated cancers are expected to increase in number. This study investigated the clinical features of intestinal cancer in patients with IBD.
METHODS
One hundred five patients with ulcerative colitis (UC) and 270 patients with Crohn's disease (CD) under the care of the Department of Colon and Rectal Surgery, Asan Medical Center, between December 1989 and January 2009 were reviewed retrospectively.
RESULTS
Ten patients of the 105 with UC and 5 patients of the 270 with CD were found to have intestinal cancer. The mean age was 45 yr (+/-8.8), and the mean duration of IBD at the time of diagnosis of the cancer was 12.6 yr (+/-6.0). Six of the 15 cancer patients had no history of treatment for IBD of more than 3 mo before diagnosis of the cancer. Eleven cancers were located in the rectum (7 in UC, 4 in CD), including 1 case of synchronous cancer. One case of small bowel cancer was found in a patient with small bowel CD. Four cases involved a mucinous adenocarcinoma. Eight of the 12 cases of an adenocarcinoma of the colon and rectum were advanced stage.
CONCLUSION
IBD-associated intestinal cancers were found at a relatively young age, were diagnosed at an advanced stage, and had a higher proportion of mucinous adenocarcinomas than in sporadic cancer. Considering the increasing incidence of IBD and the expected increase in the number of IBD-associated cancer in Korea, every effort should be made to prevent intestinal cancer in patients with IBD and to detect it early.

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Rectal Squamous Cell Carcinoma in a Patient with Familial Adenomatous Polyposis
Hye Min Jo, Hyun Jung Kim, Jina Youn, Seong Kyu Park, Dae Sik Hong, A Reum Chun, Hee Kyung Kim
Korean Journal of Medicine.2015; 88(3): 335. CrossRef
Primary Squamous Cell Carcinoma of the Ascending Colon: Report of a Case and Korean Literature Review
Dong-Keun Cho, Sang-Hun Kim, Sung-Bum Cho, Wan-Sik Lee, Young-Eun Joo
The Korean Journal of Gastroenterology.2014; 64(2): 98. CrossRef
Clinical Characteristics of Lower Gastrointestinal Cancer in Crohn's Disease: Case Series of 5 Patients
Ji Min Choi, Changhyun Lee, Yoo Min Han, Minjong Lee, Dong Kee Jang, Jeehye Kwon, Jong Pil Im, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung
Intestinal Research.2013; 11(2): 127. CrossRef
A Case of Squamous Cell Carcinoma of the Breast in a Patient with Crohn's Disease Taking Azathioprine
Kyoung Chan Park, Dong Uk Ju, Seong Wook Heo, Jung Il Ryu, Ju Youn Cho, Eui Jung Kim, Hoon Kyu Oh, Eun Young Kim
The Korean Journal of Gastroenterology.2012; 60(6): 373. CrossRef
Squamous Cell Carcinoma of the Rectum: Report of Two Cases
Na Rae Kim, Dong Hae Chung, Jeong Heum Baek, Yeon Ho Park, Hee Eun Kyung, Mi Sook Roh, Seung-Yeon Ha
Intestinal Research.2010; 8(2): 172. CrossRef

Endoscopic Submucosal Dissection for Colorectal Neoplasia: Early Outcomes After 260 Cases.: Lee, Eun Jung , Lee, Jae Bum , Lee, Suk Hee , Kim, Do Sun , Lee, Doo Han , Youk, Eui Gon; J Korean Soc Coloproctol. 2009;25(3):157-164.; DOI: https://doi.org/10.3393/jksc.2009.25.3.157

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Abstract PDF

PURPOSE
Endoscopic submucosal dissection (ESD), a recently introduced endoscopic technique, makes it possible to perform an en-bloc resection of a lesion regardless of its size. The aim of this study was to report early experiences with colorectal ESD performed in our hospital.
METHODS
Between October 2006 and December 2008, we performed an ESD for 260 consecutive cases of colorectal neoplasia in 255 patients. We evaluated the clinical outcomes, except for two failure cases of bowel perforation.
RESULTS
The mean resected tumor size was 24.2+/-9.8 (5-60) mm. Our overall endoscopic en-bloc resection rate was 93.0% (240/258). and the pathologically margin free rate was 91.5% (236/258). Perforation occurred in 7.7% (20/260) of the cases. In 17 patients, perforation was managed by endoscopic clipping without salvage surgery; the other three patients underwent a laparoscopic operation. Pathological examination showed an adenocarcinoma in 35.4% of the cases (92/260). We recommended additional radical surgery in 13 cases (submucosal invasion less than 1 mm with unfavorable pathology: 1 case; unknown depth of submucosal invasion: 1 case; submucosal invasion > or =1 mm: 9 cases; invasion to proper muscle: 2 cases). We were able to check the recurrence rate through colonoscopy for 125 patients. During the mean follow-up period of 8.0+/-4.3 (3-21) mo, there were no recurrences.
CONCLUSION
ESD was technically difficult, had a substantial risk of perforation, and needed a long procedure time. However, ESD enabled en-bloc resection of large colorectal tumors. As experience with the technique increases, ESD might gradually replace piecemeal endoscopic mucosal resection (EMR) and radical colon resection in the treatment of colorectal tumors.

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Follow-up Results of Endoscopic Mucosal Resection for Early Colorectal Cancer
Hee Jung Lee, Hyun Yong Jeong, Nam Hwan Park, Sun Chang Hong, Gwan Woo Nam, Hee Seok Moon, Eaum Seok Lee, Seok Hyun Kim, Jae Kyu Sung, Byung Seok Lee
The Korean Journal of Gastroenterology.2011; 57(4): 230. CrossRef

Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer.: Kang, Dong Baek , Shin, Chang Yeol , Lee, Jeong Kyun , Park, Won Cheol; J Korean Soc Coloproctol. 2009;25(3):165-171.; DOI: https://doi.org/10.3393/jksc.2009.25.3.165

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Abstract PDF

PURPOSE
Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome.
METHODS
A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors.
RESULTS
Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class.
CONCLUSION
The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

Citations

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Surgical Outcomes and Risk Factors in Patients Who Underwent Emergency Colorectal Surgery
Dai Sik Jeong, Young Hun Kim, Kyung Jong Kim
Annals of Coloproctology.2017; 33(6): 239. CrossRef
Emergent Colorectal Surgery: What Should Be Considered?
Chang-Nam Kim
Annals of Coloproctology.2016; 32(4): 124. CrossRef
Outcomes and Risk Factors Affecting Mortality in Patients Who Underwent Colorectal Emergency Surgery
Nam Ho Oh, Kyung Jong Kim
Annals of Coloproctology.2016; 32(4): 133. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Laparoscopic Colorectal Resection after Endoscopic Stent Insertion in Cases of Malignant Colorectal Obstruction: the Experience of a Single Center.: Yi, Jung Im , Lee, In Kyu , Kang, Won Kyoung , Cho, Hyun Min , Park, Jong Kyoung , Oh, Seung Taek , Kim, Jun Gi , Kim, Byoung Uk , Lee, Bo In , Lee, Yoon Suk; J Korean Soc Coloproctol. 2009;25(3):172-177.; DOI: https://doi.org/10.3393/jksc.2009.25.3.172

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Abstract PDF: PURPOSE
Laparoscopic surgery has been considered to be contraindicated for obstructive colorectal cancer. However, endoscopic stent insertion for obstructive colorectal cancer has recently allowed elective laparoscopic surgery. The aim of this study is to evaluate the feasibility and the short-term clinical outcomes of laparoscopic surgery following endoscopic stent insertion for management of malignant colorectal obstruction at a single center.
METHODS
The medical records of patients who had undergone endoscopic stent insertion for colorectal cancer obstruction, followed by laparoscopic colorectal resections, from August 2004 to August 2008 were reviewed. To evaluate the surgical and clinical outcomes, we analyzed the clinical and pathologic data.
RESULTS
Thirty-six endoscopic stent insertions were successfully performed during the study period. Of those 36, the 28 treated by laparoscopic surgery were enrolled in this study. The mean interval between stent insertion and surgery was 7.4+/-2.3 days. Two cases were converted to open surgery. The mean operative time was 185.5+/-53.1 min, and the mean blood loss was 77.0+/-72.9 mL. Flatus was passed on the mean 2nd postoperative day, and patients started to eat on the mean 4th postoperative day. The mean postoperative hospital stay was 11.2+/-4.4 days. Anastomosis leakages occurred in two cases and were treated by a secondary operation with a transient ileostomy. There were morbidities in five cases, but no mortalities.
CONCLUSION
A combined endoscopic stent insertion and laparoscopic surgery is an effective and safe, minimally invasive operation for malignant colorectal obstruction.

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer.: Jeong, Woon Kyung , Baek, Seong Kyu , Bae, Ok Suk; J Korean Soc Coloproctol. 2009;25(3):178-185.; DOI: https://doi.org/10.3393/jksc.2009.25.3.178

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PURPOSE
The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers.
METHODS
From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively.
RESULTS
The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%).
CONCLUSION
The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

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Trans-Sacral Local Resection as a Posterior Approach
Bong Hwa Lee, Hyoung-Chul Park, Hae Wan Lee, Chang Nam An, Taeik Um, Young A Lim, Byoung Sup Kim, Mi Young Chang, Soo Hyoung Kim, Sung Wook Cho
Journal of the Korean Society of Coloproctology.2010; 26(3): 197. CrossRef

Oncologic Impact of Extracapsular Invasion of Nodal Metastasis in Patients with Stage III Rectal Cancer.: Li, Ki Yoon , Shin, Jin Yong , Oh, Sang Hoon , Hong, Kwan Hee; J Korean Soc Coloproctol. 2009;25(3):186-192.; DOI: https://doi.org/10.3393/jksc.2009.25.3.186

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Abstract PDF: PURPOSE
Extracapsular invasion (ECI) of nodal metastasis is reported to be a prognosticator of colorectal cancer. However, limited knowledge exists about the prognostic value of ECI in stage III rectal cancer.
METHODS
From January 1996 to June 2004, 202 stage III rectal cancer patients who underwent surgery were enrolled in this study. The patients were divided into two groups according to ECI (patients with ECI, ECIP, n=122; patients without ECI, ECIN, n=80). The potential prognostic factors were compared in a Cox model.
RESULTS
Of 916 positive nodes examined, ECI was seen in 46.7% of the positive nodes. The univariate comparison between the two groups revealed the five-year results after a median follow-up of 48.0 mo. The local control rate of ECIP did not show a significant difference from that of ECIN (77.0% vs. 85.4%, P=0.550). The disease-free survival rate and the overall survival rate differed for the two groups, with rates of 44.1% and 50.0% for ECIP and 70.4% and 63.2% for ECIN (P<0.001, P=0.049, respectively). The impact of ECI on the disease-free survival was confirmed in a Cox model. In a subgroup analysis, no significant differences in the recurrence and the survival rates were seen between the N1 ECIP and the N2 ECIN subgroups.
CONCLUSION
Although ECI is not a risk factor for survival and local relapse, ECI is a prognosticator of overall recurrence. Based on these findings, more aggressive adjuvant treatment seems to be needed for decreasing the overall recurrence in stage III rectal cancer with ECI.

Case Reports

A Case of Coffee Enema-induced Colitis.: Seo, Chan Hee , Kim, Young Ho; J Korean Soc Coloproctol. 2009;25(3):193-196.; DOI: https://doi.org/10.3393/jksc.2009.25.3.193

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A coffee enema, which has been suggested as a part of cancer treatment, is a hazardous derivative of colon therapy and has been misused as a treatment for obesity and constipation among the general population. Its proponents claim that caffeine is absorbed in the colon and leads to vasodilatation in the liver, which in turn enhances the process of elimination of toxins. None of this is proven, nor is there any evidence for the clinical efficacy of coffee enemas. We experienced a patient who presented with abdominal pain and bloody stool after receiving a coffee enema to relieve constipation. We report this case of coffee-associated colitis with a review of the relevant literature.

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Proctocolitis From Coffee Enema
Anna H. Lee, Sohaip Kabashneh, Charles P. Tsouvalas, Usman Rahim, Mir Y. Khan, Mohammad Anees, Diane Levine
ACG Case Reports Journal.2020; 7(1): e00292. CrossRef
The safety and effectiveness of self-administered coffee enema
Heejung Son, Hyun Jin Song, Hyun-Ju Seo, Heeyoung Lee, Sun Mi Choi, Sanghun Lee
Medicine.2020; 99(36): e21998. CrossRef
Local Management of Constipation: Enemas, Suppositories
Seong-Eun Kim, Jeong Eun Shin, Kyoung Sup Hong, Tae Hee Lee, Bong Eun Lee, Seon-Young Park, Sung Noh Hong, Kee Wook Jung, Kyung Sik Park, Suck Chei Choi
Korean Journal of Medicine.2015; 88(1): 15. CrossRef

Goblet Cell Carcinoid of the Appendix.: Park, Sun Jin , Choi, Sung Il , Song, Jeong Yoon , Kim, Yong Ho; J Korean Soc Coloproctol. 2009;25(3):197-201.; DOI: https://doi.org/10.3393/jksc.2009.25.3.197

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Abstract PDF: A goblet cell appendiceal carcinoid (GCAC) is an uncommon tumor. It shares the histologic features of both adenocarcinoma and conventional carcinoids. The metastatic potential of GCAC is higher than that of classic appendiceal carcinoids. Their management, whether an appendectomy alone is an adequate treatment or whether a right hemicolectomy is indicated, is still under debate. The metastatic potential of GCAC is similar to that of classic appendiceal carcinoids and depends on the tumor size and the mitosis rate. Therefore, some authors advocate a simple appendectomy, not expanding beyond the appendix adventitia, for selected patients with tumors less than 1 cm in diameter with a low mitosis rate (<2/10 HPF). Otherwise, a right hemicolectomy is indicated for all other patients to reduce the risk of developing metastatic disease. Chemotherapy is the usual treatment option for metastatic disease, but more data are required if an optimal regimen is to be determined. Finally, colonoscopy plays an important role in patients with an appendiceal adenocarcinoid because of their high risk of developing a colorectal adenocarcinoma. Recently, we discovered one case of a GCAC that was diagnosed incidentally at appendectomy. A 48-yr-old man visited the emergency department with the symptom of right lower quadrant abdominal pain. Acute appendicitis was suspected after evaluation, and a laparoscopic appendectomy was performed. The type of appendicitis was gangrenous, and there were no obvious signs of malignancy. However, a pathologic diagnosis of a goblet cell carcinoid was made. A laparoscopic right hemicolectomy was subsequently performed. The patient received 5 cycles of chemotherapy applied to the goblet cell carcinoid and has shown no other remarkable indispositions during the last 12 mo.

Hyperplastic Polyposis Associated with Two Synchronous Colon Cancers.: Seong, Moo Kyung , Shim, Jin Suk , Hwang, Tae Sook , Kim, Ji Hoon; J Korean Soc Coloproctol. 2009;25(3):202-206.; DOI: https://doi.org/10.3393/jksc.2009.25.3.202

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Abstract PDF

Hyperplastic polyps are common large-bowel tumors, are frequently detected in middle- to old- aged people, and usually are minuscule lesions in the distal colon and rectum. Most hyperplastic polyps have no malignant potential, but recent studies suggest that some hyperplastic polyps can progress to colorectal cancers, possibly by the so-called serrated pathway. Hyperplastic polyposis is a rare syndrome characterized by multiple hyperplastic polyps, primarily in the proximal colon. Different from sporadic hyperplastic polyps, hyperplastic polyposis is alleged to have high potential for malignancy because patients with this syndrome may frequently have conventional adenomas, serrated adenomas, and adenocarcinomas. We report the case of a patient with hyperplastic polyposis, who had two synchronous colon cancers, as well as sessile serrated adenomas and tubular adenomas.

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Hyperplastic Polyposis Syndrome Identifi ed with a BRAF Mutation
Hyung Su Ahn, Su Jin Hong, Hee Kyung Kim, Hee Yong Yoo, Hwa Jong Kim, Bong Min Ko, Moon Sung Lee
Gut and Liver.2012; 6(2): 280. CrossRef

Review

Controversies in Pouch Surgery for Ulcerative Colitis.: Yu, Chang Sik; J Korean Soc Coloproctol. 2009;25(3):207-211.; DOI: https://doi.org/10.3393/jksc.2009.25.3.207

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Abstract PDF: Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn's disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn's disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

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