Annals of Coloproctology

Volume 26(3); June 2010

Review

Update for Indeterminate Colitis.: Um, Jun Won; J Korean Soc Coloproctol. 2010;26(3):165-170.; DOI: https://doi.org/10.3393/jksc.2010.26.3.165

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Abstract PDF: The distinctive diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. Both UC and CD show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of indeterminate colitis (IC), which was proposed by pathologists for colectomy specimens in 1978, usually from patients operated on for severe colitis, especially in cases of acute fulminant disease of the colorectum. The subgroup of patients with an uncertain diagnosis has been classified as IC. Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, or other features allowing a diagnosis of either UC or CD. More recently, the term IC has been applied to biopsy material when it is not been possible to differentiate between UC and CD. However, this term IC has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease, has led to much confusion. In resected specimens, the term colitis of uncertain type or etiology is preferred. Over time, the majority of patients remain with a diagnosis of IC or show symptoms similar to UC. Ileal pouch anal anastomosis can be performed in such patients, with outcomes of pouch failure and with functional outcomes that are similar to those in patients with UC, but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, its natural history, and the outcomes of restorative proctocolectomy.

Original Articles

Changes in Migrating Motor Complex after Bowel Obstruction in the Murine Ileum.: Moon, Sang Hui , Oh, Heung Kwon , Ryoo, Seungbum , Choe, Eun Kyung , Moon, Jung Sun , Park, Kyu Joo; J Korean Soc Coloproctol. 2010;26(3):171-178.; DOI: https://doi.org/10.3393/jksc.2010.26.3.171

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Abstract PDF

PURPOSE
Partial obstruction of the small bowel causes hypertrophy of smooth muscle cells and enteric neurons. After small bowel obstruction, slow waves have also been reported to disappear or to be greatly reduced at the oral site of the obstruction in the murine ileum. The purpose of this research was to study the changes in migrating motor complexes (MMCs) after partial obstruction in order to compensate for the attenuated function of slow waves.
METHODS
A ring of film (6 mm in length, 4 mm in internal diameter) was placed over the small intestine 5-6 cm oral to the ileocecal valve in 8-10 wk old female ICR mice. These rings resulted in a partial obstruction of the intestine after 2 wk. The mechanical activities of the small intestine were recorded and the amplitude, interval, and half-duration of the MMCs were analyzed.
RESULTS
The MMCs from a partially obstructed ileum occurred every 1.58+/-1.06 min and had a half-duration of 6.90+/-5.54 sec. The interval and the half-duration of the control MMCs were 3.60+/-1.11 min and 31.5+/-11.4 sec, respectively. The difference in interval and the half-duration of the MMCs reached statistical significance (P=0.03; P=0.00). The amplitude and the area under the curve (AUC) of the MMCs of the obstructed ileum were much higher than those of the control (31.3+/-8.86 vs. 6.05+/-1.92 mN; 161.18+/-44.09 vs. 72.95+/-2.45 mN . sec/MMC wave; P=0.00, 0.02).
CONCLUSION
The MMCs with higher amplitude and AUC, with shorter interval, and with shorter half-duration, compared with those of the control, were recorded from the partially obstructed murine ileum, reflecting efforts to overcome the effect of obstruction by increasing the power of contractions.

Citations

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Migrating motor complex changes after side-to-side ileal bypass in mouse ileumex-vivo: mechanism underlying the blind loop syndrome?
Suk-Bae Moon, Kyu-Joo Park, Jung-Sun Moon, Eun-Kyoung Choe, In-Suk So, Sung-Eun Jung
Journal of the Korean Surgical Society.2011; 80(4): 251. CrossRef

Comparison of Early Clinical Outcomes Between ALTA (Aluminum Potassium Sulfate and Tannic Acid, Ziohn(R)) Injection Therapy and a Submucosal Hemorrhoidectomy in Patients with Internal Hemorrhoids.: Lee, Young Chan , Shin, Hyun Keun , Lim, Cheong Ho , Yang, Hyung Kyu , Kang, Jung Hyun , Lee, Kang Young , Kim, Nam Kyu; J Korean Soc Coloproctol. 2010;26(3):179-185.; DOI: https://doi.org/10.3393/jksc.2010.26.3.179

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PURPOSE
The purpose of this study was to evaluate early outcomes of ALTA (aluminum potassium sulfate and tannic acid, Ziohn(R)) injection compared with those of a submucosal hemorrhoidectomy for the treatment of internal hemorrhoids.
METHODS
From September 2008 to April 2009, a total of 50 patients who had internal hemorrhoids (Golliger grade II to IV) were treated by using either ALTA injection (n=25) or a submucosal hemorrhoidectomy (n=25). Outcomes with respect to pain scores, analgesics use, and satisfaction levels of the patients, and complications were compared.
RESULTS
The mean number of hemorrhoidal piles was 3.52 in the ALTA injection group and 3.56 in the operation group. The average amount of ALTA injection was 27.34 cc. Pain scores measured at one day and 7 days after the treatment, and the number of analgesics used in the injection group were significantly lower than those in the operation group (P<0.001). However, there was no significant difference in the satisfaction level between two groups. One case of treatment failure was found in the ALTA injection group. There was no difference in complications between the injection group (n=4) and the operation group (n=5) (P=0.725).
CONCLUSION
When compared with a submucosal hemorrhoidectomy, ALTA injection showed less post-treatment pain and less analgesics use. Overall complication rates were not different between the two groups. We found the early outcomes of ALTA injection for the treatment of internal hemorrhoids to be comparable to those of surgery. Thus, large-scale and long-term follow-up studies are needed to clarify the proper indications for ALTA injection.

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Aluminum Potassium Sulfate and Tannic Acid Injection for Hemorrhoids
Seok Won Lim
Journal of the Korean Society of Coloproctology.2012; 28(2): 73. CrossRef

Predictive Factor for Surgical Indication in Postoperative Adhesive Small Bowel Obstruction.: Kang, Ji Woong , Nam, Jung Kwang , Kim, Byung Seok , Moon, Duk Jin; J Korean Soc Coloproctol. 2010;26(3):186-189.; DOI: https://doi.org/10.3393/jksc.2010.26.3.186

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Abstract PDF: PURPOSE
There is a long-standing debate about whether postoperative adhesive small bowel obstruction (SBO) is best managed operatively or nonoperatively. The aim of this study is to define predictive factors for surgical indication in the treatment of an adhesive SBO.
METHODS
Medical records and laboratory data of 211 patients who had a SBO after a laparotomy from January 2000 to December 2008 were reviewed retrospectively. The patients were divided into two groups according to the modality of SBO treatment: operatively and nonoperatively. The laboratory data and clinical parameters were compared between the two groups and a statistical analysis was performed.
RESULTS
A Mann-Whitney analysis revealed previous SBO history, amylase, erythrocyte sedimentation rate (ESR), creatine phosphokinase, drainage amount via a Levin tube to be significant factors associated with surgical management. A multivariate analysis showed drainage amount via a Levin tube of 500 mL/day or greater (P=0.007), amylase of 90 IU/L or greater (P=0.04), and ESR of 11 mm/hr or greater (P=0.03) to be independent predictive factors for surgery.
CONCLUSION
Surgical management should be considered among adhesive SBO patients with elevated amylase (> or =90 IU/L) and ESR (> or =11 mm/hr) and with large drainage amount through the Levin tube (> or =500 mL/day).

Diagnosis and Treatment of Anorectal Lesions in Crohn's Disease.: Heo, Youn Jung , Park, Won Kap , Kim, Jae Cheol , Lee, Jong Kyun , Kim, Kwang Yeon; J Korean Soc Coloproctol. 2010;26(3):190-196.; DOI: https://doi.org/10.3393/jksc.2010.26.3.190

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Abstract PDF: PURPOSE
Anorectal lesions in patients with Crohn's disease (CD) are difficult to manage because of frequent recurrences and complications. The aim of this study is to evaluate the relationship between anorectal lesions and CD and to analyze the methods of management and the results of anorectal lesions.
METHODS
The records of 33 patients with CD who had anorectal lesions, who visited our institution from July 2001 to June 2007, were reviewed retrospectively.
RESULTS
CDs involving the small and the large bowel in 24 patients, the small bowel in 4 patients, the large bowel in 4 patients, and only the anorectum in 1 patient. Twenty-two patients (75.9%) were diagnosed as CD with unusual anorectal findings: unhealed wound or delayed healing of wound after the initial anal operation, multiple ulcers or fissures, broad based or friable fistula tract, non-cryptoglandular type of fistula, multiple fistula tracts, and recurrent or concurrent fistula. The predominant type of anorectal lesion was a perianal fistula (28 patients, 84.8%). Twelve out of 45 anal specimens (26.7%) showed noncaseating epithelioid granulomas, characteristic findings of CD. Conservative treatment was performed in 7 patients (21.2%), anorectal operations in 26 patients (78.8%). Twelve of those 26 patients underwent multiple operations. Anorectal operations were performed as follows: incision and drainage (8), fistulotomy or fistulectomy (17), muscle-preserving surgery (7), seton drainage (12), and modified Hanley's procedure (1). All anorectal operations, except those for an abscess, were performed after induction of remission of the CD. Satisfactory results were achieved in 29 patients (87.9%).
CONCLUSION
In patients with unusual anorectal lesions, a diagnostic work-up for CD should be performed. Anorectal lesions with CD may be properly managed using several different methods, depending on the anorectal conditions and the activity of the CD.

Trans-Sacral Local Resection as a Posterior Approach.: Lee, Bong Hwa , Park, Hyoung Chul , Lee, Hae Wan , An, Chang Nam , Um, Taeik , Lim, Young A , Kim, Byoung Sup , Chang, Mi Young , Kim, Soo Hyoung , Cho, Sung Wook; J Korean Soc Coloproctol. 2010;26(3):197-203.; DOI: https://doi.org/10.3393/jksc.2010.26.3.197

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PURPOSE
Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique.
METHODS
A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo.
RESULTS
Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence.
CONCLUSION
In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.

Citations

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How to Treat Retrorectal Cysts or Tumors in Adult
Bong Hwa Lee, Hyoung Chul Park, Byung Seup Kim
Journal of the Korean Society of Coloproctology.2011; 27(6): 276. CrossRef

Outcomes of a Hepatic Resection for Colorectal-Carcinoma Liver Metastases.: Lee, Woo Koung , Kim, Sang Bum , Cho, Eung Ho , Hwang, Dae Yong , Moon, Sun Mi; J Korean Soc Coloproctol. 2010;26(3):204-210.; DOI: https://doi.org/10.3393/jksc.2010.26.3.204

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PURPOSE
Recent managements of liver metastasis from colorectal cancer consist of multi-disciplinary treatments. Although hepatic resection is the only curative treatment, for which long-term survival is expected, the recurrence rates is still high. Recently, liver resections, combined with chemotherapy and other additional therapy, have produced promising outcomes. We analyzed the outcomes of hepatic resection for liver metastasis from colorectal cancer.
METHODS
From 1993 to 2007, we performed 116 hepatic resections for the treatment of liver metastasis from colorectal cancer. All patients received adjuvant chemotherapy. We reviewed their medical records and investigated the clinico-pathologic data retrospectively.
RESULTS
One in hospital mortality occurred, and the postoperative morbidity rate was 37.5%, including major complication (11.7%). Five-yr overall survival rate and disease free survival rate were 33.2% and 25.0%, respectively. T stage and postoperative morbidity were independent prognostic factors for survival whereas metachronous metastases and postoperative morbidity were independent prognostic factors for recurrence. During the follow-up periods, 67 recurrences occurred.
CONCLUSION
Hepatic resections for liver metastasis from colorectal cancer were safe and effective. The surgical T stage, complications, and metastasis type (metachronous or synchronous) may determine the results in patients with surgically-curable liver metastasis from colorectal cancer.

Citations

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Scoring of prognostic factors that influence long-term survival in patients with hepatic metastasis of colorectal cancer
Sung Woo Ahn, Ahn Soo Na, Jae Do Yang, Hong Pil Hwang, Hee Chul Yu, Baik Hwan Cho
Korean Journal of Hepato-Biliary-Pancreatic Surgery.2011; 15(3): 146. CrossRef

Diagnostic Usefulness of Routinely Performed Preoperative Chest Computed Tomography for Colorectal Cancer.: Hwang, Mi Jin , Jung, Sang Hun , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2010;26(3):211-216.; DOI: https://doi.org/10.3393/jksc.2010.26.3.211

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Abstract PDF

PURPOSE
The most common site of metastases in colorectal cancer (CRC) is the liver, and the second common site is the lung (10-20%). Preoperative staging for CRC is very important. The aim of this study was to assess the usefulness of chest computed tomography (CT) for preoperative staging in CRC.
METHODS
From January 2006 to December 2007, a total of 597 patients with colorectal cancer underwent surgery at our hospital. One hundred fifty of those patients had received chest CT preoperatively. We analyzed the chest radiologic findings from chest x-ray (CXR), abdominal CT, and chest CT.
RESULTS
The detection rate of abnormal lung findings was higher in chest CT than in the other chest radiologic findings (chest PA: 10 [6.6%]; abdominal CT: 19 [12.7%]; chest CT: 48 [32.0%]). On the chest CT, 19 of the 150 (12.7%) patients that had received a chest CT preoperatively were initially suspected of having malignant lesions. Besides two primary lung malignancies (solitary nodules), metastatic lesions were revealed in 5 (3.3%), 11 (7.3%), and 17 (11.3%) patients on CXR, abdominal CT, and chest CT, respectively. Eleven (64.7%) of the patients having metastatic chest CT lesions were also identified on lower lung fields by abdominal CT. Seven also had other metastatic foci (liver and paraaortic LN). Initially, stage IV was identified in 37 (24.7%) and 40 (26.7%) patients in abdominal CT and chest CT, respectively. After one year, 11 of the 150 (7.3%) patients who had received a chest CT had been diagnosed with pulmonary metastasis.
CONCLUSION
Chest computed tomography is the most sensitive method for the diagnosis of pulmonary metastases. However, if the interpretations of abdominal CT and individualized diagnostic methods are accurate, the demand for unnecessary preoperative work-up may be reduced.

Citations

Citations to this article as recorded by

Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty
Karen Ma, Sandeep Nayak, Hong Li, Kateri Evans, Amanda Francescatti, Marc I. Brand, Bruce Orkin, Marisa Hill, James Cameron, Sohrab Mobarhan, Joanne Favuzza, Joshua Melson
Gastrointestinal Endoscopy.2015; 82(3): 497. CrossRef
Should preoperative chest computed tomography be performed in all patients with colorectal cancer?
A. R. Lazzaron, M. V. Vieira, D. C. Damin
Colorectal Disease.2015;[Epub] CrossRef
The diagnostic yield of preoperative staging computed tomography of the thorax in colorectal cancer patients without hepatic metastases
Gabriella Yongue, Alexander Hotouras, Jamie Murphy, Hasan Mukhtar, Chetan Bhan, Christopher L. Chan
European Journal of Gastroenterology & Hepatology.2015; 27(4): 467. CrossRef
Should Preoperative Chest CT Be Recommended to All Colon Cancer Patients?
Hye Young Kim, Soon Jin Lee, Gilsun Lee, Limwha Song, Su-A Kim, Jin Yong Kim, Dong Kyung Chang, Poong-Lyul Rhee, Jae J. Kim, Jong Chul Rhee, Ho-Kyung Chun, Young-Ho Kim
Annals of Surgery.2014; 259(2): 323. CrossRef
Indeterminate Pulmonary Nodules at Colorectal Cancer Staging: A Systematic Review of Predictive Parameters for Malignancy
Andreas Nordholm-Carstensen, Peer A. Wille-Jørgensen, Lars N. Jorgensen, Henrik Harling
Annals of Surgical Oncology.2013; 20(12): 4022. CrossRef
Pulmonary staging in colorectal cancer: a review
C. N. Parnaby, W. Bailey, A. Balasingam, L. Beckert, T. Eglinton, J. Fife, F. A. Frizelle, M. Jeffery, A. J. M. Watson
Colorectal Disease.2012; 14(6): 660. CrossRef

Prognostic Analysis According to N Stage and Circumferential Resection Margin in Patients with Locally Advanced Rectal Cancer.: Sohn, Yong Ki , Shin, Jin Yong , Hong, Kwan Hee; J Korean Soc Coloproctol. 2010;26(3):217-224.; DOI: https://doi.org/10.3393/jksc.2010.26.3.217

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Abstract PDF: PURPOSE
Efforts must be made to clarify the contribution of lymph node metastasis (NM) to adjuvant (chemo) radiotherapy following a curative resection for rectal cancer as the circumferential resection margin (CRM) has increasingly become a more reliable prognosticator for rectal cancer. This study examined the prognostic impact of NM on local recurrence, disease-free survival. and overall survival rates in curatively resected patients with locally advanced rectal cancer.
METHODS
Two hundred two patients with locally advanced rectal cancer curatively resected in Pusan Paik Hospital from January 1995 to December 2003 were enrolled. These patients were divided into three groups according to lymph node (N) disease (N0: node negative, n=79; N1: 1-3 nodes positive, n=70; N2: > or =4 nodes positive, n=53). The potential prognostic factors, for example, T and N stage, preoperative carcinoembryonic antigen (CEA), postoperative (chemo) radiotherapy, operative methods, and several pathologic variables, were assessed among the three groups. The potential clinicopathologic factors were analyzed by using the Kaplan-Meier method, and the prognostic factors were compared in a Cox regression model. Also, we compared the oncologic results of 26 patients with a positive CRM (CMI) with those of the N1 and the N2 subgroups.
RESULTS
N2 patients had an impaired 5-yr local control rate (19.1%) compared with N0 (6.8%) and N1 (11.6%, P=0.029) patients after a median follow up of 60 months (range, 6 to 156 mo). Differences in disease-free and overall survival were also significantly different statistically among the three groups (84.0% and 85.2% for N0; 54.9% and 65.1% for N1; 37.3% and 49.8% for N2; P<0.001 both). The impact of NM on the local recurrence, disease-free survival and overall survival was confirmed in the regression model for the curatively resected patients. There were no significant differences in the recurrence and the survival rates between CMI and N2 stage.
CONCLUSION
NM has an independent prognostic impact on local failure and on disease-free survival and overall survival. Based on these findings, NM should be considered as an indicatior for adjuvant therapy. Although the prognostic impact of CMI is similar to that of N2, a larger prospective study is needed to clarify the prognostic association of CMI and N2.

The Effects of a Standardized Postoperative Enhanced Recovery Program after a Laparoscopic Colorectal Resection in Regard to Patients' Recovery and Clinical Outcomes.: Joh, Yong Geul , Lee, Jeong Eun , Yoo, Sang Hwa , Kim, Seung Han , Jeong, Geu Young , Chung, Choon Sik , Lee, Dong Gun; J Korean Soc Coloproctol. 2010;26(3):225-232.; DOI: https://doi.org/10.3393/jksc.2010.26.3.225

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Abstract PDF

PURPOSE
A multidisciplinary program for early recovery after colorectal surgery has been developed continuously since 2000. The purpose of this study was to evaluate the effects of the standardized postoperative enhanced recovery program (SPERP) after a colorectal resection.
METHODS
The patients undergoing laparoscopic colorectal resection for colorectal cancer were cared for by using the SPERP after surgery. The comparison group consisted of patients who had undergone similar surgery before establishment of the SPERP. The two groups were compared with respect to the patients' characteristics, operation methods, operation time, blood loss, amounts of intravenous fluid and intravenous antibiotics, complications, postoperative hospital stay, readmission rate, and reoperation rate.
RESULTS
The number of patients being treated with the standardized postoperative recovery program, the standardized group (SG), was 63, and that of the traditional group (TG) was 61. Even though the day of oral feeding (1.02 vs. 2.67 days) was faster in the SG, the day of flatus and defecation was not different between two groups. The postoperative hospital stay in the SG (6.76 days) was significantly shorter than that in the TG (10.43 days). The total amount of intravenous fluid after surgery in the SG was 8,574.75 mL, compared with 19,568.22 mL in the TG. The duration of intravenous antibiotics was 2.69 days in the SG and 7.38 days in the TG (P=0.0001). The rates of complication (27.0% in SG vs. 39.3% in TG), reoperation (3.17% vs. 9.84%), and readmission (7.94% vs. 6.56%) did not increase after implementation of this program.
CONCLUSION
The standardized postoperative recovery program reduced the amounts of postoperative intravenous fluid and antibiotics and the postoperative hospital stay without increasing either complications or the readmission rate. A prospective multi-center study of this program is needed.

Citations

Citations to this article as recorded by

Perioperative surgical home: a new scope for future anesthesiology
Min A Kwon
Korean Journal of Anesthesiology.2018; 71(3): 175. CrossRef
The Effects and Variances of the Critical Pathway of Laparoscopic Colon Resection in Colon Cancer Patients
Hye Jeong Jung, Mona Choi, So Sun Kim, Nam Kyu Kim, Kang Young Lee
Asian Oncology Nursing.2012; 12(3): 204. CrossRef

Case Report

Actinomycosis of the Appendix: A Case Report.: Jee, Sung Bae , Jang, Ki Seok , Kim, Sung Ho , Kim, Chul Joong; J Korean Soc Coloproctol. 2010;26(3):233-237.; DOI: https://doi.org/10.3393/jksc.2010.26.3.233

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Abstract PDF

Actinomycosis is an uncommon disease caused by actinomycoses, which is a normal flora in the human mucosal membrane. It is difficult to diagnose pre- and intra-operatively and requires long-term use of antibiotics even after surgery. Especially, abdominal actinomycosis is frequently misdiagnosed as a tumor, diverticulitis, chronic inflammatory disease, or other infectious disease preoperatively. Thus, we report the case of a 21-yr-old male patient who was thought to have acute appendicitis and who underwent a cecal wedge resection, including the appendix, with the assistance of laparoscopy for appendiceal actinomycosis.

Citations

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Appendiceal actinomycosis mimicking malignant tumor: a rare case report
Nathan Khabyeh-Hasbani, Sivan Zino, Elena Dima, Shmuel Avital
Annals of Medicine & Surgery.2024; 86(2): 1076. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient
Gyung Eun Kim, Yong-Jun Choi, Jin-Seok Park, Yong Woon Shin, Jee-Young Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(1): 67. CrossRef
A Case of Esophageal Actinomycosis in a Patient with Normal Immunity
Hyun Soo Kim, Jong Woon Cheon, Min Su Kim, Chang Kil Jung, Kyung Rok Kim, Jae Won Choi, Dong Woo Kang, Sun Young Kim
The Korean Journal of Gastroenterology.2013; 61(2): 93. CrossRef

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