Annals of Coloproctology

Volume 39(3); June 2023

Editorial

Colorectal cancer

Organ preservation for early rectal cancer using preoperative chemoradiotherapy: Gyung Mo Son; Ann Coloproctol. 2023;39(3):191-192. Published online June 29, 2023; DOI: https://doi.org/10.3393/ac.2023.00409.0058

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Citations

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Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Review

Inflammatory bowel diseases

Colorectal surgical management of colitis induced by vasculitis in the absence of inflammatory bowel disease: a case report and literature review: Jessica A. Paynter, Kirby R. Qin, Georgia Seamer, Ruchira Fernando, Janelle Brennan, Chun Hin Angus Lee; Ann Coloproctol. 2023;39(3):193-203. Published online November 16, 2022; DOI: https://doi.org/10.3393/ac.2022.00584.0083

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Abstract PDF: Colitis caused by vasculitis is a rare and poorly understood pathology. Little evidence exists on its clinical presentation, path to diagnosis, and surgical management. In this report, we present a case report and literature review. A healthy 20-year-old male patient presented with hemorrhagic colitis requiring total colectomy with end ileostomy. Pathological examination showed pancolitis with multiple ulcers, transmural inflammation, hemorrhage, and microvascular thrombosis. Extensive serological testing revealed elevated cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and eosinophilia, leading to a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) and vasculitis-induced colitis. A literature review was subsequently conducted. Nineteen studies were found documenting vasculitis-induced colitis in the absence of inflammatory bowel disease (IBD). Systemic signs of vasculitis, hemorrhagic colitis, and progression to fulminant colitis were present. Of all patients, 40.0% required colorectal surgery and 62.5% of those patients received a stoma; 25% underwent emergency surgery following failed immunosuppression. All cases relied on clinical correlation with serology and/or histopathology to reach a final diagnosis. We report a case of vasculitis-induced colitis caused by c-ANCA−positive EGPA. The review shows that vasculitis-induced colitis without IBD is an important differential that clinicians should be aware of in patients presenting with colitis.

Original Articles

Anorectal benign disease

Radical surgical management of perianal giant condyloma acuminatum of Buschke and Löwenstein: long-term results of 11 cases: Alp Yildiz, Sezai Leventoglu, Aybala Yildiz, Arda Inan, Bedrettin Bulent Mentes; Ann Coloproctol. 2023;39(3):204-209. Published online August 23, 2021; DOI: https://doi.org/10.3393/ac.2021.00080.0011

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Abstract PDF

Purpose
Perianal Buschke-Löwenstein tumor (BLT) is characterized by an exophytic cauliflower-like mass surrounding the perianal region. Its tendency to infiltrate the adjacent tissues, its massiveness, and its high recurrence rate cause difficulties in treatment. The aim of this study is to report our strategy with wide local excision and flap reconstruction for BLT.
Methods
From November 2002 to June 2019, 11 patients (9 men) with a mean age of 33.45 years (range, 19–54 years) were operated on for BLT. All patients underwent wide local excision and V-Y flap reconstruction, supplemented with other flaps whenever needed. No additional modalities were used.
Results
Two patients had a history of anal intercourse while all patients were human immunodeficiency virus-negative. The mean tumor length was 15.54 ± 1.34 cm (range, 10–26 cm). Human papillomavirus 6 was the most common type identified. Partial wound dehiscence developed in 3 patients, while anal stenosis, mucosal ectropion, or local recurrence was not observed during the mean follow-up period of 50.45 ± 1.75 months (range, 10–196 months).
Conclusion
In patients with perianal BLT, wide local excision and flap reconstruction result in a high healing rate without significant complications.

Citations

Citations to this article as recorded by

An Anal Lesion in a 27-Year-Old Patient
Jérémy Baude, Hugues Mura, Alexis Lépinoy
JAMA Oncology.2024;[Epub] CrossRef
Clinicopathological Findings and Comprehensive Review of Buschke–Lowenstein Tumors Based on a Case Study
Andreea Grosu-Bularda, Cristian-Sorin Hariga, Catalina-Stefania Dumitru, Nicolae Calcaianu, Cosmin-Antoniu Creanga, Valentin Enache, Silvia-Elena Tache, Eliza-Maria Bordeanu-Diaconescu, Vladut-Alin Ratoiu, Razvan-Nicolae Teodoreanu, Ioan Lascar
Journal of Personalized Medicine.2024; 14(8): 887. CrossRef
Cirugía más inmunoterapia local en el tratamiento del tumor de Buschke-Löwenstein. A propósito de un caso
Nicole Emily Rojas Espinoza, Juan Pablo Torrico Vilte
Revista de Investigación e Información en Salud.2023; 18(44): 51. CrossRef
Surgical Management of Perianal Giant Condyloma Acuminatum of Buschke and Löwenstein: Case Presentation
Raul Mihailov, Alin Laurențiu Tatu, Elena Niculet, Iulia Olaru, Corina Manole, Florin Olaru, Oana Mariana Mihailov, Mădălin Guliciuc, Adrian Beznea, Camelia Bușilă, Iuliana Laura Candussi, Lavinia Alexandra Moroianu, Floris Cristian Stănculea
Life.2023; 13(9): 1916. CrossRef

Anorectal physiology & pelvic floor disorder

Efficacy and safety of anal encirclement combining the Leeds-Keio artificial ligament with injection sclerotherapy using aluminum potassium sulfate and tannic acid in the management of rectal prolapse: a single-center observational study: Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Kei Ohara, Mitsuhiro Inagaki; Ann Coloproctol. 2023;39(3):210-215. Published online November 12, 2021; DOI: https://doi.org/10.3393/ac.2021.00731.0104

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Abstract PDF

Purpose
Perineal procedures are an important surgical option for frail and high-risk patients with rectal prolapse. This study aimed to evaluate the efficacy and safety of combined therapy using injection sclerotherapy, with aluminum potassium sulfate and tannic acid (ALTA), and the Thiersch procedure, using the Leeds-Keio ligament (ALTA-Thiersch).
Methods
This study included 106 consecutive patients (mean age, 81.2 years) who underwent ALTA-Thiersch for rectal prolapse. The procedure was performed under caudal epidural anesthesia. ALTA was injected into the submucosa from the tip of the prolapsed rectum down to the dentate line, circumferentially, at 20 to 40 locations. The ligament tape was placed outside the external sphincter muscle and at an approximate depth of 2 cm into the middle anal canal.
Results
Of 106 patients, rectal prolapse was cured shortly after surgery in 105 patients. An additional tape was inserted in 1 patient who had persistent prolapse. Postoperative complications were observed in 27 patients (25.5%). Fecal impaction occurred in 12 patients; however, since it was temporary, no tape removal was required. Of the 12 cases in which the tape was infected or exposed, 11 required tape removal. There were 18 cases of recurrence at a mean follow-up of 22.1 months. Cumulative recurrence rates at 3 and 5 years were 21.3% and 38.6%, respectively.
Conclusion
ALTA-Thiersch is a simple and safe procedure for rectal prolapse, having reasonable outcomes. The use of the Leeds-Keio ligament for anal encircling can help compensate for the disadvantages of the Thiersch operation.

Citations

Citations to this article as recorded by

Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Annals of Coloproctology.2024; 40(4): 336. CrossRef
Simple Anal Reinforcement with Anal Encirclement Using an Artificial Ligament in Patients with fecal Incontinence: A Single-center Observational Study
Tatsuya Abe, Masao Kunimoto, Yoshikazu Hachiro, Shigenori Ota, Kei Ohara, Mitsuhiro Inagaki
Journal of the Anus, Rectum and Colon.2022; 6(3): 174. CrossRef

Benign bowel disease

Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases: Sara Gortázar de las Casas, Emanuela Spagnolo, Salomone Di Saverio, Mario Álvarez-Gallego, Ana López Carrasco, María Carbonell López, Sergio Torres Cobos, Constantino Fondevila Campo, Alicia Hernández Gutiérrez, Isabel Pascual Miguelañez; Ann Coloproctol. 2023;39(3):216-222. Published online March 7, 2022; DOI: https://doi.org/10.3393/ac.2021.00829.0118

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Abstract PDF

Purpose
The surgical management of deep infiltrative endometriosis (DE) involving the rectum remains a challenge. The objective of this study was to assess the outcomes from a single tertiary center over a decade with an emphasis on the role of a protective loop ileostomy (PI).
Methods
A retrospective review of outcomes for 168 patients managed between 2008 and 2018 is presented including 57 rectal shaves, 23 discoid excisions, and 88 segmental rectal resections.
Results
The nodule size (mean±standard deviation) in the segmental resection group was 32.7±11.2 mm, 23.4±10.5 mm for discoid excision, and 18.8±6.0 mm for rectal shaves. A PI was performed in 19 elective cases (11.3%) usually for an ultra-low anastomosis <5 cm from the anal verge. All Clavien-Dindo grade III/IV complications occurred after segmental resections and included 5 anastomotic leaks, 6 rectovaginal fistulas, 2 ureteric fistulas, and 1 ureteric stenosis. Of 26 stomas (15.5%), there were 19 PIs, 3 secondary ileostomies (after complications), and 4 end colostomies. The median time to PI closure was 5.8 months (range, 0.4–16.7 months) in uncomplicated disease compared with 9.2 months (range, 4.7–18.4 months) when initial postoperative complications were recorded (P=0.019). Only 1 patient with a recurrent rectovaginal fistula had a permanent colostomy.
Conclusion
In patients with DE and rectal involvement a PI is selectively used for low anastomoses and complex pelvic reconstructions. Protective stomas and those used in the definitive management of a major postoperative complication can usually be reversed.

Citations

Citations to this article as recorded by

Surgeons' workload assessment during indocyanine-assisted deep endometriosis surgery using the surgery task load index: The impact of the learning curve
Emanuela Spagnolo, Ignacio Cristóbal Quevedo, Sara Gortázar de las Casas, Ana López Carrasco, Maria Carbonell López, Isabel Pascual Migueláñez, Alicia Hernández Gutiérrez
Frontiers in Surgery.2022;[Epub] CrossRef
Quality of Life in Women after Deep Endometriosis Surgery: Comparison with Spanish Standardized Values
Alicia Hernández, Elena Muñoz, David Ramiro-Cortijo, Emanuela Spagnolo, Ana Lopez, Angela Sanz, Cristina Redondo, Patricia Salas, Ignacio Cristobal
Journal of Clinical Medicine.2022; 11(20): 6192. CrossRef

Anorectal benign disease

The role of C-reactive protein ratio in predicting mortality in patients with Fournier gangrene: Ismail Cem Eray, Kubilay Dalci, Serdar Gumus, Orcun Yalav, Ahmet Gokhan Saritas, Asli Boz, Ahmet Rencuzogullari; Ann Coloproctol. 2023;39(3):223-230. Published online February 3, 2022; DOI: https://doi.org/10.3393/ac.2021.00843.0120

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Abstract PDF

Purpose
This study aimed to determine the C-reactive protein (CRP) ratio for the survival of patients with Fournier gangrene (FG).
Methods
Fifty-two patients with FG between January 2011 and September 2018 were retrospectively analyzed. Data on clinical presentation, Fournier Gangrene Severity Index (FGSI), CRP ratio, management, and outcome were analyzed. The CRP ratio was calculated as preoperative CRP/postoperative CRP value that measured 48 hours after surgical intervention. Possible alternative cutoff points for the FGSI and CRP were determined by receiver operating characteristic (ROC) analyses. The risk factors related to the prognosis were evaluated by univariate and multivariable logistic regression analyses.
Results
The mean CRP ratios were 6.7±6.6 in the survivor group and 1.2±0.8 in the nonsurvivor group (P=0.001). FGSI was significantly higher in the non-survivor group compared to survivor group (8.5±2.5 vs. 3.5±2.2, P=0.001). There was a negative correlation between FGSI and CRP ratio (r=–0.51). ROC analysis determined the cutoff value as 1.78 for CRP (sensitivity, 86%; specificity, 82%; area under the ROC curve, 0.90) to predict death. The incidence of death for patients with CRP ratio of ≤1.78 increased 26.7 fold for those with CRP ratio of >1.78 (95% confidence interval [CI], 4.8–146.5; P=0.001). In the multivariable logistic regression model, CRP ratio (odds ratio [OR], 10.3; 95% CI, 1.5–72.2; P=0.019) and FGSI (OR, 17.8; 95% CI, 2.6–121.1; P=0.003) were independent risk factors for death.
Conclusion
The CRP ratio is a simple method to use to predict mortality in FG.

Citations

Citations to this article as recorded by

The Value of Fournier’s Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis
Antonio Tufano, Piervito Dipinto, Francesco Passaro, Umberto Anceschi, Giorgio Franco, Rocco Simone Flammia, Flavia Proietti, Luca Antonelli, Giovanni Battista Di Pierro, Francesco Prata, Roberta Rullo, Sisto Perdonà, Costantino Leonardo
Journal of Personalized Medicine.2023; 13(9): 1283. CrossRef
Biomarkers to predict mortality in patients with Fournier’s gangrene admitted to the intensive care unit after surgery in South Korea
In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim
Acute and Critical Care.2023; 38(4): 452. CrossRef
Delta neutrophil index as a prognostic factor for mortality in patients with Fournier's gangrene
In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim
International Journal of Urology.2022; 29(11): 1287. CrossRef

Colorectal cancer

Outcomes of side-to-end versus end-to-end colorectal anastomosis in nonemergent sigmoid and rectal cancers: a randomized controlled clinical trial: Tamer A.A.M. Habeeb, Hatem Mohammad, Tamer Wasefy, Mohamed Ibrahim Mansour; Ann Coloproctol. 2023;39(3):231-241. Published online March 11, 2022; DOI: https://doi.org/10.3393/ac.2021.00906.0129

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Graphical Abstract Abstract PDF

Purpose
The outcomes of open colorectal anastomosis of side-to-end versus end-to-end in nonemergent sigmoid and rectal cancer surgery in adults were compared.
Methods
A randomized controlled trial on individuals with sigmoid and rectal cancers was conducted between September 2016 and September 2018.
Results
The mean age was 62.58±12.3 years in the side-to-end anastomotic (SEA) group and 61.03±13.98 years in the end-to-end anastomotic (EEA) group. Except for the operative time, intraoperative data revealed no significant differences between the studied groups, and the SEA group revealed that the mean anastomotic time was significantly shorter. Perioperative blood loss, length of stay, reoperation, inpatient death, infection, and bleeding were significantly associated with leakage. There is a statistically significant change regarding the range of bowel frequency in the EEA group only (P=0.04). There is a statistically significant difference regarding incontinence for flatus in the SEA group only (P≤0.001). A statistically significant change in both groups regards incontinence for liquid stools (P≤0.001) and clustering of stools (P≤0.001 and P=0.043). The quality of life in the SEA group significantly dropped at 6 months and then returned to baseline as regards to physical well-being (PWB), functional well-being (FWB), and colorectal cancer symptoms (CCS) with no difference as regards SWB and EWB, while in the EEA group, the exact change happened only as regard PWB and FWB, but SWB and CCS percentage did not return to baseline.
Conclusion
The SEA group offers a safe alternative approach to the EEA group.

Citations

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Minimally invasive left colectomy with total intracorporeal anastomosis versus extracorporeal anastomosis. A single center cohort study. Stage 2b IDEAL framework for evaluating surgical innovation
Xavier Serra-Aracil, Irene Gómez-Torres, Andrea Torrecilla-Portoles, Anna Serracant-Barrera, Albert García-Nalda, Anna Pallisera-Lloveras
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
The impact of powered circular staplers on anastomotic leak in left-sided colorectal cancer surgeries
Hayoung Lee, Yong Sik Yoon, Young Il Kim, Eun Jung Park, Min Hyun Kim, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim
Surgical Endoscopy.2024; 38(10): 6111. CrossRef

Anorectal benign disease

Examination of 93 cases of perianal warts and suggestion of a new classification: Jo Unotoro, Keigo Matsuo, Takehiro Arai, Shigeru Okada, Teruki Kawanishi, Ryoichi Ikegami, Shuzo Mori, Hiroshi Matsuno; Ann Coloproctol. 2023;39(3):242-249. Published online March 17, 2022; DOI: https://doi.org/10.3393/ac.2021.00969.0138

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Abstract PDF: Purpose
The anatomical distribution of perianal warts is associated with patient characteristics such as sexual orientation. The purpose of this study is to confirm this experiential knowledge using a quantitative classification system and analysis and to obtain findings useful for future treatment.
Methods
From January 2014 to December 2020, 93 patients with perianal warts presented to our hospital. Patients were analyzed for age, sex, lesion site, and recurrence type, among other factors. The lesion site was divided into skin (S) and anal epithelium (anoderm, A), and the number and degree of each were classified into grades 0 to 3. The higher grade between S and A determines its dominant type, such as type S (e.g., S3A1) and type A (e.g., S0A2).
Results
The average age of the patients was 39.6 years, and the percentage of patients who were not married was 54.8%. In all, 95.8% of patients were positive for low-risk human papillomavirus (HPV). Type S accounted for 80.6%, whereas type A accounted for 9.7%. Type A cases were all male and were all presumed to be men who have sex with men (MSM). This indicates that the determination of type A may be highly specific for MSM. The type at the time of recurrence was the same type at the time of the first surgery in almost all cases.
Conclusion
In cases of perianal warts, it is useful to analyze the lesion by considering the range and grade separately for daily clinical practice on proctologist.

Colorectal cancer

Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer: Min Young Park, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim, Jin-hong Park, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(3):250-259. Published online April 4, 2022; DOI: https://doi.org/10.3393/ac.2022.00066.0009

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Graphical Abstract Abstract PDF Supplementary Material

Purpose
This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer.
Methods
Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy.
Results
Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures.
Conclusion
PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.

Citations

Citations to this article as recorded by

Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. CrossRef
Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Colorectal cancer

Short- and long-term outcomes of subtotal/total colectomy in the management of obstructive left colon cancer: Jung Tak Son, Yong Bog Kim, Hyung Ook Kim, Chungki Min, Yongjun Park, Sung Ryol Lee, Kyung Uk Jung, Hungdai Kim; Ann Coloproctol. 2023;39(3):260-266. Published online May 25, 2022; DOI: https://doi.org/10.3393/ac.2022.00101.0014

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Abstract PDF

Purpose
Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC.
Methods
This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed.
Results
Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1–3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%.
Conclusion
The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

Citations

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Influence of the type of anatomic resection on anastomotic leak after surgery for colon cancer
Suat Chin Ng, Andrew McCombie, Frank Frizelle, Tim Eglinton
ANZ Journal of Surgery.2024; 94(3): 424. CrossRef
Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis
Soo Young Oh, Chan Wook Kim, Seonok Kim, Min Hyun Kim, Young Il Kim, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Clinical Colorectal Cancer.2024; 23(2): 135. CrossRef

Translational/basic research

Effects of angiotensin peptides on colonic motility in rats: Gi Won Ha, Jong Hun Kim, Suhn Hee Kim; Ann Coloproctol. 2023;39(3):267-274. Published online March 30, 2022; DOI: https://doi.org/10.3393/ac.2022.00087.0012

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Abstract PDF

Purpose
Renin-angiotensin system (RAS) is involved in the pathophysiology of colonic inflammation. The aim of this study was to investigate whether small angiotensins (Angs) peptides play a role in the regulation of colonic motility and their roles are modulated in colitis.
Methods
Experimental colitis was induced by an intake of 5% dextran sulfate sodium (DSS) dissolved in tap water for 7 days in Sprague-Dawley rats. After sacrifice, plasma hormone concentrations and messenger RNAs (mRNAs) for RAS were measured. Functional analysis of colonic motility in response to Angs peptides was performed using Taenia coli.
Results
DSS-treated colon showed an increased necrosis with massive infiltration of inflammatory cells. The mRNA level of colonic angiotensin II receptor type 2 (AT2R) in DSS-treated rats was higher than that in control rats whereas the mRNA levels of angiotensin II converting enzyme (ACE), ACE2, AT1R, AT4R, and Mars receptor were not different from those in control rats. Ang III, Ang IV, and Ang-(1-9) (1, 3 μM) increased the frequency of basal colonic motility. Ang-(1-7) did not cause any significant changes in frequency and amplitude of basal motility. The order of potency for an increased frequency of basal motility seems to be Ang II>>Ang IV>Ang III=Ang-(1-9). The increased frequency of basal motility by Ang-(1-9) but not Ang IV was significantly enhanced in DSS-treated rat colon.
Conclusion
In conclusion, these data suggest that small Angs peptides are partly involved in the pathophysiological regulation of colonic motility in experimental colitis.

Citations

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Systematic-Narrative Hybrid Literature Review: Crosstalk between Gastrointestinal Renin–Angiotensin and Dopaminergic Systems in the Regulation of Intestinal Permeability by Tight Junctions
Nadia Khan, Magdalena Kurnik-Łucka, Gniewomir Latacz, Krzysztof Gil
International Journal of Molecular Sciences.2024; 25(10): 5566. CrossRef

Case Reports

Colorectal cancer

Experience of surgical treatment in a granular cell tumor in the ascending colon: a case report: In-Kyeong Kim, Young-Tae Ju, Han-Gil Kim, Jin-Kwon Lee, Dong-Chul Kim, Jae-Myung Kim, Jin Kyu Cho, Ji-Ho Park, Ju-Yeon Kim, Chi-Young Jeong, Soon-Chan Hong, Seung-Jin Kwag; Ann Coloproctol. 2023;39(3):275-279. Published online July 6, 2021; DOI: https://doi.org/10.3393/ac.2020.00836.0119

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Abstract PDF: We report a case about successful surgical treatment of a granular cell tumor in the ascending colon. A 36-year-old man underwent screening colonoscopy. An endoscopic examination revealed a 10-mm yellowish and hemispheric mass in the ascending colon, and lower endoscopic ultrasonography revealed a hypoechoic-to-isoechoic mass invaded the submucosal layer. The mass was suspected to be a colonic carcinoid tumor. Based on the preoperative evaluation, endoscopic complete resection was considered difficult. Therefore, the lesion was removed via laparoscopic right hemicolectomy. Histological examination revealed that the tumor consisted of nests of polygonal cells with abundant granular eosinophilic cytoplasm. Immunohistochemical staining revealed diffuse positivity for S100 and CD68. Therefore, the tumor was diagnosed as a granular cell tumor. We suggest that surgical resection should be considered if it is located in the thin-walled ascending colon prone to perforation, difficult to rule out malignant tumor due to submucosal invasion, or to remove endoscopically.

Benign bowel disease

A case report of an unexpected colonic polyp: cavernous hemangioma: Miguel Mascarenhas, Rui Morais, Regina Teixeira, Guilherme Macedo; Ann Coloproctol. 2023;39(3):280-282. Published online July 13, 2021; DOI: https://doi.org/10.3393/ac.2020.00535.0076

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Abstract PDF

Cavernous hemangiomas of the colon are rare, benign vascular lesions, and the site most commonly affected is the rectosigmoid junction. Surgical treatment is recommended for large diffuse lesions but in the presence of pedunculated lesions, endoscopic resection should be preferred if possible. We report a case of a 65-year-old man referred for colonoscopy after positive fecal occult blood, that revealed at the level of the sigmoid colon, a wide base pedunculated polyp (35 mm) occupying more than half of the lumen, with the covering mucosa with a vinous appearance. In order to remove the lesion, a detachable snare was placed and polypectomy was performed. During the procedure, the detachable snare was cut with active bleeding, controlled after clip placement and diluted adrenaline injection. Afterwards, histology revealed a polypoid lesion with a hyperplastic mucosa and submucosal plane expanded by numerous thick-walled vessels in the context of a cavernous colonic hemangioma.

Citations

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Endoscopic Resection of a Cavernous Hemangioma in the Sigmoid Colon: A Case Report
Noora Al-Khater, Mohamed Mohamed, Afra Juma, Faisal Abubaker, Sameer Ansari
Gastro Hep Advances.2024; 3(3): 396. CrossRef
Anorectal hemangioma, a rare cause of lower gastrointestinal bleeding, treated with selective embolization: A case report
Barbora Pospisilova, Jaromir Frydrych, Antonin Krajina, Julius Örhalmi, Ivana M Kajzrlikova, Petr Vitek
World Journal of Gastrointestinal Surgery.2024; 16(8): 2735. CrossRef
Spontaneous colonic perforation of a cavernous hemangioma during colonoscopy
María Florencia Álvarez, Domingo Cesar Balderramo, Florencia Defanti, Mariano Antonio Higa
Gastroenterología y Hepatología.2022; 45: 95. CrossRef
A giant hemangioma of the sigmoid colon as a cause of lower gastrointestinal bleeding in a young man
Lucas Fair, Benjamin Gough, Adatee Oknokwo, Ronney Stadler
Baylor University Medical Center Proceedings.2022; 35(6): 852. CrossRef

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Laparoscopic right hemicolectomy with aortocaval lymphadenectomy, and pelvic peritoneum partial resection for ascending colon cancer: Hannah Kim, An Na Seo, Soo Yeun Park; Ann Coloproctol. 2023;39(3):283-286. Published online February 9, 2023; DOI: https://doi.org/10.3393/ac.2022.00780.0111

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The aim of this video is to present the procedural details of laparoscopic right hemicolectomy with aortocaval (infrarenal aortic bifurcation) lymphadenectomy, partial resection of the pelvic peritoneum (peritoneal carcinomatosis index, 3), and hyperthermic intraperitoneal chemotherapy in a patient who received neoadjuvant chemotherapy for stage IVc colorectal cancer. The total operation time was 290 minutes, and the patient was discharged on a postoperative day 13 without any complications. No postoperative complications occurred until postoperative day 60. The pathological stage of the tumor was determined to be T3N2bM1c. The pelvic peritoneal nodule was pathologically confirmed as a metastatic lesion. Among the 12 harvested aortocaval lymph nodes, 6 were metastatic lymph nodes. The minimally invasive approach was safe and feasible in this highly selected patient with colon cancer, aortocaval lymph nodes, and peritoneal metastases.

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Clinical Effectiveness of Fluorescence Lymph Node Mapping Using ICG for Laparoscopic Right Hemicolectomy: A Prospective Case–Control Study
Gyung Mo Son, Mi Sook Yun, In Young Lee, Sun Bin Im, Kyung Hee Kim, Su Bum Park, Tae Un Kim, Dong-Hoon Shin, Armaan M. Nazir, Gi Won Ha
Cancers.2023; 15(20): 4927. CrossRef

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