[en] To our knowledge, rectal cancer arising at the anastomotic site after surgery for Hirschsprung's disease has not been reported. We report a case of mucinous adenocarcinoma arising at the anastomotic site after Soave operation 26 years ago

[en] Objective: The aim of this study was to determine the value of radiological colon transit time (CTT) measurements in relation to defecography (DFG) in chronically constipated patients. Materials and methods: In 30 patients with chronic constipation, total and segmental CTT was determined using radiopaque markers. In all of these patients defecography (DFG) was obtained. The patients were divided into three groups: In group I, 11 patients were classified with idiopathic constipation based on low stool frequency, normal DFG, or absence of symptoms of abnormal defecation. In group II, ten patients with rectal intussusception were diagnosed by DFG. In group III, there were nine patients with rectal prolapse or spastic pelvic floor syndrome, based on results of DFG. Results: Group I, idiopathic constipation (n=11), showed increased total CTT (mean, 93 h) and segmental CTT (right colon, 33 h (36%), left colon, 31 h (33%), rectosigmoid, 29 h (31%)). In group II, intussusception (n=10), patients had normal mean total CTT (54 h) and a relative decrease in rectosigmoid CTT (mean, 13 h (24%)). In group III (n=9), rectal prolapse (n=5) or spastic pelvic floor syndrome (n=4), patients showed elevated total (mean, 167 h) and rectosigmoidal CTT (mean, 95 h (57%)). Mean total CTT was significantly different between groups I and II and between groups II and III, and mean rectosigmoidal CTT was significantly different between all three groups (P<0.05). Conclusion: The use of total and rectosigmoidal CTT helps to identify the underlying pathophysiology of chronic constipation. Furthermore CTT helps to identify patients, who may benefit from DFG

No abstract available

[en] Over an 18-month period, high resolution ultrasound was used to assess 220 patients with doubtful clinical diagnosis of acute appendicitis. The ultrasonographic findings were correlated with the surgical results and the pathological results in 115 cases, and with clinical follow-up in the rest. This technique has been found to be effective in the diagnosis of acute appendicitis, with a sensitivity of 90.4%, and similar specificity and reliability (90.2%). The positive predictive value of the test was 89% and the negative predictive value, 91%. The ultrasonographic criteria applied for the diagnosis of acute appendicitis was the detection of an understood appendix measuring over 6 mm. All cases with perforation were correctly diagnosed as acute appendicitis. The observation of an accumulation of fluid pooled in DIF in patients with ultrasonographic findings suggestive of appendicitis points to a diagnosis of perforation or complicated (gangrenous) appendicitis. A relationship between complicated appendicitis and the detection of appendicoliths within the enlarged appendix was also observed. The results obtained demonstrate that high resolution ultrasound is indicated in the diagnosis of acute appendicitis in all cases in which the clinical findings are doubtful

[en] The authors have reviewed the radiological studies in 31 patients who underwent stapled colorectal anastomoses using the EEA staple gun. In 10 patients there was clinical evidence to suggest anastomotic dehiscence. Nine of these patients had a disrupted staple ring on plain abdominal radiograph. In these days of audit and financial constraint, the authors suggest that radiological investigation should be reversed for those patients with questionable clinical evidence of an anastomotic leak. (author). 5 refs.; 5 figs

[en] The ileosigmoid knot is an uncommon but life-threatening cause of closed loop intestinal obstruction. Its treatment is different from a simple volvulus in that it has to be operated upon immediately. Preoperative CT scan diagnosis and prompt treatment can lead to a good outcome. Findings of simultaneous ileal and sigmoid ischemia with non-ischemic colon interposed in between should, in an appropriate clinical setting, indicate this condition. The presence of the whirl sign, medially deviated distal descending colon and cecum, and mesenteric vascular structures from the superior mesenteric vessels that converge toward the sigmoid colon on CT scan help clinch the diagnosis

[en] Temporary epicardial pacing wires are associated with rare complications. Most of these occur in the chest. Even rarer are complications that occur within the abdomen. We report a case of migrating epicardial pacing wires entering the abdomen and penetrating the transverse colon found incidentally on colonoscopy in an asymptomatic patient

[en] Primary tumors of the colorectal cancers are assessed pathologically based on the tumor spread into the bowel wall. The assessment of serosal involvement, which may be relevant to pT4, can be challenging for pathologists, making the consistency of diagnoses questionable. As solutions to this problem, the following two strategies could be adopted. One would be to use special staining or immunohistochemical staining techniques for diagnostic assistance. The other would be to construct recommendations for the assessment of tumor spreading and to obtain a world-wide consensus on the criteria used to assess tumor spreading. Using elastic staining, we previously reported that peritoneal elastic laminal invasion (ELI) could be objectively determined and would likely contribute to a simplified and more objective stratification of deep tumor invasion around the peritoneal surface. We also noted the importance of sampling, staining, and histo-anatomical knowledge in the application of elastic staining during routine pathological diagnosis. Here we review the history of primary tumor stratification leading to the present TNM classification and report on the current status of pathological assessments made at our hospital to summarize what has been established and what is further required for the pathological diagnosis of tumor spreading in patients with colorectal cancer.

[en] Large bowel duplication is known to be a rare congenital anomaly, which could be a difficult diagnostic problem for radiologist. The authors report a case which is the type 2 according to the modified classification from Smith. Clinical, pathological and radiological findings are reviewed

[en] To evaluate effectiveness of ultrasonography (US) in the diagnosis of acute appendicitis by comparing with initial level of clinical diagnostic confidence. Graded compression US of one hundred forty eight with clinically suspected of acute appendicitis were prospectively evaluated. General surgeons classified patients into three groups bases on the clinical probability before US examination: group 1 as cases with low probability (<25%), group 2 as cases with an intermediate probability (25-75%) and group 3 as cases with a high probability (>75%). Two radiologists performed US examination. Statistical significance of ultrasonographic results in each group was assessed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sonography for all patients were 91.3%, 97%, 97.3%, 90.4%, and 93.9% respectively. Those of group 1 were 100%, 95.5%, 84.6%, 100%, and 96.4%, and those of group 2, 95.8%, 100%, 100%, 95%, and 97.7% while those of group 3, 86.4%, 100%, 100%, 50%, and 88%. There was no statistical difference in each parameter among three groups. The accuracy and NPV in group 3 was significantly higher than those in groups with the low and intermediate probability (group 1 and 2). Ultrasonography in the diagnosis of acute appendicitis is an useful and reliable method, especially in case of low clinical diagnostic confidence.