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Embryology, Anatomy, and Physiology of the Kidneys and Ureters
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Paul Sturch, Sanjeev Madaan, Seshadri Sriprasad
Left kidney:Superior − spleen and stomach.Superio-medially − left adrenal gland.Inferior − jejunum and splenic flexure.Medial − tail of the pancreas and splenic vessels.The parietal peritoneum runs as the splenorenal ligament between the upper pole of the left kidney and spleen.Splenic flexure − anterior to the left lower pole.
Electrocoagulation Of Vascular Abnormalities Of The Large Bowel
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
This patient is an example of a case where only surgical therapy can be effective. In spite of the best available skill, total colonoscopy is not possible in all patients. Pathologic alteration or anatomic variation can prevent reaching the cecum. Right colectomy had cured the patient’s gross rectal bleeding. When blood loss resumed, it was occult. The appearance of vascular abnormalities in the small bowel is of concern. Case 30: This 88-year-old woman was referred because of two unsuccessful attempts at endoscopic electrocoagulation of cecal vascular abnormalities. The patient had hypertension for many years which was never well-controlled. She had a grade IV/VI harsh holosystolic murmur heard over the apex, without radiation. Her chest X-ray showed cardiomegaly. The electrocardiograph showed borderline, left-ventricular hypertrophy with strain. At colonoscopy, a 2 ≈ 3-mm lesion was found on the lateral wall of the cecum. Close by was a larger but paler, 6 χ 7-mm lesion. Two smaller lesions were found close to the splenic flexure. All were electrocoagulated. Biospy confirmed their vascular nature. She has had no bleeding for 6 months.
Malignant Large Bowel Obstruction
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Alexander Heriot, J. Alastair D. Simpson
Splenic flexure spasm in a normal colon may mimic a fixed narrowing, and there is also the potential for CT scan to miss short annular colonic lesions, particularly in the right colon, if there is limited colonic distention.13 CT findings with malignant obstruction from colorectal cancer usually include a transition point and identification of a soft tissue mass at this site. It also facilitates assessment of the entire colon, as there may be synchronous lesions in 2% to 7% of patients.14
Does transverse colon cancer spread to the extramesocolic lymph node stations?
Published in Acta Chirurgica Belgica, 2021
Bulent C. Yuksel, Sadettin ER, Erdinç Çetinkaya, Ahmet Keşşaf Aşlar
Table 2 provides detailed information on postoperative complications. Using the Clavien-Dindo classification, the rates of complications were found to be 8.8% for grade IIIa and gradeII, and 20.5% for grade I. The number of patients who had an uneventful postoperative period was 24. Surgical complications occurred in seven patients and non-surgical complications in six patients. One of the seven patients with surgical complications had presented with a splenic flexure tumor and underwent extended left colectomy and colo-colonic anastomosis. In this patient, partial anastomosis leakage occurred and was resolved by palliative interventions. Other complications included wound site infection which was treated by wound care, diarrhea which was resolved by medication, and lymphatic fistula that spontaneously regressed.
Need For Whole Large Bowel Investigation in Sole Change in Bowel Habit: An Analysis of 719 Patients
Published in Journal of Investigative Surgery, 2021
Krashna Patel, Thomas Athisayaraj, Amitabh Mishra
Of all those referred with CIBH as a sole presenting symptom, 27/719 (3.8%) patients were subsequently diagnosed with a malignancy (Table 1). Median age was 81 years old (IQR, 73–85 years). 18/719 (2.5%) had a primary colorectal malignancy with a median age of 78.5 years (IQR, 70.75–85.75 years). 13/18 (72.2%) were located distal to the splenic flexure. More proximal tumors included 3 (16.7%) cecal and 2 (11.1%) ascending colon lesions. From the 18 colorectal malignancies, 14 (77.8%) had histological adenocarcinoma (6 poorly differentiated and 8 moderately differentiated), 1 (5.6%) neuroendocrine and the remaining 3 did not have a tissue diagnosis as they opted for no further investigations. 9 (56.3%) of the 18 patients had nodal disease. Synchronous hepatic metastases was evident in 4 (22.2%) with a further single patient demonstrating peritoneal disease on radiological staging.
Fecal immunochemical test in cancer screening – colonoscopy outcome in FIT positives and negatives
Published in Scandinavian Journal of Gastroenterology, 2019
Hanna Ribbing Wilén, Johannes Blom, Jonas Höijer, Gaya Andersson, Christian Löwbeer, Rolf Hultcrantz
The colonoscopy was carried out in one of the 33 endoscopy units participating in SCREESCO, and performed by a gastroenterologist, surgeon or endoscopist nurse with a self-reported experience of at least 1000 procedures, a minimum of 100 endoscopies per year and a caecal intubation rate of at least 90%. Bowel preparation was done with Laxabon®. Colonoscopy quality parameters, i.e., bowel preparation according to the Boston scale, caecal intubation, caecal withdrawal time, were recorded in the study database. Caecum to splenic flexure was defined as proximal and descendens to rectum as distal. If the colonoscopy was incomplete due to poor bowel preparation, the participant was rescheduled for a new examination, and if incomplete due to for example luminal stricture the participant was offered CT colonography. At the endoscopy unit, the participant also completed a questionnaire on current medication and weekly dosage of non-steroidal inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA), and the height and weight were measured.