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Laparoscopic Transverse Colectomy for Transverse Colon Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Transverse colon tumors have always remained an enigma as far as treatment options are concerned, as surgeons have different options and preferences for its surgical management. Carcinoma of the transverse colon accounts for 10% of all colorectal cancers. These tumors remain undetected until complications occur in 30%–50% of cases [3]. The commonest complications are perforation, fistulization, and obstruction. They are also more prone to involve other organs like the stomach and pancreas depending on the location [1,3]. These are present as T4 lesions in 20%–40% of cases, and the prognosis is much worse than colon cancer in other areas [2,3]. They also present a challenge in differential diagnosis between neighboring tumors, and also in benign diseases like Crohn's and tuberculosis. They can present as colonic strictures where preoperative diagnosis is sometimes not easy. The CT scan remains the gold standard for staging and deciding the surgical extent of resection for transverse colon tumors.
Mass in the Epigastrium
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Histological confirmation of the diagnosis through endoscopic biopsy is essential. Although colonic cancer is most common in the rectosigmoid region, transverse colon may also be affected. Besides an epigastric mass, a patient with carcinoma of the transverse colon may present with anaemia and abdominal discomfort. A change in bowel habit is an early feature of the carcinoma if the descending colon is involved. Since the bowel contents remain liquid in patients with carcinoma of the ascending and transverse colon, features of obstruction and change of bowel habits are not common until the late stage.
Gastrointestinal tract and salivary glands
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The large intestine is approximately 1.5 m long from caecum to anus, with a variable calibre from between 9 and 3 cm. It lies peripheral to the small intestine, with the more lateral structures being relatively fixed in position. From the right iliac fossa where the terminal ileum communicates via the ileo-caecal valve, the ceacum extends superiorly as the ascending colon before it turns abruptly to the left, beneath the liver, at the hepatic flexure. Crossing the abdomen, the transverse colon turns inferiorly at the splenic flexure, where it continues as the descending colon. The bowel loops to a variable degree at the sigmoid colon, passing along the posterior wall of the pelvis where it merges with the rectum at the recto-sigmoid junction. The rectum is 13 cm long and is a dilated part of the large intestine, continuous with the anal canal and anus. The large intestine displays large sacculations known as haustra that are thought to slow the passage of digested matter. The relations of the large intestine are complex and variable as the bowel traverses the different regions of the abdomen (Figs 5.52a–c).
A giant parastomal hernia in a high risk patient: preparation to make surgery worthwhile
Published in Acta Chirurgica Belgica, 2023
Seda Gunes, Ali Bohlok, Antoine El Asmar, Thibaut Engels, Marie Magdelaine Lefort, Eleonora Farinella, Issam El Nakadi
The first-step surgery started by closing the colostomy. Then, a circular skin incision was made 3 cm above the edge of the hernia’s neck to keep enough skin for the subsequent closure. The hernia sac was opened and 12 liters of ascites aspirated. Exploration of the sac’s cavity revealed the presence of part of the stomach and omentum, along with the small intestins and the tranverse and left colon. After reducing the herniated bowels, the intra-abdominal and intra-thoracic pressures were measured by the anesthesiologist, in order to estimate the amount of bowels to be resected, to achieve the appropriate level of pressures tolerated by the patient’s respiratory system. Subsequently, the left part of the transverse colon, along with the descending colon were resected to reach this adaptation. A terminal colostomy was created in the right abdominal quadrant. The hernia sac was resected and closed. A preperitoneal polypropylene mesh repair was performed (Figure 2).
Dasatinib-induced colitis: clinical, endoscopic and histological findings
Published in Scandinavian Journal of Gastroenterology, 2022
Kenji Yamauchi, Tomoki Inaba, Hugh Shunsuke Colvin, Ichiro Sakakihara, Kumiko Yamamoto, Koichi Izumikawa, Sakuma Takahashi, Shigetomi Tanaka, Shigenao Ishikawa, Masaki Wato, Midori Ando, Masato Waki
Of the nine patients with dasatinib-induced colitis, two patients refused colonoscopy and one patient underwent sigmoidoscopy; six patients underwent total colonoscopy during dasatinib therapy (Table 2). Colitis involved the transverse colon, descending colon, ascending colon, cecum, sigmoid colon, and rectum in six (100%), six (100%), five (83.3%), four (66.7%), three (42.9%) and two (28.6%) patients, respectively. Regarding the endoscopic features of colitis, six (100%) patients had loss of vascular pattern, five (83.3%) had multiple erosions and one (16.7%) had multiple small round elevations with erosion on the top (Figure 2). In a patient who underwent follow-up colonoscopy once a year while taking dasatinib, the endoscopic findings changed from erythematous spots (Figure 3(A)) to multiple erosions (Figure 3(B)) in the following year, and then to multiple small round elevations with erosion on the top (Figure 3(C)) in the following year. After discontinuation of dasatinib, these findings disappeared (Figure 3(D)) on colonoscopy.
Intraoperative localization of gastrointestinal tumors by magnetic tracer technique during laparoscopic‐assisted surgery (with video)
Published in Scandinavian Journal of Gastroenterology, 2021
Guifang Lu, Jing Li, Xiaopeng Yan, Xuejun Sun, Yan Yin, Xinlan Lu, Feng Ma, Fei Ma, Jianbao Zheng, Wei Zhao, Yi Lv, Mudan Ren, Shuixiang He
A flow diagram of the study is presented in Figure 1. Fifty-six of 57 (98.2%) consecutive patients were enrolled and analyzed in the study (MTT failed in one patient). The basic characteristics of the patients and lesions are summarized in Table 1. Among these patients, 37 (66.1%) were male and 19 (33.9%) were female, with a mean (± SD) age of 57.4 ± 11.1 years (range, 31–77 years) and a median age of 59 years. More than 90% of the patients were > 40 years of age. The diameter of > 80% of the lesions was < 3 cm, with a median diameter of 1.9 cm, and nearly one-half were < 1.5 cm. According to per-lesion location analysis (data reported in Table 1), gastric tumors were located in the cardia (n = 1), antrum (n = 5), antrum-body junction (n = 6), body (n = 14), angulus (n = 8), and pylorus (n = 1) (Figure 2). In addition, one patient with a duodenal lesion was enrolled in this study (Figure 3). Transverse colon tumors (n = 2), descending colon tumors (n = 5), descending-sigmoid colon junction tumors (n = 3), sigmoid colon tumors (n = 5), rectosigmoid junctions (n = 1), and rectal tumors (n = 4) were included (Figure 4).