Serrated Polyposis Syndrome
Dongyou Liu in Handbook of Tumor Syndromes, 2020
Extending from the cecum (which connects the ileum of the small intestine) to the anal canal, the colon (large intestine) is a tube of 150 cm in length that can be separated into ascending, transverse, descending, and sigmoid sections. The ascending colon (sometimes referred to as the proximal or right colon) starts from the cecum, ascends to the right lobe of the liver, and turns 90° at the right colic flexure (or hepatic flexure) to become the transverse colon, which crosses the abdomen horizontally to the spleen. The transverse colon then turns another 90° at the left colic flexure (or splenic flexure) to become the descending colon, which moves inferiorly and connects the sigmoid colon. The sigmoid colon (sometimes referred to as the distal or left colon) is a 40-cm long tube forming a characteristic “S” shape that connects the rectum, then the anus.
Operative reports of the most common procedures in pediatric colorectal surgery: Key steps
Alejandra Vilanova-Sánchez, Marc A. Levitt in Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
The patient was placed supine on the operating table. General endotracheal anesthesia was administered. The abdomen was prepped and draped in the usual sterile fashion. The abdomen was entered through a PfannenStiel incision, with a vertical split of the fascia to the level of the umbilicus. We identified the sigmoid colon. The rectosigmoid had the typical dilation with a more normal caliber proximal sigmoid and left colon. We released the left retroperitoneal attachments so the left colon was loose. We dissected clean to the location of the planned transaction at the upper rectum, several centimeters above the peritoneal reflection. We ligated several mesenteric vessels between clamps and ties, and then placed bowel clamps across the rectum and the upper sigmoid. The two ends of the planned anastomosis reached each other without tension. We then transected across the bowel and took the intervening mesentery between clamps and ties. We sutured closed the right side of the large rectal opening so that the remaining lumen matched the proximal sigmoid lumen. This was performed in two layers, running and interrupted with long-term absorbable suture. We aligned the mesentery, and then performed a primary anastomosis in two layers with Vicryl. We closed the small mesenteric defect. Hemostasis was ensured, and the abdomen was irrigated. The bowel was returned to its normal anatomic position. The peritoneum and posterior fascia were closed with interrupted absorbable suture, as was Scarpa's fascia and a subdermal layer. The skin was closed with a subcuticular closure. Sterile dressing was applied.
Emergency Colectomy
P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams in Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Sigmoid colectomy with Hartmann’s procedure and end colostomy is the procedure of choice for patients who are hemodynamically unstable, and in elderly patients with poor sphincter function or poor general health. The most common error seen when this operation is performed is to transect the rectum deep within the pelvis. Diverticulitis is a disease of the sigmoid colon. Resection of large portions of the rectum makes the subsequent surgery to restore intestinal continuity more difficult and should be avoided. The bowel in these cases is often thickened and does not easily staple. A 4.8 mm staple cartridge should be used if a linear stapling device is utilized and oversew the staple line or handsew if the bowel is too thickened. The line of proximal resection should be at the point of palpably normal bowel Figure 5.13.7.
Dose-response relationships of the sigmoid for urgency syndrome after gynecological radiotherapy
Published in Acta Oncologica, 2018
Eleftheria Alevronta, Viktor Skokic, Ulrica Wilderäng, Gail Dunberger, Fei Sjöberg, Cecilia Bull, Karin Bergmark, Rebecka Jörnsten, Gunnar Steineck
The rectum, the sigmoid colon and small intestine were delineated in the CT scans and the dose–volume histograms were exported for each patient. As we thoroughly described in a previous publication, delineation was performed manually at Karolinska University Hospital, Stockholm and at Sahlgrenska University Hospital, Gothenburg following written instructions and with the guidance of a contouring manual with illustrations [11]. The outer contour of the rectum was delineated, included filling. The rectum was extended from the anal verge to the recto-sigmoid junction. We started delineating the sigmoid colon where the rectum deviates from its midposition to where it turns cranially in the left part of the abdomen connecting to the colon descendens. For the small intestine, we delineated all visible small bowels in the pelvic cavity to the caudal part of the sacroiliac joints [11].
Detection rates for adenomas, serrated polyps and clinically relevant serrated polyps can be easily estimated by individually calculated detection rate ratios
Published in Scandinavian Journal of Gastroenterology, 2020
Martin Buerger, Philipp Kasper, Ingo Scheller, Jan-Hinnerk Hofer, Hans Toermer, Annette Stelzer, Frank Stenschke, Michael Stollenwerk, Gabriel Allo, Tobias Goeser, Hans-Michael Steffen, Christoph Schramm
Experienced endoscopists were defined as endoscopists who performed ≥300 colonoscopies annually for various indications during the study period. Time period (months) per endoscopists, during which procedures were obtained, was presented as median and range. The quality of bowel preparation was retrospectively evaluated on the basis of the endoscopy report and classified into adequate (excellent, good, fair) and poor. Histological evaluation was based on the original diagnosis of colorectal polyps, reported by the participating center, without central histopathological evaluation. SPs included HPs, SSAs and TSAs. CrSPs were defined as SPs ≥10 mm throughout the whole colon and/or SPs >5 mm located proximal to the splenic flexure as previously published [17]. To compare our results with other outcomes of large studies, we have calculated further subgroups concerning the definitions of proximal SPs analogous to the studies of Anderson et al. [19] and Ijspeert et al. [18]. In this concern, the proximal colon was defined as (i) proximal to the sigmoid colon (sc) and (ii) proximal to the descending colon (dc) (additionally listed in all tables and figures).
Changes in colonic enteroendocrine cells of patients with irritable bowel syndrome following fecal microbiota transplantation
Published in Scandinavian Journal of Gastroenterology, 2022
Tarek Mazzawi, Trygve Hausken, Magdy El-Salhy
The participants’ selection, screening and transplantation process are detailed in a previous publication [22]. Briefly, 83 patients with diarrhea-predominant and mixed type IBS according to Rome III criteria who were referred to the University Hospital of North Norway at Harstad, were included. They were allocated to receive donor-FMT (either fresh or frozen feces) or placebo FMT (own feces), in a ratio 2:1, by colonoscope to cecum in a double-blinded, randomized, placebo-controlled study after a serial of medical and physical tests to establish eligibility. To standardize the transplantation procedure, feces were collected from only two donors who fulfilled predetermined inclusion criteria. The randomization sequence was sealed in non-transparent envelopes and reveled to researchers when all participants completed a 12-month follow-up. Biopsy samples were obtained from sigmoid colon at baseline as part of the FMT procedure. Using the same cohort of IBS patients in the REFIT study [22], 10 recipients among of the best responders (6 females and 4 males, age range 19–66, mean 44 years old), defined by >100 points improvement in IBS-symptom severity score (IBS-SSS) after FMT compared to baseline, and 10 non-responders (5 females and 5 males, age range 32–69, mean 53 years old) without any changes in IBS-SSS (<100 point change), consented to a new biopsy one year after FMT. They had diarrhea-predominant IBS (n = 10) and mixed-IBS (n = 10) subtypes. Out of these participants (n = 20), 16 received donor-FMT and four received placebo FMT.