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Transverse carcinoma after Miles operation: a case in which preoperative evaluation was assisted by computed tomographic colonography.

Ito D, Teruya M, Hata S, Kobayashi K, Kaminishi M - World J Surg Oncol (2016)

Bottom Line: Thus, computed tomographic colonography (CTC) was planned to assist our examination of the proximal colon under sigmoid colostomy.Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve.Further, CTC examination was technically feasible through a sigmoid stoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan. itoudaisuke5995@yahoo.co.jp.

ABSTRACT

Background: There were only few case reports in which CTC was performed in patients with colostomy.

Case presentation: A 68-year-old man was admitted with right abdominal pain and bloody stool that had been present for 2 weeks prior to admission. His medical history included abdominoperineal rectal resection with permanent sigmoid stoma (Miles operation). Colonoscopy showed a sub-occlusive tumor in the transverse colon but provided no information about the proximal colon. Thus, computed tomographic colonography (CTC) was planned to assist our examination of the proximal colon under sigmoid colostomy. CTC revealed the apple core sign in the hepatic flexure, without any evident tumor in the proximal colon. Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve.

Conclusion: CTC examination can be an effective means of preoperatively evaluating the proximal colon in patients with occlusive tumor. Further, CTC examination was technically feasible through a sigmoid stoma.

No MeSH data available.


Related in: MedlinePlus

Computed tomographic colonography revealed the apple core sign in the hepatic flexure (black arrows show), without any evident tumor in the proximal colon
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Fig3: Computed tomographic colonography revealed the apple core sign in the hepatic flexure (black arrows show), without any evident tumor in the proximal colon

Mentions: A 68-year-old man was admitted to our hospital with right abdominal pain and bloody stool that had been present for 2 weeks prior to admission. His medical history included abdominoperineal rectal resection with permanent sigmoid stoma (Miles operation), which had been performed 25 years earlier. On admission, assessments of tumor markers revealed a carcinoembryonic antigen (CEA) level of 1.2 ng/mL (normal limits 0.1–5.0 ng/mL) and a carbohydrate antigen 19-9 (CA19-9) level of 3.0 U/mL (normal limits 0.2–37.0 U/mL). Colonoscopy showed a circumferential tumor in the transverse colon but provided no information about the proximal colon because of the presence of this occlusive tumor (Fig. 1). Histopathological analysis of the biopsy specimen revealed tubular adenocarcinoma. Abdominal enhanced computed tomography revealed a tumor located in the hepatic flexure and local lymph node metastasis. However, distant metastasis was not observed (Fig. 2). Accordingly, we considered the cancer to be resectable, although the investigation of the proximal colon was not sufficient to proceed. Thus, CTC was planned to assist our examination of the proximal colon under sigmoid colostomy. During CTC, the catheter was carefully inserted until the balloon portion was located several centimeters past the stoma. A 25-mL balloon inflation volume was employed. During the examination, the pressure of the colon was monitored through the catheter to prevent perforation and luminal collapse. Because of the patient’s stoma, he had difficulty lying in the prone position. Therefore, he lay in a standard supine position and a right-sideways position during CT scanning (Aquilion ONE 320, Toshiba, Tokyo). CTC revealed the apple core sign in the hepatic flexure, without any evident tumor in the proximal colon (Fig. 3). Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve. Histopathology revealed a tubular adenocarcinoma of the transverse colon (R0, T4N0P0H0M0, stage II). Postoperative colonoscopy confirmed that the ascending colon did not contain any lesion. The patient has remained free of recurrence for 2 years.Fig. 1


Transverse carcinoma after Miles operation: a case in which preoperative evaluation was assisted by computed tomographic colonography.

Ito D, Teruya M, Hata S, Kobayashi K, Kaminishi M - World J Surg Oncol (2016)

Computed tomographic colonography revealed the apple core sign in the hepatic flexure (black arrows show), without any evident tumor in the proximal colon
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837561&req=5

Fig3: Computed tomographic colonography revealed the apple core sign in the hepatic flexure (black arrows show), without any evident tumor in the proximal colon
Mentions: A 68-year-old man was admitted to our hospital with right abdominal pain and bloody stool that had been present for 2 weeks prior to admission. His medical history included abdominoperineal rectal resection with permanent sigmoid stoma (Miles operation), which had been performed 25 years earlier. On admission, assessments of tumor markers revealed a carcinoembryonic antigen (CEA) level of 1.2 ng/mL (normal limits 0.1–5.0 ng/mL) and a carbohydrate antigen 19-9 (CA19-9) level of 3.0 U/mL (normal limits 0.2–37.0 U/mL). Colonoscopy showed a circumferential tumor in the transverse colon but provided no information about the proximal colon because of the presence of this occlusive tumor (Fig. 1). Histopathological analysis of the biopsy specimen revealed tubular adenocarcinoma. Abdominal enhanced computed tomography revealed a tumor located in the hepatic flexure and local lymph node metastasis. However, distant metastasis was not observed (Fig. 2). Accordingly, we considered the cancer to be resectable, although the investigation of the proximal colon was not sufficient to proceed. Thus, CTC was planned to assist our examination of the proximal colon under sigmoid colostomy. During CTC, the catheter was carefully inserted until the balloon portion was located several centimeters past the stoma. A 25-mL balloon inflation volume was employed. During the examination, the pressure of the colon was monitored through the catheter to prevent perforation and luminal collapse. Because of the patient’s stoma, he had difficulty lying in the prone position. Therefore, he lay in a standard supine position and a right-sideways position during CT scanning (Aquilion ONE 320, Toshiba, Tokyo). CTC revealed the apple core sign in the hepatic flexure, without any evident tumor in the proximal colon (Fig. 3). Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve. Histopathology revealed a tubular adenocarcinoma of the transverse colon (R0, T4N0P0H0M0, stage II). Postoperative colonoscopy confirmed that the ascending colon did not contain any lesion. The patient has remained free of recurrence for 2 years.Fig. 1

Bottom Line: Thus, computed tomographic colonography (CTC) was planned to assist our examination of the proximal colon under sigmoid colostomy.Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve.Further, CTC examination was technically feasible through a sigmoid stoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Showa General Hospital, 8-1-1, Hanakoganei, Kodaira, Tokyo, 187-8510, Japan. itoudaisuke5995@yahoo.co.jp.

ABSTRACT

Background: There were only few case reports in which CTC was performed in patients with colostomy.

Case presentation: A 68-year-old man was admitted with right abdominal pain and bloody stool that had been present for 2 weeks prior to admission. His medical history included abdominoperineal rectal resection with permanent sigmoid stoma (Miles operation). Colonoscopy showed a sub-occlusive tumor in the transverse colon but provided no information about the proximal colon. Thus, computed tomographic colonography (CTC) was planned to assist our examination of the proximal colon under sigmoid colostomy. CTC revealed the apple core sign in the hepatic flexure, without any evident tumor in the proximal colon. Therefore, we performed transverse colectomy and lymph node dissection, preserving a part of the ascending colon and Bauhin valve.

Conclusion: CTC examination can be an effective means of preoperatively evaluating the proximal colon in patients with occlusive tumor. Further, CTC examination was technically feasible through a sigmoid stoma.

No MeSH data available.


Related in: MedlinePlus