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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

The catheter was placed until the balloon portion was located several centimeters past the stoma (white arrows show)
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Fig4: The catheter was placed until the balloon portion was located several centimeters past the stoma (white arrows show)

Mentions: Despite these feasibility results, CTC examinations of patients with colostomy require several unique techniques. During the examination, patients with colostomy more frequently develop air leakage and expulsion of the balloon catheter because the rectal sphincter is absent in artificial colostomy. Therefore, the catheter was carefully inserted until the balloon portion was located several centimeters past the stoma. This balloon location was chosen to avoid ballooning in the stoma and to ensure some distance between entrance of the stoma and ballooning position (Fig. 4). A 25-mL balloon inflation volume was employed. For these procedures, patients lay in a standard supine position and a right-sideways position during CTC examination, because patients with colostomy have difficulty in prone positions due to the pouch of the stoma. In our case, during the examination, we monitored the pressure of the intestine to prevent perforation and the expulsion of the catheter.Fig. 4


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)

The catheter was placed until the balloon portion was located several centimeters past the stoma (white arrows show)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: The catheter was placed until the balloon portion was located several centimeters past the stoma (white arrows show)
Mentions: Despite these feasibility results, CTC examinations of patients with colostomy require several unique techniques. During the examination, patients with colostomy more frequently develop air leakage and expulsion of the balloon catheter because the rectal sphincter is absent in artificial colostomy. Therefore, the catheter was carefully inserted until the balloon portion was located several centimeters past the stoma. This balloon location was chosen to avoid ballooning in the stoma and to ensure some distance between entrance of the stoma and ballooning position (Fig. 4). A 25-mL balloon inflation volume was employed. For these procedures, patients lay in a standard supine position and a right-sideways position during CTC examination, because patients with colostomy have difficulty in prone positions due to the pouch of the stoma. In our case, during the examination, we monitored the pressure of the intestine to prevent perforation and the expulsion of the catheter.Fig. 4

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