Minimally invasive surgery for colorectal disease has now become the standard treatment in Republic of Korea. However, there are limitations to the laparoscopic approach, such as an unstable camera support, a limited range of motion, and poor ergonomics. Recent advances in technology have led to the introduction of robotic surgical systems in colorectal surgery to overcome these shortcomings. Robot-assisted colorectal surgery has clear advantages in many aspects. Surgery involving the rectum benefits the most among colorectal diseases owing to technical difficulties in rectum dissection. The concept of robotic surgery is not different from laparoscopic surgery in that it is a minimally invasive surgery, and abundant research demonstrates comparable results from both modalities for postoperative complications, oncological outcomes, and functional outcomes. However, the cost of robot-assisted surgery limits surgeons to performing robotic surgeries in only selected cases. Improvements regarding cost-effectiveness and more convincing studies that support benefits of robotic surgery are needed to popularize robot-assisted colorectal surgery.
, Jinhoon Nam, Ryung-Ah Lee We report a rare case of suture material-related colon perforation. A 60-year-old woman visited clinics because of the nonspecific abdominal discomfort for several months. There were no specific medical history except previous laparoscopic myomectomy 15 years ago. Colonoscopy and abdomen-pelvis computed tomography revealed an unknown foreign body penetrating the sigmoid colon wall adjacent to the uterus. We performed laparoscopic exploration with foreign body removal and primary colon wall repair. The foreign body was identified as a non-absorbable suture material suggestive of used in previous myomectomy. With recent trends for minimally invasive procedures in the field of pelvic organ surgery, surgeons, especially those without sufficient training have to pay attention to selecting the proper surgical suture materials. (Ewha Med J 2022;45(3):e7)
Colonoscopy is commonly used to screen for and diagnose colorectal disease, and adequate bowel preparation is crucial to its quality. As bowel preparation regimens vary, it is important that clinicians understand each and select the proper one for each patient. Accordingly, here we investigated recent studies and describe how to choose the optimal bowel preparation regimen. We detail composition, dosages, efficacy, contraindications, and precautions of commonly used regimens including 4 L polyethylene glycol (PEG), 2 L PEG+ascorbic acid, 1 L PEG+ascorbic acid, trisulfate (oral sulfate solution/tablets), and sodium picosulfate/magnesium citrate. Here we describe that the most recently introduced 1 L PEG and oral sulfate tablets, which were developed to improve convenience and compliance, differ in composition and efficacy between South Korea and foreign countries. This review presents new evidence of and differences among products to increase clinician understanding.
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, Sun Young Kim, Min Ju Kim, Eun Kyung Hong, Sang Ho Lee, Chang Woo Shim A 56-year-old man was diagnosed with cancer of the ascending colon along with retroperitoneal lymph node and peritoneal metastases. After six cycles of palliative chemotherapy, he presented with acute-onset jaundice. Imaging examinations did not show abnormal liver findings other than a periportal linear hypoattenuating area, and endoscopic retrograde cholangiography revealed a tight stricture of the proximal common bile duct. Total bilirubin continued to increase after endoscopic sphincterotomy and biliary stent insertion. Blind liver biopsy revealed tumor infiltration along liver lymphatics, but ruled out tumor involvement of hepatic parenchyma and sinusoids. Tumor cells were predominantly confined to within the lymphatic vessels and were not observed in the arteries or veins. Although one loading dose of cetuximab and two fractions of palliative radiotherapy were administered, the patient succumbed to acute liver injury 30 days after the development of jaundice.
, Seung Ki Ryu, Seung Jung Kim, Jun-Hyuk Choi, Soon Nam Lee, Kwang Ho Kim, Woo Sup Han Although the role of surgical management of metastatic disease from primary carcinoma of the coln and recutm is still controversial, resection of hepatic metastasis improves survival rate of patients with primary colorectal carcinoma treated locally. The lung is the most common site of extra-abdominal metastasis following resection of a prymary colorectal tumor and not amenable to curative therapy.
It is possible to resect the pulmonary metastasis in selected patients following resection of colorectal cancers, but the 5-year survival rates are ranged from 9% to 57%. Authors report a case of resection of pulmonary metastasis occured 3 years after resection of primary colon carcinoma.
, Eun Young Kim, Min-Ji Seo, Eun Chung, Min-Jung Cho, Hyun-Jin Oh, Ji-Hye Jang, Ji-Chan Park, Jung-Uee Lee, Suk-Young Park Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.
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, Hye-Kyung Jung, Hyeon-Ju Kang, Yoon-Pyo Lee, Hye-Won Kang, Ki-Nam Shim, Sung-Ae Jung Amyloidosis is characterized by extracellular deposition of protein fibrils in one or multiple organs. AA amyloidosis is secondarily occurred to be related with chronic infections or inflammatory diseases. We report a 67-year-old man suffered from secondary AA amyloidosis related with chronic
, Tae-Hun Kim, Min-sun Ryu, Da-Yeon Oh, Myung-Eun Song, Shina Lee, Jae-In Ryu, Hye-In Kim, Il-Hwan Moon, Kwon Yoo The causes of pyogenic liver abscess has been known as biliary tract disease or intrabadominal infection but the large proportions of the patients has no apparent underlying disorders. Recently colonic mucosal lesions were reported in patients with cryptogenic liver abscess and it has been suggested that colonic mucosal break may play a role in developing liver abscess in otherwise healthy patients. We experienced a patient of severe recurrent liver abscess complicated with endophthalmitis only 3 months after successful treatment of initial cryptogenic liver abscess and a polypoid colon cancer was discovered by chance. It seems prudent to proceed colonoscopic examination in patients with cryptogenic liver abscess especially when it is recurrent.
, Ki Nam Shim, In Seon Kim, Jin Kyeong Park, Kyung Jong Lee, Jae Beom Lee, Jung Yoon Yoon, Hye Sung Won, In Jeong Cho Acute appendicitis is the one of the most common operative disease in general surgery following by acute cholecystitis and intestinal obstruction, and most of the acute appendicitis is diagnosed at the emergency room.
Especially, because the number of patient who present atypical symptoms of acute appendicitis increases, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease.
We report one case of acute appendicitis diagnosed by colonoscopy performed to evaluate for atypical abdominal pain.
, Sung-Ae Jung As the lifespan of men have been extended, the interest in functional aging process of each organs is increasing. The aim of this study was to investigate lbjectively several physiological changes in aged colon, using rats.
We used old healthy Sprage-Dawley rats(n=33, over 17months), and young rats(n=28, 8 - 10weeks). Glass bead expulsion tests were done
For glass bead expulsion, more time was needed significantly in young rat group (p=0.028). The speed of colon transit was accelerated in distal colon significantly regardless of age, but the number of rats with complete transt was superior in young rat group. Development of tension in respose to Carbachol was not different significantly between two groups (p=0.345).
Colonic functional decline with age was observed through
, Sung-Ae Jung, Seong-Eun Kim, Jong Soo Lee, Seung Hyun Nam, Jeong Eun Shin, Hae Sung Moon, Seung Cheol Kim, Kwon Yoo In Lynch syndrome II, colon cancer was associated with endometrial and ovarian cancer. The aim of this study was an evaluation for the clinicopathologic characteristics of rectosigmoid adenomas on preoperative sigmoidoscopy in gynecologic cancer patients.
A total 187 gynecologic cancer patients(139 cervical, 35 ovarian, 13 endometrial cancer) and 58 normal controls were reviewed sigmoidscopic finding and pathologic reports retrospectively from September 1993 to March 2001.
The mean age of gynecologic cancer patients was 54(38-82) year-old and normal controls was 50(20-68) year-old. Total 26 adenomas were in 21 patients(11.2%) and 3 adenomas were in 3 normal controls(5.2%). The incidence of adenomas was 9.4% in cervical cancer, 8.6% in ovarian cancer and 38.5% in endometrial cancer. Multiple adenomas were in 5 gynecologic cancer patients and 0 normal controls. The incidence of advanced adenoma was 12.5% in cervical cancer, 25.5% in ovarian cancer, 83.5% in endometrial cancer and 33.3% in normal controls. The location of adenoma was 23.1% in rectum and 76.9% in sigmoid colon.
The incidence of adenomas and multiple adenomas were higher in gynecologic cancer patients than normal controls but not significantly. The incidence of advanced adenoma and adenomas were significantly higher in endometrial cancer than normal controls. Colonoscopic evaluation of whole colon will be recommanded in gynecologic cancer than sigmoidoscopy.
, Sung Ae Jung, Min A Yu, Young Ju Choi, Ji Yoon Cho, Su Hyun Kim, Kwon Yoo, Il-Hwan Moon The aim of this study was to evaluate the clinicopathologic characteristics of the colorectal polyps in people under 50 years old.
From January to August 2001, the colonoscopic finding and pathologic reports of 527 patients under 50 years old who underwent colonoscopy were reviewed retrospectively. The advanced polyp was defined as an adenoma more than 10mm in diameter or with the histology of villous or high grade dysplasia.
Total 94 colonic polyps(17.8%) were analyzed. On age distribution, 65 cases(69.1%) were in forth decade, 25 cases(26.6%) in third decade. Abdominal pain(29.8%) was the most common cause of taking the colonoscopic examination followed by rectal bleeding(18.1%), asymptomatic screening(12.7%). Rectosigmoid area was the most common site of polyps in 63.8%. On the pathologic review, adenoma was found 55.1%, inflammatory polyp 38.5% and hyperplastic polyp 6.4%. Advanced adenomas were 17.9%(17/156) and adenomas with focal carcinomatous changes were 1.9%(3/156). Patients who had symptoms of abdominal pain or rectal bleeding, multiple polyps or familial history of colorectal cancer had a higher prevalence of advanced adenoma than that of non-advanced adenoma(
This study showed that major symptoms of patients with advanced polyps under 50 years old were abdominal pain and rectal bleeding. The symptoms, multiplicity of polyp and family history were important indicator of advanced polyps. Further study was needed for reasonable indication and cost effectiveness for colonoscopic examination in young age people.
, Hee Sun Kim, Yoonjung Kim, Eun Kyung Byun, Young Sook Lee, Soo Jin Jung, Youn Ju Ryu The aim of this study was to investigate the characteristics of colonic mucosal lesions by colonoscopy and for assessment of clinical features in patients with acute diarrhea.
From March 2000 to August 2001, one hundred and ten patients with watery or bloody diarrhea lasting less than 14 days. The colonoscopic finding was assessed to extent of lesion(rectum, left, right and total colon) and severity of inflammation(mild ; erythema and edema, moderate ; exudates and blood coagula, severe ; hemorrhage and ulcer).
Male was 60(54.5%) and median age was 43 years(range ; 15-84 years). The day of colonoscopy from symptom onset was 5 days(range 1-14 days). The causative food was flesh and meat, sea food and fish, and vegetable in order. Eight patient have history of travel including oversea. Pancolitis was the most common finding(46/110, 41.8%) and the normal colonoscopic finding was noted in eighteen cases(16.4%). The mild inflammation was 40(43.5%), moderate was 26(28.3%) and severe was 26(28.3%). The severity of inflammation was significantly correlated to the extent of lesion(p<0.05, r=0,655).
The colonoscopy in acute infectious colitis was a useful to evaluate the extent of lesion and the severity of disease.
, Byung Chul Kang, Jung Soo Suh, Eung Bum Park, Kang Sup Shim We studied to determine the usefulness of dynamic magnetic resonance imaging(MRI) in the preoperative evaluation of invasion of colorectal cancer and to compare its usefulness with the conventional CT. To observe the enhancement pattern of colorectal wall after iv administration of Gd-DTPA between normal and cancerous wall.
Twenty patients with colon cancer and 8 patients with rectosigmoid cancer, who were diagnosed between October 1997 and June 1998 by barium enema, colonoscopic biopsy were evaluated. The patients population consisted of 16 men and 12 women, with ages ranging from 46 to 68 years(mean 61years). Preoperative staging was done by conventional CT and dynamic MRI. All MR images were performed with 1.5T superconducting magneting unit(Vision, Siemens, Erlangen, Germany). 2D-FLASH(Fast Low-Angle Shot) sequence was used for the dynamic and delayed images(TR/TE/NEX/FA=72.5-117.3/4.1/1/80°), and acquisition time of 13-15sec.
For the dynamic images, five MR images were obtained with a single breath hold. Precontrast images(axial, or sagittal or coronal) was obtained first, and then dynamic MR images were obtained at 30, 60, 90, 120sec after intravenous injection of 0.1mmol/kg Gd-DTPA. Ten to fifteen delayed images were also obtained with the interval of 4-5 minutes with a single breath hold. Preoperative staging of CT and MRI were decided with a consensus by two radiologists. Pathologic staging were done by TNM classification.
The dynamic MR image-determined stage of colorectal cancer correlated with histopathologic findings in 2 of 3 pT2 tumor(67%), 19 of 21 pT3(90%), and 4 of 4 pT4 tumors(100%). MRI correctily diagnosed tumor deposits of involved lymph nodes in 16 patients, overall accuracy was 57%(16/28%). And the signal intensities after IV Gd-DTPA administration between the cancerous wall and normal wall ws not significantly different at the 30, 60, and 90 seconds MR images with the indifferent Student
Dynamic MRI has a role for the preoperative assesment of colorectal carcinoma.
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