, Jae Uk Shin, Su Sin Jin, Hyeon Jeong Kang, Ho Wook Jeon, Joon Yub Lee Constipation is a prevalent, often chronic, gastrointestinal motility disorder. Bisacodyl, a stimulant laxative, is widely used to treat constipation in adults and children. This drug is usually safe, but it has some side effects including diarrhea, abdominal pain, colitis, and proctitis. There have been reports that rectal administration of bisacodyl could cause injury to the rectal mucosa by mechanical and chemical mechanisms. However, there has been no report of severe proctitis with rectal ulcers in patients taking oral bisacodyl. In this report, we describe the case of an 80-year-old woman with severe rectal ulcers and proctitis after taking oral bisacodyl for several days, and review the literature.
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, Jang Won Park, Byung Wook Jung, Jun Gyu Song, Hyun Sik Oh, Kwonoh Park Primary rectal lymphoma is a rare disease among the gastrointestinal (GI) lymphoma. In particular, diffuse large B-cell lymphoma (DLBCL) transformed from mucosa-associated lymphoid tissue (MALT) lymphoma is often the primary type of GI lymphoma, mostly in stomach or duodenum, but has never been reported in rectum. Here we report an unusual case in which a 75-year-old male patient diagnosed with DLBCL transformed from MALT lymphoma in the rectum. The patient was diagnosed as rectal DLBCL transformed from MALT lymphoma as Lugano stage II2 and was treated with chemotherapy (R-CHOP) with CD-20 monoclonal antibody (rituxaimb). Complete remission of multiple lymphadenopathy and mass forming ulcer of the rectum was achieved after 6 cycles of R-CHOP. He has been free from disease for 12 months.
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, Kyung Ja Lee The effects of radiation and Cis dichlorodiammineplatinum(II) (Cis-DDP) were assessed in rectum of rats by histopathological changes. Rats were exposed to single doses of X ray(6~10 Gy) without or with Cis-DDP(2.5mg/kg). In combined group, Cis-DDP was given 30 minntes before or immediately after irradiation. Cis-DDP alone showed inflammatory cell infiltration and increased goblet cells in the mucosa and edema and fibrosis of submucosa with vascular sclerosis. With increased radiation dosage. such changes were aggravated. Necrosis of muscle layer developed 8 Gy irradiation. In groups with combination treatment of X-ray and Cis-DDP. changes of mucosa and submucosa were not significantly different from radiation alone group, but necrosis of the muscle layer was developed in 6 Gy combination group and degree was more severe in 8 and 10 Gy combination group compared to radiation alone group. There was no difference according to the timing of Cis DDP administration before or after irradiation. This result suggests Cis DDP enhance the radiation effect on the rectum of rats and enhancement ratio was 1.3 as the endpoint was necrosis of the muscle layer.
, Ki Nam Shim, Sun Hee Roh, Min Jin Lee, Hye In Kim, Seung Jung Jun, Da Yeon Oh, Sung Chul Hong, Jae In Ryu, Kwang-Ho Kim A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7×5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.
, Kwang Ho Kim While some information about colonic function may be obtained from fluoroscopic assessment, detailed depiction of function of the rectum and anal canal during defecation is not possible with conventional technique. Defecography is a useful technique of examining the rectum and canal in which the patient is studied while sitting down and video recordings could be obtained during the procedure. To evaluate the clinical usefulness of defecography in patients with anorectal dysfunction, defecographic examinations were retrogradely reviewed.
Thirty symptomatic patients performed defecography. The ratio of men : women was 9 : 21, and the age was 8 to 86 years(mean, 36year). Presenting symptoms included a sensation of rectal blockage during straining, rectal prolapse through the anus, anal pain, etc.. While the patient was in the left decubitus position, 250㎖ of a thick barium past was injected into the rectum. The patient was then seated a toilet chair mounted on the footplate of a remote-control stand. And lateral images and video recording centered over the rectum and true pelvis obtained over a period of several minutes, both at rest and during and sqeezing and straining. The defecographaic results were analyzed for the anorectal angle and perineal descent at rest, sqeezing and during straining. Change of rectal configuration and canal width during staining were reviewed.
Defecation was normal in 5 patients(16.6%). Rectocele was seen in 17case(56.6%). Rectal proplase with or without intususception was 11 case(36.3%), 3 cases(10%) of sigmoidcele, and 2 cases(6.6%) of dynsfunction of puborectalis. There was a 1 case(3.3%) of rectal polyp. Seven cases(23%) show combined findings : 2 cases with rectocele, rectal intussusception and sigmoidcele, 4 cases with rectocele, rectal intussusecption and rectal prolapse, rectocele and dynsfunction of puborectalis in 1 case. The measurement of anorectal angel was 65°-125°(mean, 104°) in resting state, 57°-90°(mean, 63°) in sqezzing, and 78°-115°(mean, 103°) in straining state.
Defecography with video recording is a useful study in assessment and diagnosis of various discase causing anorectal dysfunciton. However, the measurement of anorectal angle was wide range without statistical significance.
, 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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