A Case of Surgically Treated Varices of the Rectum and Sigmoid Colon with Klippel-Trenaunay-Weber Syndrome.
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Abstract:
症例は53歳,男性.小学生の頃より,左下肢の腫脹と下血があり,17歳時にKlippe1-Trenaunay-Weber症候群と診断された.1990年11月18日,十二指腸潰瘍穿孔のために,公立七戸病院で手術が行われ,手術中の腹腔内検索で,S状結腸から直腸にかけて静脈瘤が認められた,下血を繰り返し,静脈瘤による腸管狭窄症状を併発しているため根治的手術が必要と判断され,当科に紹介された.1991年2月26日,S状結腸・直腸切除を行い,経肛門的に結腸肛門吻合で再建した.予防的回腸ストーマ閉鎖後の排便は頻回であったが,現在は日常生活に支障なく社会復帰している.S状結腸・直腸に静脈瘤を合併しているKlippel-Trenaunay-Weber症候群は本邦では6例が報告されている.いずれの症例も保存的に治療されており,われわれの症例は根治的な肛門温存手術で治療された第1例目である.この手術は,下血を繰り返す例や腸管狭窄の症状を伴う例には有効な術式と考えられた.Keywords:
Sigmoid function
Klippel-Trenaunay-Weber Syndrome
Although the prevalence of cancer in the rectosigmoid is high compared with that in the more proximal colon, the features of cancer developing from an adenoma have yet to be elucidated. The aim of this study is to examine the clinicopathological relationship between cancer and adenoma in the rectosigmoid.A total of 340 adenomas located in the rectosigmoid in 255 patients were retrospectively examined regarding such clinicopathological factors as location and the grade of dysplasia.The prevalence of adenoma was 102 in the rectum and 238 in the sigmoid colon, respectively, whereas the prevalence of adenoma with high-grade dysplasia was 39 in the rectum and 48 in the sigmoid colon, respectively. This prevalence of adenoma with high-grade dysplasia was thus significantly higher in the rectum than in the sigmoid colon (p < 0.02).These findings suggest the possibility of different types of cancer development between adenoma of the rectum and sigmoid colon.
Tubular adenoma
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Abstract The case is reported of n 10-year-old boy who had severe diarrhoea with blood and mucus for I year which was found to be due to bilharzial polyposis of the rectum and sigmoid colon. He was treated first with anti-bilharzial drugs. Later, because of multiple polyps and secondary infection, local surgical resection was performed.
Sigmoid function
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OBJECTIVE: Although the prevalence of cancer in the rectosigmoid is high compared with that in the more proximal colon, the features of cancer developing from an adenoma have yet to be eluciated. The aim of this study is to examine the clinicopathological relationship between cancer and adenoma in the rectosigmoid. METHODS: A total of 340 adenomas located in the rectosigmoid in 255 patients were retrospectively examined regarding such clinicopathological factors as location and the grade of dysplasia. RESULTS: The prevalence of adenoma was 102 in the rectum and 238 in the sigmoid colon, respectively, whereas the prevalence of adenoma with high-grade dysplasia was 39 in the rectum and 48 in the sigmoid colon, respectively. This prevalence of adenoma with high-grade dysplasia was thus significantly higher in the rectum than in the sigmoid colon (p < 0.02). CONCLUSIONS: These findings suggest the possibility of different types of cancer development between adenoma of the rectum and sigmoid colon.
Tubular adenoma
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A difficult part of coloscopy is the passage of the instrument through the sigmoid colon. Particularly difficulties are encountered in an attempt to advance the flexible coloscope into the descending colon when an S-type loop of the sigmoid colon exists.
Sigmoid function
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THE NORMAL SIGMOID
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Large intestine
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The electric activity of the sigmoid colon (electrosigmoidogram=ESG) and rectum (electrorectogram=ERG) and their relationship was studied in nine patients. Slow waves or pacesetter potentials (PPs) of the sigmoid colon and rectum were recorded. The PP frequency and amplitude of the electrorectograms were higher (p less than 0.05) than electrosigmoidograms. Balloon distention of the sigmoid colon or rectum increased the frequency, amplitude and velocity of PPs and APs proximal to the balloon and led to their decrease distally. These effects were enhanced with increased balloon distention until the balloon was expelled. Balloon distention of the sigmoid colon did not affect the rectal electromechanical activity and vice versa. This study suggests that the movement of the sigmoid colon or rectum is of the "mass type".
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