Unexpected Liver Lesions in Crohn’s Disease
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To the Editors, A 24-year-old man presenting with a history of abdominal discomfort, poor appetite, and progressive weight loss was admitted to our hospital. Crohn’s disease (CD) was suspected. He was not taking any medication for CD. Colonoscopy revealed multiple ulcers located from the cecum to the rectum, and typical longitudinal ulcers were found in the descending colon (Figure 1A). The diagnosis of CD was confirmed by pathological examination. When we performed computed tomography enterography (CTE) for this patient, we found several unexpected low-density liver lesions (Figure 2A), in addition to the small bowel and colon lesions that reflected CD (Figure 1B and C). The magnetic resonance imaging (MRI) scan confirmed these changes. Multiple long T1 and long T2 signal foci were observed in the S2, S5, S6, and S8 areas in the liver. The most significant lesion measured 40 mm × 33 mm...Keywords:
Cecum
Descending colon
Ascending colon
Our objective was to describe thin-section helical CT findings of acute diverticulitis of the cecum and ascending colon in 12 patients.Thin-section helical CT is able to reveal inflamed diverticula in acute diverticulitis of the cecum and ascending colon, which are diagnostic of this disease. Preservation of the enhancing pattern of the colonic wall was the most common helpful ancillary finding.
Ascending colon
Cecum
Diverticulitis
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A 69-year-old woman was admitted to the hospital because of epigastralgia. She had been treated for pulmonary tuberculosis 35 years before admission. A barium enema examination showed an elevated lesion 5 cm in diameter in the ascending colon, ahaustral appearance and multiple pseudo-diverticula of the cecum and ascending colon. Colonoscopic examination demonstrated an elevated lesion in the ascending colon and multiple ulcer scars in the cecum and ascending colon. Biopsy specimens of this lesion revealed well-differentiated tubular adenocarcinoma. Right hemicolectomy was performed. Macroscopic findings revealed that the tumor was 4.5×4.0cm in size. Histologically, the tumor was mainly mucinous adenocarcinoma invading the serosal layer. The nonspecific inflammatory changes were seen in the cecum and ascending colon, but no tuberculous granuloma or atypical epithelium was observed. There has been no evidence of disease as of 1 year after the operation.
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Barium enema
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Ascending colon
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IT IS the purpose of this paper to present 7 cases of volvulus of the cecum and ascending colon and to discuss the preoperative diagnosis of this condition, with emphasis on roentgenologic findings, and the proper surgical treatment.The problem of volvulus of the cecum is not frequent, and yet one of us (E.L.Y.) has operated on 3 cases in the last four years. The incidence in North America is relatively low. At the Massachusetts General Hospital over a period of fifty-seven years it was 1.15 per cent (6 cases) in 520 cases of acute intestinal obstruction exclusive of those . . .
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Ascending colon
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The patient, a woman aged 45, weighing 150 pounds, came for roentgen-ray examination by direction of her family physician, for an obscure abdominal condition. The blood picture was approximately normal with the exception of a slightly high leukocyte count (10,000 odd). No pathology was discoverable by the X-ray until six hours had passed, at which time a screen examination yielded the information that the patient carried a cecum and ascending colon “upside down.” (See Fig. 1.) After ingestion of the dye the gall bladder was found to be sufficiently suspicious to justify surgery being advised. At operation, a large biliary concretion was removed, and the malposition of the cecum and ascending colon was confirmed.
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Cecum
Right hemicolectomy
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Colorectal cancer is increasing due to both a real increase and a better diagnosis. More cases are seen in men than in women (ratio 1.45). The incidence increases with age, reaching the highest point at 75 years of age in men and at 84 years of age in women. Before 50 years of age, the risk of colorectal cancer is higher in women; the contrary happens after this age. Colorectal cancer is localized in the rectum (47.5%), sigmoid flexure (25.3%) and coecum (8.1%). Synchronous colorectal carcinomas are seen in 2.3% of the patients, frequently coexisting with multiple adenomas, and show a tendency to be localized out of the rectum. A higher proportion of carcinomas localized in the descending colon and a diminution of rectum carcinomas are observed in men with increasing age, while in women the number of carcinomas of the ascending colon increases and that of the descending colon decreases. For the considered period (1970-81), a diminution of the ascending colon carcinomas has been registered.
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Descending colon
Distal colon
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Ascending colon
Cecum
Proximal colon
Distal colon
Right hemicolectomy
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Ascending colon
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We assessed the pattern of metabolic activity in the colon of subjects who received oral contrast and had no known or suspected colonic disease.Positron emission tomography/computed tomography (PET/CT) with [F-18]-fluorodeoxyglucose was performed in 50 patients with cancer and no known or suspected colonic pathology. Studies with intense focal or segmental colonic activity (in comparison to liver reference activity), which are known to be predictive of colonic pathology were excluded. Retrospectively, colon was divided into cecum, ascending, transverse, descending, and rectosigmoid partitions, and the corresponding volumetric regions of interest were drawn on all relevant CT images. Partitioned colonic maximum standardized uptake values (SUVmax) were compared using Wilcoxon rank-sum test. Frequency of occurrence for the various colonic uptake rank orders was also tabulated.For colonic partitions, range and median SUVmax, respectively, were in decreasing order: rectosigmoid (1.5-9.9, 2.9), cecum (1.2-6.3, 2.6), ascending (0.7-4.0, 1.8), transverse (0.4-4.1, 1.2), and descending (0.6-3.1, 1.2). The SUVmax at different colonic partitions were significantly different from each other (P<0.001), except for the SUVmax between descending and transverse colonic segments (P=0.77). Combining the latter segments, the uptake rank order of "rectosigmoid>cecum>ascending" was demonstrated in 50% and "cecum>rectosigmoid>ascending" in 30% of subjects.Rectosigmoid and cecum tend to demonstrate higher metabolism than other colonic segments in the majority subjects who receive oral contrast during [F-18]-fluorodeoxyglucose positron emission tomography/CT and have no known or suspected colonic pathology.
Cecum
Ascending colon
Descending colon
Fluorodeoxyglucose
Transverse colon
Standardized uptake value
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To characterize colon and rectum walls, pericolic and perirectal spaces, using endoscopic ultrasonography miniprobes.Sixty individuals (50% males), aged 18-80, were included. Using 12 and 20 MHz endoscopic ultrasonography miniprobes, all different colon segments (ascending, transverse, descending, sigmoid) and rectum were evaluated according to the number and thickness of the different layers in intestinal wall, to the presence and (largest) diameter of vessels in the submucosa and of peri-intestinal nodes.The 20 MHz miniprobe identified a higher number of layers than the 12 MHz miniprobe, with medians of 7 and 5 respectively (p < 0.001). The rectal wall (p = 0.001), its muscularis propria (p < 0.001) and mucosa (p = 0.01) were significantly thicker than the different segments of the colon, which had no significant differences between them. Patients aged 41-60 presented thicker colonic wall and muscularis propria in descending (p = 0.001 and p = 0.004) and rectum (p = 0.01 and p = 0.01). Submucosal vessels were identified in 30% of individuals in descending and rectum, and in 12% in ascending. Adenopathies were observed in 9% of the colon segments and 5% in rectum.A higher frequency enabled the identification of a higher number of layers. Rectal wall is thicker than the one from all the segments of the colon and there are no differences between these, namely in the ascending colon. Moreover, periintestinal adenopathies were rarely identified but present in asymptomatic individuals. All together, these results describe for the first time features which are relevant during staging and therapeutic management of colonic lesions.
Ascending colon
Submucosa
Descending colon
Transverse colon
Large intestine
Muscularis mucosae
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