Journal of the Korean Society of Coloproctology最新文献

{"title":"Does t3 subdivision correlate with nodal or distant metastasis in colorectal cancer?","authors":"Hong Yeol Yoo,&nbsp;Rumi Shin,&nbsp;Heon-Kyun Ha,&nbsp;Heung-Kwon Oh,&nbsp;Seung-Yong Jeong,&nbsp;Kyu Joo Park,&nbsp;Gyeong Hoon Kang,&nbsp;Woo Ho Kim,&nbsp;Jae-Gahb Park","doi":"10.3393/jksc.2012.28.3.160","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.3.160","url":null,"abstract":"<p><strong>Purpose: </strong>We analyzed the clinical data of T3 colorectal cancer patients to assess whether T3 subdivision correlates with node (N) or metastasis (M) staging and stage-independent factors.</p><p><strong>Methods: </strong>Five hundred fifty-five patients who underwent surgery for primary colorectal cancer from January 2003 to December 2009 were analyzed for T3 subdivision. T3 subdivision was determined by the depth of invasion beyond the outer border of the proper muscle (T3a, <1 mm; T3b, 1 to 5 mm; T3c, >5 to 15 mm; T3d, >15 mm). We investigated the correlation between T3 subdivision and N, M staging and stage-independent prognostic factors including angiolymphatic invasion (ALI), venous invasion (VI) and perineural invasion (PNI).</p><p><strong>Results: </strong>The tumors of the 555 patients were subclassified as T3a in 86 patients (15.5%), T3b in 209 patients (37.7%), T3c in 210 patients (37.8%) and T3d in 50 patients (9.0%). The nodal metastasis rates were 39.5% for T3a, 56.5% for T3b, 75.7% for T3c and 74.0% for T3d. The distant metastasis rates were 7.0% for T3a 9.1% for T3b, 27.1% for T3c and 40.0% for T3d. Both N and M staging correlated with T3 subdivision (Spearman's rho = 0.288, 0.276, respectively; P < 0.001). Other stage-independent prognostic factors correlated well with T3 subdivision (Spearman's rho = 0.250, P < 0.001 for ALI; rho = 0.146, P < 0.001 for VI; rho = 0.271, P < 0.001 for PNI).</p><p><strong>Conclusion: </strong>Subdivision of T3 colorectal cancer correlates with nodal and metastasis staging. Moreover, it correlates with other prognostic factors for colorectal cancer.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 3","pages":"160-4"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/61/jksc-28-160.PMC3398112.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30777419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comprehensive review of inflammatory bowel disease focusing on surgical management.","authors":"Seung Hyuk Baik,&nbsp;Won Ho Kim","doi":"10.3393/jksc.2012.28.3.121","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.3.121","url":null,"abstract":"<p><p>The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 3","pages":"121-31"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/06/jksc-28-121.PMC3398107.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30777925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipose-tissue-derived Stem Cells Enhance the Healing of Ischemic Colonic Anastomoses: An Experimental Study in Rats.","authors":"Jong Han Yoo,&nbsp;Jae Ho Shin,&nbsp;Min Sung An,&nbsp;Tae Kwun Ha,&nbsp;Kwang Hee Kim,&nbsp;Ki Beom Bae,&nbsp;Tae Hyeon Kim,&nbsp;Chang Soo Choi,&nbsp;Kwan Hee Hong,&nbsp;Jeong Kim,&nbsp;Soo Jin Jung,&nbsp;Sun Hee Kim,&nbsp;Kuk Hwan Rho,&nbsp;Jong Tae Kim,&nbsp;Young Il Yang","doi":"10.3393/jksc.2012.28.3.132","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.3.132","url":null,"abstract":"<p><strong>Purpose: </strong>This experimental study verified the effect of adipose-tissue-derived stem cells (ASCs) on the healing of ischemic colonic anastomoses in rats.</p><p><strong>Methods: </strong>ASCs were isolated from the subcutaneous fat tissue of rats and identified as mesenchymal stem cells by identification of different potentials. An animal model of colonic ischemic anastomosis was induced by modifying Nagahata's method. Sixty male Sprague-Dawley rats (10-week-old, 370 ± 50 g) were divided into two groups (n = 30 each): a control group in which the anastomosis was sutured in a single layer with 6-0 polypropylene without any treatment and an ASCtreated group (ASC group) in which the anastomosis was sutured as in the control group, but then ASCs were locally transplanted into the bowel wall around the anastomosis. The rats were sacrificed on postoperative day 7. Healing of the anastomoses was assessed by measuring loss of body weight, wound infection, anastomotic leakage, mortality, adhesion formation, ileus, anastomotic stricture, anastomotic bursting pressure, histopathological features, and microvascular density.</p><p><strong>Results: </strong>No differences in wound infection, anastomotic leakage, or mortality between the two groups were observed. The ASC group had significantly more favorable anastomotic healing, including less body weight lost, less ileus, and fewer ulcers and strictures, than the control group. ASCs augmented bursting pressure and collagen deposition. The histopathological features were significantly more favorable in the ASC group, and microvascular density was significantly higher than it was in the control group.</p><p><strong>Conclusion: </strong>Locally-transplanted ASCs enhanced healing of ischemic colonic anastomoses by increasing angiogenesis. ASCs could be a novel strategy for accelerating healing of colonic ischemic risk anastomoses.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 3","pages":"132-9"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d7/b0/jksc-28-132.PMC3398108.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30777926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Good Post-operative Results Depend on Strict Patient Selection and Strict Operative Procedure.","authors":"Yong Hee Hwang","doi":"10.3393/jksc.2012.28.3.118","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.3.118","url":null,"abstract":"See Article on Page 140-144 \u0000 \u0000Post-operative results are variable. Some rectoceles might be caused by a paradoxical puborectalis contraction leading to an outlet obstruction and to disappointing surgical results [1]. Thus, an anorectal physiologic study including anal sponge (anal plug) electromyography should be performed for excluding non-relaxing puborectalis syndrome [2]. In that case, biofeedback therapy should be applied first. A vital point for a good post-operative result is the tightness (strength) of the reconstructed rectovaginal septum even though long-term post-operative results aredisappointing [3]. A larger decrease in the rectocele diameter means greater strength of the rectovaginal septum.","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 3","pages":"118"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3393/jksc.2012.28.3.118","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30777923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of nutritional assessment on the outcome of ostomy takedown.","authors":"Min Sang Kim,&nbsp;Ho Kun Kim,&nbsp;Dong Yi Kim,&nbsp;Jae Kyun Ju","doi":"10.3393/jksc.2012.28.3.145","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.3.145","url":null,"abstract":"<p><strong>Purpose: </strong>Ostomy takedown is often considered a simple procedure without intention; however, it is associated with significant morbidity. This study is designed to evaluate factors predicting postoperative complications in the ostomy takedown in view of metabolism and nutrition.</p><p><strong>Methods: </strong>A retrospective, institutional review-board-approved study was performed to identify all patients undergoing takedown of an ostomy from 2004 to 2010.</p><p><strong>Results: </strong>Of all patients (150), 48 patients (32%; male, 31; female, 17) had complications. Takedown of an end-type ostomy showed a high complication rate; complications occurred in 55.9% of end-type ostomies and 15.7% of loop ostomies (P < 0.001). Severe adhesion was also related to a high rate of overall complication (41.3%) (P = 0.024). In preoperative work-up, ostomy type was not significantly associated with malnutrition status. However, postoperatively severe malnutrition level (albumin <2.8 mg/dL) was statistically significant in increasing the risk of complications (72.7%, P = 0.015). In particular, a significant postoperative decrease in albumin (>1.3 mg/dL) was associated with postoperative complications, particularly surgical site infection (SSI). Marked weight loss such as body mass index downgrading may be associated with the development of complications.</p><p><strong>Conclusion: </strong>A temporary ostomy may not essentially result in severe malnutrition. However, a postoperative significant decrease in the albumin concentration is an independent risk factor for the development of SSI and complications.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 3","pages":"145-51"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/f3/jksc-28-145.PMC3398110.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30777928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula: a randomized, controlled pilot trial.","authors":"Do Sun Kim","doi":"10.3393/jksc.2012.28.2.67","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.67","url":null,"abstract":"See Article on Page 78-82 \u0000 \u0000The ultimate purpose of surgical treatment for an anal fistula is the eradication of sepsis while maintaining continence. To achieve these goals, it is essential to identify the internal opening, as well as the relationship between the fistula tract and the sphincters, before or at the time of surgery. When the internal opening is not identified or is misdiagnosed, recurrence and unnecessary sphincter injury may be the result. Accurate diagnosis of the type of fistula is also important to determine an appropriate surgical treatment. A simple way of differentiating a simple fistula from a complex fistula is palpation of the tract. If the tract is palpable from the external opening to the anal verge, it is safe to regard the fistula as a simple type. \u0000 \u0000Various surgical treatments, including a fistulotomy, a fistulectomy, a seton and more complex sphincter-preserving procedures, are currently used depending on the type of fistula and the patient's continence. Recently, newer sphincter-preserving treatments, such as fibrin glue injection and fistula plug insertions, have been introduced. However, the postoperative healing rates are unpredictable and sometimes below our expectation. In the case of the ligation of intersphincteric fistula track (LIFT), the procedure is simple and shows results comparable to those of advancement flaps. No studies have been done comparing LIFT with other conventional treatments, and some questions as to whether it is as effective and technically feasible for complicated-course suprasphincteric fistulae or fistulae remain. \u0000 \u0000Therefore, the fistulotomy is regarded as the standard treatment for simple anal fistulae and is the most widely-performed procedure. Although whether to perform a fistulotomy or a fistulectomy may be controversial, the fistulotomy is thought to be preferable because healing times are significantly shorter whereas recurrence rates are comparable. \u0000 \u0000Compared with the fistulotomy, the fistulectomy is slightly more demanding, especially when the tract has ill-defined walls, because more damage is caused to the tissues surrounding the fistula tracts. A randomized controlled study comparing the fistulectomy with the fistulotomy revealed more sphincter defects in the fistulectomy group [1]. The fistulectomy has a potential advantage over the fistulotomy only when the fistula tract has not been explored via probing. \u0000 \u0000Marsupialization after anal fistula surgery is postulated to leave less raw unepithelialized tissue in the fistulotomy wound, thereby resulting in less postoperative blood loss and faster wound healing [2, 3]. However, this added procedure cannot prevent postoperative deformity and showed no improved functional outcome. Marsupialization is not regarded as an essential procedure even though it can facilitate faster wound healing. Therefore, whether to implement marsupialization over a fistulotomy depends on the surgeon's preference. In spite of the limitations of","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"67-8"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3393/jksc.2012.28.2.67","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Oncologic Outcomes after Tumor-specific Mesorectal Excision for Rectal Cancer.","authors":"Kil Yeon Lee","doi":"10.3393/jksc.2012.28.2.71","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.71","url":null,"abstract":"See Article on Page 100-107 \u0000 \u0000Total mesorectal excision (TME) was proposed by Heald et al. [1] more than 20 years ago and it is defined as the complete excision of the visceral mesorectal tissue to the level of the levators. The local recurrence rate after rectal cancer surgery has decreased dramatically to below 10% thanks to this TME technique. Currently TME is the gold standard for treatment of rectal cancer. However, if the tumor is located in upper rectum, partial mesorectal excision (PME) down to 5 cm below tumor can be performed. In 1998, Lopez-Kostner et al. [2] from Cleveland clinic insisted that TME is not necessary in case of the upper rectal cancer. And in the same year, Zaheer et al. [3] from Mayo clinic stated that appropriate \"tumor-specific\" mesorectal excision during anterior resection when tumor is high in the rectum is likewise consistent with a low rate of local recurrence and good long-term survival. The term tumor-specific mesorectal excision (TSME) was noted first in this article. In the Europe, Maurer et al. [4] from Germany concluded that the rectal cancers of upper third are appropriately treated by PME to 5 cm below the tumor. TSME is defined as the precise perpendicular and circumferential excision of the mesorectum to the level of an appropriate distal resection margin by American Society of Colon and Rectal Surgeons. \u0000 \u0000Law and Chu et al. [5] from Queen Mary's Hospital in Hong Kong compared the patients with TME for mid and lower rectal cancer and PME for upper rectal cancer, where the rectum was transected 4 to 5 cm below the tumor. Due to longer operative times, higher anastomotic leak rates, a more technically demanding surgery and a higher incidence of stoma formation, the authors called for a more selective use of TME. The authors argue that oncologic outcome is not compromised with this approach based on similar cancer-specific survival patterns between TME and PME in this study. This conclusion was confirmed by meta-analysis. Mirnezami et al. [6] examined the long-term oncological impact of anastomotic leakage after rectal cancer surgery using meta-analysis methods. They found that anastomotic leakage has a negative impact on local recurrence after the rectal cancer surgery. A significant association between anastomotic leakage and reduced long-term cancer specific survival was also noted. Junginger and Hermanek [7] reviewed the literature concerning oncologic outcomes after the rectal surgery. The authors recommended PME, if the rectal cancer is located 12 to 16 cm from anal verge. \u0000 \u0000Oncologic outcomes after the rectal cancer surgery can be divided into the long-term survival and the local recurrence rate. Regarding rectal cancer, local recurrence rate is especially important compared to colon cancer. TSME itself and its quality is one of the most important factors to predict the local recurrence and even the long-term survival after rectal cancer surgery. Survival is mainly determined by the occurrence of ","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"71-2"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/d1/jksc-28-71.PMC3349812.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aluminum potassium sulfate and tannic Acid injection for hemorrhoids.","authors":"Seok Won Lim","doi":"10.3393/jksc.2012.28.2.73","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.73","url":null,"abstract":"A quick hemostatic effect, as well as sclerosing and shrinkage of hemorrhoids, can be attained when internal hemorrhoids are treated by using injection therapy with aluminum potassium sulfate and tannic acid (ALTA), the outcomes of treatment may be similar to those of a hemorrhoidectomy. However, if the type of hemorrhoid or the method of injection is not appropriate for ALTA treatment, complications peculiar to ALTA or recurrence may develop. Accordingly, sufficient understanding of the treatment mechanism of ALTA injection and repeated training for injection are required for effective use of the ALTA treatment.","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"73-7"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/55/75/jksc-28-73.PMC3349813.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula: a randomized, controlled pilot trial.","authors":"Bhupendra Kumar Jain,&nbsp;Kumar Vaibhaw,&nbsp;Pankaj Kumar Garg,&nbsp;Sanjay Gupta,&nbsp;Debajyoti Mohanty","doi":"10.3393/jksc.2012.28.2.78","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.78","url":null,"abstract":"<p><strong>Purpose: </strong>This randomized clinical trial was conducted to compare a fistulectomy and a fistulotomy with marsupialization in the management of a simple anal fistula.</p><p><strong>Methods: </strong>Forty patients with simple anal fistula were randomized into two groups. Fistulous tracts were managed by using a fistulectomy (group A) while a fistulotomy with marsupialization was performed in group B. The primary outcome measure was wound healing time while secondary outcome measures were operating time, postoperative wound size, postoperative pain, wound infection, anal incontinence, recurrence and patient satisfaction.</p><p><strong>Results: </strong>Postoperative wounds in group B healed earlier in comparison to group A wounds (4.85 ± 1.39 weeks vs. 6.75 ± 1.83 weeks, P = 0.035). No significant differences existed between the operating times (28.00 ± 6.35 minutes vs. 28.20 ± 6.57 minutes, P = 0.925) and visual analogue scale scores for postoperative pain on the first postoperative day (4.05 ± 1.47 vs. 4.50 ± 1.32, P = 0.221) for the two groups. Postoperative wounds were larger in group A than in group B (2.07 ± 0.1.90 cm(2) vs. 1.23 ± 0.87 cm(2)), however this difference did not reach statistical significance (P = 0.192). Wound discharge was observed for a significantly longer duration in group A than in group B (4.10 ± 1.91 weeks vs. 2.75 ± 1.71 weeks, P = 0.035). There were no differences in social and sexual activities after surgery between the patients of the two groups. No patient developed anal incontinence or recurrence during the follow-up period of twelve weeks.</p><p><strong>Conclusion: </strong>In comparison to a fistulectomy, a fistulotomy with marsupialization results in faster healing and a shorter duration of wound discharge without increasing the operating time.</p>","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"78-82"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3393/jksc.2012.28.2.78","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is abdominal computed tomography helpful for the management of an intestinal obstruction caused by a bezoar?","authors":"Byung-Kwon Ahn","doi":"10.3393/jksc.2012.28.2.69","DOIUrl":"https://doi.org/10.3393/jksc.2012.28.2.69","url":null,"abstract":"See Article on Page 89-93 \u0000 \u0000Bezoars can be defined as retained concretions of animal or vegetable material in the gastrointestinal tract. Bezoars are classified according to their composition into phytobezoars (undigested vegetables), trichobezoars (hairs), lactobezoars (milk) and pharmacobezoars (medications) [1]. Phytobezoars are composed of undigested food fibers, such as cellulose, hemicellulose, lignin and fruit tannin. These fibers occur in fruits and vegetables such as celery, pumpkins, prunes, raisins, leeks, beets and persimmons. Especially, ingestion of persimmons is known to be a common cause of bezoars. Persimmon bezoars are also known as diospyrobezoars. In 1986, Krausz et al. [2] reported that 91.2% of 113 patients with phytobezoars had a history of persimmon intake. Kement et al. [3] also reported that excessive consumption of persimmons was identified in 40.5% of bezoar patients. Unripe persimmons contain soluble tannin. Tannin polymerizes in an acidic environment to form a glue-like coagulum, which can affix to other materials in the stomach [4]. \u0000 \u0000A number of predisposing factors may contribute to the risk of bezoar formation. Previous gastric surgery was reported in 20 to 93% of patients with bezoars [2, 5-8]. In this paper, the authors reported that 35% (7 patients) of patients had had previous gastric surgery. The other predisposing factors observed in our study included mastication problems, diabetic gastroparesis and antacid drug use. \u0000 \u0000Bezoars usually form in the stomach and can pass into the small bowel where they occasionally cause obstruction. Although bezoars are the most common type of foreign body lodged in any part of the gastrointestinal tract, the overall incidence of bezoar-induced intestinal obstruction remains relatively low. Incidence of intestinal obstruction caused by bezoars is 2 to 4% [9]. \u0000 \u0000The differential diagnosis of intestinal obstruction secondary to bezoars is difficult before surgery because the clinical and the radiographic findings are similar to those of intestinal obstruction attributable to other causes. However, findings from recent studies suggest that sonography or computed tomography (CT) can be useful in diagnosing bezoars before surgery [6, 10]. CT scans demonstrate a well-defined round, heterogeneous intraluminal mass in the gastrointestinal tract. The mass can be outlined by the bowel wall and presents a characteristic internal gas bubble-soft tissue appearance [11-14]. Kement et al. [3] reported that abdominal CT was carried out in 16 patients and that bezoars were revealed in 14 (77.7%) of those patients before surgery. In this paper, the accuracy of abdominal CT in diagnosing bezoars was 47% (7 of 15 patients). The authors compared the clinical courses of three groups, patients who were preoperatively diagnosed with bezoars by using abdominal CT (group 3), patients who were not diagnosed using abdominal CT (group 2), and patients who did not undergo abdominal CT (group 1). In th","PeriodicalId":17346,"journal":{"name":"Journal of the Korean Society of Coloproctology","volume":"28 2","pages":"69-70"},"PeriodicalIF":0.0,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/72/jksc-28-69.PMC3349811.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30628429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}