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Laterally spreading tumors:Limitations of computed tomography colonography

World Journal of Gastroenterology 2014年第46期20卷 17552-17557页

作者： Kazutomo Togashi Kenichi Utano Shigeyoshi Kijima Yosuke Sato hisanaga horie Keijirou Sunada Alan T Lefor Hideharu Sugimoto Yoshikazu Yasuda Department of Coloproctology Aizu Medical CenterFukushima Medical UniversityAizuwakmatsu-cityFukushima 969-3492Japan Department of Surgery Jichi Medical UniversityShimotsukeTochigi 329-0498Japan Department of Radiology Jichi Medical UniversityShimotsukeTochigi 329-0498Japan Department of Gastroenterology Jichi Medical UniversityShimotsukeTochigi 329-0498Japan

AIM:To prospectively investigate the detection rate of laterally spreading tumors(LSTs)of the colorectum by computed tomography(CT)colonography(CTC).METHODS:Patients with LSTs measuring≥20 mm detected during colonoscopy were prospectively enrolled in the *** patients underwent colonoscopy and subsequent CTC on the same *** was performed using multi-detector CT without contrast in the prone and supine *** radiologists blinded to the existence of LSTs read the virtual endoscopic images as well as 2-D *** were classified into granular and non-granular types based on colonoscopic ***:Forty-seven pathologically proven LSTs were evaluated *** included adenomas in 19,mucosal cancers in 19 and T1 cancers in *** mean diameter of the LSTs was 35.1 ***-eight(60%)LSTs were correctly identified by CTC,and the configuration was similar to the colonoscopic appearance in most *** rate for the granular type was significantly higher than that for the nongranular type(71%vs 31%,P=0.013).Detection rate of adenomas was significantly lower than mucosal cancers(32%vs 79%,P=0.008)and T1 cancers(32%vs 78%,P=0.042).CONCLUSION:The detection rate of LSTs by CTC,particularly the non-granular type was not *** should be aware of the relatively low detection rate when using CTC.

关键词： Computed tomography colonography Laterally spreadi

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Hepatic portal venous gas after endoscopy in a patient with anastomotic obstruction

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World Journal of Gastrointestinal Surgery 2015年第2期7卷 21-24页

作者： Ai Sadatomo Koji Koinuma Rihito Kanamaru Yasuyuki Miyakura hisanaga horie Alan T Lefor Yoshikazu Yasuda Department of Surgery Jichi Medical University

A 72-year-old male underwent a laparoscopic low anterior resection for advanced rectal cancer.A diverting loop ileostomy was constructed due to an anastomotic leak five days *** months later,colonoscopy performed through the stoma showed complete anastomotic *** mucosa of the proximal sigmoid colon was atrophic and *** days after the colonoscopy,the patient presented in shock with abdominal *** computed tomography scan showed hepatic portal venous gas(HPVG) and a dilated left *** induced by obstructive colitis was diagnosed and a transverse colostomy performed *** subsequent hospital course was *** anastomosis with diverting ileostomy is often performed in patients with low rectal *** patients with anastomotic obstruction or severe stenosis,colonoscopy through diverting stoma should be *** operation to decompress the obstructed proximal colon is necessary in patients with a blind intestinal loop accompanied by HPVG.

关键词： Portal venous gas Abdominal computedtomography Colonoscopy Anastomotic obstruction Bacterial translocation

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Diagnosis of a submucosal mass at the staple line after sigmoid colon cancer resection by endoscopic cuttingmucosa biopsy

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World Journal of Gastrointestinal Endoscopy 2016年第8期8卷 374-377页

作者： Mitsuaki Morimoto Koji Koinuma Alan K Lefor hisanaga horie Homare Ito Naohiro Sata Yoshikazu Hayashi Keijiro Sunada Hironori Yamamoto Department of Surgery Jichi Medical University Department of Gastroenterology Jichi Medical University

A 48-year-old man underwent laparoscopic sigmoid colon resection for cancer and surveillance colonoscopy was performed annually thereafter. Five years after the resection, a submucosal mass was found at the anastomotic staple line, 15 cm from the anal verge. Computed tomography scan and endoscopic ultrasound were not consistent with tumor recurrence. Endoscopic mucosa biopsy was performed to obtain a definitive diagnosis. Mucosal incision over the lesion with the cutting needle knife technique revealed a creamy white material, which was completely removed. Histologic examination showed fibrotic tissue without caseous necrosis or tumor cells. No bacteria, including mycobacterium, were found on culture. The patient remains free of recurrence at five years since the resection. Endoscopic biopsy with a cutting mucosal incision is an important technique for evaluation of submucosal lesions after rectal resection.

关键词： Submucosal tumor Staple line Endoscopic cutting-mucosa biopsy

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