Abnormal Intestinal Anatomy in Late-stage Human Fetuses: Three Case Series.

OBJECTIVE: We reported three cases of fetuses with abnormal intestinal anatomy found during our recent study of the transverse mesocolon using 20 late-stage fetuses. CASES: The first case (CRL: 328 mm) appeared to have a duodenum and transverse colon trapped in Winslow's foramen (foramen epiploicum) and the duodenum superior portion elongated rightward. The second case (CRL: 264 mm) had a transverse colon inserted deeply into a space between the right kidney and duodenum. The third case (CRL: 276 mm) had a descending colon that ran inferiorly through a deep space between the left kidney and duodenum. Each case had a greater omentum that was shifted leftward, but this is usual. These 3 abnormalities were not evident in the anterior view during dissection of the liver, stomach, jejunum, and ileum. With underdeveloped pancreatic ducts due to unknown reason other than the internal hernia, the first case seemed to be fatal after birth. However, the second and third cases could have recovered after birth because there was no evidence of definite malrotation and because of loose attachments of the intestines to surrounding structures. CONCLUSIONS: The intestinal morphologies described here could cause some sort of symptoms, such as abdominal pain, whose cause might be difficult to determine.

Embryonic origin of primary colon cancer predicts survival in patients undergoing ablation for colorectal liver metastases.

BACKGROUND: In patients with primary colorectal cancer (CRC) or unresectable metastatic CRC, midgut embryonic origin is associated with worse prognosis. The impact of embryonic origin on survival after ablation of colorectal liver metastases (CLM) is unclear. METHODS: We identified 74 patients with CLM who underwent percutaneous ablation during 2004-2015. Survival and recurrence after ablation of CLM from midgut origin (n = 18) and hindgut origin (n = 56) were analyzed. Prognostic value of embryonic origin was evaluated. RESULTS: Recurrence-free survival (RFS) and overall survival (OS) after percutaneous ablation were worse in patients from midgut origin (3-year RFS: 5.6% vs. 24%, P = 0.004; 3-year OS: 25% vs. 70%, P 0.001). In multivariable analysis, factors associated with worse OS were midgut origin (hazard ratio [HR] 4.87, 95% CI 2.14-10.9, P 0.001), multiple CLM (HR 2.35, 95% CI 1.02-5.39, P = 0.044), and RAS mutation (HR 2.78, 95% CI 1.25-6.36, P = 0.013). At a median follow-up of 25 months, 56 patients (76%) had developed recurrence, 16 (89%) with midgut origin and 40 (71%) with hindgut origin (P = 0.133). Recurrent disease was treated with local therapy in 20 patients (36%), 2 (13%) with midgut origin and 18 (45%) with hindgut origin (P = 0.022). CONCLUSION: Compared to CLM from hindgut origin tumors, CLM from midgut origin tumors were associated with worse survival after ablation, which was partly attributable to the fact that patients with hindgut origin were more frequently candidates for local therapy at recurrence.

Development of the descending colon during the human foetal period.

The growth, changes in shape, topography and relation to the peritoneum of the descending colon were assessed on the basis of material taken from 178 foetuses of both sexes, aged from 72 to 236 days of pregnancy. The statistical analysis method demonstrated that the descending colon growth process occurs about a month earlier in female foetuses as compared to male ones. From the statistical point of view, the longitudinal growth of the descending colon significantly slows down in the 7th and 8th months of pregnancy, while the width of this part of the large intestine increases sharply towards the end of the foetal development period. The statistically important process of the descending colon rising over the surface of the left kidney and adrenal gland was noticed in male foetuses. This occurs approximately one month earlier in female foetuses as compared to males. The ascent of this part of the colon is accompanied by a change in its shape from straight, to curved and, finally, to wavy in the oldest age group of male foetuses. The changes in relation to the peritoneum are manifest in a gradual change in the position of this section of the intestine from the intraperitoneal, where more than 40% of the cases examined had a fully movable mesentery, to the extraperitoneal, with 14% of foetuses having a mesentery in the 8th month of pregnancy.

The development of large intestine during the fetal period.

OBJECTIVE: The aim of this study is to determine the colon types, developmental change of the colon morphology during the fetal period. METHODS: The study was realised on 131 human fetuses (male 69, female 62) ages between 10 and 40 weeks, which have no external pathology and anomalies. The colon types were evaluated in two parts. As the first part, the colon part between the ileal orifice and sigmoid colon was typed. The sigmoid colon was typed as the second part. The macroscopic diameters of parts of the colon and the thicknesses of wall layers of ascending and descending colons were measured under the light microscope. RESULTS: For the proximal part of the colon, there were seven types of colon, and there were five types for the sigmoid colon. For the first part, transverse type colon was a rare type during the fetal period (3%). The oblique type colon was observed mostly in the first and second trimester during the fetal period. Adult type colon was the most common type in the third trimester and full-term groups. The pendulous type colon was observed mostly in the third trimester. The development of the haustra and tenia coli in the first trimester was quite slow, but later the development increased more and more, and during the full-term period, the haustra and tenia coli could be seen clearly. CONCLUSION: The percentage distribution of the colon types between the trimesters was significant. It was observed that the maturation of haustra and tenia coli started from the ascending colon and progressed towards the sigmoid colon. The thickness of the tunica mucosa layer both in the ascending and in descending colon part increased considerably in the middle of the second trimester.