[Tumor-induced colocolonic invagination in an adult]. / Tumorinduceret kolokolisk invagination hos en voksen.

A case of colocolonic invagination is presented. The mass was palpated preoperatively and diagnosed by barium enema X-ray and ultrasound. Operation confirmed the diagnosis and demonstrated a coecum tumor. The patient was treated successfully with a right hemicolectomy.

[Protective silicone prosthesis prior to radiotherapy of recurrent colonic cancer]. / Skjermende silikonprotese ved bestråling for residiv av coloncancer.

Radiation therapy for abdominal recurrence of colon cancer is rarely an option due to subsequent bowel injury. Our case is a woman who underwent resection for a large retroperitoneal recurrence of caecal cancer. Tumour deposits encasing the iliac vessels had to be left behind. A silicone breast prosthesis for displacement of the abdominal content was implanted, allowing postoperative irradiation with 50 Gy. The prosthesis was removed once radiotherapy was accomplished; tumour regression was then complete. Complications are described, so are indications for surgical management of local recurrences of colonic origin as well as technical aspects of abdominal implantation of displacing prostheses. At follow-up after eighteen months the patient has no signs of enteropathy, she enjoys a good quality of life, and she is free of disease. Still, her prognosis is considered uncertain.

[Differential diagnosis of morbus Crohn disease: intussusception of the colon]. / Zur Differenzialdiagnose des Morbus Crohn: Invagination des Kolons.

We report on a 35-year old women with severe abdominal pain, cramps, diarrhea with blood and a palpable paraumbilical resistance. The symptoms appeared a few days before admission and were recurrent within the last two years. The abdominal ultrasound showed a target sign with a thickened wall from the right to the left colon flexure with inhomogeneous reflexes. The CT-scan and barium enema showed an intussusception of the colon. After hemicolectomy of the right colon a 6 x 4 x 4 cm exophytic tumor near the ileocoecal valve was detected. Histologically the tumor was diagnosed as adenocarcinoma of the coecum (pT2pNOpMX G2).

Caecal carcinomas in the elderly: useful signs in minimal preparation CT.

OBJECTIVE: Frail, elderly and immobile patients frequently have difficulty in tolerating formal colonic investigations. Caecal tumours may account for up to 35% of colonic tumours. Barium enema and colonoscopy have limitations in assessing this region. The aims of this study were to evaluate the accuracy of a minimal preparation CT technique (merely with prolonged oral contrast medium) in identifying caecal carcinomas and to determine helpful radiological signs. MATERIALS AND METHODS: The CT technique involved helical acquisition following 2 days of preparation with oral contrast medium. The outcome of 4 years' experience (1995-1998) was reviewed. The gold-standards were pathological and cancer registration records, together with colonoscopy and barium enema where available, with a minimum of 15 months' follow-up. RESULTS: CT correctly identified 27 of 30 caecal carcinomas, and missed three, in a total of 1077 CT studies in 1031 patients (median age 80 years). There were also 21 false-positive cases in which CT incorrectly raised the possibility of a caecal tumour. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were 90%, 98%, 99% and 56%, respectively. Serosal margin blurring, tumour length, presence of abnormal peri-colic fat and terminal ileal wall thickening were identified as useful radiological signs. CONCLUSIONS: Minimal preparation CT is able to identify caecal carcinomas with fair accuracy. Such evaluation may become important given the increasing population age and evidence of a 'proximal shift' in the site of colonic tumours in the elderly.

Cecal carcinoma: initially diagnosed as Crohn's disease on small bowel follow-through.

Lesions in the terminal ileum are often difficult to visualize on routine small bowel follow-through (SBFT) and may require further investigation to rule out associated abnormalities in the ileocecal valve or cecum. This may be done by peroral pneumocolon at the same sitting as the SBFT, but may require bowel preparation. Two cases of cecal carcinoma that were initially diagnosed as Crohn's disease on SBFT without further investigation of the cecum are reported.

Imaging of mucocoele of the appendix with emphasis on the CT findings: a report of 10 cases.

AIM: Mucocoele of the appendix denotes an obstructive dilatation of the appendiceal lumen due to abnormal accumulation of mucus. It is sometimes associated with pseudomyxoma peritonei, which predicts a malignant origin. We present the CT findings and additional imaging studies of 10 patients with neoplastic appendiceal mucocoele and discuss the clinical implications. MATERIALS AND METHODS: Abdominal CT findings from 10 patients with appendiceal mucocoele were reviewed. Barium enema, US and MRI were additionally performed in three patients. There were five men and five women aged 45-80 years. Special attention was directed to the shape and nature of the mass, its relation to the caecum and the presence of ascites or peritoneal implants, as well as possible additional ovarian tumours in female patients. RESULTS: The mucocoele was an incidental finding in five patients. They were either spherical or elongated cystic lesions, attached to the wall of the caecum, six of them with mural calcification. Ascites were present in six patients and hypodense large peritoneal implants representing pseudomyxoma peritonei in four. Pathologically the series included five cases of cystadenoma (in one, a malignant pseudomyxoma peritonei subsequently developed), four cases of cystadenocarcinoma and one villous adenoma (this patient later developed pseudomyxoma peritonei). Pseudomyxoma peritonei was found in five cases. Three women had associated ovarian cystic tumour. CONCLUSION: The appearance of an appendiceal mucocoele is quite characteristic and can be diagnosed on CT. CT can also depict additional findings suggesting pseudomyxoma peritonei. In women with an appendiceal mucocoele the ovaries should be examined closely for cystic tumour and vice versa.

[Contribution of imaging in intestinal intussusception in the adult. Apropos of a case of ileocolic intussusception secondary to cecal lipoma]. / Apport de l'imagerie dans les invaginations intestinales de l'adulte. A propos d'un cas d'invagination iléo-colique, secondaire à un lipome caecal.

On the basis of a case of ileocolonic intussusception in a 35-year-old patient secondary to an obstructive lipoma of the caecum, the authors review the literature and discuss the clinical and radiological aspects of this disease. The diagnosis was established by CT scan and barium enema before surgery. Adult intussusception is a rare disease, which does not have any specific clinical features. Radiological imaging is the only complementary investigation which can suggest the diagnosis.

Colon cancer: morphology detected with barium enema examination versus histopathologic stage.

PURPOSE: To determine the relationship between the morphology of colon carcinomas detected with barium enema examination and the cancer stage. MATERIALS AND METHODS: Clinical, radiographic, endoscopic, surgical, and histopathologic findings were retrospectively reviewed in 152 patients with colon cancer detected with barium enema examination during a 2-year period. RESULTS: Eighty-six patients (57%) had lesions in the rectum and sigmoid and descending colon, and 66 (43%) patients had lesions more proximally in the colon. Lesions on the right side of the colon were less likely to cause symptoms than those on the left side. Eighty-one patients (53%) had annular or semiannular lesions, 57 (38%) had polypoid lesions, and 14 (9%) had plaquelike or carpet lesions. Six patients (4%) had Dukes stage A lesions; 84 (55%), Dukes stage B lesions; 42 (28%), Dukes stage C lesions; and 20 (13%), Dukes stage D lesions. CONCLUSION: Annular or semiannular carcinomas had higher rates of serosal invasion and lymph node metastasis than polypoid carcinomas, but the rates of liver metastases were comparable.

Endoscopic localization of colon cancers.

In order to determine the accuracy of endoscopic localization of colon cancers, the endoscopic location was compared to the actual location at the time of operation in 320 patients who underwent resection of intraabdominal colon cancer between 1983 and 1988. The endoscopic location was correct in 86% of the cases. There were 44 endoscopic errors, including seven missed cancers. One-third of all endoscopic errors occurred when the tumor was in the cecum. We conclude that endoscopy is an accurate method of localizing colon cancers. However, with the advent of laparoscopic surgery and the loss of the ability to palpate the colon, the 14% of endoscopic errors take on a greater importance and additional means for localizing tumors should be pursued in selected cases.

Direct invasion of the transverse colon by a cecal tumor.

Direct invasion of the transverse colon is known to result from noncontiguous primary tumors spreading along ligamentous attachments or from direct extension of metastatic disease involving the greater omentum. The resultant desmoplastic reaction produces characteristic findings on barium enema. However, to our knowledge, these findings have not been reported to result from extension of a cecal tumor to the transverse colon via the pericolonic fat. We present such a case and discuss the radiographic findings.

Case report: renal excretion of gastrografin following rectal administration.

Renal excretion of water soluble iodinated contrast media following oral administration has often been described but no reports describing renal excretion following rectal administration of such contrast have previously been described. We describe a case of renal excretion of diatrizoate methylglucamine (Gastrografin, Schering) following a diagnostic 'gastrografin enema' in a woman with caecal carcinoma.

Complete appendicular inversion: the "inside-out" appendix. An unusual presentation of Crohn's disease. A case report and review of the literature.

Intussusception of the appendix into the caecum is an uncommon condition and the diagnosis is rarely made preoperatively. Specific anatomic requirements as well as pathological conditions that cause irritation or increased peristalsis should be present for this event to occur. A case is discussed in which the diagnosis was made preoperatively by barium enema and in which the lead point was a large inflammatory polyp due to Crohn's disease. It appeared in this case that inflation at the time of the barium enema resulted in reduction of the intussusception.

[A carcinoma of the cecum arising from the orifice of the appendix: a case report].

Reported is the case of a 50-year-old man who was admitted to hospital because of an abdominal pain. A barium enema revealed the shade of a distended, unfilled appendix that had reversed itself on the cecum and the ascending colon, the latter showing compression from the exterior. Further, a colonoscopic examination uncovered a flat, nodular tumor of the cecum that had elevated at the orifice of the vermiform appendix, and 67Ga scintigraphy indicated the uptake at the lower right abdomen. A resected specimen of the tumor showed proliferation in the cecal mucosa at the orifice of the appendix, causing an appendiceal abscess, and the histopathological findings revealed an adenocarcinoma of the cecal mucosa but no malignant transformation of the appendiceal mucosa.

Colorectal carcinoma detected initially with barium enema examination: site distribution and implications.

The authors analyzed the site distribution of 122 consecutive cases of colorectal carcinoma in which a barium enema examination was available for review. The carcinoma was detected initially with barium enema studies in 82 cases (67%), sigmoidoscopy in 18 (15%), colonoscopy in 12 (10%), digital rectal examination in seven (6%), and computed tomography in three (3%). Thirty (37%) of the 82 cases found initially at barium examination were located in the cecum and ascending colon, which is a considerably higher proportion than that reported in studies based on cancer registry data or in surgical series. Thirty-eight (95%) of the 40 carcinomas first detected with other techniques were located distal to the hepatic flexure; 18 of those were identified initially with sigmoidoscopy. Because many distal carcinomas were first detected with nonradiologic techniques, an unusually high percentage of carcinomas in the cecum and ascending colon were found initially with barium enema studies. These findings suggest that barium enema evaluation of the right side of the colon needs to be at least as detailed as that of the rectum and sigmoid colon, areas that are increasingly assessed with sigmoidoscopy before barium enema studies are performed.

[Radiological aspects of intestinal lipomas]. / Aspetti radiologici dei lipomi intestinali.

The radiological detection of intestinal lipomas is not unusual; however, in-depth studies of their radiological features have never been carried out, so far. Eighteen cases of intestinal lipoma were observed, out of different clinical histories. Through a careful survey of these cases, the authors describe the semiological characteristics of the lipomas, which were studied with radiographic contrast examinations of the small intestine and colon. In most cases the characteristics of the mass and--when present--the even more revealing features of its pedicle allowed the identification of such expansive lesions as lipomas. In some lesions detected by means of conventional methods CT proved extremely useful in diagnosing the nature of the lipomas. Such a diagnosis is extremely useful for it allows extensive surgery to be avoided and replaced with less extensive procedures--e.g. endoscopic removal of the lesion, or no specific treatment at all.

[Imaging of cecal tumors using computer tomography]. / Die Darstellung von Zökumtumoren in der Computertomographie.

Although contrast enema of the colon and endoscopy remain the preferential diagnostic methods in tumour of the caecum, computed tomography can accurately determine the extent of extraluminar tumour growth and hence help to arrive preoperatively at the appropriate therapeutic concept. Adenocarcinomas are morphologically distinctly different, due to focal thickenings of the colon wall, from the diffuse wall thickenings associated with malignant lymphomas, or from inflammatory conglomerate tumours. Computed tomography of the caecal region is a noninvasive examination method that can speed up diagnosis especially in elderly patients with elongated colon and stool incontinence.

Angiography in colonic carcinoma.

Angiography of the mesenteric arteries was performed in 17 patients with adenocarcinoma of the colon and rectum. At angiography, the marginal artery was encased in 13 patients and 10 of these were surgically unresectable while three could be resected radically. Encasement of the mesenteric arterial branches was found in seven of 11 unresectable tumors and in two of five resectable tumors. The resectability of colonic carcinoma cannot be established by means of angiography but in two patients with recurrent colonic carcinoma, barium-enema examinations were negative, while infiltrated vessels were demonstrated by angiography and the carcinomas were verified at surgery. Four patients received intra-arterial chemotherapy with mitomycin C. In one of these, a slight decrease in tumor size was noted, while in the others no change was noted.

Sensitivity of single and double contrast barium enema in the detection of colorectal carcinoma.

The preoperative barium enema of the 188 colorectal carcinoma patients operated at the Oulu University Central Hospital (Finland) during 1977-1982 were examined retrospectively. Altogether 112 single contrast studies and 87 double contrast studies had been made on these patients. The single contrast barium enemas had resulted in a correct diagnosis of colorectal carcinoma in 93 cases (sensitivity 83%). The correct diagnosis in the double contrast studies numbered 71 (sensitivity 82%). Most of the overlooked carcinomas were located in the caecum, in the sigmoid or the rectum. Most of the errors made in the single contrast studies were due to detection errors and poor evacuation. The most common failures in double contrast enemas were detection errors and nonvisualisation of the sigmoid. The authors recommend use of the double contrast technique and suggest that the two methods of barium enema be used to complement each other. A false negative diagnosis delayed the operation of the colorectal carcinoma patients by 2.2 months (median).