Colonic carcinoma after ureterosigmoidostomy

Abstract

A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension. (Postgrad Med J 2000;76:576-577) Keywords: portal hypertension; lingual; tongue; varicose vein Case reportAn 82 year old women with known portal hypertension secondary to cirrhosis of the liver was referred to the otolaryngology outpatient department with a two month history of daily haemoptysis and bloodstained pharyngeal secretions; this occurred mostly on early morning coughing. There was no history of weight loss, dysphagia, dysphonia, or throat pain. She had already been investigated for a pulmonary cause of the haemoptysis and none was found. In keeping with her history, liver function tests and the prothrombin time were abnormal. She also had a history of well controlled essential hypertension. Chest radiography showed cardiomegaly, but the jugular venous pressure was not raised and there was no other clinical manifestation of heart failure.Indirect laryngoscopy revealed varicose vessels in the tongue base, mainly on the left side (see fig 1). These appeared friable and one area revealed a propensity to bleed on examination. The rest of the ear, nose, and throat examination was normal.After perioperative cover with fresh frozen plasma, vitamin K, and tranexamic acid she underwent ablation of the varicosities using a 15 watt continuous carbon dioxide laser under general anaesthesia (see fig 2). She had an uneventful recovery and has remained symptom free. AnatomyThe dorsal lingual veins drain the tongue base through two or more tributaries. These course inferiorly, join together and form the lingual vein, which accompanies the lingual artery. These vessels pass between genioglossus and hyoglossus and the vein empties into the internal jugular vein just above the level of the greater cornu of the hyoid bone. (2) Periumbilical veins-veins contained in the falciform ligament anastomose with superior and inferior epigastric veins of the anterior abdominal wall. Excessive dilatation of these veins are evident as caput medusa.(3) Haemorrhoids-the superior rectal vein anastomoses with the middle rectal vein which drains into the internal iliac vein. In addition the middle rectal veins anastomose with the inferior rectal veins which drain into the internal pudendal vein. Increased shunting results in internal and external haemorrhoids. Thus, there is no recognised anastomosis between lingual venous drainage and the portal circulation. DiscussionA varicosity is a condition indicating an enlarged and tortuous vein. Previously described lingual varices referred to sublingual varices on the ventral surface of the tongue or floor of mouth. These were ascribed to the use of dentures, and vitamin C deficiency in an elderly population. 3Burket associated the occurrence of lingual varices with cardiorespiratory disease,...

An Initial Evaluation of Pelvic Floor Function and Quality of Life of Bladder Exstrophy Patients After Ureterosigmoidostomy

“…5 The incidence of carcinoma after ureterosigmoidostomy may reach as high as 24% in long-term follow-up studies. 6 The incidence increases over time, with the mean time of cancer formation at 17.2 years after ureterosigmoidostomy; therefore, annual surveillance with flexible sigmoidoscopy to just beyond the ureteral anastomoses is recommended. Lesions at the anastomosis should be biopsied.…”

“…Routine biopsies are not recommended. 6 It is well known that significant musculoskeletal defects exist in patients with bladder exstrophy. 7,8 However, the effect of these defects on pelvic floor function, including prolapse and fecal continence, is not known.…”

Rare gastrointestinal stromal tumor in an ileal conduit detected by recurrent massive bleeding from the stoma

“…N‐nitrosamine has been suggested to initiate the multistage process of neoplastic transformation by causing irreversible changes in DNA structure 7 . Other possible mechanisms, such as surgical and mechanical trauma, an excess concentration of electrolytes, and exposure to free radicals, are recognized 8 …”

Rectal adenocarcinoma in an adult with imperforate anus at birth

“…Several theories have been proposed to explain this carcinogenesis in colon but the most favoured one is the increased formation of N-nitroso compounds in colon by bacterial flora from urinary nitrates 4. The latency between ureterosigmoidostomy and development of colorectal cancer is 6–50 years with mean time of 21 years 5. But cases of colon cancer have been reported even after exposure of colonic mucosa to urine for as little as 8 months probably because the initial exposure of the colonic mucosa to the urine is enough to start the chain of events leading to development of tumours 6…”