Right colon cancer presenting as hemorrhagic shock

Iwata, Takeo; Konishi, Kazuo; Yamazaki, Takahisa; Kitamura, Katsuya; Katagiri, Atsushi; Muramoto, Takashi; Kubota, Yutaro; Yano, Yuichiro; Kobayashi, Yasuna; Yamochi, Tadanori; Ohike, Nobuyuki; Murakami, Masahiko; Gokan, Takehiko; Yoshikawa, Nozomi; Imawari, Michio

doi:10.4291/wjgp.v2.i1.15

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…Cancer invaded the small intestine and the large blood vessels of the abdomen. The values of CEA and CA19-9 were negative, or they were in the reference range ( 4 ).…”

Section: Resultsmentioning

confidence: 99%

Sensitivity of Symptomatology Versus Diagnostic Procedures and Concentration of CEA and CA19-9 in the Early Detection of Colorectal Cancer

et al. 2014

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Introduction:Colorectal cancer is the major diagnostic and therapeutic problem. The number of patients in the world has increased recently. In our country it is detected late and patients visit doctor in the advanced stage of the disease with already developed metastases.Material and methods:A clinical study was conducted at the Clinic of gastroenterohepatologists, Clinical Center of Sarajevo University on 164 patients. Special attention was given to the symptoms, which are considered to be a macroscopically visible as bleeding, anemia pain, weight loss and disturbance of defecation. Smoking had no effect because a small number of observed patients smoked. Endoscopic examination revealed localization of the tumor in the colon and then underwent targeted biopsy, histological analysis by pathologist, and we determined the concentration of CEA and CA19-9 in the serum.Results:In order to get the most relevant results we used larger data set. The program used to prepare the data was Microsoft Excel 2013, and for the creation of decision trees is a used software RapidMiner version 5. Our research has shown that patients older than 55 years with significant stenosis, metastasis and diarrhea that lasted longer than 3.5 months and bleeding that lasted up to 10 months had cancer of the rectum. Bleeding that lasts longer than 10 months indicated that it was the case of cancer that was localized in the rectum in men and sigma in women. Patients older than 82.5 years and had diarrhea up to 3.5 months developed cancer in the sigma part of the colon. Analyzing pain as a symptom of an alarm, the study found that pain that lasts longer than a few days, is caused by rectal cancer, and occurs after the age of 70.5 years, and in patients younger than 63 years anemia as a alarm symptom, which lasted more than two months in men was caused by cancer of the rectum and in women cancer in other localizations within colon. In patients without stenosis developed bleeding as the most important symptom. We can say that after the age of 74 years cancer of the rectum and sigmoid is more common in men and in women dominate sigma and other locations in the colon. In patients under the 70 years of age with short time of bleeding, cancer predominates in rectum. In patients younger than 63 years can be concluded that weight loss is greater than 8 kg follows rectal cancer. In patients with bleeding that lasted one month or more as classifier occurring the age and gender. Patients younger than 74 years have rectal cancer, while older than 73 years have cancer at other sites. In women these locations are sigma and rectum.Conclusion:Based on this study we can conclude that regardless of the technical advances in medicine must pay special attention to the symptoms that doctors will refer to the localization of the tumor, stenosis of the intestine and possibly metastasis. Key words: Colorectal cancer, diagnostic procedures, concentration of CEA and CA19-9.

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“…Cancer invaded the small intestine and the large blood vessels of the abdomen. The values of CEA and CA19-9 were negative, or they were in the reference range ( 4 ).…”

Section: Resultsmentioning

confidence: 99%

Sensitivity of Symptomatology Versus Diagnostic Procedures and Concentration of CEA and CA19-9 in the Early Detection of Colorectal Cancer

et al. 2014

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“…La mortalidad global de la serie es del 3%, (incluye pacientes con tratamiento médico y tratamiento quirúrgico). Estas cifras se encuentran dentro de los parámetros aceptables referidos por diversos autores extranjeros aún cuando es muy superior a la comunicada por Zapa y col, realizadas en la II CCQx (14,15). La HDB se constituye en una situación de frecuencia no despreciable, por lo tanto se torna prioritario que aquellos profesionales de la salud que se desempeñan en la urgencia en Atención Primaria de la Salud, zona central e interior de nuestro país, poder estar capacitados para reconocer los signos y síntomas de esta situación y sobre todo detectar en aquellos pacientes a los cuales llevarles a cirugía de urgencia.…”

Section: Discussionunclassified

“…La fisiopatología, en la formación de los divertículos colónicos intervienen: 1.-Alteraciones de la motilidad cólica, 2.-Anomalía de la pared muscular del colon, 3.-Efecto de la carencia en fibras alimentarias, 4.-Otro de los factores que se citan es el estreñimiento (11,12). Los procesos diverticulares del colon pueden clasificarse en divertículos colónicos congénitos y adquiridos (13)(14)(15).…”

Section: Introductionunclassified

Lower gastrointestinal hemorrhage: emergency room management

Alderete¹

2016

An. Fac. Cienc. Méd. (Asunción)

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RESUMEN INTRODUCCIÓN:La Hemorragia Digestiva Baja (HDB) tiende a ser autolimitante: en un 80% -85% de los casos cesa en forma espontánea. Predomina en el varón, su mortalidad es del 5 al 10% aproximadamente. El objetivo general de este trabajo fue el de describir el manejo de la HDB en la 1ª C.C.Q-SALA X del Hospital de Clínicas desde Enero de 1997 hasta Enero de 2010. SUJETOS Y MÉTODOS: Estudio observacional, descriptivo, temporalmente retrospectivo, con componente analítico, de corte transverso. Se incluyeron pacientes con HDB que consultaron en la urgencia de la 1ª C.C.Q., Sala X del Hospital de Clínicas. Muestreo no probabilístico de casos consecutivos. Las variables fueron edad y sexo, motivo de consulta, nivel de hemoglobina, diagnóstico de ingreso, signos y síntomas, manejo inicial, medios auxiliares de diagnóstico, tratamiento instituido, anatomía patológica, complicaciones del procedimiento, mortalidad. RESULTADOS: El estudio incluyo 124 pacientes con HDB, de los cuales 63% eran mujeres y 37% varones. La mayor frecuencia (39%) se dio entre 50 y 59 años. El 95% de los pacientes consultó por rectorragia y 5% por melena. Síntomas acompañantes, 21% de los pacientes presentaron dolor en fosa iliaca izquierda, 12% tuvo palidez, y 8% distensión abdominal. Nivel de hemoglobina al ingreso entre 6 a 13 mg% (media = 9,8). Al ingreso, el tacto rectal permitió comprobar sangre en todos los pacientes. En todos se realizó análisis de laboratorio, a 44 pacientes se les realizcó radiografía de colon por enema opaca, en 6 pacientes se realizó rectosigmoidoscopia y ambos procedimientos en 5. A 69 pacientes no se les practicó ningún medio auxiliar de diagnóstico.Los 124 pacientes que fueron internados en la 1ª C.C.Q. Sala X del Hospital de Clínicas todos recibieron tratamiento médico, 26% pacientes requirieron tratamiento quirúrgico de urgencia por hemorragia persistente (n=31) o masiva (n=22). Las intervenciones efectuadas en la urgencia fueron: colectomía subtotal con ileostomía, con anastomosis termino terminal en 42% pacientes, colectomía izquierda con colostomía y cierre del muñón distal en 34%, colectomía derecha con ileostomía y fístula mucosa en 13% y operación de Hartmann en 11%. DISCUSIÓN: 1.-Las causas de la Hemorragia Digestiva Baja (HDB), en los pacientes que consultaron en la urgencia de la 1ª C.C.Q. Sala X del Hospital de Clínicas, durante el periodo comprendido entre Enero de 1997 hasta Enero de 2010 fueron: Enfermedad Diverticular del Colon 62% de los casos, el 38% de Burgos Alderete J.  Hemorragia Digestiva Baja Manejo en la urgencia An. Fac. Cienc. Méd. (Asunción) / Vol. 48 -Nº 1, 2015 14 los pacientes pasaron a consultorio externo para su estudio correspondiente. 2.-Los métodos auxiliares de diagnóstico utilizados durante la internación por urgencia fueron el tacto rectal, rectosigmoidoscopia y colon por enema opaco. No se pudo realizar estudios endoscópicos y tampoco angiográficos. 3.-Todos los pacientes recibieron tratamiento médico, resultando satisfactorio en 70 pacientes. Se realizó cirugía de ...

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“…Patients are mostly aged, with frequent co-morbidities and sometimes malnutrition. Emergency surgery for symptomatic colon cancer is usually performed with the traditional open technique, as the most common clinical scenarios (perforation, occlusion, massive bleeding) [ 11 ] do not allow for proper preparation for minimally invasive techniques. However, minimally invasive emergency colectomy performed by laparoscopy has already been described.…”

Section: Introductionmentioning

confidence: 99%

Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy

et al. 2014

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Right colon cancer rarely presents as an emergency, in which bowel occlusion and massive bleeding are the most common clinical presentations. Although there are no definite guidelines, the first line treatment for massive right colon cancer bleeding should ideally stop the bleeding using endoscopy or interventional radiology, subsequently allowing proper tumor staging and planning of a definite treatment strategy. Minimally invasive approaches for right and left colectomy have progressively increased and are widely performed in elective settings, with laparoscopy chosen in the majority of cases. Conversely, in emergent and urgent surgeries, minimally invasive techniques are rarely performed. We report a case of an 86-year-old woman who was successfully treated for massive rectal bleeding in an urgent setting by robotic surgery (da Vinci Intuitive Surgical System®). At admission, the patient had severe anemia (Hb 6 g/dL) and hemodynamic stability. A computer tomography scanner with contrast enhancement showed a right colon cancer with active bleeding; no distant metastases were found. A colonoscopy did not show any other bowel lesion, while a constant bleeding from the right pre-stenotic colon mass was temporarily arrested by endoscopic argon coagulation. A robotic right colectomy in urgent setting (within 24 hours from admission) was indicated. A three-armed robot was used with docking in the right side of the patient and a fourth trocar for the assistant surgeon. Because of the patient’s poor nutritional status, a double-barreled ileocolostomy was performed. The post-operative period was uneventful. As the neoplasia was a pT3N0 adenocarcinoma, surveillance was decided after a multidisciplinary meeting, and restoration of the intestinal continuity was performed 3 months later, once good nutritional status was achieved. In addition, we reviewed the current literature on minimally invasive colectomy performed for colon carcinoma in emergent or urgent setting. No study on robotic approach was found. Seven studies evaluating the role of laparoscopic colectomy concluded that this technique is a safe and feasible option associated with lower blood loss and shorter hospital stay. It may require longer operative time, but morbidity and mortality rates appeared comparable to open colectomy. However, the surgeon’s experience and the right selection of candidate patients cannot be understated.

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Right colon cancer presenting as hemorrhagic shock

Cited by 5 publications

References 10 publications

Sensitivity of Symptomatology Versus Diagnostic Procedures and Concentration of CEA and CA19-9 in the Early Detection of Colorectal Cancer

Sensitivity of Symptomatology Versus Diagnostic Procedures and Concentration of CEA and CA19-9 in the Early Detection of Colorectal Cancer

Lower gastrointestinal hemorrhage: emergency room management

Robotic right colectomy for hemorrhagic right colon cancer: a case report and review of the literature of minimally invasive urgent colectomy

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