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For 6 months the patient had noted an increase in the frequency of bowel function. For this reason the patient took part in a community bowel screening program (Hemoccult II) for bowel cancer. The stools were positive for occult blood. Colonoscopy revealed a “convoluted bowel“. In “the mid ascending colon” there was a 1.5cm ulcerated lesion, which on biopsy revealed moderately differentiated adenocarcinoma. A computerized tomography (CT) scan showed a mass related to the right colon, extending posteriorly into the psoas muscle (Figure 11.1). No metastatic disease was detected in the liver. The patient was referred for surgical treatment.

A barium enema was performed in this patient to investigate the recent onset of constipation, abdominal distention, and weight loss. The x-ray demonstrated a large irregularity of the sigmoid colon and no other colonic pathology (Figure 12.1). On referral, examination of the abdomen revealed a large asymptomatic distention of the urinary bladder wall above the umbilicus. Flexible sigmoidoscopy revealed a large soft polypoid tumor at 22cm. Urological investigations indicated the need for prostatectomy, which was performed prior to the colorectal surgery.

The patient complained of diarrhea for 10 years. Sigmoidoscopy revealed an extensive flat polyp with polypoid areas which extended from the anal canal to the lower sigmoid colon, reaching a level of 20cm. There were no obvious features of malignancy. A barium enema showed diverticulosis proximal to the lesion.

The patient presented with a 3-year history of rectal bleeding and “explosive” diarrhea. Flexible sigmoidoscopy revealed a large polyp at 22cm and 4 small polyps at lower levels. Colonoscopy identified 4 small polyps between the large lesion and the splenic flexure.

The patient complained of diarrhea and mucous discharge for 13 years. There had been intermittent rectal bleeding. Prolapse of the rectum had been noted for a period of 12 months. There had been recent weight loss and general weakness. On digital rectal examination, a soft polyp encircling the rectum was easily palpable at the 7cm level. Complete rectal prolapse was present on straining. There was laxity of the anal sphincter. Sigmoidoscopy revealed an extensive rectal polyp with a combination of flat and polypoid contours. The upper limit of the polyp was 20cm from the anal verge. There were no macroscopic features to suggest malignancy. There were abnormalities of biochemistry on blood examination: Na, 125mmol/L (N-134–143); K, 3.8mmol/L (N-3.5–5.0); Urea, 28.9mmol/L (N-2.0–7.0); and creatinine, 0.21mmol/L (N-0.05–0.11).

The male patient aged 13 years had noticed rectal bleeding for 15 months. A prolapsed rectal polyp had been observed. A barium enema showed no evidence of other polyps.

In 1981, approximately 40 polyps were identified in the colon and rectum by colonoscopy. At least 30 of the polyps were situated in the right colon. Initially 6 excised polyps were thought to be the Peutz Jegher variety, but subsequently the diagnosis of juvenile polyposis (JP) was established.

The patient, who suffered from morbid obesity, and denying any bowel symptoms presented with a 7- week history of a fecal vaginal discharge. There was no family history of bowel cancer. Examination revealed a large fixed carcinoma of the rectum with a lower edge at 5cm. There was a small malignant ulcer on the posterior wall of the vagina, discharging flatus and fecal liquid. The narrow lumen of the tumor prevented endoscopic examination beyond the lower edge. A barium enema was contraindicated due to the possibility of initiating bowel obstruction. Biopsy showed a well differentiated adenocarcinoma. Computerized tomography (CT) examination showed perirectal extension of the tumor with adherence to the uterus and vagina. There was no pelvic lymphadenopathy or evidence of extra pelvic metastases. The patient was treated with a 5-week course of radiotherapy (40Gy), and after 4 weeks CT examination showed “an overall reduction in size” of the tumor.

In July 1970 the patient underwent colectomy and ileorectal anastomosis for the treatment of familial adenomatous polyposis (FAP). At follow up, villous adenomata had been removed by diathermy snare on 10 occasions. The surgeon supervising the follow up referred her in 1994 for a restorative proctocolectomy, since he was concerned about future malignant change in the rectum. Flexible sigmoidoscopy identified the ileorectal anastomosis (IRA) at 20cm and multiple flat polyps in the rectum. No obvious carcinoma was identified on endoscopy or digital examination. Operation was advised to anticipate the onset of carcinoma.

In July 1970 the patient underwent colectomy and ileorectal anastomosis for the treatment of familial adenomatous polyposis (FAP). At follow up, villous adenomata had been removed by diathermy snare on 10 occasions. The surgeon supervising the follow up referred her in 1994 for a restorative proctocolectomy, since he was concerned about future malignant change in the rectum. Flexible sigmoidoscopy identified the ileorectal anastomosis (IRA) at 20cm and multiple flat polyps in the rectum. No obvious carcinoma was identified on endoscopy or digital examination. Operation was advised to anticipate the onset of carcinoma.