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Delayed Colon Perforation after Palliative Treatment for Rectal Carcinoma with Bare Rectal Stent: A Case Report

  • Young Min Han;Jeong-Min Lee;Tae-Hoon Lee
    • Korean Journal of Radiology
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    • v.1 no.3
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    • pp.169-171
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    • 2000
  • In order to relieve mechanical obstruction caused by rectal carcinoma, a bare rectal stent was inserted in the sigmoid colon of a 70-year-old female. The procedure was successful, and for one month the patient made good progress. She then complained of abdominal pain, however, and plain radiographs of the chest and abdomen revealed the presence of free gas in the subdiaphragmatic area. Surgical findings showed that a spur at the proximal end of the bare rectal stent had penetrated the rectal mucosal wall. After placing a bare rectal stent for the palliative treatment of colorectal carcinoma, close follow-up to detect possible perforation of the bowel wall is necessary.

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Prediction of Late Rectal Complication Following High-dose-rate Intracavitary Brachytherapy in Cancer of the Uterine Cervix (자궁경부암 환자의 고선량률 강내치료 시행 시 직장합병증의 예측)

  • Lee, Jeung-Eun;Huh, Seung-Jae;Park, Won;Lim, Do-Hoon;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.21 no.4
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    • pp.276-282
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    • 2003
  • Purpose: Although high-dose-rate intracavitary radiotherapy (HDR ICR) has been used in the treatment of cervical cancer, the potential for increased risk of late complication, most commonly in the rectum, is a major concern. We have previously reported on 136 patients treated with HDR brachytherapy between 1995 and 1999. The purpose of this study is to upgrade the previous data and confirm the correlation between late rectal complication and rectal dose in cervix cancer patients treated with HDR ICR. Materials and Methods: A retrospective analysis was peformed for 222 patients with cevix cancer who were treated for curative intent with external beam radiotherapy (EBRT) and HDR ICR from July 1995 to December 2001. The median dose of EBRT was 50.4 (30.6$\~$56.4) Gy with a daily fraction size 1.8 Gy. A total of six fractions of HDR ICR were given twice weekly with fraction size of 4 (3$\~$5.5) Gy to A point by Iridium-192 source. The rectal dose was calculated at the rectal reference point using the barium contrast criteria. in vivo measurement of the rectal dose was peformed with thermoluminescent dosimeter (TLD) during HDR ICR. The median follow-up period was 39 months, ranging from 6 to 90 months. Results: Twenty-one patients (9.5$\%$) experienced late rectal bleeding, from 3 to 44 months (median, 13 months) after the completion of RT. The calculated rectal doses were not different between the patients with rectal bleeding and those without, but the measured rectal doses were higher in the complicated patients. The differences of the measured ICR rectal fractional dose, ICR total rectal dose, and total rectal biologically equivalent dose (BED) were statistically significant. When the measured ICR total rectal dose was beyond 16 Gy, when the ratio of the measured rectal dose to A point dose was beyond 70$\%$, or when the measured rectal BED was over 110 Gy$_{3}$, a high possibility of late rectal complication was found. Conclusion: Late rectal complication was closely correlated with measured rectal dose by in vivo dosimetry using TLD during HDR ICR. If data from in vivo dosimetry shows any possibility of rectal bleeding, efforts should be made to reduce the rectal dose.

Rectal Injury Associated with Pelvic Fracture

  • Gwak, Jihun;Lee, Min A;Yu, Byungchul;Choi, Kang Kook
    • Journal of Trauma and Injury
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    • v.29 no.4
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    • pp.201-203
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    • 2016
  • Rectal injury is seen in 1-2% of all pelvic fractures, and lower urinary tract injury occurs in up to 7%. These injuries are rare, but if missed, can lead to a severe septic response. Rectal injury may be suspected by the presence of gross blood on digital rectal examination. However, this classic sign is not always present on physical examination. If an Antero-Posterior Compression type pelvic fracture is seen, we should consider the possibility of rectal and lower urinary tract injury. It is important to define the anatomic location of the rectal injury as it relates to the peritoneal reflection. Trauma to the intraperitoneal rectum should be managed as a colonic injury. Extraperitoneal rectal injury should be managed with fecal diversion regardless of primary repair. We present the case of a 46-year-old man who was referred to our hospital following a major trauma to the pelvis in a pedestrian accident.

Evaluation of Stapled versus Hand-Sewn Techniques for Colo-Rectal Anastomosis after Low Anterior Resection of Mid-Rectal Carcinoma: a Study on 50 Patients

  • Fayek, Ihab Samy
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.13
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    • pp.5427-5431
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    • 2014
  • Aim: To evaluate the outcome of stapled versus sutured colo-rectal anastomosis after low anterior resection of mid-rectal carcinoma. Patients and Methods: A prospective study of fifty patients who underwent colo-rectal anastomosis following low anterior resection (LAR) of T2 mid-rectal cancers at the Egyptian National Cancer Institute during the time period from June 2010 to June 2013 was conducted. Classification was into two groups; a stapled anastomosis group I (25 patients) and a hand-sewn anastomosis group II (25 patients). All operations are evaluated regarding intra-operative complications such as anastomotic line bleeding, visceral injuries or major blood loss. The anastomotic time and operative time are documented for each operation. All patients are evaluated post-operatively for anastomotic leakage (AL), wound infection and ileus. Results: The distance of the tumor from the anal verge was $9.6{\pm}2.0cm$ in group I and $9.9{pm}2.4cm$ in group II. The mean operative time was $191.5{\pm}16.2min$ in the stapled group and $208{\pm}18.6min$ in the sutured group (p=0.002). The mean anastomotic times were $9.0{\pm}1.9min$ and $19.7{pm}12.2min$ (p=0.001). Anastomotic leakage developed in three (12.0%) patients in the stapled group and in four (16.0%) patients in the sutured group (p=1.000). Post-operative ileus was observed in 3 patients in group I and one patient in group II. Wound infection developed in three (12.0%) patients in the stapled group and four (16.0%) patients in the sutured group (p=1.000). Conclusion: Colo-rectal anastomosis after low anterior resection for mid rectal carcinoma can be conducted safely either by stapling or hand-sewn techniques; however the stapling technique showed shorter anastomotic and operative times with no significant advantages regarding intra- or post-operative complications or hospital stay.

Use of ultrasonography for improving reproductive efficiency in cows I. Accuracy of rectal palpation and ultrasonography for determining the presence of a functional corpus luteum in subestrous daitry cows (초음파 진단장치를 이용한 축우의 번식효율증진에 관한 연구 I. 무발정 젖소에서 기능성황체를 평가하기 위한 직장검사와 초음파검사의 진단정확성)

  • Son, Chang-ho;Kang, Byong-kyu;Choi, Han-sun;Kang, Hyun-gu;Oh, Ki-seok;Shin, Chang-rok
    • Korean Journal of Veterinary Research
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    • v.36 no.4
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    • pp.941-948
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    • 1996
  • The accuracy of rectal palpation and ultrasonography for predicting the presence of a functional corpus luteum in subestrous dairy cows was investigated, using the result of a radioimmunoassay for progesterone in plasma. Luteal status (high or low progesterone concentrations) was diagnosed in 820 cows, using rectal palpation and B-mode transrectal ultrasonography, and the results of rectal palpation and ultrasonography were compared in $2{\times}2$ contingency table with plasma progesterone concentrations. A $2{\times}2$ contingency table analysis allowed the calculation of sensitivity, specificity and predictive values for rectal palpation and ultrasonography. The sensitivity, specificity, predictive value of a positive test and predictive value of a negative test were 81.9%, 67.5%, 79.0% and 71.4% for rectal palpation, and 96.3%, 88.8%, 94.5% and 92.4% for ultrasonography, respectively. The percentages of observed agreement and expected agreement between rectal palpation and ultrasonography were 71.8% and 57.1%, respectively. An evaluation of agreement between rectal palpation and ultrasonography, the value of Kappa was 0.34. It was concluded that a ultrasonography was more sensitive and specific than rectal palpation in predicting the presence of a functional corpus luteum. Therefore, ultrasonographic examination is a reliable method for assessing the functional status of ovarian structures in subestrous dairy cows.

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Late Rectal Complication in Patients treated with High Dose Rate Brachytherapy for Stage IIB Carcinoma of the Cervix (FIGO병기 IIB 자궁경부암에서 고선량 강내 방사선치료후의 후기 직장 합병증)

  • Chung, Eun-Ji;Kim, Gwi-Eon;Suh, Chang-Ok;Keum, Ki-Chang;Kim, Woo-Cheol
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.41-52
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    • 1996
  • Purpose : This paper reports a dosimetric study of 88 patients treated with a combination of external radiotherapy and high dose rate ICR for FIGO stage IIB carcinoma of the cervix. The purpose is to investigate the correlation between the radiation doses to the rectum, external radiation dose to the whole pelvis, ICR reference volume, TDF BED and the incidence of late rectal complications, retrospectively. Materials and Methods : From November 1989 through December 1992, 88 patients with stage IIB cervical carcinoma received radical radiotherapy at Department of Radiation Oncology in Yonsei University Hospital. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam irradiation plus high dose rate intracavitary brachytherapy with 5 Gy per fraction twice a week to a total dose of 30 Gy on point A. The maximum dose to the rectum by contrast(r, R) and reference rectal dose by ICRU 38(dr, DR) were calculated. The ICR reference volume was calculated by Gamma Dot 3.11 HDR planning system, retrospectively The time-dose factor(TDF) and the biologically effective dose (BED) were calculated. Results : Twenty seven($30.7\%$) of the 88 patients developed late rectal complications:12 patients($13.6\%$) for grade 1, 12 patients($13.6\%$) for grade 2 and 3 patients($3.4\%$) for grade 3. We found a significant correlation between the external whole pelvis irradiation dose and grade 2, 3 rectal complication. The mean dose to the whole pelvis for the group of patients with grade 2, 3 complication was Higher, $4093.3\pm453.1$ cGy, than that for the patients without complication, $3873.8\pm415.6$ (0.05$7163.0\pm838.5$ cGy, than that for the Patients without rectal complication, $0772.7\pm884.0$ (p<0.05). There was no correlation of the rate of grade 2, 3 rectal complication with the iCR rectal doses(r, dr), ICR reference volume, TDF and BED. Conclusion : This investigation has revealed a significant correlation between the dose calculated at the rectal dose by ICRU 38(DR) or the most anterior rectal dose by contrast(R) dose to the whole pelvis and the incidence of grade 2, 3 late rectal complications in patients with stage IIB cervical cancer undergoing external beam radiotherapy and HOR ICR. Thus these rectal reference points doses and whole pelvis dose appear to be useful Prognostic indicators of late rectal complication in high dose rate ICR treatment in cervical carcinoma.

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Application of Modified Mupit for the Recurrent Vulva Cancer in Brachytherapy

  • Kim, Jong-Sik;Jung, Chun-Young;Oh, Dong-Gyoon;Song, Ki-Won;Park, Young-Hwan
    • 대한방사선치료학회:학술대회논문집
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    • 2005.06a
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    • pp.23-26
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    • 2005
  • Introduction: To evaluate whether modified MUPIT applicator can effectively eradicate recurrent tumor in uterine cervix cancer and reduce rectal complication after complete radiation treatment. Methods and Materials: Modified MUPIT applicator basically consists of an acrylic cylinder with flexible brain applicator , an acrylic template with a predrilled array of holes that serve as guides for interstitial needles and interstitial needles. CT scan was performed to determine tumor volume and the position of interstitial needles. Modified MUPIT applicator was applied to patient in operation room and the accuracy for position of interstitial needles in tumor volume was confirmed by CTscan. Brachytherapy was delivered using modified MUPIT applicator and RALS (192-Ir HDR) after calculated computer planning by orthogonal film. The daily dose was 600cGy and the total dose was delivered 3000cGy in tumor volume by BID. Rectal dose was measured by TLD at 5 points so that evaluated the risk of rectal complication. Result: The application of modified MUPIT applicator improved dramatically dose distributions in tumor volume and follow-up of 3 month for this patient was clinically partial response without normal tissue complication, Rectal dose was measured 34.1cGy, 57.1cGy, 103.8cGy, 162.7cGy, 165.7cGy at each points, especially the rectal dose including previous EBRT and ICR was 34.1cGy, 57.1cGy Conclusion: Patients with locally recurrent tumor in uterine cervix cancer treated with modified MIUPIT applicator can expect reasonable rates of local control. The advantages of the system are the fixed geometry Provided by the template and cylinders, and improved dose distributions in irregular tumor volume without rectal complication

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Damage of Omeprazole Suppository on Rectal Mucosa of Rats (오메프라졸 좌제의 흰쥐 직장점막 국소 자극성)

  • Kim, Hyun-Ji;Han, Yong-Hae;Shim, Chang-Koo
    • Journal of Pharmaceutical Investigation
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    • v.23 no.3
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    • pp.127-132
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    • 1993
  • The effect of omeprazole (OPZ) suppository on rat rectal mucosa was investigated microscopically. The suppository was prepared with Witepsol H15 base by molding method. Rectal irritation was evaluated according to defined pathological features. The suppository produced a slight damage to the rectal mucosa at 1 hr after the interectal administration, which was almost completely recovered within 24 hr. The damage was not due to OPZ but due to suppository base, Witepsol H15, itself, since Witepsol H15 suppository without OPZ produced the same damage. Therefore, it was concluded that OPZ itself has no rectal mucosa-irritating effect and thus can be developed as a suppository dosage form without any further toxicity problems.

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The Analysis of Clinical Report about Rectal Injection Therapy on Chronic Prostatitis (만성전립선염(慢性前立腺炎)의 관장요법(灌腸療法)에 대한 고찰(考察))

  • Lee, Gu-Hyun;Cho, Chung-Sik;Kim, Chul-Jung
    • Journal of Haehwa Medicine
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    • v.14 no.2
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    • pp.137-142
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    • 2005
  • Objective : This study was designed to report the clinical effect of Rectal Injection therapy on chronic prostatitis. Methods : We analyzed 20 manuscripts contributed to the Chinese medical journals from 1999 to 2003 that presenting report of Rectal Injection therapy on chronic prostatitis. Results : The results are summarized as follows 1. Operation of rectal injection therapy was treated 2~3 times and one course take time 5~30 days. 2. During therapy, average amount of fluid is 100~150 ml and it takes 1~2 hours. 3. Using medication was 'chung-yol' medicine, 'hwal-hyul-gu-er' medicine, 'bo-yik' medicine, 'lee-soo-sam-sup' medicine. Conclusion : We conclusion that Rectal Injection therapy was clinical effect on chronic prostatitis.

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A Case of Dyspnea due to Endobronchial Metastasis from Rectal Cancer (주기관지내 전이에 의해 호흡곤란을 일으킨 직장암 1예)

  • 이정익;신성준;손장원;양석철;윤호주;신동호;박성수;장세진
    • Korean Journal of Bronchoesophagology
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    • v.6 no.2
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    • pp.204-208
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    • 2000
  • Endobronchial metastases from extrathoracic primary malignancies are uncommon. Breast, renal, and colonic carcinomas are primary sites most likely to give rise to endobronchial metastases. A number of other tumours have been reported as being complicated by endobronchial metastasis, including ovarian, thyroid, uterine, adrenal, testicular and prostatic carcinomas. The incidence of endobronchial metastasis has been estimated at 2% in patients who died of metastatic disease. Lung parenchymal metastases are common manifestations in patients with rectal cancer, however spread to the major airway is extremely rare. We herein report a case of endobronchial metastasis from rectal adenocarcinoma. A 69-year-old male patient who had been previously treated with surgical resection with rectal cancer presented with a 8-month history of gradually increasing dyspnea and non-productive cough. Clinical and radiological investigations revealed endobronchial metastasis involving, and penetrating, the lower carina and the left main bronchus. We confirmed endobronchial metastasis from the rectal carcinoma by bronchoscopic biopsy.

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