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Linitis plastica carcinoma of the large intestine is very uncommon, especially it has extensive metastasis including peritoneal dissemination. This paper describes a juvenile case of linitis plastica carcinoma of the sigmoid colon presenting a stenosis at the colon and peritoneal dissemination with massive ascites, in which chemotherapy followed by palliative sigmoidectomy has provided a lifeprolonging effect over a year as well as a good quality of life. A 25-year-old man was admitted to the hospital with a several months history of melena and abdominal fullness. Barium enema showed diffuse stenosis 9cm in length in the sigmoid colon. Ultrasonography and CT revealed massive ascites, thickened omentum, and multiple nodules floating in the fluid. Cytology of the ascites demonstraled that it resulted from peritoneal dissemination of mucinous carcinoma. Following chemotherapy with intravenous injection of CDDP, 5FU, and leucovorin, palliative sigmoidectomy was carried out. Postoperative course was uneventfal. He has been enjoying a satisfactory quality of life for one year after the first admission and for eight months after the operation.

A 63-year-old man was admitted to the hospital because of bloody stool and abdominal fullness. The tuberculin reaction was surely positive, but bacteriological examination of the feces resulted in negative. A chest X-ray film showed a characteristic shadow in the left upper lobe. Radiological examination of the sigmoid colon revealed diminishing of haustra, narrowing and shortening of the colon, but there was no ulcerative lesion. Moreover, elevated lesion was found in the descending colon. An inflammatory disease of the colon was strongly suspected, but the differential diagnosis for malignancy was difficult. Therefore, sigmoidectomy with dissection of regional lymph node was performed. The histologic examination showed the specific inflammatory change of tuberculitis in the bottom of diverticulum. We report a very rare case suggested tuberculous colitis, in the view of the tuberculous colitis associated with diverticulum, and of the mechanism of the onset intuberculous colitis. No such case has been seen in the Japanese literature so far.

A 54-year-old woman with cancer of the sigmoid colon with multiple metastasis underwent a sigmoidectomy, and postoperatively received o-leucovorin 250mg/m2 and 600mg/m2 combinedly once a week for the multiple liver metastasis. After 2 courses of the combinated treatment, the blood levels of carcinomebryonic antigen (CEA) decresed markedly from 1400ng/ml to 39ng/ml, and the multiple liver metastasis almost disappeared on computed tomography (CT). After that chemotherapy was suspended, but the patient had a relapse 5 months later. The blood levels of CEA incresed to 890ng/mg, multiple liver metastasis was detected by CT again. With additional 4 courses of the combined treatment, the blood levels of CEA decreased and the effect of tumor reduction was judged “Partial Response” once more by CT. Side effects due to the treatment increased dermatitis, nausea, anorexia and leucopnea, but which did not demand hospitalization for management. She received all 6 courses, on our ambulant basis. These findings suggest that 1-LV/5-FU combined chemotherapy may become an effective and useful modality in the treatment of multiple liver metastasis of colonic cancer.

A 33-year-old pregnant woman had constipation, abdominal pain and fullness since the 7th week of pregnancy, but she was diagnosed as hyperemesis gravidarum. After her delivery on the 34th week of pregnancy, she was seen at the hospital because of persisting symptoms. Abdominal swelling, hepatomegaly and ascites were noted. As a result of various examination, ileus due to a sigmoid colon-cancer was diagnosed, and sigmoidectomy was performed after 10 days of delivery. Opertive diagnosis was sigmoid colon cancer, which was circ, 3-type, 3.0×3.0cm size, SE, P0, H3, M(-), N2(+), Stage 4. Histological diagnosis was well-differentiated adenocarcinoma. Postoperative chemotherapy was done to the metastasis of the liver with reservoir, but she died of liver failure 3 months after of the surgery. Colorectal cancer in pregnancy is rare. Only 28 cases have been reported in the Japanese literature, and generally their prognoses were poor. Even if the patient with suspected colorectal cancer is a pregnant woman, appropriate examination including occult blood and ultrasonography which have no effects on the fatus sould be aggressively tried.

A very rare case of glomus tumor of the colon presenting with forsion of the sigmoid colon is reported. An 82-year-old woman was admitted to the hospital because of abdominal distension and abdominal pain. There was a previous history of undergoing an operation for a mesenteric mesothelioma 7 years before. The patient underwent sigmoidectomy for torsion of the sigmoid colon and a tumorous lesion was found at the neck of the torsion. Pathological findings of the lesion revealed glomus tumor without malignancy arising from the proper muscle layer, serosa and mesenterium of the colon. Clomus tumors are painful and occur mostly in the extremities, particularly in the subungal region. These tumors can occasionally occur in the gastrointestinal tract, wherein the stomach is the most frequent site of occurrence. According to our knowledge, only one case of glomus tumor of the colon has been reported by Baura in 1988.

A 61-year-old woman was admitted to the hospital because of a tumor in the left upper abdomen. A gastrointestinal series revealed an extragastric type of leiomyosarcoma of the stomach with central necrosis. Partial gastrectomy without lymph node dissection was perfomed on June 16, 1986. The resected encapselated tumor with central necrosis, 26×23×6cm in size and 1, 570g in weight, was histologically diagnosed as leiomyosarcoma. During six years and six months after the initial operation, four operations were carried out for intraperitoneal recurrent tumors. First recurrent tumor was located in the perigastic area and the other three were in the mesoileum. a partial distal gastrectomy with splenectomy, pan-createctomy (body and tail), partial colectomy and partial resection of the ileum was perfomed for the first recurrent tumor, following by extirpations, sigmoidectomy and partial resction of the ileum for the latter recurrent tumors. All recurrent tumors were diagnosed as leiomyosarcoma. Up to now, the patient has been leading a good life without recurrence. A suspected cause of these recurrences was implantation of tumor cells at the initial operation. Better prognosis can be expected by aggresive surgical treatment for resectable intraperitoneal seeding.

We experienced a rare case of colonic cancer causing intussusception twice for these 6 years. An 88-year-old man was seen at the hospital because of diarrhea. There was a previous history of undergoing sigmoidectomy for retrograde intussusception due to a cancer of the sigmoid coin in the hospital 6 years earlier. The resected specimen showed a cancer in villous adenoma measuring 4.5×3.5cm in size and the depth of invasion was mucosa, without lymph node metastasis. In this admission an ascending colon cancer with intussusception was suspected by physical findings, ultrasonography, computed tomography and colonoscopy. Lapalotomy was performed, and we found the terminal ileum invaginated into the ascending colon and two tumors in the ascending colon. Ileocecal lesion and the ascending colon were resected with regional lymph nodes. The resected specimen showed two Borrman's type 1 cancers, measuring 6.0×4.0cm (moderately differentiated adenocarcinoma, ss, ly2, v0) and 3.5×1.5cm in size (moderately differentiated adenocarcinoma, pm, ly1, v0). The postoperative course was uneventful. Such a specific clinical feature as we experienced in this case developing intussusception twice has not been discribed in the literature so for. Adult intussusception of the large intestine can occur easier when the tumor of origin is protrudent and large, the mount of invasion is little in comparison with the size of the tumor, and the tumors arises in a portion of the colon where is more movable.

Among 205 cases of cancer of the sigmoid colon were operated on in the department from 1972 to 1990, adhesion of the sigmoid colon to bladder was noted in 9 cases (4.4%). An average age of the 9 patients was 59.6 years. The male-to-female ratio was 6:3. Most of the carcinomas were large (an average diameter of the tumors was 7.2cm) and the tumors in 8 of 9 cases were circular. The lesions of adhesion or infiltration to the bladder were at the appex of the bladder in 4 cases, the left posterior wall in 3 and the fundus in 2. Six of 9 patients were diagnosed as cancer invasion positive to the bladder wall at the operation. So, Hartmann's operation with partial cystectomy was performed in 2, sigmoidectomy with partial cystectomy in 3 and low anterior resection with total cystectomy in one. But, only three of them showed microscopic invasion to the bladder wall. It is said that there are some cases judged invasion negative (false negative) even if examination with an intraoperative frozen section is carried out. So another new examination methods at operation are desired.

This paper presents two cases of intussusception due to a carcinoma of the sigmoid colon with a review of the literature. Case 1 was an 80-year-old woman with muco-bloody stool and intestinal obstruction. Pre-operative examinations included ultrasonography, computed tomography and colonoscopy. Laparotomy revealed colo-rectal intussusception. Sigmoidectomy was performed after manual reduction of the intussusception. Macroscopic examination showed the type 1 carcinoma of the sigmoid colon (2.8×2.5×1.6cm). Case 2 was a 91-year-old woman with prolapsing through the anus. Physical examination revealed a 15cm long intestine prolapsing through the anus and type 1 carcinoma (2.8×2.7cm) at the apex of the prolapsing intestine. Transanal resection of the prolapsing intestine was performed under the spinal anesthesia. Fifty-two cases of intussusception caused by a carcinoma of the sigmoid colon were reported in the Japanese literature, and in 23 percent of these cases the intussusception protruded through the anus. Etiology of rectal prolapse may also contribute to such condition. In treatment, the resection should be carried out whithout reduction whenever possible, if malignant tumor is present. Otherwise, the most appropriate operation must be selected according to the situation of each patient.

A 72-year-old male was admitted to our hospital because of the symptoms of cerebral infarction and acute cholecystitis on March, 1992. There was no previous nor family history. Laboratory data showed the existence of severe inflammation and high level of serum CA19-9. Under the image diagnosis, several cystic lesions in lateral and a part of internal segment of the liver and gallbladder stones were recognized. In spite of no malignant sign, high level of serum CA19-9 continued after the inflammation had disappeared. And so cholangioma was suspected. In the pathological findings, Caroli disease and cholelithiasis with cholecystitis were diagnose without malignancy. But after discharged, serum CA19-9 and CEA levels gradually arose, therefore colon fiberscopy was performed. A sigmoid colon tumor was found, and it was malignant (group 5) by the biopsy. The patient was re-admitted to our hospital on November, 1992, and received sigmoidectomy. The postoperative course was uneventful and he discharged from the hospital. Now, serum CA19-9 and CEA levels are within normal limits. No report of Caroli disease with a colon cancer has been seen in the literature as far as we could review. This case is considered very rare.

A retrospective analysis was made on 12 cases of volvulus of the sigmoid colon experienced at the hospital between 1981 and 1992. Patients with volvulus of the sigmoid colon were predominant in their sixties and seventies who kept their bed for a long time or had severe constipation. Preoperative diagnosis was achieved easily by abdominal X-ray or enema examination. For the treatment, laparotomy was performed in all cases. In six cases, simple reduction or fixation was performed, but three of them recurred subsequently. In the other six cases undergoing sigmoidectomy, primary anastomosis was performed in five cases without any postoperative complications. In the remaining case the patient was bedridden and descending colostomy was performed. Diseaseperiod to the treatment was within 5 days in all cases. No patient was in shock state at operation. Present study indicates that the early diagnosis and treatment is essential, and subsequent sigmoidectomy and primary anastomosis is the first choice of the treatment for volvulus of the sigmoid colon.

We experienced three cases of acute gangrenous cholecystitis following a lower gastrointestinal operation. Case 1: A 76-year-old man developed acute gangrenous cholecystitis after left hemicolectomy for a cancer of the descending colon. Case 2: A 51-year-old man had intractable fistula due to perforation of the small intestine after appendectomy for acute appendicitis, and then developed this disease during a long fasting period. Case 3: A 77-year-old man manifested this disease 5 days after sigmoidectomy for perforation of diverticulum in the sigmoid colon. In all 3 cases laparotomy was carried out within several days after the onset and acalculous gangrenous gallbladder was confirmed. It is supposed that fasting due to lower intestinal operation and following initiation of ingestion can be a probable trigger for this disease.

A 73-year-old man, who had undergone standard radical mastectomy for a right breast cancer 5 years before, noticed anal bleeding. Close examination disclosed a cancer of the sigmoid colon. Sigmoidectomy was carried out. Histopathologically this case was found out of heterochronous double cancer of the sigmoid colon and breast. It is thought very rare that the sigmoid colon cancer heterochronously developed after breast cancer in a male patient.

This paper presents two patients with Ogilvie's syndrome. Patient 1: A 33-year-old female, undergone laparotomy for ileus in 1980, had been well after the operation until 1988. From 1988 she had suffered from constipation. In Dec. 1992 abdominal distension with remarkable dilatation of the colon appeared and she was admitted to the hospital. The condition was treated by conservative measures, and improved. But slight distension continued, so subtotal colectomy was performed with a successful outcome. Patient 2: A 55-year-old male, undergone laparotomy for gastric ulcer in 1988 and Cabrol's operation for AAE in 1992, had abdominal distension with remarkable dilatation of the sigmoid colon in Dec. 1993. The condition was treated by urgent colonoscopic decompression. But slight distension continued, so sigmoidectomy was performed with a succesful outcome. Generally many clinicians believe that initial management for most of patients with this disease is to be treated by conservative measures, while for ones with high risk of perforation by palliative surgical treatment. From our experiences we conclude that radical operation should be performed for patients who have abdominal distension continuousely after conservative treatment for QOL.

A 52-year-old man was seen at the hospital because of massive melena at defecation. On digital examination of the rectum a movable elastic hard mass was palpated. A rectal carcinoma was suspected. Barium enema and rectoscopy revealed a hemi-circumference and gently rising torous lesion about 50cm distant from the anal verge, and its center involved a shallow ulcerative lesion and erosion. From biopsy findings a diagnosis of inflammatory epithelium was made, but a sigmoidal cancer was strongly suspected. Laparotomy was carried out. During surgery a tumor of hen's egg size was palpated in the sigmoid colon but no serosa invasion was noted. It was determined as P0H0N0 (n0)S0(s0) and sigmoidectomy R2 was carried out. Resected specimen revealed a 6×5cm torous lesion of Yamada's type I accompanying by an ulcerative lesion in the mucosa. Histopathologically it was diagnosed as submucosal lipoma of the large intestine. This paper describes a relatively rare resected case of lipoma of the large intestine presenting with melena, with a review of the literature.

An 88-year-old man was urgently admitted to the hospital because of massive melena on September 27 1991. Emergency colonoscopy revealed a polyp of Yamada's type III in the sigmoid colon, but no definite bleeding site was determined. Ultrasonography and CT showed bilateral common iliac aneurysms which were not thought the bleeding source. Hemorrhagic scintigraphy for exploration of bleeding site led to a diagnosis that it was located in a portion of the sigmoid colon. On October 1 sigmoidectomy and colostomy were performed. A 10×8mm Yamada's type III polyp was found in the sigmoid colon and clots adhered to its surface. So it was determined that the bleeding stemmed from the polyp. Histopathologically the polyp was carcinoma in adenoma with invasion depth of m, with an artery locating in shallow layer of sm which appeared the bleeding vessel. It is very rare that massive hemorrhage breaks out from a small carcinoma in adenoma with a diameter of less than one cm, and is also interesting that hemorrhagic scintigraphy greatly contrubutes to determine the bleeding site. This paper describes such a rare and interesting case with a review of the literature.

Presented here are 2 resected cases of diffusely infiltrating carcinoma of the colon and rectum. Case 1: A 71-year-old man was admitted with the chief complaint of disconfort after defecation. With barium enema and colonfiberscopy, a stenotic lesion 10 cm in length was diagnosed as being a diffusely infiltrating carcinoma of the rectum. Proctotomy was performed, but the patient died of liver metastasis. Case 2: A 64-year-old woman was admitted with the chief complaints of left lower abdominal pain and tumor. With barium enema and sigmoidoscopy, an obstructive lesion of the sigmoid colon was diagnosed as being a sigmoid colon cancer. Left hemicolectomy and sigmoidectomy combined with external colic artery and vein were carried out. In a review of 210 cases of primary and diffusely infiltrating carcinoma of the large intestine, including these 2 cases, seen in the Japanese literature, it is found this type of carcinoma is rare; it has metastasis to the peritoneum and/or lymph nodes in a high rate when it is diagnosed; and the prognosis is poor. Here the importance of multidisciplinary treatments including early diagnosis and operation is emphasized.

A 43-year-old man was admitted to the hospital because of constipation and abdominal distention. From abdominal ultrasonography, enema, endoscopy of the large intestine, MRI, and angiography, some malignant disease such as sarcoma arising in the sigmoidal mesentery was suspected. Sigmoidectomy was carried out. Resected specimen revealed a diffuse infiltrating carcinoma.Histopathologically it was squamous cell carcinoma arising in the sigmoid colon. Among of all colonic carcinomas, squamous cell carcinoma is very rare. Some notes on relevant literature are also presented here.

Carcinoid tumor arising from the colon is a relatively rare entity. A case of perforated sigmoid colon carcinoid is reported.A 67-year-old female was diagnosed as having peritonitis due to perforation of a sigmoid colon cancer, and underwent sigmoidectomy. The tumor was about 10 cm in diameter and about 5 mm size of perforation was noticed in it. Diffusely infiltrating carcinoid tumor was recognized microscopically. The patient developed multiple liver metastasis shortly after the operation. Inspite of frequent hepatic arterial infusion of chemotherapy, she dided 10 months after the operation. We have experienced twenty-nine cases of carcinoid tumor arising from the digestive tract in as relatively low as a recent one decade, but only two cases from the colon. The rate is 6.9%. The case of perforated colon carcinoid is quite rare and we found only one case in the literature. The clinical course and prognosis in this case were discussed.

Recently a case of depressed type early cancer of the sigmoid colon was experienced. A 57-year-old man without any chief complaints visited the hospital for minute examination, because he was pointed out on ulcerative lesion of the sigmoid colon at another hospital Colonoscopy showed a reddish depressed lesion with marginal elevasion in the sigmoid colon. Endoscopy showed that the lesion was a IIa+IIc type early colon cancer. The lesion was not considered a possible candidate for endoscopic polypectomy, and sigmoidectomy was performed. Resected specimen showed a depressed lesion, measuring 9×8mm, with marginal elevation and fold convergence macroscopically, although microscopically cancer cells invaded mucosa without any metastasis. Histological diagnosis was well differentiated adenocarcinoma. The cancer tissues were present partially in the marginal elevation but mostly in the depressed lesion.

Apple core sign in barium enema is assumed to be characteristic of advanced ulcer-forming colon cancer invading the subserosa with a size of more than 3 cm in diameter. We experienced two cases of sigmoid colon diverticulitis with apple core sign on preoperative barium enema. In both cases colonoscope could not pass through the stenosis. Although biopsies taken from that region showed no malignancy, possibility of carcinoma could not be excluded and laparotomy was performed. Case 1 was a 64-year-old man. Barium enema revealed an apple core sign with diverticula at the sigmoid colon. Sigmoidectomy was performed. Histological diagnosis was inflammatory stenosis resulted from diverticulitis, and there was no malignant findings. Case 2 was a 47-year-old man. Left hemicolectomy was performed because of an apple core sign at the sigmoid colon and diverticular in the descending and sigmoid colon demonstrated on the barium enema. Histological examination of the resected colon revealed diverticulitis. These two cases suggest that colon diverticulitis can demonstrate an apple core sign due to the fibrous hyperplasia of the serosa caused by chronic inflammation in the adjacent plural diverticula.

A relatively rare operated case of signoid colon cancer synchronously associated with multiple myeloma (MM) is reported.A 64-year-old man pointed out hypergammaglobulinemia from the biochemical examination was diagnosed as having IgG (λ) type MM by electrophoresis and bone marrow biopsy. Two weeks after the melphalan treatment was begun, he underwent a barium enema and was diagnosed as having a sigmoid colon cancer. sigmoidectomy with lymph nodes dissection was performed. The patient left our hospital 30 days after the operation. Unfortunately he acquired a pulmonary infection due to pancytopenia caused by MM and died 11 months after the melphalan treatment, or 9 months after the operation.We should use caution with any other cancer patient which is complicated by MM. It is rare that colorectal cancer is associated with MM, but not rare that MM is associated with malignant disease. We should pay attention to renal failure and leakage from colorectal anastomosis in the operative management of colorectal cancer complicated by MM, because MM is a high risk disease accompanying with renal dysfunction and hypoalbuminemia.

A relatively rare case of leiomyoma of the sigmoid colon is described. The case was a 46-year-old female with the chief complaint of melena. Barium enema and endoscopy of the colon revealed a subpedunculated submucosal tumor of the sigmoid colon. Sigmoidectomy was performed. The tumor was 4.0×3.6×2.8 cm in size and was covered with normal epithelium. It was a leiomyoma which might arise in the muscular layer of mucosa.A total of 54 cases of leiomyoma of the colon was collected from the Japanese literature and reviewed. Some considerations of the treatments are also presented.

A patient, who had treated with neuroleptic drugs for schizophrenia in a long period, was diagnosed as having a sigmoid colon cancer and underwent sigmoidectomy. The patient developed adhesive intestinal obstruction postoperatively, and intramuscular administration of halperidol was started instead of oral medication. Intractable high fever, akinetic mutism and marked rigidity on extrimities developed on the 25th post-operative day. Cessation of haloperidol and intravenous administration of dantrolene sodium promptly induced relief from these symptoms. Reoperation for adhesive intestinal obstruction which had been diagnosed before malignant syndrome occurred could be uneventfully carried out under general anesthesia together with dantrolene sodium treatment.

It is general that the metachronous metastasis of primary colorectal cancer to the liver occurs within 3 years after surgery, and it rarely occurs after 3 years. This time we could successfully resect a hepatic metastasis which was found 8 years and 6 months after resection of the primary lesion.A 60-year-old male was referred to our hospital because of the elevated serum CEA. He had undergone sigmoidectomy for primary colon cancer in Oct. 1980, which was 3.5×3.0 cm in size and moderately differentiated tubular adenocarcinoma of type 2. Abdominal US, CT and celiac angiogram demonstrated a mass, 5×5 cm in size, at the anterior segment of the liver. Extended right hepatic lobectomy was performed. The hepatic lesion was diagnosed as tubular adenocarcinoma that was similar to the primary sigmoid colon cancer in the histological feature.It seemed inevitable that the periodical measurements of serum CEA and evaluative imagings should be taken for a long term.

Colonic carcinoma associated with ossification is very rare as Dukes reported that it might occur with frequency of around 0.4%. We report a case of the disease together with a review of the literature. A 59-year-old man who noticed blood in the stoll was transferred to our hospital because he was diagnosed to have a carcinoma of the sigmoid colon. He had no remarkable family nor past history, and barium enema and colorectal fiberscopy could confirmed the diagnosis sigmoidectomy being carried out. Preoperative blood CEA level was within normal limit. Histological examination revealed a well differentiated adenocarcinoma and according to general rules for clinical and pathlogical studies on cancer of colon, rectum and anus, the feature were drawn as follows S, type II, 2/3 occupation of the circumference, 3×4cm in size, ss, ly0, V2 n(-), and Dukes b. there were two polyps in the resected specimen. Ossification was found adjacent to carcinoma in one of the two adenomatous polyps.

In this report, we present a case of metastatic liver tumor which was unresectable and treated with simultaneous ligation of both right hepatic artery and right portal vein. A 61 year-old female received a sigmoidectomy for the diagnosis of sigmoid colon cancer on July 18, 1985. Computed Tomography which was examined on September 29, 1986, revealed 2 low density areas in the right lobe of the liver. On October 29, 1986, under general anesthesia, an upper median incision was performed and the right hepatic artery and right portal vein were ligated simultaneously. After the operation, neither liver failure nor shock appeared, and decrease in size of the tumor was noticeable. Her postoperative course was uneventful and she was discharged from the hospital without any symptoms. On September 15, 1987, she died of acute cardiac failure. Ligation of the hepatic vessels seems to have some effects for malignant liver tumor. However, we could find no reports concerning simultaneous ligation of both hepatic artery and portal vein for liver tumor. A case is discussed with a review of the previous literatures.