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Large intestines with diverticula exhibit functionally abnormal peristaltic activity and elevated luminal pressure that may indicate functional changes in the myenteric plexus; however, no studies have investigated the characteristics of either normal or diverticula myenteric plexuses.Tissue specimens obtained from 93 colorectal cancer patients without diverticula, 14 patients with perforated diverticulitis, and 12 colorectal cancer patients with asymptomatic diverticula were included in this study. Myenteric plexuses and ganglion cells were counted per centimeter, and the area and maximum diameter of the nuclei of ganglion cells were measured using an image analyzer.The number of myenteric plexuses and ganglion cells per centimeter was significantly higher in the descending colon, sigmoid colon, and rectum than in the cecum, ascending colon, and transverse colon. The area of the nuclei of ganglion cells was significantly larger in the descending colon and sigmoid colon than in the cecum and ascending colon. Compared with large intestines without diverticula, the number of myenteric plexuses was significantly higher in large intestines with diverticula, whereas the number of ganglion cells decreased in both right-sided and left-sided large intestines with perforated diverticulitis or asymptomatic diverticula. The area of the nuclei of ganglion cells was significantly smaller in large intestines with diverticula.The morphology of myenteric plexuses and the ganglion cells differs significantly among segments of the human large intestine. Large intestines with diverticula had significantly more plexuses but significantly fewer ganglion cells than large intestines without diverticula. The area of the nuclei of ganglion cells was also significantly smaller in large intestines with diverticula. Further studies are required to clarify how these changes are related to intestinal function and how they are involved in the etiology of diverticulosis.

PURPOSE: Bilateral ligation of the internal iliac arteries has been reported to be a safe procedure in pelvic surgery because there are five collateral pathways. Some of the five pathways are surgically interrupted after resection of the rectum and two cases in which necrosis developed in the perineum were reported. The aim of the study was to assess the degree of safety and blood flow reducing efficacy of internal iliac artery ligation in rectal cancer surgery. METHODS: The subjects were 23 patients with advanced rectal cancer. Tissue blood flow on the surface of the bladder was measured using a laser Doppler flow meter when unilateral or bilateral internal iliac artery were clamped at a central site or at a peripheral site. RESULTS: Tissue blood flow of the bladder before clamping the internal iliac artery was 6 to 74 ml/min/100 g. Blood flow in the right half of the bladder decreased significantly when the right and both internal iliac arteries were clamped (both,P

Villous adenoma of the appendix is a rare neoplasm and intussusception of the appendix is a rare pathologic condition. A very rare case seen in a 35-year-old male with pain in the right lateral abdomen is reported. In this patient, the appendix along with the villous adenoma intussuscepted and invaginated into the cecal lumen, and presented as cecocolic intussusception. A polypoid lesion was diagnosed in the cecum by fiberoptic colonoscopy. Unlike polypoid lesions at other sites in the large intestine, polypoid lesions of the cecum may accompany intussusception and invagination of the appendix. Consequently, caution is required in performing endoscopic polypectomy in cases of polypoid lesions of the cecum.

We have devised a new "soft trocar" for laparoscopic surgery. This translucent trocar, made of silicon, has a flexible sleeve that permits a curved instrument to pass through. Eighteen patients underwent laparoscopic cholecystectomy with the use of the soft trocar. There were no complications related to its use. The soft trocar is useful during laparoscopic cholecystectomy because it is radiolucent, a curved forceps can be inserted, and it is potentially less traumatic to the abdominal viscera than a standard trocar.