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We present the successful management of a patient presenting with pneumo-peritoneum early after surgery due to transvere colon injury after placement of the temporary pacing wires. The patient was asymptomatic, underwent computed tomography, the temporary pacing wires were removed and he was managed conservatively. [ABSTRACT FROM AUTHOR]

Congenital colonic stenosis (CCS) is a rare cause of intestinal obstruction, most commonly presenting in the neonatal period. We present a case of delayed CCS and describe the diagnostic challenges experienced. A 16-week-old female patient presented with persistent failure to thrive associated with signs of intestinal obstruction. Prior encounters included investigation for pyloric stenosis, gastrointestinal pathogens, acid reflux, and cow milk allergy, with no to little improvement in symptoms. Abdominal imaging showed bowel dilation with possible colonic obstruction while excluding malrotation. Exploratory laparotomy revealed abrupt reduction in caliber of the mid/distal transverse colon and extreme luminal narrowing, consistent with colonic stenosis. Extended right hemicolectomy and anastomosis resulted in returned bowel function and appropriate weight gain in follow-up. Though rare, CCS should be considered in cases of partial or subacute intestinal obstruction throughout the first year of life. Inconclusive clinical and imaging results may support exploratory laparotomy after excluding differential diagnoses. [ABSTRACT FROM AUTHOR]

Diastatic perforation corresponds to a bursting of the cecal wall caused by excessive distension resulting from a remote obstruction of the low large bowel. This perforation could be explained by Laplace's physical law, and by the particular vascular anatomy of the cecal wall. We report the case of a 75-year-old man admitted for peritonitis with an abdominal CT scan highly suggestive of a diastatic perforation of the cecum complicating colonic distension upstream of a stenosing tumor of the rectosigmoid junction. To our surprise, surgical exploration revealed the defect to be in the transverse colon and not in the cecum. Diastatic perforation of the transverse colon is exceptional, and would require other pathophysiological explanations than those for classical cecal perforation.

A 61-year-old man present to us with continued abdominal pain without abdominal tenderness for 1 month. Blood testing showed elevated biliary enzymes and inflammation. Contrast-enhanced computed tomography (CT) revealed thickening of the transverse colon with relatively strong enhancement but no bile duct dilatation. Colonoscopy revealed localized edema and granular mucosa in the transverse colon. Fluoroscopic endoscopy exhibited the absence of haustra. Multiple biopsies were performed, but differentiation between mild inflammation and mucosa-associated lymphoid tissue (MALT) lymphoma was inconclusive. To establish a definitive diagnosis, transgastric endoscopic ultrasound-guided fine needle biopsy of the hypoechoic mass was performed. Histopathological analysis exhibited the proliferation of small-sized lymphocytes. Fluorescence in situ hybridization revealed the characteristic API2-MALT1 translocation of MALT lymphoma. We performed liver biopsy to investigate biliary enzyme elevation. Histopathology confirmed lymphocytic infiltration within Glisson's capsule. Immunohistochemistry showed positive for CD20 and negative for CD3 and CD5, signifying the infiltration of MALT lymphoma in the liver. Based on these findings, we diagnosed MALT lymphoma, Lugano classification Stage IV. We performed bendamustine–rituximab (BR)-combined therapy. After six courses of BR-combined therapy, colonoscopy revealed improvement in the lead pipe sign and CT revealed disappearance of the mass. [ABSTRACT FROM AUTHOR]

Crohn's disease is an inflammatory chronic disease affecting the gastrointestinal tract, mostly the colon and terminal ileum. A 42-year-old female patient presented to a tertiary care centre in Riyadh, Saudi Arabia, in 2021 with chronic abdominal pain. The computed tomography findings showed a transverse colon mass invading the stomach. The biopsy report indicated reactive colonic mucosa with focal inflammatory exudate. She underwent a laparoscopic extended left hemicolectomy with en-bloc resection of the greater curvature of the stomach and primary anastomosis. The patient was subsequently diagnosed with Crohn's disease based on the final pathology report. The patient had an uncomplicated postoperative course and is being follow-up. [ABSTRACT FROM AUTHOR]

The article provides a brief overview of the frequency and prevalence of Pair syndrome, the causes of its development, the clinical picture and diagnosis of this form of splanchnoptosis, the tactics of surgical treatment depending on the stage of the disease. There are 2 clinical cases of successful surgical treatment of chronic constipation in patients with Pair syndrome. At the same time, in the classical picture of the disease, left-sided hemicolectomy with a thick-colonic anastomosis "end to end" was performed, in a patient with concomitant diverticular disease - an extended hemicolectomy. All patients are discharged with recovery, all have an independent regular stool every 1-3 days

Background: Duplication of the transverse colon is a rare gastrointestinal malformation. Its pathogenesis is still unclear, and it is extremely rare in adults. Patients often present with symptoms of tumor compression such as abdominal mass, abdominal pain, and constipation as the first manifestation. Methods and result: A patient with a duplication of the transverse colon was admitted to the Department of General Surgery of our hospital. Laparoscopic exploration found a mass at the rear of the transverse colon near the splenic flexure, and the root was connected to the middle portion of the transverse colon. Conclusion: Surgery is a radical treatment and reduces the possibility of perforation, bleeding, obstruction, and cancer. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. Methods This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. Results The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). Conclusions This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice.

In this case report, we discuss an 83-year-old woman who presented to the emergency department with complaints of constipation and progressive abdominal pain 2 days after a right total knee arthroplasty. Chest X-ray indicated a possible hiatal hernia, but computed tomography revealed a Morgagni hernia with a portion of the transverse colon and omentum in the thoracic cavity, resulting in a large bowel obstruction. The more common presenting symptoms associated with Morgagni hernia, dyspnea, and chest pain were not present. Surgical management was pursued with a transabdominal approach, the bowel was successfully reduced and the defect was closed using sutures. This case provides an interesting insight into the many potential presentations and clinical signs of the rare Morgagni hernia.

Aim: During surgery for mid‐transverse colon cancer (MTC), surgeons often face the dilemma of whether to mobilize the hepatic or splenic flexure. There is no established optimal minimally invasive surgical procedure for MTC. Methods: We present our novel minimally invasive surgical technique, called the 'moving the left colon' technique for MTC, along with a video demonstration. The procedure involves four main steps: (i) mobilization of the splenic flexure using a medial‐to‐lateral approach, (ii) dissection of lymph nodes around the middle colic artery from the left side of the superior mesenteric artery approach, (iii) separation of the pancreas and transverse mesocolon and (iv) 'moving the left colon' and performing an intracorporeal anastomosis. By mobilizing the splenic flexure, anatomical landmarks are revealed, which enables safer dissection. Combining this technique with intracorporeal anastomosis allows for a safe and easy anastomosis. Results: Between April 2021 and January 2023, a single‐skilled colorectal surgeon performed laparoscopic transverse colectomies using our new approach on three consecutive patients with MTC. The patients had a median age of 75 years (range 46–89 years). The median operative time was 194 min (range 193–228 min) and blood loss was 8 mL (range 0–20 mL). None of the patients experienced any perioperative complications and the median postoperative hospital stay was 6 days. Conclusion: We introduced a novel approach for laparoscopic surgery for MTC. This technique can be performed safely and may help standardize minimally invasive surgery for MTC. [ABSTRACT FROM AUTHOR]

Introduction: Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous colonic volvulus is extremely rare; even if there are some case reports on synchronous colonic volvulus, there are no reported cases of synchronous ascending and transverse colon volvulus in the medical literature to our knowledge. Case Presentation: A 25-year-old girl with a previous history of epilepsy presented with a one-day duration of abdominal cramps with associated symptoms of vomiting of bilious matter, failure to pass faeces, and flatus of the same duration. The patient underwent surgical intervention, and ascending and transverse volvulus were discovered. Conclusion: In spite of ascending and transverse colon volvulus rarity, we advised including these in the differential diagnosis of patients associated with large bowel obstruction. [ABSTRACT FROM AUTHOR]

Schwannomas of the gastrointestinal tract are rare spindle cell tumors that account for 2–6% of mesenchymal tumors. An elderly male was found to have a left colon mass on CT scan and colonoscopy with pathology of fibrotic tissue. A laparoscopic-assisted left hemi-colectomy with primary anastomosis was performed. Pathology demonstrated spindle cell neoplasm arranged in short fascicles that were strongly and diffusely positive for S100. An elderly female was found to have a submucosal lesion on surveillance colonoscopy in the proximal transverse colon. Biopsy with jumbo forceps revealed spindle cell neoplasm positive for S100. Patient underwent an uncomplicated limited non-oncologic segmental transverse colectomy. We report only the ninth case of left and sixth in the transverse colon described in the literature. As is true for other mesenchymal tumors, mucosal biopsy is usually inconclusive and deep biopsy or submucosal resection is required, making pre-operative surgical decision difficult. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. Methods This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. Results Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. Conclusion Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.

The transverse colon has anatomical peculiarities in the middle position between the foregut and the midgut. Because the transverse colon harbors a flexure at both ends, mobilization of the transverse colon can be especially challenging compared with other colons. Although transverse colon cancer is relatively uncommon, an optimal surgical management for transverse colon cancer must be established. In transverse colon cancer, proximity to the pancreas and variation in arterial and venous anatomy make radical resection more difficult. Dissection of lymph nodes around the middle colic vessels is a critical step in transverse colon cancer resection. The proximity of the middle colic vessels to the superior mesenteric vessels contributes to the complexity of this step, making it challenging for less-trained surgeons. For these reasons, patients with transverse colon cancer were not included in most landmark studies that compared laparoscopic surgery with open surgery. More radical operations, such as subtotal colectomy or extended right or left hemicolectomy, can be performed for transverse colon cancer to secure an adequate lymphadenectomy. Such cancers have also been treated with limited segmental colectomies, such as right, transverse, or left colectomy. Currently, there is still a lack of standardized definitions and procedures. Therefore, it is time to discuss and establish optimal surgical treatments for transverse colon cancer.

Background: Laparoscopic and robotic surgery for transverse colon cancer are difficult due to complex fusion of the foregut and midgut and variation of the vessels of the transverse colon. Although the vessels of the right colon have been investigated, middle colic artery (MCA) variation and the relationship with vessels around the transvers colon are unknown. We investigated variation of the MCA using computed tomography angiography (CTA) and cadaver specimen and the relationship between the superior mesenteric vein (SMV) and MCA using CTA. The classification of vessels around the transverse colon may lead to safer and reliable surgery. Methods: This study included 505 consecutive patients who underwent CTA in our institution from 2014 to 2020 and 44 cadaver specimens. Vascular anatomical classifications and relationships were analyzed using CT images. Results: The MCA was defined as the arteries arising from the superior mesenteric artery (SMA) that flowed into the transverse colon at the distal ends. The classifications were as follows: type I, branching right and left from common trunk; type II, the right and left branches bifurcated separately from the SMA; and type III, the MCA branched from a vessel other than the SMA. Type II was subclassified into two subtypes, type IIa with one left branch and type IIb with two or more left branches from SMA. In the CTA and cadaver studies, respectively, the classifications were as follows: type I, n = 290 and n = 31; type IIa, n = 211 and n = 13; type IIb, n = 3 and n = 0; and type III, n = 1 and n = 0. We classified the relationship between the MCA and left side of the SMV into three types: type A, a common trunk runs along the left edge of the SMV (n = 173; 59.7%); type B, a right branch of the MCA runs along the left edge of the SMV (n = 116; 40.0%); and type C, the MCA runs dorsal of the SMV (n = 1; 0.3%). Conclusions: This study revealed that The MCA branching classifications and relationship between the SMV and MCA. Preoperative CT angiography may be able to reliably identify vessel variation, which may be useful in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study compared the surgical outcomes between laparoscopic colectomy (LC) and open colectomy (OC) for mid-transverse colon cancer (MTC). Methods: This multicenter retrospective study compared the short- and long-term surgical outcomes for patients with advanced MTC (T3 and T4 with or without nodal involvement) who underwent LC or OC between January 2008 and December 2019 using a propensity score–matched analysis. Results: A total of 177 patients with advanced MTC were enrolled. After matching, 58 cases for the OC and LC groups were selected. No significant differences in age, sex, tumor progression, or procedure type (extended resection or segmental resection) existed between groups. The LC group had significantly less blood loss (20 mL vs. 50 mL, p=0.048) and a shorter postoperative hospital stay (8 days vs. 12 days, p<0.001) than the OC group. Postoperative complications (Clavien–Dindo grade ≥ 2) occurred in 27.6% and 25.9% of the OC and LC groups respectively (p=1). Three patients (5.2%) and one patient (1.7%) of the OC and LC groups respectively developed anastomotic leakage (p=0.62). Re-operation was required in five patients (8.6%) in the OC group and one patient (1.7%) in the LC group (p=0.21). No surgery-related deaths occurred in either group. The 3-year overall survival rates (stage II: LC 100% vs. OC 92.8%, p=0.15; stage III: 88.9% vs. 84.3%, p=0.88, respectively) were similar between the two groups. Conclusion: LC is a minimally invasive technique with lesser blood loss, shorter postoperative hospital stays, and oncologic equivalence to OC. Hence, LC is useful for MTC treatment. Trial registration: UMIN000042676 [ABSTRACT FROM AUTHOR]

Introduction: While there may be microbial contributions to Alzheimer's disease (AD), findings have been inconclusive. We recently reported an AD-associated CD83(+) microglia subtype associated with increased immunoglobulin G4 (IgG4) in the transverse colon (TC)., Methods: We used immunohistochemistry (IHC), IgG4 repertoire profiling, and brain organoid experiments to explore this association., Results: CD83(+) microglia in the superior frontal gyrus (SFG) are associated with elevated IgG4 and human cytomegalovirus (HCMV) in the TC, anti-HCMV IgG4 in cerebrospinal fluid, and both HCMV and IgG4 in the SFG and vagal nerve. This association was replicated in an independent AD cohort. HCMV-infected cerebral organoids showed accelerated AD pathophysiological features (Aβ42 and pTau-212) and neuronal death., Discussion: Findings indicate complex, cross-tissue interactions between HCMV and the adaptive immune response associated with CD83(+) microglia in persons with AD. This may indicate an opportunity for antiviral therapy in persons with AD and biomarker evidence of HCMV, IgG4, or CD83(+) microglia., Highlights: Cross-tissue interaction between HCMV and the adaptive immune response in a subset of persons with AD. Presence of CD83(+) microglial associated with IgG4 and HCMV in the gut. CD83(+) microglia are also associated presence of HCMV and IgG4 in the cortex and vagal nerve. Replication of key association in an independent cohort of AD subjects. HCMV infection of cerebral organoids accelerates the production of AD neuropathological features., (© 2024 The Author(s). Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

BackgroundColon interposition is a complex and time-consuming procedure requiring at least three or four digestive anastomoses. However, the long-term functional outcomes are promising, with an acceptable operative risk.Case presentationHerein, two cases of esophageal carcinoma that received esophagus reconstruction using the distal continual colon interposition technique have been described. The transverse colon was lifted to the thoracic cavity for the end-to-side anastomosis with the esophagus, and a closure device was used to close the colon instead of severing and isolating the distal end. The duration of the operation was 140 and 150 min, respectively. The blood supply of the colon was maintained during the intervention. The tension-free anastomosis was performed without severe complications, and oral food intake was resumed on postoperative day 6. Neither anastomotic stenosis, antiacid or heartburn, dysphagia, or emptying obstacles nor complaints of diarrhea, bloating, or malodor were reported during the follow-up period.ConclusionsThe modified distal-continual colon interposition technique may have the advantages of a short operation time and potential prevention of serious complications caused by the torsion of mesocolon vessels.

Transverse colonic volvulus is exceptionally rare and is the rarest compared to sigmoid or cecal volvulus. This case report summarizes the care of a young 19-year-old woman who presented with transverse colonic volvulus. This woman came to the emergency room with abdominal pain, nausea, and vomiting, and she had no risk factors for a volvulus. This case report has the goal of raising awareness among those taking care of anyone coming in for abdominal pain. Volvulus is a serious issue and can be life threatening if not treated appropriately. [ABSTRACT FROM AUTHOR]

Congenital Diaphragmatic Hernia (CDH), usually presents in the childhood period. It presents as an idiopathic human malformation. It is a condition, where the organs of the abdomen enter the thorax due to a defect in the diaphragm, that is, herniation from the pleuroperitoneal fistula. Morgagni hernias are commonly incidentally diagnosed on a chest radiograph or a patient may have cardiorespiratory or abdominal symptoms. Repair of hernia without the use of mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration. The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that, surgical repair should be done even in asymptomatic cases. The present case report is about a 66-year-old female patient with a right-sided Morgagni hernia, who presented with abdominal pain and vomiting. Since the patient was symptomatic, surgical approach was preferred and she underwent laparoscopic abdominal surgery which was converted to open abdominal approach. Postoperatively, the patient recovered from her symptoms and had no complications.

Abstract Purpose Studies on unresectable colorectal cancer liver metastasis(CRLM) rarely analyze the prognosis of the patients from the point of colonic subsites. We aimed to evaluate the effect of primary tumor resection (PTR) and different scope of colectomy on the prognosis of patients with unresectable transverse colon cancer liver metastasis (UTCLM), hepatic flexure cancer liver metastasis (UHFLM), and splenic flexure cancer liver metastasis (USFLM). Patients and methods The patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cause-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of PTR on survival. Results In total, this study included a cohort of 1960 patients: 556 cases of UHFLM, 1008 cases of UTCLM, and 396 cases of USFLM. The median survival time of whole patients was 11.0 months, ranging from 7.0 months for UHFLM patients to 15.0 months for USFLM patients. USFLM patients had the best OS and CSS, followed by UTCLM patients. UHFLM patients had the worst OS and CSS (All P

Abstract Background Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy. Case presentation A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy. Conclusions Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.

Neuroendocrine tumors are the proliferation of neuroendocrine cells that are known to be highly aggressive with a high mortality rate. The vast majority are seen within the small intestine and rectum. Rarely, within the colon, they are observed in the cecum or the ascending colon. In this case, a 66-year-old woman presented to the clinic with chronic fatigue and constipation. Work-up of the patient led to the diagnosis of an ulcerating mass within the mid-transverse colon, a highly unlikely location, where the biopsy revealed neuroendocrine carcinoma. Extended right hemicolectomy and ileotransversostomy were performed, and the pathological report was consistent with primary neuroendocrine carcinoma. These tumors are usually observed in the elderly population and are detected at an advanced stage. Routine colonoscopic examinations should therefore be performed for early diagnosis and management. [ABSTRACT FROM AUTHOR]

Colonic volvulus may infrequently occur in the transverse colon, and synchronous double volvulus is a rarely reported phenomenon in the literature. Additionally, intestinal volvulus is a rare but serious complication that has been reported in scleroderma and systemic lupus erythematosus (SLE) patients. We report a 26-year-old patient with a history of scleroderma-SLE overlap syndrome who presented with an acute abdomen. CT imaging revealed a transverse colon volvulus and a cecal bascule (cecal volvulus). To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. Additionally, this is the second reported case of transverse colon volvulus occurring in a patient with scleroderma and the first case in a patient with scleroderma-SLE overlap syndrome.

Background: Colorectal cancer (CRC) is the most prevalent gastrointestinal (GI) cancer. With 5% risk of developing CRC in life, it became the third leading cause of cancer death in developed nations. In Nigeria, it is the most common GI cancer. However, there are limited data on CRC in the study area (North-Western part of Nigeria). The aim of this study was to identify the clinical, endoscopic and histological profile of CRC seen on colonoscopy. Methodology: This was a retrospective descriptive study where colonoscopic and histological records of suspected CRC in the study centre between January 2008 to December 2017 were evaluated. Results: Records of 135 patients were reviewed, and males constituted 63.7%. The mean age was 46.61 ± 16.80 years, with 30–39 years as a modal group. Common presentations were diarrhoea (86.7%) and bleeding per rectum (68.9%). Areas affected were rectosigmoid colon (63%), ascending colon (14.1%), descending colon (8.9%), transverse colon (7.4%) and anal canal (6.7%). Histologically, adenocarcinoma was reported in 57.8%, mucinous adenocarcinoma in 8.1% and signet ring cell adenocarcinoma in 3.7%. Tubular and villous adenomas were 3% each. Others were carcinoid tumours (1.5%), metastatic adenocarcinoma, squamous cell carcinoma, basal cell carcinoma, GI stromal tumour, inflammatory myofibroblastic tumour, angiosarcoma and adenoid cyst carcinoma reported in 0.7% each. Conclusion: Majority of the patients with CRC were in their young age. The most common presentations were diarrhoea, weight loss and anaemia. The most common site of affectation was in the left colon, while the most common histological finding was adenocarcinoma.

Abstract Transverse colon, owing its origin to midgut and hindgut and harbouring a flexure at both ends, continues to pose a surgical challenge. When compared to the rest of the colon, transverse colon adenocarcinoma is relatively uncommon. These cancers usually present late and lie in close proximity to the stomach, omentum, and pancreas. Adequate lymphadenectomy entails dissection around and ligation of the middle colic vessels. Hence, resectional surgery for transverse colon carcinoma is considered difficult. This is more so because of the variation of arterial and venous anatomy. From this perspective, the surgeon is tempted to perform a more radical operation like extended right or left hemicolectomy to secure an adequate lymphadenectomy. Such a cancer has also been dealt with a more limited transverse colectomy with colo‐colic anastomosis. For all these reasons, patients with transverse colon adenocarcinoma were excluded from randomised trials which compared laparoscopic resection with traditional open operation. Surgical literature is yet to establish a definite operation for transverse colon cancer and the exact procedure is often dictated by surgeon's preference. This is primarily because this is an uncommon cancer. The rapid adoption of laparoscopic operation favoured extended colectomy as transverse colectomy can be difficult by minimally invasive technique. However, in the recent past, cohort studies and meta‐analyses have shown equivalent oncological outcome between transverse colectomy and extended colectomy. It is time to resurrect transverse colectomy and consider it equivalent to its radical counterpart for cancers around the mid‐transverse colon.

Background: Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum.Methods: This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated.Results: Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations.Conclusion: Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer. [ABSTRACT FROM AUTHOR]

Purpose: The laparoscopic surgery approach for mid-transverse colon cancer (MTC) varies depending on tumor characteristics and the guidelines implemented by each surgeon; the optimal surgical procedure for MTC has not been established. This study aimed to compare the surgical outcomes of laparoscopic extended right hemicolectomy (Lap-ERHC) and laparoscopic transverse colectomy (Lap-TC) for MTC. Methods: This was a multicenter, retrospective study. We surveyed eight hospitals, by questionnaire, on MTC surgery policies and retrospectively compared the short- and long-term surgical outcomes for patients with MTC who underwent Lap-ERHC or Lap-TC between January 2008 and December 2019. Results: A total of 129 patients were enrolled, of whom 35 underwent Lap-ERHC and 94 underwent Lap-TC. There were no significant differences in tumor progression between the two groups. Operation time was significantly longer (202 min vs. 185 min, p = 0.026). We observed a higher complication rate (≥ grade 3) in the Lap-ERHC group than in the Lap-TC group (11.4% vs. 3.2%, p = 0.086). Three patients (8.6%) who underwent Lap-ERHC developed anastomotic leakage; none of the patients who underwent Lap-TC had this complication (p = 0.018). The 3-year overall survival rates (stage I: 100% vs. 91.9%, p = 0.64; stage II: 100% vs. 95.5%, p = 0.46; stage III: 100% vs. 88.2%, p = 0.91, respectively) were similar between the two groups. Conclusion: Lap-ERHC for MTC has the same long-term outcomes as Lap-TC. However, Lap-ERHC for MTC has a higher complication rate. Therefore, Lap-TC may be recommended for patients with MTC. Trial registration: UMIN000042674 [ABSTRACT FROM AUTHOR]

Background and Objectives: Complete mesocolon excision and high vascular ligation have become a standard procedure in the treatment of colon cancer. The transverse colon has certain embryological and anatomical particularities which require special attention in case of oncological surgeries. Proximal transverse colon cancer (TCC) can metastasize to the lymph nodes in the gastrocolic ligament. The aim of this study is to assess the tumor involvement of these lymph nodes and to determine the applicability of gastrocolic ligament lymph nodes dissection as the standard approach for proximal transverse colon cancer. Materials and Methods: this study analyzes the cases of patients admitted to the Surgery Department, diagnosed with proximal transverse colon cancer, with tumor invasion ≥ T2 and for which complete mesocolon excision with high vascular ligation and lymphadenectomy of the gastrocolic ligament (No. 204, 206, 214v) were performed. Results: A total of 43 cases operated during 2015–2020 were included in the study. The median total number of retrieved central lymph nodes was 23 (range, 12–38), that had tumor involvement in 22 cases (51.2%). Gastrocolic ligament tumor involvement was found in 5 cases (11.6%). The median operation time was 180 min, while the median blood loss was 115 mL (range 0–210). The median time of hospitalization was 6 days (range, 5–11). Grade IIIA in the Clavien-Dindo classification was noticed in 3 patients, with no mortality. Upon Kaplan–Meier analysis, tumors > T3 (p < 0.016) and lymph node ratio < 0.05 (p < 0.025) were statistically significant. Conclusions: lymph node dissection of the gastrocolic ligament in patients with advanced proximal transverse colon cancer may improve the oncological outcome in T3/T4 tumors, and therefore standardization could be feasible [ABSTRACT FROM AUTHOR]

The hepatic flexure and transverse colon have a complex intermingled lymphovascular anatomy crossing between mesocolon and mesogastrium. Few studies have investigated the oncological relevance of metastatic infrapyloric and gastroepiploic lymph nodes (IGLN) from hepatic flexure and transverse colon tumors. This study aimed to evaluate the incidence and risk factors for IGLN metastases, and the indications, surgical morbidities, and oncological outcome following extended lymphadenectomy. According to the PRISMA statement, a systematic review on IGLN lymphadenectomy for colon cancer was conducted into PubMed, Embase, and Cochrane databases. A critical appraisal of study was performed according to the Joanna Briggs Institute Tools. Nine studies were included. IGLN metastases incidence ranged 0.7–22%. IGLN positivity for patients with metastatic mesocolic lymph nodes ranged 1.7–33.3%. Postoperative complication rate ranged 8.5–36.9%, mostly low grade according to Clavien-Dindo's classification. Postoperative mortality rate ranged 0–5.4% at 30-days. IGLN metastases were associated with advanced disease with a 5-year progression-free survival rate up to 33.9%. Two authors reported perineural invasion and N stage as risk factors, while another reported endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage to be risk factors for IGLN involvement. Apart from one study, all other studies were of moderate/high quality. Metastatic IGLNs are not uncommon and should be highly considered. IGLN metastases could be potentially associated with an aggressive disease. IGLN dissection is not associated with higher morbidity and mortality than standard CME. Preoperative risk factors of IGLN involvement could guide surgical indication for extended lymphadenectomy. • Hepatic flexure and transverse colon have a complex lymphovascular anatomy • Infrapyloric and gastroepiploic node (IGLN) metastases from colon cancer ranges 0.7–22% • IGLN are not considered in current staging system • Indication of IGLN dissection are not considered in current surgical guidelines • IGLN dissection is not standardized • IGLN metastases are associated to advanced disease • Endoscopic obstruction, signet ring adenocarcinoma, CEA level ≥17 ng/ml, and M1 stage are risk factors for IGLN metastases [ABSTRACT FROM AUTHOR]

The optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. This study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. Baseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786–3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530–2.952, p = 0.609). The oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer. ● Optimal surgical approach for distal transverse colon cancer has not been well established ● Left colectomy for descending colon cancer was demonstrated oncological safety ● The oncologic outcomes of left colectomy for the distal transverse colon were comparable ● Left colectomy can be an acceptable surgical treatment for distal transverse colon cancer. [ABSTRACT FROM AUTHOR]

Colonic volvulus is an uncommon surgical condition that occurs due to a twisting around the mesenteric axis, which results in partial or complete reduction in intestinal transit. The sigmoid colon is the most commonly affected segment. We report a rare case of acute abdomen caused by transverse colon volvulus, associated with intestinal obstruction. Abdominal computed tomography showed significant distension and air-fluid levels in the ascending and transverse colons, with loop interposition between the liver and right hemidiaphragm (Chilaiditi's sign). The patient underwent exploratory laparotomy with extended right colectomy and side-to-side ileocolic anastomosis. The postoperative period was uneventful. Diagnosis of this condition is not always easy, and in most cases a definitive diagnosis is made intraoperatively. [ABSTRACT FROM AUTHOR]

Minimally invasive esophagectomy has emerged as the established standard for treating esophageal cancer. The gastric graft is usually placed in the posterior mediastinum or the retrosternal tunnel for reconstruction. Hiatal hernia occurrence is more common in the posterior mediastinal reconstruction and is more frequently observed in laparoscopic compared to open approach. On the other hand, retrosternal hernia is a rare complication that deserves greater attention, considering the increasing popularity of retrosternal reconstruction in esophageal cancer treatment. We present the case of a 55-year-old male patient who underwent minimally invasive esophagectomy with retrosternal reconstruction using gastric conduit and cervical anastomosis. After four years, the patient experienced symptoms, including dyspnea and chest pain. CT scan revealed transverse colon herniation into the retrosternal tunnel. Our diagnosis was retrosternal herniation of the transverse colon. Although there was no sign of obstruction, the abundant colon in the retrosternal space caused mass effect symptoms. For that reason, we performed laparoscopic surgery to release the herniated organ and close the hernia hole. Postoperatively, the patient had a satisfactory recovery, and a follow-up CT scan confirmed the absence of any remaining herniated organs. While hiatal hernia is a well-known complication in minimally invasive esophagectomy, retrosternal hernia is a lesser-known entity. Surgical intervention is necessary to alleviate symptoms caused by herniation or address complications such as strangulation. The occurrence of retrosternal hernia warrants further attention and research in the future. • Retrosternal hernia is a rare but specific complication after esophagectomy. • Retrosternal hernia can cause mass effects, which require reoperation to repair. • Laparoscopy has the advantages of being less invasive and effective in mobilizing the abundant colon. [ABSTRACT FROM AUTHOR]

Congenital Diaphragmatic Hernia (CDH), usually presents in the childhood period. It presents as an idiopathic human malformation. It is a condition, where the organs of the abdomen enter the thorax due to a defect in the diaphragm, that is, herniation from the pleuroperitoneal fistula. Morgagni hernias are commonly incidentally diagnosed on a chest radiograph or a patient may have cardiorespiratory or abdominal symptoms. Repair of hernia without the use of mesh is advised in asymptomatic cases also due to feared complications like strangulation and incarceration. The treatment of Morgagni Hernia is primary surgical repair which can be done either transthoracically or transabdominally. It is advised that, surgical repair should be done even in asymptomatic cases. The present case report is about a 66-year-old female patient with a right-sided Morgagni hernia, who presented with abdominal pain and vomiting. Since the patient was symptomatic, surgical approach was preferred and she underwent laparoscopic abdominal surgery which was converted to open abdominal approach. Postoperatively, the patient recovered from her symptoms and had no complications. [ABSTRACT FROM AUTHOR]

Abstract Background Transverse colon volvulus is an uncommon cause of bowel obstruction. The total number of cases reported in the literature is 100. It constitutes a surgical emergency since it can lead to bowel infarction, peritonitis, and death if not diagnosed at once. It seemed appropriate to report this case that was treated at the Department of Visceral Surgery A, University Hospital Center Hassan II of Fez in Morocco. Case presentation We report a rare case of transverse colon volvulus in a 42-year-old Arabic man, with no particular history, who presented to our emergency department with a 5-day history of constipation, progressive abdominal pain, nausea, and vomiting. His last bowel movement had been 3 days ago. Abdominal radiography showed a large bowel obstruction with a “U-shaped” loop in the left upper abdomen. Abdominal computed tomography was not performed because of impaired renal function. He was operated on urgently after conditioning and the diagnosis of a transverse colon volvulus was done intraoperatively. Rotated in a 360° clockwise direction on its mesentery, the bowel was intact without signs of ischemia. An extended right hemicolectomy was carried out with end-to-side ileocolic anastomosis. Through this case, we will try to discuss its physiopathology, etiologies, diagnosis, and management in emergencies. Conclusion This case is unusual because no etiological factor has been found. Its diagnosis can be difficult and management effectiveness remains controversial. It is important to highlight this case and those of the literature, as many surgeons may have never seen a case of transverse colon volvulus. Volvulus of the transverse colon may therefore not be considered in the differential diagnosis of recurrent intermittent abdominal pain or acute intestinal obstruction. Prompt recognition with emergency intervention constitutes the key to a successful outcome.

Aim: The optimal surgical method for cancer of the mid‐transverse colon has not been well established. The present study aimed to explore the distribution of lymph node metastasis and compare the outcomes of extended and transverse colectomies for cancer of the mid‐transverse colon. Methods: We retrospectively analysed the data of patients with cancer of the mid‐transverse colon treated with either an extended hemicolectomy (right or left) or a transverse colectomy. A propensity score matching analysis was performed to rule out selection bias, and short‐term and survival outcomes were compared. The distribution of lymph node metastasis was also investigated. Results: A total of 107 patients were included, 70 of whom underwent an extended colectomy while 37 underwent a transverse colectomy. There were no significant differences in the operation time, postoperative complications, hospital stay, 3‐year disease‐free survival (86.5% vs. 90.9%, P = 0.675) and 5‐year overall survival (87.4% vs. 93.0%, P = 0.349) between the two groups after propensity score matching. However, metastases were observed in the lymph nodes along the right colic artery (pericolic [#211], 14.0%; intermediate [#212], 8.2%; apical [#213], 9.8%) in the extended colectomy group. Conclusion: Extended and transverse colectomies showed similar short‐term and long‐term outcomes for mid‐transverse colon cancer. However, care should be taken to determine the extent of resection considering the possibility of metastatic lymph nodes along the right colic artery. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the human gastrointestinal tract. They usually develop in the stomach and small intestine, but extremely rarely in the colon. Although most GISTs form a mass, some cases showing a flatly proliferating lesion called planar-type GIST have been reported in the sigmoid colon and small intestine. Those are often associated with diverticular lesion and/or perforation. We present here a case of planar-type GIST of the transverse colon with perforation. A 49-year-old Japanese woman abruptly complained of abdominal pain, and was clinically diagnosed as perforation of the transverse colon. Partial resection of the transverse colon including the perforated site was done, and no apparent mass lesion was present. Histology showed that spindle cells flatly proliferated around the perforated area and replaced the layers from submucosa to subserosa. Immunohistochemistry revealed that the spindle cells were KIT-, DOG1- and CD34-positive. Codons 557 and 558 of exon 11 of the c-kit gene were heterozygously deleted at the lesional tissue but not at the normal mucosal tissue. Planar-type GIST of the transverse colon has not been reported yet, and the literature search for the similar cases was done. [ABSTRACT FROM AUTHOR]

Purpose: Studies on unresectable colorectal cancer liver metastasis(CRLM) rarely analyze the prognosis of the patients from the point of colonic subsites. We aimed to evaluate the effect of primary tumor resection (PTR) and different scope of colectomy on the prognosis of patients with unresectable transverse colon cancer liver metastasis (UTCLM), hepatic flexure cancer liver metastasis (UHFLM), and splenic flexure cancer liver metastasis (USFLM).Patients and Methods: The patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. Cox proportional hazards regression models were used to identify prognostic factors of overall survival (OS) and cause-specific survival (CSS). Kaplan-Meier analyses and log-rank tests were conducted to assess the effectiveness of PTR on survival.Results: In total, this study included a cohort of 1960 patients: 556 cases of UHFLM, 1008 cases of UTCLM, and 396 cases of USFLM. The median survival time of whole patients was 11.0 months, ranging from 7.0 months for UHFLM patients to 15.0 months for USFLM patients. USFLM patients had the best OS and CSS, followed by UTCLM patients. UHFLM patients had the worst OS and CSS (All P < 0.001). PTR could improve the OS and CSS of UTCLM, UHFLM, and USFLM (All P < 0.001). Subgroups analysis revealed that USFLM patients with tumor size≤5 cm and negative CEA had not demonstrated an improved OS and CSS after PTR. Multivariate analysis showed that PTR and perioperative chemotherapy were common independent prognostic factors for UHFLM, UTCLM, and USFLM patients. There was no difference between segmental colon resection and larger colon resection on CSS of UHFLM, UTCLM, and USFLM patients.Conclusions: We confirmed the different survival of patients with UTCLM, UHFLM, and USFLM, and for the first time, we proved that PTR could provide survival benefits for patients with unresectable CRLM from the perspective of colonic subsites of transverse colon, hepatic flexure, and splenic flexure. Besides, PTR may not improve the prognosis of USFLM patients with CEA- negative or tumor size≤5 cm. For oncologic outcomes, we concluded that segmental colon resection seemed an effective surgical procedure for UTCLM, UHFLM, and USFLM. [ABSTRACT FROM AUTHOR]

Background: Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy.Case Presentation: A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months' duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy.Conclusions: Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention. [ABSTRACT FROM AUTHOR]

Objective: Mid‐transverse colon cancers are uncommon. The optimum operative strategy, whether extended colectomy or limited transverse colectomy, is not well established. Herein we share our local experience. Methodology: Consecutive patients with mid‐transverse colon cancer resection from January 2000 to January 2020 were identified from electronic records. Short‐ and long‐term outcomes were analyzed. Additional propensity‐score matching adjusted for potential treatment selection bias. Results: A total of 107 patients were analyzed. 23 patients (21.5%) underwent transverse colectomy (TC) and 84 (78.5%) underwent extended colectomy (EC) of which 68 were extended right hemicolectomy. 53% of all operations were laparoscopic. Similar postoperative complication rate, postoperative length of stay and 30 day mortality rate were found. Although fewer lymph node (median 11 vs 19, P <.01) and shorter closest axial margin (3.8 vs 5.5 cm, P <.01) were achieved in the TC group, similar 5‐years overall survival, and 1‐year disease‐free survival were found. Subgroup analysis revealed a trend of poorer survival amongst stage III/IV patients with transverse colectomy. Conclusions: Our study verifies the feasibility and safety of transverse colectomy for mid‐transverse colon cancers. Attention should focus on achieving adequate margin length and nodal yield. [ABSTRACT FROM AUTHOR]

Objectives: Colon cancer emerges as a serious health problem in both men and women. Cancers in the colon have different genotypes and phenotypes according to the anatomical region. Tumors in ascending colon are usually diagnosed later, but it is more malignant than the descending and transverse colon, and the survival rates of patients are lower than other regions. The purpose of this study was to determine significantly high or low expressed genes in the ascending colon tumors by comparing all genome information obtained from cancer samples of ascending, transverse and descending colon. In concordance with all this information, another aim of the study was to identify the pathways to which the genes obtained from the colon in the large intestine and to determine their relationship with each other and to correlate them with the characteristics of cancer. Methods: Gene expression values for three subtypes of colon cancer as ascending, transverse, and descending were obtained from GEO (Gene Expression Omnibus) (GSE41258). Data included a total of 47 ascending, 18 transverse and 31 descending colon cancer patient samples. Linear regression analysis was performed to determine differentially expressed genes. Gene Cluster 3.0 was used in order to cluster the genes hierarchically. In addition to linear regression and hierarchical clustering, network analysis with multivariable genes was performed in Cytoscape application 3.8.2 using GeneMANIA. GSEA 4.1.0 (Gene Set Enrichment Analysis) was performed to understand the different genes among the specified groups. Results: As a result of these analyses, it was determined that there were 85 genes with high expression and 139 genes with low expression in the ascending colon tumor samples. It has been shown that these genes can differentiate tumor samples in the ascending colon better than tumor samples in other colon regions. Conclusion: Our findings are important for understanding the genome of ascending colon tumors; if these findings are confirmed in vitro and clinically, it may have potential to be revealed that the identified genes also have biomarker properties for tumors in the ascending colon. [ABSTRACT FROM AUTHOR]

Aim: There is no consensus on the appropriate extent of oncological resection for tumours of the transverse colon. Concerns regarding tumour factors such as pattern of lymph node spread and technical factors such as anastomotic perfusion lead to a variety of procedures being performed. Methods: A comprehensive search for published studies examining outcomes following segmental versus extended colectomy for transverse colon tumours was performed adhering to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta‐analyses) guidelines. Random effects methods were used to combine data. Results: Seven comparative series examining outcomes in 3395 patients were identified. Segmental colectomy results in shorter operating times (mean difference 15.80 min, 95% CI −20.98 to −10.62, P < 0.001) and less ileus (OR 0.52, 95% CI 0.33–0.81, P = 0.004). There was no difference in length of hospital stay (mean difference 1.53 days, 95% CI −3.79 to 0.73, P = 0.18). Extended colectomy results in a lower rate of anastomotic leak (OR 0.62, 95% CI 0.40–0.97, P = 0.04). There are fewer nodes retrieved in segmental colectomy (mean difference 7.60 nodes, 95% CI −9.60 to −5.61, P < 0.001) but no difference in disease recurrence (OR 0.88, 95% CI 0.59–1.34, P = 0.56) or overall survival (OR 0.98, 95% CI 0.68–1.4, P = 0.9). Conclusions: Available data are limited due to a lack of randomized controlled trials. However, based on current evidence, segmental resection for transverse colon tumours is associated with less ileus but lower lymph node yields and higher anastomotic leak rates. Length of stay is similar. Oncological outcomes are equivalent. [ABSTRACT FROM AUTHOR]

Acute pericarditis is a serious and potentially fatal disease in which a diagnostic workup is not always straightforward. Hiatal hernia, on the other hand, is often asymptomatic and can be easily diagnosed if symptomatic. In advanced forms of hiatal hernia, oppression of intrathoracic organs and heart failure can occur. In uncommon cases, the large intestine can also be translocated into the chest cavity, and very rarely, it can be perforated with the development of mediastinitis and/or pericarditis. We report the case of a 74-year-old female with a 1.5-month history of chest pain with elevated inflammatory markers. This patient was empirically treated with antibiotics for suspected pneumonia. After a few weeks, due to a worsening of the patient's condition, an echocardiogram and then a CT of the chest were performed, showing a large hiatal hernia and a very probable purulent pericarditis, necessitating a surgical exploration. A cardiac surgeon found stercoral contents in the pericardium, with a fistula at the apex of the heart. The operation continued with an exploration of the abdominal cavity; the general surgeon returned the massive hiatal hernia to the abdomen, the contents of which were the stomach and transverse colon. An extensive perforation in the transverse colon was found. Lavage, drainage, and resection of the affected part of the intestine were performed, and a permanent (terminal) colostomy was constructed. The patient was in severe septic shock with multiorgan failure and died 10 hours after surgery despite maximal therapy. This case highlights the importance of interdisciplinary cooperation and the importance of considering the possible fistula in the co-occurrence of hiatal hernia and pericarditis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Branny et al.)

Diverticular disease is a condition that ranges from asymptomatic disease to severe complications, such as abscesses, fistulas, and perforations. It is prevalent in Western countries, with up to 60% of people aged 60 having diverticula. In Asian countries, the prevalence is lower, ranging from 13 to 25%. Diverticulitis can occur in any location of the diverticula, with increasing incidence with age. Complications occur in 12% of patients with diverticulitis, with phlegmon or abscesses being the most common. Perforation is a life-threatening complication with a 1-year mortality rate of 20%. Recent studies suggest that chronic inflammation and alteration of the gut microbiome may play a role in diverticulitis, leading to a less aggressive and conservative approach to treatment. Even though diverticular disease represents a very common clinical entity, diverticula located in the transverse colon it is an extremely rare presentation. We present the case of a 39-year-old female with a history of multiple medical conditions who presented to the Emergency Room (ER) with severe diffuse abdominal pain predominantly in the right lower quadrant associated with shortness of breath. Upon physical examination, she was found to have severe pain, bilateral rhonchi, and a diffusely tender abdomen with guarding without rebound tenderness. Lab analysis showed leukocytosis, and a CT scan of the abdomen and pelvis revealed acute transverse diverticulitis which was treated medically., Competing Interests: Conflicts of interest: There is no conflict of interest., (© 2024 Greater Baltimore Medical Center.)

Background and Objectives: Complete mesocolon excision and high vascular ligation have become a standard procedure in the treatment of colon cancer. The transverse colon has certain embryological and anatomical particularities which require special attention in case of oncological surgeries. Proximal transverse colon cancer (TCC) can metastasize to the lymph nodes in the gastrocolic ligament. The aim of this study is to assess the tumor involvement of these lymph nodes and to determine the applicability of gastrocolic ligament lymph nodes dissection as the standard approach for proximal transverse colon cancer. Materials and Methods: this study analyzes the cases of patients admitted to the Surgery Department, diagnosed with proximal transverse colon cancer, with tumor invasion ≥ T2 and for which complete mesocolon excision with high vascular ligation and lymphadenectomy of the gastrocolic ligament (No. 204, 206, 214v) were performed. Results: A total of 43 cases operated during 2015–2020 were included in the study. The median total number of retrieved central lymph nodes was 23 (range, 12–38), that had tumor involvement in 22 cases (51.2%). Gastrocolic ligament tumor involvement was found in 5 cases (11.6%). The median operation time was 180 min, while the median blood loss was 115 mL (range 0–210). The median time of hospitalization was 6 days (range, 5–11). Grade IIIA in the Clavien-Dindo classification was noticed in 3 patients, with no mortality. Upon Kaplan–Meier analysis, tumors > T3 (p < 0.016) and lymph node ratio < 0.05 (p < 0.025) were statistically significant. Conclusions: lymph node dissection of the gastrocolic ligament in patients with advanced proximal transverse colon cancer may improve the oncological outcome in T3/T4 tumors, and therefore standardization could be feasible

Malakoplakia is a rare chronic granulomatous disease that may affect many organs, including the lung, brain, adrenal glands, pancreas, bone, and the genitourinary tract. The gastrointestinal tract is the most common site of involvement outside of the urinary tract. Herein, we present a case of a 65-year-old male who presented with abdominal pain and unintentional weight loss. Physical examination findings were unremarkable, but colonoscopy revealed an isolated large, flat, soft, and pale lesion in the transverse colon. Histopathological examination of the lesion showed expansion of the lamina propria due to numerous lymphocytes, plasma cells, neutrophils, and polygonal cells. Von Kossa stain showed small intracytoplasmic basophilic granular inclusions, and these histiocyte cells showed numerous Michaelis-Gutmann bodies, findings considered as diagnostic features of colonic malakoplakia. This is a rare case of isolated malakoplakia of the transverse colon diagnosed on endoscopic specimens. The majority of reported cases have shown an association between systemic diseases and colorectal adenocarcinoma. In addition, most reported cases of colonic involvement have been in the rectum, sigmoid, and right colon.

Presence of kinked transverse colon is not a very common phenomenon. Its presence may not cause physiological disturbance. However, at times when it requires endoscopy, the abrupt looped course of the transverse colon might set a risk of entrapment of the device, which in turn might lead to severe complications and undue discomfort to the patient. An idiopathic kink in the transverse colon of an adult male cadaver was noted and its morphometric and histopathological analysis was performed. The exact location and gross morphometric measurements of the kinks in the transverse colon was recorded. Small pieces of the colon at the regions of kinks were removed, processed, and stained with Haemetoxylin and Eosin, Alcian Blue- Periodic Acid Schiff (PAS) stain and Masson Trichrome stain for histopathological examination. Transverse colon presented with an abrupt loop towards its splenic end by the presence of proximal and distal kinks. Histopathological features of the mucosa at the areas of kink showed foci of surface erosions composed of parallelly placed tubular glands lined by columnar cells, interspersed by goblet cells. Submucosa was oedematous with few congested vessels. Presence of such unusual kink and the loop together may be the cause for forceful forward push of the device introduced into it during colonoscopy and might result in the damage of its mucosa.

Transverse colon volvulus is rare among the colonic volvulus, usually presented as a surgical emergency at the second and third decades of life. We present a rare case of transverse colon volvulus in a 27-year-old man who complains of sudden onset of generalised abdominal pain and distension associated with bilious vomiting for three days. On examination, the abdomen is distended and tender on palpation. Chest radiography showed Chilaiditi's sign and non-specific "coffee bean" sign on the abdominal radiography. Computed Tomography (CT) scan of the abdomen suggestive of transverse colon volvulus. Emergency laparotomy with transverse colectomy was performed and we found the transverse colon volvulus twisted along the narrowed transverse mesocolon. Segmental colectomy was our treatment of choice for colonic volvulus because of acute presentation of intestinal obstruction and lower recurrence rate. Colonic endoscopic decompression would have been an alternative initial approach in those who did not present with clinical suspicion of peritonitis, however, this was associated with a higher risk of perforation due to the proximal site of the volvulus and recurrence compared to colopexy or segmental colectomy. [ABSTRACT FROM AUTHOR]

Alterations in complement component 3 (C3) expression has been reported to be linked to several bowel diseases including Crohn's disease, inflammatory bowel disease, and ulcerative colitis; however, the association with constipation has never been investigated. In this study, we aimed to investigate the correlation between C3 regulation and constipation development using a C3 deficiency model. To achieve these, alterations in stool excretion, transverse colon histological structure, and mucin secretion were analyzed in FVB/N‐C3em1Hlee/Korl (C3 knockout, C3 KO) mice with the deletion of 11 nucleotides in exon 2 of the C3 gene. The stool excretion parameters, gastrointestinal transit, and intestine length were remarkably decreased in C3 KO mice compared with wild‐type (WT) mice, although there was no specific change in feeding behavior. Furthermore, C3 KO mice showed a decrease in mucosal and muscle layer thickness, alterations in crypt structure, irregular distribution of goblet cells, and an increase of mucin droplets in the transverse colon. Mucin secretion was suppressed, and they accumulated in the crypts of C3 KO mice. In addition, the constipation phenotypes detected during C3 deficiency were confirmed in FVB/N mice treated with C3 convertase inhibitor (rosmarinic acid (RA)). Similar phenotypes were observed with respect to stool excretion parameters, gastrointestinal transit, intestine length, alterations in crypt structure, and mucin secretion in RA‐treated FVB/N mice. Therefore, the results of the present study provide the first scientific evidence that C3 deficiency may play an important role in the development of constipation phenotypes in C3 KO mice. [ABSTRACT FROM AUTHOR]