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Journal articles on the topic 'Painless colonoscopy'

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Published: 14 March 2023

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1

Yang, You-Lin, Shan-Shan Li, Xiao-Bing Wang, and Ji-Neng Li. "Painless Colonoscopy." Chinese Medical Journal 131, no. 7 (April 2018): 857–58. http://dx.doi.org/10.4103/0366-6999.228250.

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2

Xu, Xiufang, Dongqiong Ni, Yuping Lu, and Xuan Huang. "Diagnostic application of water exchange colonoscopy: A meta-analysis of randomized controlled trials." Journal of International Medical Research 47, no. 2 (January 11, 2019): 515–27. http://dx.doi.org/10.1177/0300060518819626.

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Background Few well-designed studies have investigated water exchange colonoscopy (WE). We performed a meta-analysis to comprehensively evaluate the clinical utility of WE based on high-quality randomized controlled trials (RCTs) and to compare the impacts of WE, water immersion colonoscopy (WI), and gas-insufflation colonoscopy. Methods We searched the Cochrane Library, MEDLINE, Embase, PubMed, Elsevier, CNKI, VIP, and Wan Fang Data for RCTs on WE. We analyzed the results using fixed- or random-effect models according to the presence of heterogeneity. Publication bias was assessed by funnel plots. Results Thirteen studies were eligible for this meta-analysis. The colonoscopic techniques included WE as the study group, and WI and air- or CO2-insufflation colonoscopy as control groups. WE was significantly superior to the control procedures in terms of adenoma detection rate, proportion of painless unsedated colonoscopy procedures, and cecal intubation rate according to odds ratios. WE was also significantly better in terms of maximal pain score and patient satisfaction score according to mean difference. Conclusions WE can remarkably improve the adenoma detection rate, proportion of painless unsedated colonoscopy procedures, patient satisfaction, and cecal intubation rate, as well as reducing the maximal pain score in patients undergoing colonoscopy.
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Yeung, Chung‐Kwong, Jo LK Cheung, and Biji Sreedhar. "Emerging next‐generation robotic colonoscopy systems towards painless colonoscopy." Journal of Digestive Diseases 20, no. 4 (April 2019): 196–205. http://dx.doi.org/10.1111/1751-2980.12718.

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4

Kim, Hyun Gun. "Painless Colonoscopy: Available Techniques and Instruments." Clinical Endoscopy 49, no. 5 (September 30, 2016): 444–48. http://dx.doi.org/10.5946/ce.2016.132.

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5

Kurahashi, Toshinori, Kazuhiro Kaneko, Hiroaki Ito, Taikan Yamamoto, Yosuke Kumekawa, Meiko Kuwahara, Yutaro Kubota, Takashi Muramoto, and Michio Imawari. "Safe and Painless Insertion in Colonoscopy." Gastrointestinal Endoscopy 63, no. 5 (April 2006): AB220. http://dx.doi.org/10.1016/j.gie.2006.03.553.

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6

Waye, J. D. "The Best Way to Painless Colonoscopy." Endoscopy 34, no. 6 (June 2002): 489–91. http://dx.doi.org/10.1055/s-2002-31994.

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7

Khan, Mubashir H., William Kessler, Mouen Khashab, Viju Deenadayalu, and Douglas Rex. "Toward Painless Colonoscopy: Propofol Plus Carbon Dioxide." Gastrointestinal Endoscopy 61, no. 5 (April 2005): AB230. http://dx.doi.org/10.1016/s0016-5107(05)01257-5.

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8

Wong, James C. H., Kevin K. Yau, Hester Y. S. Cheung, Denis C. T. Wong, Cliff C. Chung, and Michael K. W. Li. "TOWARDS PAINLESS COLONOSCOPY: A RANDOMIZED CONTROLLED TRIAL ON CARBON DIOXIDE-INSUFFLATING COLONOSCOPY." ANZ Journal of Surgery 78, no. 10 (October 2008): 871–74. http://dx.doi.org/10.1111/j.1445-2197.2008.04683.x.

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9

Li, Xuefeng, Feng Liang, and Guifeng Liu. "Applicable observation of butorphanol in painless colonoscopy examination." BIO Web of Conferences 8 (2017): 01044. http://dx.doi.org/10.1051/bioconf/20170801044.

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10

Cosentino, Felice, Emanuele Tumino, Giovanni Rubis Passoni, Elisabetta Morandi, and Alfonso Capria. "Functional Evaluation of the Endotics System, a New Disposable Self-Propelled Robotic Colonoscope: in vitro tests and clinical trial." International Journal of Artificial Organs 32, no. 8 (August 2009): 517–27. http://dx.doi.org/10.1177/039139880903200806.

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Objective Currently, the best method for CRC screening is colonoscopy, which ideally (where possible) is performed under partial or deep sedation. This study aims to evaluate the efficacy of the Endotics System, a new robotic device composed of a workstation and a disposable probe, in performing accurate and well-tolerated colonoscopies. This new system could also be considered a precursor of other innovating vectors for atraumatic locomotion through natural orifices such as the bowel. The flexible probe adapts its shape to the complex contours of the colon, thereby exerting low strenuous forces during its movement. These novel characteristics allow for a painless and safe colonoscopy, thus eliminating all major associated risks such as infection, cardiopulmonary complications and colon perforation. Methods An experimental study was devised to investigate stress pattern differences between traditional and robotic colonoscopy, in which 40 enrolled patients underwent both robotic and standard colonoscopy within the same day. Results The stress pattern related to robotic colonoscopy was 90% lower than that of standard colonoscopy. Additionally, the robotic colonoscopy demonstrated a higher diagnostic accuracy, since, due to the lower insufflation rate, it was able to visualize small polyps and angiodysplasias not seen during the standard colonoscopy. All patients rated the robotic colonoscopy as virtually painless com-pared to the standard colonoscopy, ranking pain and discomfort as 0.9 and 1.1 respectively, on a scale of 0 to 10, versus 6.9 and 6.8 respectively for the standard device. Conclusions The new Endotics System demonstrates efficacy in the diagnosis of colonic pathologies using a procedure nearly completely devoid of pain. Therefore, this system can also be looked upon as the first step toward developing and implementing colonoscopy with atraumatic locomotion through the bowel while maintaining a high level of diagnostic accuracy.
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11

Bianchi, Federico, Gastone Ciuti, Anastasios Koulaouzidis, Alberto Arezzo, Danail Stoyanov, Sebastian Schostek, Calogero Maria Oddo, Arianna Menciassi, and Paolo Dario. "An innovative robotic platform for magnetically-driven painless colonoscopy." Annals of Translational Medicine 5, no. 21 (November 2017): 421. http://dx.doi.org/10.21037/atm.2017.09.15.

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12

Wong, J. C. H., K. K. Yau, H. Y. S. Cheung, D. C. T. Wong, C. C. Chung, and M. K. W. Li. "2 TOWARDS PAINLESS COLONOSCOPY: A DOUBLE BLIND RANDOMIZED CONTROLLED TRIAL ON CARBON DIOXIDE INSUFFLATION COLONOSCOPY." Surgical Practice 11, no. 2 (May 2007): A1. http://dx.doi.org/10.1111/j.1744-1633.2007.00349_2.x.

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13

Bansal, R., H. Ghanta, R. Blue, and R. Sharma. "Anorectal polyp." Acta Gastro Enterologica Belgica 84, no. 2 (June 2021): 387–88. http://dx.doi.org/10.51821/84.2.387.

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A 71-year-old female with hypertension presented with painless rectal bleeding and found to have a soft mass on rectal exam. The colonoscopy revealed a large pedunculated polyp with patchy discoloration arising from the dentate line (Fig. 1). Biopsies of the polyp were obtained.
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Sharma, Shweta, Steven Nicolaides, Ola Niewiadomski, and Amanda Nicoll. "Recurrent haematochezia in an 85-year-old man with hepatocellular carcinoma." BMJ Case Reports 14, no. 1 (January 2021): e238378. http://dx.doi.org/10.1136/bcr-2020-238378.

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An 85-year-old man with Child-Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented to casualty with four days of painless haematochezia with dark blood without haemodynamic compromise. This was in the setting of receiving stereotactic body radiation therapy (SBRT) as treatment for his hepatocellular carcinoma (HCC).He was found to have haemorrhagic radiation colitis which was treated with argon plasma coagulation (APC). Our case demonstrates the importance of considering radiation induced colitis as a cause for painless lower gastrointestinal bleeding in patients with a background of radiation therapy for HCC. Earlier review of the imaging and consideration of this differential could have prevented the need for repeat hospitalisations and would have led to prompt colonoscopy and diagnosis.
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Yang, Yun, Ya-Jie Wang, Hui Liang, Shi-Kun Deng, and Xi-Feng Zhang. "Clinical effects of dezocine plus propofol vs fentanyl plus propofol in painless colonoscopy." World Chinese Journal of Digestology 22, no. 22 (2014): 3340. http://dx.doi.org/10.11569/wcjd.v22.i22.3340.

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Malik, Adnan, Faisal Inayat, Muhammad Hassan Naeem Goraya, Eman Shahzad, and Muhammad Adnan Zaman. "Severe Acute Colonic Diverticular Bleeding: The Efficacy of Rapid Bowel Preparation With 1 L Polyethylene Glycol Ascorbate Solution and Direct Endoscopic Hemoclipping for Successful Hemostasis." Journal of Investigative Medicine High Impact Case Reports 9 (January 2021): 232470962199438. http://dx.doi.org/10.1177/2324709621994383.

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Colonic diverticular bleeding is an established cause of painless acute lower gastrointestinal hemorrhage. Colonoscopy, performed within 24 hours of presentation, is the usual initial diagnostic procedure in such patients. In order to improve the diagnostic and therapeutic yield of urgent colonoscopy, adequate colon cleansing is required in patients with signs and symptoms of ongoing bleeding. We hereby delineate the importance of rapid bowel preparation with a very-low-volume novel 1 L polyethylene glycol ascorbate solution in the setting of acute severe colonic diverticular bleeding. The 1-L regimen may demonstrate similar efficacy to that of traditional higher volume preparations and it can substantially reduce the time for bowel preparation. Therefore, it can be considered for bowel purge when colonoscopy has to be rapidly planned in critical patients. This article further illustrates that the endoscopic technique using epinephrine followed by direct hemoclipping may be added to the armamentarium for acute colonic diverticular hemorrhage as the first treatment, especially in elderly patients with multiple comorbid conditions. While ample evidence surrounding the efficacy of the clipping method persists in the literature, rapid bowel preparation with 1 L polyethylene glycol ascorbate solution’s imperativeness to achieve hemostasis with direct hemoclipping remains elusive.
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17

Yang, Youlin, Shanshan Li, and Shujing Wang. "Tu1008 A Painless and Safe Colonoscopy Without Sedation by Using a 5.9-Mm Endoscope." Gastrointestinal Endoscopy 85, no. 5 (May 2017): AB537—AB538. http://dx.doi.org/10.1016/j.gie.2017.03.1238.

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Yang, Youlin, Shanshan Li, Li Ma, HongYu Xu, Zhibin Ma, Guoyin Shang, and Chang Liu. "Sa2001 PAINLESS COLONOSCOPY: A NEW SMALL CALIBER OVERTUBE COULD IMPROVE THE CECAL INTUBATION RATE OF UNSEDATED COLONOSCOPY WITH 5.9-MM ENDOSCOPE." Gastrointestinal Endoscopy 91, no. 6 (June 2020): AB235—AB236. http://dx.doi.org/10.1016/j.gie.2020.03.1776.

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19

Valdastri, P., G. Ciuti, A. Verbeni, A. Menciassi, P. Dario, A. Arezzo, and M. Morino. "Magnetic air capsule robotic system: proof of concept of a novel approach for painless colonoscopy." Surgical Endoscopy 26, no. 5 (December 17, 2011): 1238–46. http://dx.doi.org/10.1007/s00464-011-2054-x.

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20

He, Tao, Chan Liu, Zhi-Xia Lu, Li-Li Kong, Yan Li, Zhe Xu, Ya-Jing Dong, and Wei Hao. "Effect of wrist-ankle acupuncture on propofol dosage during painless colonoscopy: A randomized controlled prospective study." World Journal of Clinical Cases 10, no. 12 (April 26, 2022): 3764–72. http://dx.doi.org/10.12998/wjcc.v10.i12.3764.

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21

王, 跃振. "Clinical Application of Dexmedetomidine Nasal Drip in Painless Gastroscopy and Colonoscopy Comfort Treatment in the Elderly." Advances in Clinical Medicine 10, no. 11 (2020): 2628–32. http://dx.doi.org/10.12677/acm.2020.1011399.

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22

Li, Xiaoxiao, Xueli Lv, Zhenfei Jiang, Xinrui Nie, Xinghe Wang, Tong Li, Lianyi Zhang, and Su Liu. "Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study." Drug Design, Development and Therapy Volume 14 (August 2020): 3509–18. http://dx.doi.org/10.2147/dddt.s266062.

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23

Perri, Francesco, Angelo Iacobellis, Marco Gentile, Emanuele Tumino, and Angelo Andriulli. "The intelligent, painless, “germ-free” colonoscopy: A Columbus’ egg for increasing population adherence to colorectal cancer screening?" Digestive and Liver Disease 42, no. 12 (December 2010): 839–43. http://dx.doi.org/10.1016/j.dld.2010.06.007.

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24

Zhao, Feng. "Clinical effect of use of Bhutto butorphanol combined with propofol in painless colonoscopy: An analysis of 70 cases." World Chinese Journal of Digestology 21, no. 20 (2013): 1996. http://dx.doi.org/10.11569/wcjd.v21.i20.1996.

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25

Verra, Mauro, Andrea Firrincieli, Marcello Chiurazzi, Andrea Mariani, Giacomo Lo Secco, Edoardo Forcignanò, Anastasios Koulaouzidis, et al. "Robotic-Assisted Colonoscopy Platform with a Magnetically-Actuated Soft-Tethered Capsule." Cancers 12, no. 9 (September 2, 2020): 2485. http://dx.doi.org/10.3390/cancers12092485.

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Background and Aims: Colorectal cancer (CRC) is a major cause of morbidity and mortality worldwide. Despite offering a prime paradigm for screening, CRC screening is often hampered by invasiveness. Endoo is a potentially painless colonoscopy method with an active locomotion tethered capsule offering diagnostic and therapeutic capabilities. Materials and Methods: The Endoo system comprises a soft-tethered capsule, which embeds a permanent magnet controlled by an external robot equipped with a second permanent magnet. Capsule navigation is achieved via closed-loop interaction between the two magnets. Ex-vivo tests were conducted by endoscopy experts and trainees to evaluate the basic key features, usability, and compliance in comparison with conventional colonoscopy (CC) in feasibility and pilot studies. Results: Endoo showed a 100% success rate in operating channel and target approach tests. Progression of the capsule was feasible and repeatable. The magnetic link was lost an average of 1.28 times per complete procedure but was restored in 100% of cases. The peak value of interaction forces was higher in the CC group than the Endoo group (4.12N vs. 1.17N). The cumulative interaction forces over time were higher in the CC group than the Endoo group between the splenic flexure and mid-transverse colon (16.53Ns vs. 1.67Ns, p < 0.001), as well as between the hepatic flexure and cecum (28.77Ns vs. 2.47Ns, p = 0.005). The polyp detection rates were comparable between groups (9.1 ± 0.9% vs. 8.7 ± 0.9%, CC and Endoo respectively, per procedure). Robotic colonoscopies were completed in 67% of the procedures performed with Endoo (53% experts and 100% trainees). Conclusions: Endoo allows smoother navigation than CC and possesses comparable features. Although further research is needed, magnetic capsule colonoscopy demonstrated promising results compared to CC.
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Mohammed Ilyas, Mohammed Iyoob, and Eric Szilagy. "Management of Diverticular Bleeding: Evaluation, Stabilization, Intervention, and Recurrence of Bleeding and Indications for Resection after Control of Bleeding." Clinics in Colon and Rectal Surgery 31, no. 04 (June 22, 2018): 243–50. http://dx.doi.org/10.1055/s-0037-1607963.

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AbstractDiverticular bleeding is the most common cause of lower gastrointestinal bleeding with nearly 200,000 admissions in the United States annually. Less than 5% of patients with diverticulosis present with diverticular bleeding and present usually as painless, intermittent, and large volume of lower gastrointestinal bleeding. Management algorithm for patients presenting with diverticular bleeding includes resuscitation followed by diagnostic evaluation. Colonoscopy is the recommended first-line investigation and helps in identifying the stigmata of recent hemorrhage and endoscopic management of the bleeding. Radionuclide scanning is the most sensitive but least accurate test due to low spatial resolution. Angiography is helpful when patients are actively bleeding and therapeutic interventions are performed with angioembolization. Surgery for diverticular bleeding is necessary when associated with hemodynamic instability and after failed endoscopic or angiographic interventions. When the bleeding site is localized preoperatively, partial colectomy is sufficient, but subtotal colectomy is necessary when localization is not possible preoperatively.
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Grattagliano, Ignazio, Cesare Tosetti, Enzo Ubaldi, and Claudio Cricelli. "Comments to “The intelligent, painless, “germ-free” colonoscopy: A Columbus’ egg for increasing population adherence to colorectal cancer screening?”." Digestive and Liver Disease 43, no. 10 (October 2011): 836–37. http://dx.doi.org/10.1016/j.dld.2011.05.012.

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28

Li, LingXia, DongHua Zhang, Hao Zhang, Ping Jiang, GuangChao Wang, and Ying Yao. "The Effect of Carbohydrate Drinks Before Painless Colonoscopy on Hemodynamic Stability and Comfort of Elderly Patients: A Randomized Controlled Study." Psychosomatic Medicine Research 3, no. 2 (2021): 53. http://dx.doi.org/10.53388/psmr2021-0620-043.

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29

Hegar, Badriul, and Hans A. Buller. "Breath Hydrogen Test in Lactose Malabsorption." Paediatrica Indonesiana 35, no. 7-8 (October 8, 2018): 161–71. http://dx.doi.org/10.14238/pi35.7-8.1995.161-71.

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Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.
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30

Guo, Hong-Ye, and Hai-Yan Zhou. "Intravenous anesthesia with different doses of propofol combined with etomidate for painless colonoscopy in elderly obese patients: Effectiveness and impact on neurocognitive disorders." World Chinese Journal of Digestology 30, no. 17 (September 8, 2022): 756–61. http://dx.doi.org/10.11569/wcjd.v30.i17.756.

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31

Kovács, Márta, Péter Pák, Gábor Pák, and János Fehér. "Screening and surveillance for hereditary polyposis and non-polyposis syndromes with capsule endoscopy." Orvosi Hetilap 149, no. 14 (April 2008): 639–44. http://dx.doi.org/10.1556/oh.2008.28349.

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The hereditary polyposis syndromes and non-polyposis colorectal carcinoma have been considered as scarcely occuring but inheritable dominant autosomal syndromes. The increasing risk of small bowel carcinoma and prevention of obstruction and intussusception have been making frequent and acute surgical interventions inavoidably led to the necessity of screening and surveillance the patients. Earleir the diagnosis of these symptoms was difficult to establish because traditional radiological methods have a low yield for small polyps. Futhermore, small bowel is only partially accessible with traditional endoscopic techniques such as upper endoscopy, colonoscopy and push-enteroscopy. The “wireless” capsule endoscopy has opened the way then for the non-invasive and painless test of the entire small intestine. – Test results have been cumulated to justify the efficiency and safety of capsule endoscopy concerning the syndromes above. This method can be applied safely even consequently to repeatedly performed surgical interventions by low risk of capsule retention. As the results compared of the diagnosed familial adenomatous polyposis and of Peutz–Jeghers syndrome reflect on capsule endoscopy, its diagnostic sensitiveness is stated as significantly higher than the Barium-contrast X-Ray and MR-enterography. Nevertheless, determination of size and localisation of polypus has becoming more problematic when evaluating the test results.
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32

Hasan, M., and Z. Gallinger. "A257 NEW ONSET ULCERATIVE COLITIS IN A PATIENT WITH KNOWN AUTOIMMUNE HEPATITIS TYPE 1." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 134–35. http://dx.doi.org/10.1093/jcag/gwz047.256.

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Abstract Background Elevated transaminases can occur in up to 17 per cent of cases of Inflammatory Bowel Disease (IBD)1, with many cases related to concurrent autoimmune conditions of the liver. Primary Sclerosing Cholangitis (PSC) is the most common autoimmune disease of the liver that is associated with IBD. Other causes of liver inflammation in patients with IBD can include Autoimmune Hepatitis (AIH). Aims We aim to report a case of new onset ulcerative colitis in a patient with autoimmune hepatitis type 1 in the absence of concomitant PSC. Methods Case report and review of literature. Results A 25-year-old male with painless jaundice and was found to have Autoimmune hepatitis type 1 with typical morphological changes, positive Antinuclear antibodies and elevated IgG levels. Histopathological exam of the liver did not show any direct changes to the bile ducts to suggest PSC. The patient was started on steroids and Mycophenolate Mofetil (MMF) and developed new onset diarrhea. Colonoscopy was performed and both endoscopic and pathological findings were suggestive of likely inflammatory bowel disease, although drug induced colitis (MMF) could not be excluded. Conclusions We conclude that there is a link between autoimmune hepatitis with IBD, in absence of concomitant PSC. Funding Agencies None
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Hasan, S., and A. Ilnyckyj. "A119 ACUTE DIVERTICULITIS & CONCURRENT DIVERTICULAR BLEED: A RARE CLINICAL ENTITY." Journal of the Canadian Association of Gastroenterology 5, Supplement_1 (February 21, 2022): 138–39. http://dx.doi.org/10.1093/jcag/gwab049.118.

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Abstract Aims Colonic diverticula are mostly asymptomatic incidental findings on cross sectional imaging or colonoscopy. In the setting of known diverticulosis, complications like diverticulitis and diverticular bleeding occur in only 4% and 1% of patients respectively. It is unusual to see both complications expressed in the same patient and moreover, rare to see them expressed concurrently. We report a case of concurrent diverticulitis with diverticular bleed and expand on the clinical course. Methods Case report Results A 73-year old was diagnosed with sigmoid diverticulitis based on her clinical presentation and an abdominal CT scan. She was discharged home on oral antibiotics but presented a week later with painless rectal bleeding. In view of the ongoing diverticulitis, a colonoscopy was not pursued although it is the typical procedure of choice to manage active gastrointestinal bleeding. A CT scan was recommended as the alternate initial investigation, which revealed active colonic bleeding in the region of the hepatic flexure immediately adjacent to a diverticulum. A subsequent CT angiogram identified the middle colic artery to be the responsible blood supply to the region and embolization coils were deployed within this vessel in an attempt to achieve hemostasis. Despite vascular intervention the patient continued to bleed and resuscitation with blood products was insufficient. A repeat CT scan ruled out any areas of colonic ischemia as well as any further active areas of extravasation. A decision was made to proceed with a total colectomy to provide definitive treatment of the diverticular disease and manage the bleeding. An urgent intraoperative colonoscopy was attempted but quickly abandoned due to suboptimal preparation and ongoing bleeding obscuring the view. The patient underwent a total colectomy with ileorectal anastomosis. On pathology there was extensive diverticulosis of the ascending and the sigmoid colon with diverticulitis and diverticular abscess cavities within the sigmoid colon. Conclusions Diverticulitis and diverticular bleed are thought to be unrelated complications of diverticulosis involving distinct physiologic pathways (Figure 1). Although diverticular bleed may occur in patients with a history of prior diverticulitis, concurrent presentation of these two entities is extremely rare. In addition, diverticular bleed is mostly self-limiting. While endoscopic and vascular embolization are established treatment options, colectomy is rare for the management of diverticular bleeding. We report a rare case of concurrent diverticulitis and lower GI bleeding. The presence of the sigmoid diverticulitis made interventional radiology a relatively safer option over endoscopy, which is the typical first line diagnostic and interventional procedure. Ongoing bleeding led to total colectomy and provided the patient with a definitive cure for her diverticular disease. Funding Agencies None
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Krstic, M. N., J. Martinov, S. N. Krstic, Dj Saranovic, Z. D. Lausevic, T. Milosavljevic, I. Jovanovic, T. Alempijevic, D. Marisavljevic, and P. Pesko. "The role of wireless capsule endoscopy in the evaluation of patients with suspected small bowel bleeding: A single center experience." Acta chirurgica Iugoslavica 54, no. 1 (2007): 25–33. http://dx.doi.org/10.2298/aci0701025k.

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Background: Capsule endoscopy (CE) is a new diagnostic tool for the study of patients with suspected small bowel pathology. The aim of the study was to clarify the usefulness of CE in the group of patients with obscure (overt / occult) gastrointestinal (GI) bleeding. Patients and methods: Thirty patients (14 men, 16 women, mean age 50 years, range 9 -79 years) were enrolled in the study. All of them undergone non-diagnostic esophagogastroduodenoscopy, colonoscopy and barium follow-through of the small bowel. All patients underwent capsule endoscopy. Fourteen patients had overt and sixteen occult bleeding. The single senior endoscopist interpreted CE findings in an unblended manner. Results: CE identified a source of bleeding in 14/30 patients (46,6 %). Lesions identified were: tumors in five pts, vascular lesions, Crohn's disease and Meckel's diverticulum in two pts and fresh bleeding, segmental celiac disease and colonic diverticulosis in one patient each. CE identified a source of bleeding in 9/14 (64,3%) of patients with ongoing overt bleeding and in only 5/16 (31,3%) of patients with occult bleeding. The positive suspicious findings were seen in 6/30 (20%) of patients (2/14 with overt bleeding and 4/16 with occult bleeding. In 3/14 (21,4%) with overt and 7/16 (43,7%) with occult bleeding findings on CE were negative. All patients with negative findings on follow-up remained asymptomatic for one year. Capsule retention because of unsuspected stenosis occurred in a single patient and required surgery, which resolved the problem. Conclusion: CE is an effective diagnostic tool for patients with obscure GI bleeding. It is safe and painless technique which can diagnose the bleeding site beyond the reach of conventional endoscopy. The best candidates for the procedure are those with ongoing and overt bleeding.
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Xu, Qingqin, Hong Tu, Shunju Xiang, Qinghua Tan, and Xiao Wang. "The effect of intravenous infusion on the rapid recovery of elderly patients treated with painless colonoscopy and the value of ultrasonic measurement of the inferior vena cava diameter in guiding intravenous infusion." Annals of Palliative Medicine 10, no. 1 (January 2021): 61–73. http://dx.doi.org/10.21037/apm-20-2217.

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36

Gozdzik, M., and S. Murthy. "A199 SEVERE COLITIS FOLLOWING PELVIC RADIOTHERAPY: CASE REPORT AND REVIEW OF THE LITERATURE." Journal of the Canadian Association of Gastroenterology 4, Supplement_1 (March 1, 2021): 223–24. http://dx.doi.org/10.1093/jcag/gwab002.197.

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Abstract Background Mild-to-moderate proctocolitis is a well-known complication of pelvic radiation therapy, occurring in 43% and 6% of patients following external beam radiotherapy (EBRT) and brachytherapy (BT), respectively. This typically presents as recurrent painless rectal bleeding, diarrhea, urgency, and/or iron-deficiency anemia. Severe ulcerating proctocolitis is a less common complication of pelvic radiotherapy and is rare following BT. We report two cases of severe ulcerating proctocolitis mimicking inflammatory bowel disease (IBD) following pelvic radiotherapy in patients without known IBD, including an elderly male undergoing EBRT, and an elderly female undergoing vaginal vault BT. Aims To describe two cases of severe ulcerating proctocolitis, mimicking IBD, following pelvic radiotherapy. Methods Case descriptions and literature review. Results A 71-year-old male without antecedent gastrointestinal disease developed bloody diarrhea 3 months following EBRT for treatment of prostate cancer. Infectious work-up was negative. Blood work showed anemia and an elevated CRP. CT scan showed distal large bowel inflammation concerning for proctocolitis. Flexible sigmoidoscopy revealed severe proctosigmoiditis with circumferential thickening and nodularity of the mucosa and multiple ulcers. Biopsies showed ulcer tissue with fibrinopurulent exudate. He was treated with systemic corticosteroids and symptoms gradually resolved. Repeat colonoscopy 8 months later showed healed inflammation with scarring and residual radiation proctosigmoiditis. A 74-year-old female without antecedent gastrointestinal disease developed watery diarrhea 2 weeks after initiating low dose vaginal vault BT for treatment of endometrial cancer. Infectious work-up was negative. Blood work showed an elevated CRP and CT scan revealed proctocolitis extending to the descending colon. Flexible sigmoidoscopy revealed severe ulcerating proctosigmoiditis with tram tracks of denuded mucosa. Biopsies showed moderate diffuse chronic active colitis with crypt abscesses and apoptotic bodies. She was treated with systemic corticosteroids followed by infliximab and methotrexate, with mild symptomatic improvement. However, repeat endoscopy revealed persistent severe ulceration. Unfortunately, she developed a sigmoid perforation with pelvic abscess, leading to bacteremia and fungemia, and subsequently passed. Conclusions While rare, severe ulcerating proctocolitis mimicking IBD can occur following pelvic radiotherapy, including BT. The decision to manage these patients as IBD using immunosuppressive therapy should be weighed against the risks of these therapies, considering a patient’s age and underlying health, and in collaboration with a patient’s health care team. Careful assessment for risk factors and pathological findings from biopsy specimens may help in predicting the likelihood of IBD in such patients. Funding Agencies None
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Zeng, Ziwei, Xianrui Wu, Junji Chen, Shuangling Luo, Yujie Hou, and Liang Kang. "Safety and Feasibility of Transanal Endoscopic Surgery for Diffuse Cavernous Hemangioma of the Rectum." Gastroenterology Research and Practice 2019 (June 19, 2019): 1–8. http://dx.doi.org/10.1155/2019/1732340.

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Purpose. To evaluate the safety and feasibility of transanal endoscopic surgery for diffuse cavernous hemangioma of the rectum (DCHR). Methods. All DCHR patients who underwent transanal endoscopic surgery in our hospital between January 2014 and June 2018 were reviewed. Results. A total of 7 patients with a diagnosis of DCHR underwent transanal endoscopic surgery during the study period. Four patients (57.1%) were male, with a mean age at surgery of 34.5±7.7 years, and three patients (42.9%) were female, with a mean age at surgery of 29.9±3.8 years. Recurrent painless rectal bleeding was the main symptom in all patients. The mean age was 32 years old (range 21-54 years). The median duration of symptoms was 10 years (range 1 month-50 years). The level of hemoglobin at admission ranged from 59.0 to 148.0 g/l (mean 106.6 g/l), and the level of mean corpuscular volume (MCV) ranged from 75.1 fl to 93.5 fl (mean 83.7 fl). Colonoscopy, computed tomography (CT), and magnetic resonance imaging (MRI) were important in the diagnosis of DCHR because of their high positive rates and accurate features. All of the lesions are between the anal canal and the descending colon. Two patients could be found with some enlarged serpentine vessels in the cervix, vagina, or corpus cavernosum by MRI. After admission, all the patients underwent transanal endoscopic surgery and four patients had simultaneous loop ileostomy. The mean operative time was 278 min (range 168-400 min). The median amount of intraoperative blood loss was 50 ml (range 10-300 ml). The mean distance from anal verge to anastomosis was 2.2±0.2 cm. The anastomosis was fashioned with a stapler in two patients (28.6%). There were no intraoperative and postoperative complications. All the patients continued to recover well from the surgery, and nobody needed postoperative blood transfusions. Conclusions. The specific diagnosis rate of DCHR is low. Preoperative MRI and CT examination can make a definitive diagnosis and determine the extent of the lesions. DCHR is mostly restricted to the rectum, sigmoid colon, anal wall, and mesorectum. The best treatment for DCHR is complete lesion resection. It is safe and feasible to treat DCHR using transanal endoscopic surgery. Moreover, transanal endoscopic surgery might have a huge potential when used to treat other rectal diseases.
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Upadhyay, Satyam, Anna Sharma, and Prabita Sapkota. "Endoscopic Profile of Children with Colorectal Polyps Attending a Tertiary Centre." Journal of Nepal Paediatric Society 37, no. 2 (February 24, 2018): 134–37. http://dx.doi.org/10.3126/jnps.v37i2.17715.

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Introduction: Polyps are the most common causes of colorectal bleeding in children. This report describes an endoscopic profile of children with colorectal polyps at Nepal Medical College and Teaching Hospital.Materials and Methods: This prospective study was conducted in children who were evaluated for painless lower GI bleed who underwent colonoscopyin Nepal Medical College, Kathmandu, Nepal from November 2014 to May 2017. Patients with age of presentation less than or equal to 18 years and diagnosed endoscopically to have colorectal polyp were included in the study and were followed up till histopathological reports.Results:A total of 35children with colorectal polyps were identified. Twenty-three (65.7%) patients were males and 12 (35.3%) were females, male/ female ratio being 2.1: 1. The mean age of the patients at the time of diagnosis was 5.2 years (±3.7 years), (range 1.3-13.5) years. The duration of bleeding varied from 1 week to 3 years (mean 13 months), and 23 (67.6%) children were symptomatic for more than 12 months. All patients (100%) had painless rectal bleed, eight (23.5%) presented with anaemia and two of them requiring blood transfusion before the procedure (< 7.0 gm/dl),seven (20.5%) patients had blood and mucus in stools, six (17.6%) of them had rectal mass (prolapsed polyp).Conclusion:Juvenile colorectal polyps are the most common cause of painless rectal bleeding in young children. In the majority, these are solitary, occur in the rectosigmoid. Delay in treatment may cause anaemia.Colonoscopic snare polypectomy is a safe therapeutic modality.
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Al-Hussaini, Abdulrahman A., Helen M. Machida, and J. Decker Butzner. "Crohn’s Disease and Cheilitis." Canadian Journal of Gastroenterology 17, no. 7 (2003): 445–47. http://dx.doi.org/10.1155/2003/368754.

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A five-year-old boy presented to his family physician with painless swelling of both lips. One year later he developed abdominal pain, nonbloody diarrhea, weight loss and joint pains. Colonoscopic examination demonstrated patchy erythema, friability and multiple aph-thous ulcers consistent with the appearance of Crohn’s colitis, and treatment with prednisone was initiated. Colonic biopsies displayed a chronic inflammatory cell infiltrate, focal cryptitis and fissure formation. The patient’s lip swelling relapsed on multiple occasions when steroids were tapered, despite minimal intestinal symptoms of Crohn’s disease. The objective of the present report is to alert physicians to this unusual presentation of Crohn’s disease and that cheilitis may run a protracted course.
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40

Vahedi Larijani, Laleh, Maryam Ghasemi, and Hassan Karami. "Adenomatous Polyps in Adolescent Girl and Boy: A Report of Two Cases." Case Reports in Pathology 2016 (2016): 1–3. http://dx.doi.org/10.1155/2016/8256745.

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A polyp is defined as a mass of the mucosal surface that protrudes into the lumen of the gastrointestinal tract. Neoplastic epithelial polyps are classified histologically as either benign adenoma or malignant carcinoma. The colonic polyps that most commonly present in children occur sporadically and individually and are of the juvenile type; they are most frequently associated with painless rectal hemorrhage (which is the most common symptom). Adenomatous polyps are similar to other nontumoral polyps, and it is very rare for children to have symptoms other than rectal bleeding. This report describes two rare cases of polyps in pediatric patients. An 11-year-old girl presented with tubulovillous adenoma and a 13-year-old boy with tubular adenoma; both patients complained of rectal hemorrhage as well as anemia and abdominal pain. Epithelial adenoma is a tumor that is rarely found in adults or children. Colonoscopic perforation and biopsy are mandatory for establishing a definitive diagnosis and avoiding medical mismanagement.
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41

"Towards Painless Colonoscopy." Case Medical Research, September 18, 2019. http://dx.doi.org/10.31525/ct1-nct04093687.

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"Safety and Efficacy of Dexmedetomidine in Painless Colonoscopy." Case Medical Research, March 27, 2019. http://dx.doi.org/10.31525/ct1-nct03892928.

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43

Qi, Xiu-Ru, Jing-Yi Sun, Li-Xin An, Ke Zhang, and Fu-Shan Xue. "Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: study protocol for a prospective, randomized, controlled trial." Trials 23, no. 1 (September 24, 2022). http://dx.doi.org/10.1186/s13063-022-06719-6.

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Abstract Background Oxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy. Methods We will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction. Discussion Propofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy. Trial registration Chinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.
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44

Zhan, Yongtong, Shuqing Liang, Zecheng Yang, Qichen Luo, Shuai Li, Jiamin Li, Zhaojia Liang, and Yalan Li. "Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial." BMC Gastroenterology 22, no. 1 (August 20, 2022). http://dx.doi.org/10.1186/s12876-022-02467-8.

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Abstract Background Painless gastrointestinal endoscopy is widely used for the diagnosis and treatment of digestive diseases. At present, propofol is commonly used to perform painless gastrointestinal endoscopy, but the high dose of propofol often leads to a higher incidence of cardiovascular and respiratory complications. Studies have shown that the application of propofol combined with ketamine in painless gastrointestinal endoscopy is beneficial to reduce the dosage of propofol and the incidence of related complications. Esketamine is dextrorotatory structure of ketamine with a twice as great anesthetic effect as normal ketamine but fewer side effects. We hypothesized that esketamine may reduce the consumption of propofol and to investigate the safety of coadministration during gastrointestinal endoscopy. Methods A total of 260 patients undergoing painless gastrointestinal endoscopy (gastroscope and colonoscopy) were randomly divided into P group (propofol + saline), PK1 group (propofol + esketamine 0.05 mg/kg), PK2 group (propofol + esketamine 0.1 mg/kg), and PK3 group (propofol + esketamine 0.2 mg/kg). Anesthesia was achieved by 1.5 mg/kg propofol with different doses of esketamine. Propofol consumption per minute was recorded. Hemodynamic index, pulse oxygen saturation, operative time, induction time, awakening status, orientation recovery time, adverse events, and Mini-Mental State Examination (MMSE) were also recorded during gastrointestinal endoscopy. Results Propofol consumption per minute was 11.78, 10.56, 10.14, and 9.57 (mg/min) in groups P, PK1, PK2, and PK3, respectively; compared with group P, groups PK2 and PK3 showed a decrease of 13.92% (P = 0.021) and 18.76% (P = 0.000), respectively. In all four groups, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), but not pulse oxygen saturation (SpO2) significantly decreased (P = 0.000) immediately after administration of induction, but there were no significant differences between the groups. The induction time of groups P, PK1, PK2, and PK3 was 68.52 ± 18.394, 64.83 ± 13.543, 62.23 ± 15.197, and 61.35 ± 14.470 s, respectively (P = 0.041). Adverse events and psychotomimetic effects were observed but without significant differences between the groups. Conclusions The combination of 0.2 mg/kg esketamine and propofol was effective and safe in painless gastrointestinal endoscopy as evidenced by less propofol consumption per minute, shorter induction time, and lower incidence of cough and body movement relative to propofol alone. The lack of significant differences in hemodynamic results, anesthesia-related indices, adverse events, and MMSE results showed the safety to apply this combination for painless gastrointestinal endoscopy. Trial registration This study was registered with China Clinical Trial Registration on 07/11/2020 (registration website: chictr.org.cn; registration numbers: ChiCTR https://clinicaltrials.gov/ct2/show/2000039750).
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Hao, Changjuan, Chunsong Kang, Xiaoyan Kang, Zhuanzhuan Yu, Tingting Li, and Jiping Xue. "Primary Borderline Mucinous Testicular Tumor: A Case Report and Literature Review." Frontiers in Oncology 10 (March 9, 2021). http://dx.doi.org/10.3389/fonc.2020.619774.

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Primary mucinous tumors of the testis and paratestis are very rare, with only 29 reported cases detected in a PubMed search. The histopathological characteristics of primary testicular mucinous tumors are similar to their ovarian counterparts, and the diagnosis and naming criteria refer to the criteria for female ovarian mucinous tumors. However, the clinical and imaging features of primary testicular mucinous tumors are poorly understood, and they are thus frequently undiagnosed or misdiagnosed. We present the case of a patient with a primary testicular mucinous tumor. A 52-year-old man presented with a 1-year history of painless enlargement of the left scrotum. Ultrasound examination revealed a cystic mass in the left testis, with viscous fluid areas and calcified spots, irregular solid bulges on the cyst wall, and a small blood supply. Serum alpha-fetoprotein, β-human chorionic gonadotropin, lactate dehydrogenase, renal function, inflammatory markers, and routine urine and blood examinations were all normal. The patient underwent radical resection of the left testis. Postoperative pathology showed a multilocular cystic mass, with the inner wall of the sac lined with mucous columnar epithelial cells, some with mild nuclear atypia, and no interstitial infiltration. The pathological diagnosis was testicular mucinous tumor. Postoperative abdominal and pelvic computed tomography, colonoscopy, and gastroscopy showed no suspicious lesions. The final diagnosis was primary testicular borderline mucinous tumor. The patient underwent postoperative follow-up examinations once a year for 4 years. Serum tumor markers, scrotal ultrasound, abdominal and pelvic computed tomography scans, and colonoscopy and gastroscopy revealed no evidence of metastases or other primary adenocarcinoma. This case highlights the clinical and imaging characteristics of primary testicular mucinous tumors, which might aid their differential diagnosis.
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46

Kurigamba, Gideon K., Vivian V. Akello, Asaph Owamukama, Irene Nanyanga, and Racheal J. Ayikoru. "Solitary Juvenile Polyp at a Rural Ugandan Hospital Presenting with Recurrent Rectal Bleeding." Journal of Surgery & Anesthesia Research, September 30, 2021, 1–3. http://dx.doi.org/10.47363/jsar/2021(2)134.

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Juvenile polyps (JP) are rare but important causes of acute gastrointestinal symptoms in children. They are a recognized cause of painless rectal bleeding in preschool age children and also the most common intraluminal disorder of the colon in children They are often solitary, pedunculated and small in size but may occasionally grow to large sizes or occur in great numbers, as in juvenile polyposis syndrome. Histologically juvenile polyps are similar to inflammatory polyps with irregular dilated glands, lamina propria expansion and granulation tissue expansion. Sporadic juvenile polyps of the colon occur in up to 2 percent of children under the age of 10 years, are usually solitary, and are not associated with an increased cancer risk. The etiology, diagnosis, clinical presentation, and management of these intestinal polyps depend on the type of polyp or polyposis syndrome. A change in bowel habits, abdominal pain, rectal bleeding, rectal prolapse, and even intussusception may be the initial presentation in children. In addition to a careful history, including a detailed family history, a physical examination, contrast studies, and endoscopic examination are vital diagnostic tools. Juvenile polyps may also present with prolapse of the polyp from the anus, abdominal pain due to intussusception or may even be asymptomatic. All such polyps should be removed by colonoscopy or transanal resection
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47

Suzuki, Toshinao, and Satoru Murata. "Hemorrhagic shock due to colonic arteriovenous malformation in late pregnancy: a case report." International Journal of Emergency Medicine 15, no. 1 (May 17, 2022). http://dx.doi.org/10.1186/s12245-022-00424-6.

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Abstract Background Intestinal arteriovenous malformations are difficult to detect because they often present asymptomatically. However, pregnancy increases the hemorrhagic risk of intestinal arteriovenous malformations. This can lead to massive bleeding and hemodynamic instability, threatening the lives of both the mother and fetus. We describe a life-threatening case of hemorrhagic shock due to a colonic intestinal arteriovenous malformation during late pregnancy that was successfully treated through endovascular management. Case presentation A 36-year-old gravida 1, para 1 woman at 35 weeks’ gestation presented with hemodynamic instability and painless hematochezia. The patient had hemorrhagic shock and required massive transfusion. A colonoscopy failed to secure a visual field due to bloody fluid, and endoscopic hemostasis was difficult. Before the bleeding could be controlled, the condition of the fetus continued to deteriorate, showing bradycardia dysrhythmia. Therefore, an emergency cesarean section was performed, which was successful. However, the bleeding did not subside, with the patient’s hemodynamic instability and hematochezia persisting. An angiogram revealed an ascending colonic intestinal arteriovenous malformation, with extravasation of the contrast medium from a branch of the ileocolic artery. Localized blood flow control and hemodynamic stability were achieved via angioembolization. The patient had an uneventful postoperative recovery and was discharged on postoperative day 12. The newborn was admitted to the neonatal intensive care unit. She successfully recovered and was discharged when she was 22 days old. Conclusions We reported a case of colonic intestinal arteriovenous malformation resulting in hemodynamic instability due to hematochezia during late pregnancy, which was successfully treated via angioembolization. Intestinal arteriovenous malformation should be considered as a differential diagnosis in pregnant patients with hemodynamic instability and hematochezia.
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de Almeida Lança, Maria Leticia, Yasmin Rodarte Carvalho, Janete Dias Almeida, and Estela Kaminagakura. "Hidden colon adenocarcinoma diagnosed from mouth metastasis: case report and literature review." World Journal of Surgical Oncology 21, no. 1 (March 10, 2023). http://dx.doi.org/10.1186/s12957-023-02978-y.

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Abstract Background We report an unusual case of metastatic colon adenocarcinoma to the maxilla as an initial clinical sign of the disease, this being the second case reported in the palate. In addition, we show an extensive review of the literature, with clinical cases of adenocarcinoma with metastasis to the mouth. Case presentation An 80-year-old man complained of “swelling on the palate” with a 3-week evolution time. He reported suffering from constipation and high blood pressure. The intraoral examination revealed a pedunculated, red, and painless nodule on the maxillary gingiva. Under the diagnostic hypotheses of squamous cell carcinoma and malignant neoplasm of the salivary gland, an incisional biopsy was performed. Microscopically, the columnar epithelium was observed forming papillary areas, neoplastic cells with prominent nucleoli, hyperchromatic nuclei, atypical mitotic figures, and mucous cells, being positive for CK 20, suggesting the provisional diagnosis of metastatic adenocarcinoma, probably of gastrointestinal origin. The patient was submitted to endoscopy and colonoscopy exams, and a lesion in the sigmoid region of the colon was observed. After a colon biopsy, a moderately differentiated adenocarcinoma was confirmed, establishing the final diagnosis of metastatic neoplasia of colon adenocarcinoma to the oral lesion. The literature review revealed 45 clinical cases of colon adenocarcinoma with metastasis to the oral cavity. To the best of our knowledge, it is the second case on the palate. Conclusions Colon adenocarcinoma with metastasis to the oral cavity is rare but should be included in the differential diagnosis of neoplasms of the oral cavity, even when there are no known primary tumors in some cases, and this may be the first indication of the presence of a tumor.
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Dos Santos, Endreo Alan Pail, Maria Lígia De Arruda Mestieri, Mauren Picada Emanuelli, Laís Fernanda Wojahn, Fabiana Wurster Strey, and Bruno Leite Dos Anjos. "Intrapelvic Intestinal Leiomyoma in a Dog - Diagnostic and Therapeutic Challenges." Acta Scientiae Veterinariae 49 (April 24, 2021). http://dx.doi.org/10.22456/1679-9216.105393.

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Background: Rectal tumors are uncommon in dogs and cats. The clinical signs result from intra- and extraluminal compression. Diagnosis and treatment of rectal tumors are challenging due to their intraplevic location. Owing to considerable bone superposition, computed tomography is the best exam to evaluate the tumor and plan surgery; however, poor availability and high costs may hinder its use. The objective of this case report is to describe the successful use of a combination of diagnostic techniques, namely transrectal ultrasound, transrectal fine-needle aspiration, and colonoscopy, for diagnosis and surgery planning in a case of intrapelvic intestinal leiomyoma in a dog.Case: A 13-year-old female mongrel dog with tenesmus, low stool production, and hematochezia for two months was presented for examination. During this two-month period, a symptomatic treatment was administered, but there was no clinical improvement. In the clinical evaluation revealed a painless mass on the left dorsolateral region, at a depth of around 4 cm, with considerable luminal reduction. Abdominal ultrasound revealed a mass close to the descending colon; however, bone superposition precluded identification of its origin or delimitation of its boundaries. The patient was subjected to transrectal ultrasound imaging, colonoscopy, and cytological examination of fine-needle aspiration biopsy material collected under general anesthesia. The mass was located at the final portion of the descending colon; it was extraluminal, and measured around 7 x 7 cm. The integrity of the intestinal wall was preserved. Next, radiographic examination of the thorax using three projections (ventrodorsal, left lateral, and right lateral) was performed to check for metastases, and no alteration was detected. Cytology suggested presence of leiomyoma. The patient underwent exploratory laparotomy with pubic osteotomy for intrapelvic access. The extraluminal mass was found adhered to the dorsal colorectal surface, whose serosa was compromised. The mass, which occupied around 80 to 90% of the pelvic canal, was completely removed and submitted to histopathological examination, which confirmed presence of proliferative neoplastic mesenchymal cells (intestinal leiomyoma). The patient's clinical picture evolved without intercurrences, and the patient was discharged 40 days after the pubic bone consolidation procedure.Discussion: The occurrence of leiomyomas in the colorectal segment of the intestine is rare in dogs. Neoplasms that develop in such a region of the intestine are usually more frequently found in elderly animals, such as the patient of this report. Leiomyomas are benign (non-invasive) neoplasms with slow growth. Consequently, clinical signs emerge when the mass exhibits a large size, which causes intra- or extraluminal compression, tenesmus, diminished production or absence of defecation, and hematochezia, as observed in the present case. Even though the clinical signs are similar in these cases, they are unspecific; consequently, for reaching a diagnosis, biopsy and histological investigation are required. In spite of the usefulness of these procedures for diagnosis, computed tomography is the exam of choice to investigate neoplasms in intrapelvic intestinal segments because it allows three-dimensional reconstruction of the affected structures and facilitates surgical planning. Unfortunately, computed tomography was not available for this case. Consequently, colonoscopy, transrectal ultrasound, and transrectal fine-needle aspiration biopsy were performed. When combined, these procedures allowed determination of the location, size and type of neoplasm, which were crucial pieces of information for the correct diagnosis and surgical planning, thus contributing for the successful management of the patient.
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