Intestinal Research

Rare Diseases of Rectum and Sigmoid Colon: Geun Am Song; Intest Res 2006;4(1):1-6. Published online June 30, 2006

Abstract PDF: The rectum is approximately 10 to 15 cm in length and extends from the sigmoid colon to the anal canal. It contribute to defecation as the rectal walls expand, stretch receptors from the nervous system located in the rectal walls stimulate the desire to defecate. There are some differences between rectum and colon. The rectum is divided into two portion by peritoneal reflection and makes pouch. The pouch is associated with many pathologic conditions, such as rectal shelf in stomach cancer, rectal endometriosis, and spread of pelvic inflammation. The inferior mesenteric arteries and middle, inferior rectal arteries supply the rectum. This dual blood supply system causes different incidence of ischemic inserts and metastatic site in rectum and colon cancer. The function of anal sphincter and rectum in pelvic cavity is significantly important in defecation and its disturbance causes some specific rectal disease. Due to its position, rectum may be injuried by external and internal events and show the initial suggestion of colorectal disease. We describe uncommon specific diseases in rectum classified into inflammatory diseases, functional disease and tumor. (Intestinal Research 2006;4:1-6)

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Calreticulin Expression in Colon Cancer and Adenoma with Western Blot Assay: Bora Keum, Yoon Tae Jeen, Sanghoon Park, Yeon Seok Seo, Yong Sik Kim, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Sang Woo Lee, Jai Hyun Choi, Chang Duck Kim, Ho Sang Ryu; Intest Res 2006;4(1):7-11. Published online June 30, 2006

Abstract PDF: Background/Aims
Colon cancer has a multistep process of molecular changes on the way of carcinogenesis. The detection of gene mutations associated with those molecular changes is expected to be able to predict or diagnose colon cancer. Calreticulin is one of the protein which has being investigated as a biomarker of colorectal cancer. The Aims of this study was to demonstrate the expression of calreticulin in normal colon mucosa, colonic tubular adenoma and colorectal cancer of each patient, and analyze the differences among them. Methods: 8 patients who have colorectal adenocarcinoma and more than 10 mm sized tubular adenoma synchronously were enrolled. Colorectal adenocarcinoma, tubular adenoma and normal colon tissue were taken from each patient. After proteins isolation and separation, western blot assay were performed to demonstrate calreticulin. The results were analyzed by Wilcoxon Signed Rank Test. Results: Calreticulin was more expressed in colorectal adenocarcinoma and tubular adenoma significantly compared with normal mucosa. Also, calreticulin was more expressed in adenocarcinoma than in adenoma but there were no significant diffences. Conclusions: These results suggest that calreticulin may be available for an early diagnostic biomarker for colorectal cancer or advanced colon adenoma. (Intestinal Research 2006;4:7-11)

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Clinical Characteristics and Long-term Course of Ulcerative Colitis in Korea: Young Min Kim, Sang Hyoung Park, Suk-Kyun Yang, Jae-Won Choe, Sai-Hui Kim, Jeong-Sik Byeon, Seung-Jae Myung, Yun Kyung Cho, Chang-Sik Yu, Kwi-Sook Choi, Jun-Won Chung, Benjamin Kim, Kee Don Choi, Jin-Ho Kim; Intest Res 2006;4(1):12-21. Published online June 30, 2006

Abstract PDF: Background/Aims
Clinical characteristics of ulcerative colitis (UC) in Asian populations are not well recognized. We therefore investigated the clinical features and natural history of UC in Korea. Methods: We retrospectively analyzed 304 Korean UC patients first diagnosed at Asan Medical Center between June 1989 and August 2005. Results: The male to female ratio was 0.94：1 and the median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 (22.7%), and extensive colitis in 101 (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 (41.1%), and severe in 26 (8.6%). In addition, 4 (1.3%) asymptomatic patients were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rates at 1, 5, 10 years were 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% at 5 years and 44.5% at 10 years. The cumulative probability of colectomy was 2.0% at 1 year, 2.8% at 3 years, and 3.3% at 5-15 years. The cumulative survival rates at 1, 5, and 10 years were 100%, 99.4%, and 97.4%, respectively. Conclusions: Clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, since Koreans have a lower rate of colectomy. (Intestinal Research 2006;4:12-21)

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The Incidence and Natural History of Perianal Fistulas in Korean Patients with Crohn's Disease: Ja Young Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Seung-Jae Myung, Jae-Won Choe, Ji-Yun Jo, Dong-Hoon Yang, Yun Kyung Cho, Jin-Ho Kim; Intest Res 2006;4(1):22-31. Published online June 30, 2006

Abstract PDF: Background/Aims
We performed this study to investigate the incidence and natural history of perianal fistulas in Korean patients with Crohn's disease (CD). Methods: A total of 546 patients diagnosed with CD at Asan Medical Center were included. Results: Perianal fistulas occurred in 265 patients (48.5%), with 355 episodes. Eighty-two patients (15.0%) initially presented with perianal fistulas in the absence of other symptoms suggestive of CD. Out of 265 patients who developed perianal fistulas, 205 (77.4%) presented with perianal fistulas before, or at the time of, the diagnosis of CD. The cumulative incidence of perianal fistulas at 1, 5, 10, 20 years was 40.7%, 48.2%, 55.3% and 62.1%, respectively. Medical treatment was done in 30.7%, and surgery in 80.8% of perianal fistulas. The remission rate was 23.9% with medical treatment, and 83.6% with surgery. At least 1 recurrent fistula occurred in 77 patients (29.1%). The cumulative recurrence rate of perianal fistulas at 1, 5, 10, 20 years was 10.1%, 26.9%, 42.4% and 68.8%, respectively. Conclusions: The incidence of perianal fistulas in Korean patients with CD appears to be higher than that of Western patients. Also, the proportion of patients who develop perianal fistulas before the diagnosis of CD is very high. Therefore, we should consider the possibility of CD in patients with perianal fistulas to manage them properly, and thereby to reduce there complications. (Intestinal Research 2006;4:22-31)

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Risk Factor of Ischemic Colitis and Usefulness of High-Resolution Ultrasonography: Woon Geon Shin, Cheol Hee Park, Jae One Jung, Joon Ho Moon, Kyoung Oh Kim, Yong Woo Chung, Gwang Ho Baek, Taeho Hahn, Kyo-Sang Yoo, Sang Hoon Park, Jong Hyeok Kim, Sea Hyub Kae, Kwan Seop Lee, Choong Kee Park; Intest Res 2006;4(1):32-38. Published online June 30, 2006

Abstract PDF: Background/Aims
Although the majority of ischemic colitis have excellent prognosis by supportive management, there are a lot of controversies in relation to the prognostic factors. Lately, role of sonography has been emphasized in colonic ischemia. The aim of this study is the identification of the prognostic factors and the usefulness of high-resolution ultrasonography in detecting involved site and severity of ischemic colitis. Methods: The clinical databases were reviewed between April 1999 and March 2004. 60 cases were diagnosed as ischemic colitis. Clinical characteristics, coexisting illness, segment of colon involved, and sonographic finding were analyzed. Results: The poor prognosis group was significantly older than the good prognosis group (p=0.017). The difference in involved colonic segment between the two groups was statistically significant (p=0.001). However, in logistic regression, only right colonic involvement was an independent poor prognostic factor (95% confidence interval, 1.7-46.4; p=0.01). Ultrasonography had a sensitivity of 85% and a specificity of 82%. Conclusions: Only right colonic involvement was an independent poor prognostic factor. Noninvasive high-resolution ultrasonography was a valuable technique for the detection and the follow-up of colonic ischemia. Therefore, sigmoidoscopy and sonography are preferable to heavy going colonoscopy in severe colonic ischemia. (Intestinal Research 2006;4:32-38)

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The Inflamed Appendiceal Orifice does not Always Suggest Acute Appendicitis: Min Huh, Bo-In Lee, Kyu Yong Choi, Kyoung Mee Kim, Jeong Seon Ji, Byung Wook Kim, Hwang Choi, Se Hyun Cho, Woo Chul Chung, Kang Moon Lee, Sok Won Han, In Sik Chung; Intest Res 2006;4(1):39-44. Published online June 30, 2006

Abstract PDF: Background/Aims
Colonoscopy may be helpful in the diagnosis of appendicitis occasionally. However, it is unclear that isolated inflammation at the appendiceal orifice is always suggestive of acute appendicitis. Methods: Eighteen consecutive patients with colonoscopic findings of the isolated inflammatory lesion in the area of the appendiceal orifice were included. Surgical- pathology-proven appendicitis within 6 months after the colonoscopy were defined as 'true-appendicitis'. Results: Of the 18 patients, 16 patients were followed up for more than 6 months. Seven patients underwent appendectomy within 5-79 days after the colonoscopy. Of these, 4 patients (25%) had true-appendicitis, one periappendiceal abscess without appendicitis, two normal appendices. Nine patients did not take appendectomy. Of these, no definite etiology was defined in 6. Of the rest, one patient revealed Crohn's disease, one Behcet's disease and one cecal involvement of distal ulcerative colitis later. Conclusions: Isolated inflammation at the appendiceal orifice does not always suggest acute appendicitis but diverse etiologies. The diagnosis of appendicitis should not be made only by colonoscopic findings but also by clinical course and other imaging studies. (Intestinal Research 2006;4:39-44)

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The Changes of Non-steroidal Anti-inflammatory Drug Induced Gut Damage, Bacterial Overgrowth, Bacterial Translocation and Organ Weights in Rat Model: Eun Jeong Kim, Jeong Wook Kim; Intest Res 2006;4(1):45-52. Published online June 30, 2006

Abstract PDF: Background/Aims
NSAIDs induce gut damage throughout the entire gastrointestinal tract and bacterial translocation. The aim of this study was to exam the change of NSAID induced gut damage, enteric bacterial overgrowth, bacterial translocation and organ weight in the animals. Methods: Rats were utilized in 4 group; control group, diclofenac 60 mg/kg group, diclofenac 120 mg/kg group and diclofenac 60 mg/kg group. Gut injury was induced by oral administration of a single dose of diclofenac. Intestinal permeability (24 hour urinary excretion of pheonolsulfonphthalein), intestinal adhesion and number of stool pallet were measured to evaluate gut injury. Enteric aerobic total and gram negative bacterial counts in distal ileum and cecum were measured to evaluate enteric bacterial overgrowth. Bacterial counts of gram negatives in mesenteric lymph nodes, liver, spleen, kidney and heart were measured to evaluate bacterial translocation. Also, the organ weight change of liver, spleen, kidney and heart was measured. Results: Diclofenac caused the increase in intestinal permeability, intestinal adhesion, enteric bacterial numbers, bacterial translocation to mesenteric lymph nodes, liver, spleen, kidney and heart and hepatomegaly, and the decrease in numbers of stool pellet. Conclusions: Diclofenac induced gut damage, enteric bacterial overgrowth, bacterial translocation and hepatomegaly. (Intestinal Research 2006;4:45-52)

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Recur of Malignant Mixed Mullerian Tumor of the Ovary in Intestine: Ji Eun Lee, Jang Won Sohn, Hee Jung Moon, Sang Hoon Lee, Youn Sun Park, Jae Won Choi, Kook Hyun Kim, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim, Jae Hwang Kim, Mi Jin Kim; Intest Res 2006;4(1):53-56. Published online June 30, 2006

Abstract PDF: Malignant mixed mullerian tumor (MMMT) is rare tumor of the ovary, representing less than 1% of all ovarian malignancies. MMMT is an uncommon tumor containing epithelial and mesenchymal components. Most of all were heterologous type and 80% occur in postmenopausal women. It is a aggressive and rapidly progressive tumor. MMMT is highly malignant and the prognosis is poor because of frequent metastasis and recurrance. The survival rate is very low in spite of surgery, chemotherapy and radiotherapy. The optimal treatment is still controversial. We experienced one recur case of malignant mixed mullerian tumor of the ovary in intestine and report with brief review of literature. (Intestinal Research 2006;4:53-56)

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Positron Emission Tomography Finding of Small Bowel Crohn's Disease: Report of a Case: Youn Sun Park, Kook Hyun Kim, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim; Intest Res 2006;4(1):57-60. Published online June 30, 2006

Abstract PDF: Endoscopic and radiologic studies are frequently required in inflammatory bowel disease to determine disease activity, extent of disease, and delineating type. Positron emission tomography (PET) using fluorine-18-fluoro-deoxyglucose to identify metabolically active tissues may offer a simple noninvasive alternative to conventional studies in identification and localization of active intestinal inflammation with inflammatory bowel disease. Crohn's disease can also be detected by PET-CT. In this case, we discribe a small bowel Crohn's disease with PET-CT finding. There was intensely increased fluorine-18-fluoro-deoxyglucose uptake in terminal ileum area. (Intestinal Research 2006;4:57-60)

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A Case of Ileocolic Intussusception Induced by Mantle Cell Lymphoma: Kum Hei Ryu, Ki-Nam Shim, Hyun Joo Song, Yoon Ju Na, Su Jung Baik, Su Jin Yoon, Hae-Sun Jung, Hye Jung Yeom, Sung-Ae Jung, Tae Hun Kim, Kwon Yoo, Min-Sun Cho; Intest Res 2006;4(1):61-63. Published online June 30, 2006

Abstract PDF: Although the gastrointestinal tract is one of the major sites of primary extranodal malignant lymphoma, the colon and small bowel are less frequently involved than the stomach. Mantle cell lymphoma comprising only 6% of the malignant non-Hodgkin lymphomas. Mantle cell lymphoma usually distributes from the esophagus to rectum, with advanced stages of peripheral lymphadenopathy, splenomegaly, and bone marrow infiltration. We report a case of ileocolic intussusception due to ileal mantle cell lymphoma. (Intestinal Research 2006;4:61-63)

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A Case of Rifampin-induced Severe Thrombocytopenia and Leukopenia in a Patient with Intestinal Tuberculosis: Ji Woong Kim, Gum Mo Jung, Eun Young Cho, Chang Soo Choi, Geom Seog Seo, Jin Woong Cho, Suck Chei Choi, Yong Ho Nah; Intest Res 2006;4(1):64-68. Published online June 30, 2006

Abstract PDF: Drug induced thrombocytopenia is a relatively not uncommon and potentially serious side effect of therapy. It's characterized by thrombocytopenia, petechia, purpuric lesions and occasionally serious bleeding such as intracranial hemorrhage. The patient was 24 year-old female who was given rifampin 600mg daily for treatment of intestinal tuberculosis. Rifampin-induced immune thrombocytopenia was occurred 25 days after initiating therapy. Platelet and leukocyte count were 23,000/mm³, 2,850/mm³,respectively. Two week after discontinuation of antituberculous medication, platelet count was recovered. We report this case with a review of literature. (Intestinal Research 2006;4:64-68)

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Adult Intussusception: Three-dimensional Reconstruction of Computed Tomography: Joon Ho Moon, Cheol Hee Park, Kyoung Oh Kim, Taeho Hahn, Kyo-Sang Yoo, Sang Hoon Park, Jong Hyeok Kim, Choong Kee Park; Intest Res 2006;4(1):69-72. Published online June 30, 2006

Abstract PDF: Intussusceptions in adults are relatively rare. About 70% to 90% of cases have demonstrable etiologies, and 40% of them are caused by malignant neoplasm. Diagnosis may be difficult with conventional diagnostic techniques due to the low incidence and the rare consideration to intussusception in adults. Computed tomography (CT) is now widely used in the evaluation of abdominal mass and nonspecific abdominal pain that may be the first presentation of an intussusception. But, CT is often not successful in determining the specific causes of the intussusception, as the lead point in many cases is small and often hidden within the intussuscepted mass. We report two cases of adult intussusceptions by sigmoid colon cancer with three-dimensional reconstruction of conventional CT. (Intestinal Research 2006;4:69-73)

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