Proportion of colonic carcinoma in cases presenting with acute intestinal obstruction: a cross sectional study

Background: Acute intestinal obstruction is one of the most common emergencies encountered by the general surgeon in routine practice. Although historically, obstructed hernia has been the most common cause, recent studies have shown that adhesive intestinal obstruction is now the commonest reason. Malignant bowel obstruction is also on the rise especially with the change in dietary habits. This study aims at identifying the proportion of colonic carcinoma in cases presenting with acute intestinal obstruction.Methods: The patients with acute intestinal obstruction which was diagnosed clinically and radiologically were studied. Based on operative and clinical findings along with investigation results, the etiology was identified. The patients having colonic neoplasms were identified and the data was compared with other etiological factors to find out the proportion of colonic carcinoma in the cases.Results: The proportion of colon cancer in patients presenting with acute intestinal obstruction was around 15%. The most common cause was obstructed hernia followed by post-operative adhesions. Males were more commonly affected than females. Most of the cases underwent operative management. The most common age group affected was around 50-60 years.Conclusions: This study confirms that there is a definite rise in the number of cases of colon cancer presenting as acute intestinal obstruction. There is also a skewing of the age at presentation towards younger age groups. Small bowel obstructions were much more common mainly due to adhesions and obstructed herniae.

The Importance of CT Pneumocolon in Detecting Colonic Lesions

Background: Colonic masses are clinically important because some of them are malignant and others have a tendency to become malignant such as polyps. CT pneumocolon may have a role in the evaluation and diagnosis of these masses. Objective: To determine the accuracy of computed tomography (CT) pmeumocolon in the detection of colonic masses compared with colonoscopy. Patients and Methods: A total of 60 patients with colorectal symptoms underwent evaluation for the presence of colorectal neoplasms by using both colonoscopy and CT pneumocolon and a comparison was made between them. Results: On colonoscopy, 10 out of 60 patients were having a negative colonoscopy. The results of colonoscopy of the other 50 patients were as follow; three out of fifty colonoscopies revealed invasive colorectal carcinomas in threse patients. The remaining 47 colonoscopies for 47 patients revealed benign polyps. The sizes of these polyps were as follows; (6 polyps were ˃1 cm in diameter), (17 polyps were 6-9 mm), and (24 polyps were ≤5 mm). CT pneumocolon detected all 3 malignant masses seen and biopsied by colonoscopy, but only (28 single polyps) which according to their size (4 polyps were ≥ 1cm), (11 polyps were 6-9 mm) and (13 polyps ≤5 mm), this gives CT pneumocolon a sensitivity of (63%), specificity of (70%) and accuracy (63%). Conclusion: CT pneumocolon has high sensitivity and specificity for a detection of large-sized masses, but not for small ones. CT pneumocolon may be suitable for investigating patients with symptomatic colorectal masses noninvasively. Keywords: Pneumocolon, colonoscopy, polyp, colonic carcinoma

ANTERIOR ABDOMINAL WALL ABSCESS A RARE PRESENTATION OF LEFT SIDED COLONIC CARCINOMA: A DIAGNOSTIC CHALLENGE FOR A GENERAL SURGEON

Background: The various presentations of carcinoma of the colon are well known. Abscess formation occurs in 0.3 to 0.4% and is the second most common complication of perforated lesions. Perforation and penetration of adjacent organs with intra-abdominal abscess formation as the initial presentation is uncommon. It is difcult to make an accurate diagnosis of abscess formation as the rst evidence of colonic carcinoma preoperatively. A 68 yrs old female who presented to the ED with acute onset of left lower abdominal f Case presentation: ullness, pain and local redness for 15 days. She denied any history of vomiting, fever, anorexia but history of altered bowel habit. Clinically she had a palpable lump (20 x15) cm in left lumber region .The lump was parietal with local raise of temperature , redness and tenderness can be elicited . So our initial impression was parietal wall abscess and we underwent emergency drainage of abscess. She had uneventful recovery and discharged after 2 weeks. She was admitted with similar presentation in previous location 30 days after discharge. Now we investigate thoroughly, a CECT scan of whole abdomen which conrms radio-logically as carcinoma of descending colon with abscess extending into the parietal wall .We underwent an exploratory laparotomy and HPE proven as adenocarcinoma of the colon. Post op she developed SSI which was managed with regular dressing and she was discharged in post-op day 20. We report this case because of an unusual Conclusion: presentation of left sided colonic Ca. The accurate preoperative diagnosis of these conditions extremely complicated because of the fuzzy clinical presentation. The CT scan can diagnose malignancy pre-operatively, even if the denitive diagnosis of colonic perforated neoplasia may be evident only during surgery. So early diagnosis and prompted intervention can save the patient to developed sepsis and to reduce signicantly the morbidity and mortality. The importance is to focus on the differential diagnosis and keep in mind that a colon carcinoma can present with abdominal abscess. Surgeons should be aware of this differential because it is easily ignored pre-operatively.

Interactive Effects of Biosynthesized Nanocomposites and Their Antimicrobial and Cytotoxic Potentials

The present study investigated the biosynthesis of silver (AgNPs), zinc oxide (ZnONPs) and titanium dioxide (TiO2NPs) nanoparticles using Aspergillusoryzae, Aspergillusterreus and Fusariumoxysporum. Nanocomposites (NCs) were successfully synthesized by mixing nanoparticles using a Sonic Vibra-Cell VC/VCX processor. A number of analytical techniques were used to characterize the synthesized biological metal nanoparticles. Several experiments tested biologically synthesized metal nanoparticles and nanocomposites against two types of human pathogenic bacteria, including Gram-positive Staphylococcus aureusand methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative Escherichia coli and Pseudomonasaeruginosa. Additionally, the antitumor activity in HCT-116 cells (colonic carcinoma) was also evaluated. Significant antimicrobial effects of various synthesized forms of nanoparticles and nanocomposites against E. coli and P. aeruginosa bacteria were detected. Various synthesized biogenic forms of nanoparticles and nanocomposite (9.0 to 29 mm in diameter) had high antibacterial activity and high antitumor activity against HCT-116 cells (colonic carcinoma) with IC50 values of 0.7–100 µg/mL. Biosynthesized NPs are considered an alternative to large-scale biosynthesized metallic nanoparticles and nanocomposites, are simple and cost effective, and provide stable nanomaterials.

Entamoeba Histolytica Cohabiting Colonic carcinoma -A rare case report

Endameba histolytic a of the gastrointestinal tract is common in developing countries. There are many cases where colonic amebiasis can mimic colonic carcinoma but amebiasis and coexisting carcinoma is exceedingly rare. We present a case of 43 years old male who presented with abdominal pain, generalized weakness and bleeding per rectum. Endoscopic examination showed superficial ulceration with edematous mucosa in proximal, transverse and ascending colon which was indistinguishable from ulceration and amebomas. Histopathological examination of tissue revealed the coexistence of Endameba trophozoites with adenocarcinoma of colon. The organism was demonstrated by Periodic Acid Schiff’s stain with engulfed red blood cell. Our report is to enhance the awareness that amebiasis is may not only mimic carcinoma but can also coexist with carcinoma. After extensive search of literature, our isolated case report might be under tenth of reported cases. Keywords: Amoebiasis; Endameba histolytic; Carcinoma

The Histological Diagnosis of Colonic Adenocarcinoma by Applying Partial Self Supervised Learning

Background: The cancer of colon is one of the important cause of morbidity and mortality in adults. For the management of colonic carcinoma, the definitive diagnosis depends on the histological examination of biopsy specimens. With the development of whole slide imaging, the convolutional neural networks are being applied to diagnose colonic carcinoma by digital image analysis. Aim: The main aim of the current study is to assess the application of deep learning for the histopathological diagnosis of colonic adenocarcinoma by analysing the digitized pathology images. Materials & Methods: The images of colonic adenocarcinoma and non neoplastic colonic tissue have been acquired from the two datasets. The first dataset contains ten thousand images which were used to train and validate the convolutional neural network (CNN) architecture. From the second dataset (Colorectal Adenocarcinoma Gland (CRAG) Dataset) 40% of the images were used as a train set while 60% of the images were used as test dataset. Two histopathologists also evaluated these images. In this study, three variants of CNN (ResNet-18, ResNet-34 and ResNet-50 ) have been employed to evaluate the images. Results: In the present study, three CNN architectures(ResNet-18, ResNet-30, and ResNet-50) were applied for the classification of digitized images of colonic tissue. The accuracy (93.91%) of ResNet-50 was the highest which is followed by ResNet-30 and ResNet-18 with the accuracy of 93.04% each. Conclusion: Based on the findings of the present study and analysis of previously reported series, the development of computer aided technology to evaluate the surgical specimens for the diagnosis of malignant tumors could provide a significant assistance to pathologists.