Descending colon

The examination was carried out on 178 human foetuses (90 male and 88 female) aged from 72 to 256 days of pregnancy and grouped in monthly age groups. The age of the foetuses was calculated on the basis of clinical data for menstrual age, followed by verification using our own computer method for assessing foetal age [5, 17]. After the abdominal cavity had been opened, in situ measurements were made, using classical anthropometrical methods, of the descending colon and topographical and peri- toneal relations were determined. The results ob- tained, both metrical and descriptive, were statisti- cally analysed with the statistical software package Statistica. The mean values of the characteristics test- ed were interpolated with Lagrange’s method into the central part of the age group to obtain equal intervals between the values of the characteristics in consecutive age groups. This was necessary in order to assess the growth rate of specific characteristics and the differences in growth rate between the sex- es (Table 1).

The sigmoid colon was mobilized in a caudal-to- cranial direction. After preserving the retroperiton- eal tissue, including the hypogastric nerve plexus, ureter, and gonadal vessels, we exposed the root of the IMA clearly and dissected the swollen nodes along the IMA. The LCA was clipped and divided at the origin. Following this, the lateral attachment was dissected, and the descending colon was lat- erally mobilized to the splenic flexure.

The patient was suspected to have NF due to penetra- tion of descending colon cancer. Left hemicolectomy and open drainage of the left femoral region were per- formed (Fig. 2a, b). A microbiological culture of the ab- scess revealed the presence of group C β-Streptococcus, Escherichia coli, Prevotella species, and Corynebacterium species. Histopathological findings showed a tumor with a histological type of well-differentiated adenocarcinoma. The tumor had grown through the serosa (T4a), but there was no metastasis to lymph nodes (N0).

An 87-year-old woman was referred to our hospital in poor general condition (Eastern Cooperative Oncology Group performance status 3) with dyschezia and loss of appetite for the past week. A colonoscopy confirmed an obstructive descending colon cancer that could not be penetrated by the colonoscope (Fig. 1a), and computed tomography revealed an obstructive ileus (Fig. 1b). The patient’s medical history included coronary artery bypass surgery 11 years ago, surgery for dissecting aortic aneurysm 8 years ago, pacemaker implantation for sick sinus syndrome a year ago, chronic renal failure, and type 2 diabetes. Although a colectomy to reduce the ob- struction was required at the earliest possible time, we first placed a colonic stent on the first day of admission

The density of TGF-β type I receptors is significantly in- creased in the descending colon of LS dieted rats specifi- cally on myofibroblasts; indicating that it is TGF- β in conjunction with AT II that provides the trophic stimulus for activation and subsequent collagen production. How- ever, there are also significant levels of TGF- β 1 receptors in the caecum, which are increased under LS diet. The lack of a pericryptal sheath in the caecum as shown by the lack of OB-cadherin and smooth muscle actin and the absence of collagen deposition and ACE production would suggest that TGF- β 1 receptors are not localised to myofibroblasts at this site. The caecum has a much more extensive capil- lary network than the descending colon [2] as shown by the presence of the vascular endothelial adhesion mole-

In all the mutant animals (number of X-Gal-stained samples: mutant, n=37; control, n=48), the ENCCs showed a delay in the gut colonisation, detected from E11.5. At this stage, the control ENCCs migratory front was located at the base of the caecum, although the mutant front was still located in the distal midgut (not shown). At E12.5, chains of control ENCCs had invaded the hindgut, whereas mutant ENCCs had entered the proximal caecum (Fig. 2A,B). At E16.5, control ENCCs had reached the rectum, whereas the ␤ 1-null ENCC migratory front was located in the middle of the hindgut (Fig. 2C,D). Thus, the difference in the distance travelled by control and mutant ENCCs increased with time. This defect did not appear to be just a delay, as the ␤ 1-null ENCCs did not subsequently invade the caudal hindgut, leading to an aganglionosis of the descending colon after birth that resembles the human Hirschsprung’s disease (HSCR) (Passarge, 2002) (Fig. 2E,F). The majority of the new-born mutants had a distended ascending colon and caecum (megacolon) (Fig. 2G,H). In addition, as it has been documented in HSCR, bundles of extrinsic neurons innervated the aganglionic segments (Fig. 2F). These bundles were ␤ -gal + and expressed tyrosine hydroxylase (not shown), revealing their sympathetic neuronal origin. We did not detect any anomaly in the radial location of ENCCs during their progression in the gut, or any delay in the formation of the submucosal plexus in the mutant (not shown). Thus, in contrast to the migration across the longitudinal axis, the loss of ␤ 1 integrins does not affect the radial distribution of ENCCs in the gut.

descending colon cancer (cT4N0M0, stage IIB) in late Octo- ber 2011. During surgery, the tumor was observed to invade the jejunum and pancreas without involving the superior mesenteric artery, superior mesenteric vein, or stomach. The surgical specimen consisted of an irregular mass of tissue, containing a portion of the left colon and the jejunum and the pancreas and the spleen (14 × 9.5 × 7.0 cm) (Figure 3). Curative resection was performed, but severe lymphatic and venous invasion was found pathologically. Histopathology revealed an acinar pattern consisting of cells growing in well- formed acini, and a solid pattern characterized by sheets and cords of cell separated by a thin fibrovascular stroma. A positive periodic acid-Schiff reaction was noted following diastase digestion in the cytoplasm and apical cytoplasmic tips. Immunohistochemically, the tumor cells were diffusely positive for pancytokeratin (AE1/AE3), focally positive for lipase and trypsin, and negative for cytokeratin 7, cytokeratin 20, CDX2, and endocrine markers such as chromogranin, synaptophysin, and CD56. From these morphological and immunohistochemical findings, a final diagnosis was made of moderately differentiated ACC with multiple organ (colon, small bowel, and spleen) involvement (pT3N0M0, stage IIA; Figure 4). No increase was noted in the levels of serum lipase, amylase, or elastase-1 after the operation. Despite an appar- ently curative resection, multiple liver metastases and portal thrombosis were found 8 weeks after surgery (Figure 5). Serum DUPAN-2 was 191 U/L (normal: 0–150 U/L). However, Serum CA19-9, CEA, Span-1, and alpha-fetoprotein (AFP) were within the normal range. Combination chemotherapy with oral S-1 (tegafur, 5-chloro-2,4-dihydroxypyridine, and oteracil potassium in a 1 : 0.4 : 1 molar ratio; 80 mg/body, days 1–14/q3w [3]) and gemcitabine (30 min intravenous injection of 1000 mg/m 2 on days 1 and 8 of each 21-day cycle) was administered. However, the patient died of hepatic failure 14 weeks after surgery, with no effect of chemotherapy observed.

counts revealed thrombocytopenia, neutrophilia, lympho- penia, anemia, microcytosis, and anisocytosis (Table 1). The medical team requested upper digestive endoscopy (Figure 1) and colonoscopy (Figure 2), which verified the presence of ulcer with irregular and raised edges, fibrinonecrotic base, measuring approximately 3 cm in the middle third of the esophagus and 30 cm from the incisors and the mild antrum gastritis, and swollen, irregular, and fibrinous ulcers in the ileocecal valve, descending colon, and all other segments. The lesions were similar to those found in the esophagus, which could suggest the same etiology. It was suggested by the internal medicine team that the diagnosis could be a coin- fection (tuberculosis, cytomegalovirus, and herpes simplex virus disease). The diagnosis of tuberculosis and cytomega- lovirus coinfection of the gastrointestinal tract was confirmed by the histopathological report (Ziehl–Neelsen staining of acid-fast bacilli, CMV intracytoplasmic inclusions in Giemsa staining, and immunohistochemical study with positive la- beling for CMV in cells with clear halos), and some time later, culture with the growth of M. tuberculosis (Figure 3). Treatment was started with an RIPE scheme (rifampicin + isoniazid + pyrazinamide + ethambutol) 4 tablets daily and ganciclovir 350 mg IV for 21 days with a weight gain of 4 kg and clinical and laboratory improvement. He was discharged from the hospital with ART lamivudine, tenofovir, and efa- virenz (TDF + 3TC + EFV) one tablet per day and was re- ferred to a clinical follow-up for tuberculosis and HIV/HCV coinfection monitoring. At the end of the treatment for tu- berculosis and 6 months after ART was restarted, the patient’s viral load was <40 copies/dL and the CD4+ T-cell count was 356 cells/dL, asymptomatic.

Figure 6: Correlations of relaxometry with fecal water content and stool frequency A Fasting T1 relaxometry of descending colon content T1DC plotted against fecal water content measured [r]

A retrospective study by Mukherji A et al on 32(9.9%) young patients with colorectal cancer between ages of 10-25 years treated between January 2000 and December 2006 were studied. In this same period, the total number of colorectal carcinomas registered was 324. The median age of presentation was 21.5 years. The male to female distribution was almost equal, with a slightly higher female predominance. The mean duration of symptoms was 11.7 months. Four-fifths of the cases presented in late stage. Nodal involvement was seen in 38% cases and metastatic disease in 12% cases. Rectum was the most commonly involved site (81%), followed by the sigmoid colon (19% cases) and then the descending colon. Anal canal was also involved in 12% cases. A majority of the patients presented with pain (81%), altered bowel habits (72%) and bleeding per rectum (78%). Most common type of malignancy was the mucinous or mucin secreting adenocarcinoma (31%). cases. Well differentiated adenocarcinoma was seen in 5 patients (16%). Poorly differentiated carcinomas were seen in 3 cases (9%) and moderately differentiated adenocarcinoma was seen in only six (19%) cases(49).

Thirty-eight IBS patients who had constipation- predominant type (C-IBS) or diarrhea-predominant type (D-IBS) according to the Roman III diagnostic criteria [7] were recruited for this study, including 20 PI-IBS patients with a history of acute enteritis and bacillary dysentery within the previous 3 to 12 months (13 men and 7 women, mean age: 49.71 ± 11.20 years) and 18 non-PI-IBS patients (8 men and 10 women, mean age: 40.52 ± 5.20 years). Twenty healthy people served as normal controls (11 men and 9 women, mean age: 43.74 ± 7.20 years) who had no in- testinal symptoms, infections, immune rheumatic diseases, or history of anticoagulant administration. Mucosal speci- mens of each subject were collected from every region of the large intestine (ascending colon, descending colon, and rectum) with biopsy forceps (the same type was used for all sample collection); specimens were preserved in liquid ni- trogen immediately for subsequent RNA extraction and protein assay. The study was carried out with institutional review board approval from Baogang Hospital, the third Affiliated Hospital of Inner Mongolia Medical College. All subjects provided written informed consent for endoscopy for study purposes.

Surgical resection, for rectal gist performed low anterior resection and milles, descending colon GIST per- formed left hemicolectomy was performed for the only treatment. patients have no remained chief complain for several months after surgery and no recurrence has been observed, but one patient post milles with urinary in- continence complaints found and that patients trained to CIC (intermittent catheterization). The prognosis of GIST is aggressive and complete surgical for this reason, enbloc resection without tumor rupture is the treatment modality [2] [8].

2014 showed smaller mass in the left pelvic (64 mm×63 mm), and incomplete lower part of descending colon and connected enteric cavity with air of low abdominal wall, intestinal fistula was suspected; the left thigh became gangre- nous and enlarged lymph nodes in the left groin (Figure 5). The barium examination (Fig- ure 6) of the whole digestive tract showed de- creased gastrointestinal motility and soft tis- sue emphysema of the left thigh. Barium ene- ma showed that the distal part of descending colon was connected with the soft tissue of the left thigh, conforming to the diagnosis of intes- tinal fistula; subcutaneous emphysema of the left thigh. According to the examinations above, the diagnosis of intestinocutaneous fistula was confirmed. And at this moment, the patient still had amounts of fecal effusion, and significantly swollen left thigh and the whole left leg, with red skin and high temperature, and many burs-

The colon is the portion of the intestine that follows the small intestine. It begins with the caecum, location of the appendix, is extended by straight or the ascending colon, the right angle, transverse colon, left corner, descending colon, sigmoid and then continues through the rectum and ends with the anus. It is in the colon that faeces are concentrated after re-absorption of water and salt, and then transported to the rectum, which acts as a reservoir. Continence is provided by a muscle, the anal sphincter. The colorectal cancer (CRC) develops from the cells that line the inner wall of the colon or rectum. It is Caused by mutations (or disorders) of genes. These mutations

After making the connections and attaching the sensors to the rubber colon, a colonoscopy was performed on the training model by an expert colonoscopist. While performing the test, the data were acquired using the data acquisition system. The data were then plotted as shown in Figure 9. The graph, port 1, shows the connections of sensors 1 to 8, and voltage values which indicate that the colonoscope required 75 seconds to pass through the rectum and the sigmoid. It can also be noted that after port 1, port 0 shows voltage values. Sensors 9 to 16 are connected to port 0. This conclusively indicates that the distal end of the colonoscope passed from the descending colon and to the transverse colon in 116 seconds. Figure 9 also shows that port 2 has some voltage values, which shows that the distal end required 49 seconds to pass through the right hepatic flexure and the ascending colon. The voltage data acquired by the data acquisition system, which were decimal values, were converted to 8 bit binary numbers. Eight sensors are connected to each port, namely, port 1, port 2, and port 0. In the above graph, these binary numbers are plotted against corresponding time in seconds. Similarly, during retraction, port 2 indicates voltage values from 4 minutes 7 seconds to 4 minutes 58 seconds. It is followed by port 0, which shows voltage values from 4 minutes 58 seconds to 5 minutes and 48 seconds. After port 0, port 1 shows the presence of the distal end from 5 minutes 48 seconds to 6 minutes 15 seconds. The same information is quantitatively presented in Table 3.

Knotting (compound volvulus) if of 2 types – Ileosigmoid and Ileo – ileal. In ileo – sigmoid, a loop of ileum knots around the base of the sigmoid resulting in gangrene of the sigmoid and the ileal loop. In the ileal form, knots are formed between loops of ileum. Both these are indications for emergency surgery. At surgery, for ileo – sigmoid knotting the gangrenous segment is drawn to the right to expose the left side of the mesentery, mobilise descending colon, sigmoid and upper rectum. The large bowel is divided below recto – sigmoid junction. The proximal ileum is divided above the knot. Ileo – caecal junction is inspected and distal end of involved ileum identified. The ileum is divided between clamps, 5 cm distal to the gangrenous area. Direct ileo – ileal anastomosis is possible when 5-10 cm of ileum is preserved, and is viable. If this is not possible, terminal ileum is closed and an ileo – caecal anastomosis is made.

Knowledge of the topographic relations of the large intestine (caecum and colon) to the body wall is essential to the veterinary surgeon for its clini- cal examination, which includes the techniques of transrectal palpation, laparoscopy, ultrasonogra- phy, and diagnostic laparotomy. The caecum lies in the dorsal part of the right abdominal cavity and extends from the middle of the lumbar region to the pelvic inlet with a free, rounded blind apex which projects caudally from the supraomental recess. The colon consists of the ascending colon, trans- verse colon, and descending colon. The ascending colon, the longest part of the large intestine, has three parts/loops (proximal, spiral, and distal). The proximal loop of the ascending colon (PLAC) runs

The ascending mesocolon, which linked both parts of the distal ansa, was extremely narrow, es- pecially at the opposite end of the flexure that joined both parts (Fig. 1, 3, AM). The ascending mesoco- lon of the distal ansa adhered cranially to the great- er omentum (Fig. 4, black arrow). The smooth distal part of the distal ansa of the ascending colon (Fig. 1, 5, ADC, DP) attached to the initial portion of the descending colon distal to the transverse colon by means of a peritoneal fold, which was 2.3 cm long at its free border (Fig. 1, 4).

A 29 year old Nigerian female banker presented in 2005 at the Lagos State University Teaching Hospital with chronic constipation of 16 years duration which commenced when she was admitted into boarding school. Later, she noticed blood on cleaning the anus and this progressed to frequent loose stools six years prior to referral. She then had up to 10 bowel motions without pus per day. There was associated lower abdominal pain without history of nausea, vomiting or fever. The family history of similar problems was negative. Clinical examination confirmed an undistended soft abdomen, with areas of tenderness that outlined the surface area of ascending, transverse and descending colon. There was no palpable abdominal mass seen. Digital rectal examination did not reveal any suspicious mass or tenderness and the examining finger was not blood stained. A provisional diagnosis of chronic inflammatory bowel disease was made. She was commenced on antibiotics and antidiarrhoeal drugs whilst awaiting the results of investigations. Stool microscopy did not reveal any pathogen whilst a retroviral screening was negative. Barium enema showed numerous granular defects more in the transverse colon, ascending and descending colon, thus suggesting inflammatory bowel disease and Video colonoscopy suggested a non- specific colitis. She was therefore commenced on Salazopyrine and later sulphasalazine (500mgb.d) with a remarkably response and improvement. Two years post treatment and whilst on follow up with maintainance sulphasalazine, her condition remained stable before she was thereafter lost to follow up when she relocated to the United States.

Gut is derived from endoderm. Caecal bud gives rise to caecum and appendix. The ascending colon, right 2/3 of Transverse colon develops from the postarterial segment of the midgut loop. Left 1/3 of the Transverse colon and descending colon is derived from hind gut. Rectum is derived from the dorsal subdivision of the Cloaca. After its formation, the gut undergoes rotation. As a result the caecum and ascending colon come to lie on the right side; Jejunum and ileum lie mainly in the left half of the abdominal cavity.