[Pathophysiology] Ischiorectal abscesses typically originate from an infection in a posterior midline anal crypt. The infection subsequently penetrates through the internal sphincter in a dorsocranial direction and extends into the posterior deep space (IIIP), where a primary abscess is formed. A high ischiorectal abscess (IIIHa) is formed when the abscess further extends through the external sphincter at the deeper portion of IIIP, and a low ischiorectal abscess (IIILa) when the shallow portion.
[Operation] The aim of the procedure is to drain both the primary and secondary abscesses. An incision is made in the posterior midline approximately 2cm from the anal verge. The primary abscess is drained first by inserting a forceps into IIIPa. The forceps can then be easily advanced into the secondary abscess in IIIHa or IIILa. A drain is placed through IIIPa into the bottom of the secondary abscess.
[Results] Abscess drainage via IIIP was possible in all cases of IIIH and IIIL. When limited to cases where this operation was the initial drainage procedure, secondary fistula formation was prevented in as much as 15/24 (62.5%) of the cases. Therefore, this operation helps to shorten and straighten the fistula tract formed after drainage of the ischiorectal abscesses.

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Background: In this study, we assessed the long-term outcomes of an implantable central venous access system via the subclavian vein under real-time ultrasonographic guidance in the chest of patients with colorectal cancer.
Material and methods: A central venous access port was placed in the chest in 81 consecutive patients with advanced recurrent colorectal cancer (ARCRC). All patients received modified FOLFOX6 or FOLFIRI regimens, to which bevacizumab was added occasionally. Following dissection of subcutaneous tissue to create a pocket for the port body, puncture of the subclavian vein was completed under real-time ultrasonographic guidance in all patients.
Results: The cumulative follow-up period was 35,705 catheter days. The mean operative time was 30 minutes. The technical success rate was 98.8%. No intraoperative complications occurred in our series. Postoperative complications were observed in 4 patients: post-site infection in 1, thrombosis of superior vena cava in 1, and port inversion in 2, yielding complication rates per 1,000 catheter-days of 0.03, 0.03, 0.06, respectively. Port removal was performed in 1 patient. A second port was placed in 2 patients.
Conclusion: The central venous access system via the subclavian vein under real-time ultrasonographic guidance in the chest is a safe technique. Chest ports can be maintained with excellent long-term outcomes in patients with ARCRC.

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PURPOSE: The aim of this study was to compare the controllability of bowel distension, which makes the operation harder, using two oral solutions for laparoscopic surgery.
METHODS: All eligible patients were prospectively randomized to receive either 180ml of magnesium citrate (MGC) or 2l of polyethylene glycol electrolyte solution (PEG) as mechanical bowel preparation (MBP) for laparoscopic surgery. During the operations, the surgeons evaluated the distension of intestines and marked the each part of them.
RESULTS: Sixty-seven patients, well matched for age, gender, body mass index, clinical history, and diagnosis, were prospectively randomized to receive either MGC or PEG for laparoscopic surgery. Comparing the score of bowel distension between MGC and PEG group showed that MGC controlled bowel distension significantly in each part of intestines except descending and sigmoid colon.
CONCLUSION: MBP with MGC proved to be more effective to make the laparoscopic surgery easy and safe by the controllability of bowel distension.

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Campylobacter colitis is a common type of infectious enteritis. During the two years from January 2007 to December 2008, we have seen 39 cases of campylobacter colitis, and here we report the clinical characteristics. These 39 patients included 24 males and 15 females, with an average age of 35.9 years. There was a peak in the incidence rate during April-May-June. Of all 39 cases, the most common cause was concluded to be from eating chicken meat, involving a total of 7 patients. Most patients presented diarrhea, with sigmoid colonoscopic findings of redness, patchy erythemas, edema and granular mucosa. A total of 9 patients underwent total colonoscopy, and 4 of these showed erosion or ulcer on the ileocecal valve. Of the 39 patients, 30 did not need special treatment and improved spontaneously with conservative treatment, while the other 9 were hospitalized for an average 8.7 days and received specialized treatment. Patient interview, consideration of the clinical conditions, and endoscopic findings are all important for an accurate diagnosis of this disease.

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The efficacy of a cross incision at the rectus muscle fascia and ileostomy rotation for outlet obstruction in restorative proctocolectomy with diverting loop ileostomy for ulcerative colitis was evaluated. Sixty patients with loop ileostomy were randomized into two groups: one with a cross incision at the rectus muscle fascia and the other with a lengthwise incision. The efficacy of ileostomy rotation was then subjected to ongoing study in 29 consecutive patients. The results demonstrate that a cross incision at the stoma tunnel and forced rotation of the mesentery cause disadvantages such as outlet obstruction and were associated with increased complications. We recommend lengthwise incision and simple rotation for diverting a loop ileostomy in restorative proctocolectomy.

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A 67-year-old man underwent colostomy for hematochezia at the age of 19 years. He had several recent episodes of hematochezia for which he underwent colonoscopic examination. Dilated veins in the subcutaneum and mucosal edema were observed at the left side of colon up to the rectum. Abdominal ultrasonography and enhanced computed tomography indicated liver tumor. Mile's operation and liver resection were performed. During the Mile's operation, active bleeding occurred from the colon mesenterium. Pathological diagnosis of diffuse cavernous hemangioma of the colon and hepatocellular carcinoma was made. The patient was discharged after the operation. We report a diffuse cavernous hemangioma case. This is a very rare disorder, and hence, explains the paucity of literature few references.

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A 64-year-old male visited a local hospital with the chief complaints of abdominal pain and diarrhea. Based on colonoscopic examination, he was diagnosed to have type 0-Is+IIc sigmoid colon cancer that had possibly invaded the deep submucosa. The patient was then referred to our hospital for surgery. During initial examination, a colonoscopy revealed only a white ulcer was observed on the sigmoid colon. A biopsy revealed mild atypia of the ulcer. Therefore spontaneous regression of the sigmoid colon cancer was diagnosed. Radical excision was recommended, however an intensive follow-up was instead selected at the patient's request. Four months after the initial presentation to our hospital, colonoscopy showed an irregularly-shaped reddish mucosa beside the ulcer scar with group 5 of the biopsy specimen. A diagnosis of recurrence after spontaneous regression was made, and a laparoscopic sigmoidectomy with D3 lymph node dissection was thus performed. Pathologically, tumor invasion was confined to the mucosal level. In conclusion, this example demonstrates that treatment should be carefully selected for colon cancers that are suspected to have spontaneously cured, because it is difficult to determine the tumor depth and curability when the tumor is no longer present.

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A 54-year-old woman underwent colonoscopy for bloody feces. Colonoscopy confirmed the presence of a tumor in rectum. Tumor biopsy indicated a well differentiated adenocarcinoma. CT of the abdomen showed a wide pelvic abscess formation from the front side of the sacrum to the both side of piliformis muscle. Hartmann's operation and drainage were performed based on a diagnosis of the pelvic abscess induced by rectal cancer resulting in perforation to the mesentery side. The abscess cavity that extended from the front side of the sacrum into both sides of the pelvis wall was included in the surgical finding. CT images demonstrating wide spread pelvic abscess induced by rectal cancer perforation to mesentery side are rare. We report this rare case together with a review of the literature.

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Anal disease is seen with a high frequency in HIV-positive patients. The patient was a 35-year-old male, attending the HIV clinic in our hospital. He was admitted to our hospital with complaint of anal pain, caused by anal fistula. Both the primary opening with anal fissure and secondary opening exhibited exposed condyloma. Fistulectomy was performed, and resected specimen exhibited fistula filled with macroscopic white condyloma. The pathological diagnosis was condyloma acuminatum of the anus. We report a very rare case of anal fistula filled with condyloma acuminatum in HIV positive patient with a review of the literature.

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