Background: Transanal drainage tubes (TDT) are commonly used in Japan as alternatives to colonic decompression (ACD) to avoid emergency surgery for malignant colorectal stenosis. Self-expandable metallic stents (SEMS) have been available and increasingly used since 2012. However, few studies have compared SEMS and TDT. Purpose: To compare and clarify the usefulness and safety of TDT and SEMS. Subjects and Methods: TDT and SEMS results were retrospectively compared in patients who underwent ACD for malignant colorectal stenosis (TDT, n=37; SEMS, n=25) at our hospital between January 2006 and September 2016. The primary and secondary endpoints were the clinical and technical success rates, respectively. Patients were divided into two groups based on whether they underwent bridge to surgery (BTS) or palliative surgery. The observation period was the duration of hospitalization for ACD. Results: No significant differences were found between TDT and SEMS in technical (TDT: 86.5%, SEMS: 96.0%) or clinical (TDT: 86.0%, SEMS: 96.2%) success rates. All patients in the SEMS group could resume dietary intake, and their mean ColoRectal Obstruction Scoring System score improved from a pretreatment score of 0.5 to 3.9 after treatment. Analysis of BTS patients showed that 77.8% in the SEMS group were temporarily discharged (P < 0.001). Time to surgery in the SEMS group was significantly longer but duration of hospitalization was not significantly different between groups, suggesting that patients in the SEMS group were discharged sooner after surgery. The incidence of procedural complication between groups did not differ significantly, but perforation was noted only in the TDT group. Conclusion: Safety and usefulness of SEMS were comparable to those of TDT and allowed patients to resume oral ingestion and be temporarily discharged. The short-term outcomes in this study indicate that SEMS could become a first-choice treatment for decompression of malignant colorectal stenosis.
Background Calcific tendinitis of the longus colli muscle is an important condition that causes neck pain. It is sometimes reported in otolaryngology and orthopedics journals, but not in internal medicine journals. If other diseases causing the same symptoms are suspected, invasive methods become necessary for a definitive diagnosis. This study retrospectively examined the clinical background, imaging findings, and treatment course in six patients with calcific tendinitis of the longus colli muscle. Results The patients comprised three men and three women whose ages ranged from 42–77 years. Their chief complaints were neck pain, stiff neck, and pain on swallowing. The primary symptoms were either unilateral or bilateral neck pain. The day after the onset of neck pain, the patients had a stiff neck and pain on swallowing. Computed tomography revealed that the patients had calcification on the anterior caudal side of C1 or C2 or both vertebrae. The symptoms were resolved within 1 to 14 days by the use of nonsteroidal anti-inflammatory drug treatment. Conclusions Calcific tendinitis of the longus colli muscle is a rare condition. However, awareness of this condition and use of computed tomography can easily lead to the correct diagnosis. Internal medicine specialist should also be aware of this condition.