Case Studies

Case Study:  Example 1

Patient admitted with abdominal pain, cramps, anorexia, nausea and weight loss. Esophagogastroduodenoscopy and colonoscopy were performed.

EGD findings:  Hemorrhagic gastritis and villous appearing lesion 2nd portion duodenum. Biopsy of lesion confirms adenomatous polyp.

Colonoscopy findings:  Constricting lesion transverse colon near the hepatic flexure, biopsy report confirms adenocarcinoma.

Patient undergoes surgical resection of the colon tumor. Four days later to prevent bowel obstruction, refuses surgical resection of duodenal lesion and chooses endoscopic removal.

Session One:  Patient returns 4 months after colon resection and had an EGD with snare and cautery removal of duodenal lesion.

Adenmontous Polyp Duodenum (Original Lesion)
After Snare Removal

Session Two:  Patient return one month later for snare, cautery and laser vaporization.

Laser Probe vaporization

Session Three:

One month later, residual lesion treated with laser. Residual Lesion

Session Four:

8 weeks later, residule lesion vaporizated with laser. Patient to return in 3-4 months for follow up. Vaporization of residual polyp

Session Five:  Patient return in 4 months for follow up EGD and Colonoscopy. It has bow been one year since original procedure. Area is biopsied and report confirms small intestinal mucosa without significant pathological changes. Colon anastomosis is free of tumor and random biopsies confirm fragments of colonic mucosa without significant pathological changes. Patient will be followed in 6 - 8 months for duodenal lesion and one year for Colon CA.

No residual duodenal lesion is noted.

This small polyp was removed from the descending colon; it is a tubular adenoma.

Case Study:  Example 2

Patient referred for colonoscopy by family physician who performed a screening sigmoidoscopy. Sigmoidoscopy revealed a polyp at 14 cm.

Colonoscopy revealed multiple colonic polyps of the ascending, transverse, descending and sigmoid colon. A large superficially spreading mass was seen at 14 cm. The polyps were successfully removed with snare and cautery and pathology report indicated that all polyps were tubular adenoma's. Biopsy of the mass at 14 cm revealed adenomatous polyp with high grade dysplasia.

Dysplasia is abnormal development of tissue, high grade refers to a high risk condition consistent with cancer or impeding cancer formation.

These results were discussed with the patient and family, surgical removal was recommended. Due to the patient's other medical problems such as diabetes, obesity and debilitating arthritis the decision for endoscopic removal was chosen.

Original Mass

The patient returned 8 weeks later. Several pieces of the mass were removed with snare and cautery. The pathology report indicated histologic features verging upon carcinoma in situ with high grade dysplasia. (Insitu refers to localized, has not invaded surrounding tissue, dysplasia is abnormal development of tissue, high grade refers to high risk condition consistent with cancer or impending cancer formation.)

Once again the patient refused surgery despite strong recommendation for such by the gastroenterologist.

The patient returns in two weeks and more pieces of the mass are removed with snare and cautery. Pathology report indicates adenomatous polyp, tubular type: no evidence of In Situ Adenocarcinoma.

Sigmoidoscopy is repeated one month later, biopsy report indicates benign colonic mucosa with changes consistent with hyperplastic polyp.
One month later, the lesion is treated with laser vaporization.
The patient was to have a repeat colonoscopy 4-6 months following the laser procedure. However, despite physician recommendation the patient did not return.

 

 

Case Study:  Example 3

Patient referred for colonoscopy by family physician because of rectal bleeding.

A total of 4 polyps or lesions were noted throughout the colon, an ulcerated mass at 15 cm with luminal narrowing, a polyp at midportion transverse colon, ascending colon lesions and a small ulcerative lesion in the transverse colon. The transverse colon polyp and the ascending colon lesion were removed with snare and cautery, the flat ulcerated lesions were biopsied. Pathology report confirms that all four lesions are consistent with adenocarcinoma.

The patient is at poor surgical risk due to age and other medical problems. Surgery is refused by patient and family. Laser treatment of the mass at 15 cm for the purpose of palliation will be done to prevent bowel obstruction.

15 cm mass
Ascending colon mass removed in a piecemeal fashion with snare and cautery
Ulcerated lesion transverse colon

 

 

Case Study:  Example 4

Patient referred for colonoscopy for rectal bleeding and guaiac positive stools. A lesion was found at 14 cm, revolving one-third of the colon circumference. The appearance is fairly consistent with carcinoma, biopsy confirms adenocarcinoma and patient schedule for sigmoid colon resection.

Original Mass

Surgery was performed and pathology report indicates moderately differentiated adenocarcinoma with invasion into but not through the muscularis. The patient to have follow up colonoscopy in one year.

Patient is scheduled for colonoscopy after 10 months due to rectal bleeding. Reoccurrence of the tumor is found at the anastomotic junction.

Reoccurring Mass Patient scheduled for Colon Resection.