Between 1993 and 1997, 11 patients with rectal carcinoids less than 8 mm in diameter (mean size: 5.5 mm) were endoscopically treated at Tsuboi Hospital. Seven patients were treated by polypectomy or endoscopic mucosal resection. Three of the seven lesions were microscopically diagnosed as having positive submucosal margins. The remaining four showed a distance between the tumor and the resection line(DBTRL) of 0 to 0.33 mm. Then, we attempted endoscopic double snare polypectomy (EDSP) in 1996 and 1997. In four consecutive patients, the tumor was completely resected by this method. The DBTRL ranged from 0.08 to 0.75 mm in four lesions resected by EDSP. With endoscopic resection of these tumors, the incidence of positive margins is high using the conventional single snare methods, even when the lesions are less than 10 mm in diameter. EDSP was useful for total removal of small rectal carcinoids.

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Little is known about the early development of rectal cancer in patients with radiation-induced colitis. We describe two patients with a history of radiation colitis who developed rectal cancer. The macroscopic appearance of these lesions suggested that they arose de novo, but the histologic findings were more consistent with progression along the adenoma-to-carcinoma sequence, a hybrid of de novo lesion and adenoma. Early rectal cancer associated with chronic inflammation should be considered if a nonpolypoid adenomatous lesion is detected in a patient who has received pelvic radiation.

A 64-year-old female was admitted to the hospital with constant abdominal pain. She had been previously hospitalized five times in 2 years with similar symptoms. Computed tomography revealed dilatation and fecal impaction from the ileum to the transverse colon. A barium enema and simultaneous ileus tube radiography demonstrated a segment of narrow descending-sigmoid colon. Colonoscopy did not show any mucosal change. These symptoms did not improve with conservative therapy when a descending and sigmoid colectomy was performed. In terms of histology, there was a disappearance of ganglion cells, and axon of Meissner's plexuses was present along with a decrease in the number of Auerbach's plexuses. The definite diagnosis given was segmental hypoganglionosis (SH) of the colon. The postoperative course was uneventful, and the functional result was positive following 1 year postoperatively. SH is extremely rare; however, surgical intervention is expected to be of benefit. Therefore, it is important to keep SH in mind when treating patients with chronic obstruction in the left side of the colon as it can cause SH.