title: Virtual colonoscopy in stenosing colorectal cancer.
abstract: BACKGROUND
  Between 5 and 10% of the patients undergoing a colonoscopy cannot have a complete procedure mainly due to stenosing neoplastic lesion of rectum or distal colon. Nevertheless the elective surgical treatment concerning the stenosis is to be performed after the pre-operative assessment of the colonic segments upstream the cancer. The aim of this study is to illustrate our experience with the Computed Tomographic Colonography (CTC) for the pre-operative assessment of the entire colon in the patients with stenosing colorectal cancers.
  
  
  METHODS
  From January 2005 till March 2009, we observed and treated surgically 43 patients with stenosing colorectal neoplastic lesions. All patients did not tolerate the pre-operative colonoscopy. For this reason they underwent a pre-operative CTC in order to have a complete assessment of the entire colon. All patients underwent a follow-up colonoscopy 3 months after the surgical treatment. The CTC results were compared with both macroscopic examination of the specimen and the follow-up coloscopy.
  
  
  RESULTS
  The pre-operative CTC showed four synchronous lesions in four patients (9.3% of the cases). The macroscopic examination of the specimen revealed three small sessile polyps (3-4 mm in diameter) missed in the pre-operative assessment near the stenosing colorectal cancer. The follow-up colonoscopy showed four additional sessile polyps with a diameter between 3-11 mm in three patients. Our experience shows that CTC has a sensitivity of 83,7%.
  
  
  CONCLUSIONS
  In patients with stenosing colonic lesions, CTC allows to assess the entire colon pre-operatively avoiding the need of an intraoperative colonoscopy. More synchronous lesions are detected and treated at the time of the elective surgery for the stenosing cancer avoiding further surgery later on.
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Coccetta
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Migliaccio
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: La Mura
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Eriberto
authors.initials: E
authors.lastname: Farinella
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Galanou
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Pamela
authors.initials: P
authors.lastname: Delmonaco
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Spizzirri
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Napolitano
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Cattorini
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Milani
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of General Surgical, St Maria Hospital, Terni, University of Perugia, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sciannameo