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Menni A, Tzikos G, Sarafis A, Ververi A, Chatziantoniou G, Rafailidis V, Panidis S, Goulas P, Karlafti E, Apostolidis S, Giouleme O, Michalopoulos A, Paramythiotis D. Bowel Perforation in Vascular Ehlers-Danlos Syndrome: Case Report and Comprehensive Review. J Pers Med 2023; 13:1247. [PMID: 37623497 PMCID: PMC10455523 DOI: 10.3390/jpm13081247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Ehlers-Danlos syndromes (EDS) comprise a rare variety of genetic disorders, affecting all types of collagen. Herein, we describe a case of the vascular type of EDS, with coexisting segmental absence of intestinal musculature, while simultaneously performing a narrative review of the existing literature. CASE PRESENTATION A 23-year-old male patient with a history of multiple abdominal operations due to recurrent bowel perforations and the presence of a high-output enterocutaneous fistula was admitted to our surgical department for further evaluation and treatment. After detailed diagnostic testing, the diagnosis of vascular-type EDS (vEDS) was made and a conservative therapeutic approach was adopted. In addition, a comprehensive review of the international literature was carried out by applying the appropriate search terms. RESULTS The diagnosis of vEDS was molecularly confirmed by means of genetic testing. The patient was treated conservatively, with parenteral nutrition and supportive methods. Thirty-four cases of bowel perforation in vEDS have been reported so far. Interestingly, this case is the second one ever to report co-existence of vEDS with Segmental Absence of Intestinal Musculature. CONCLUSIONS Establishing the diagnosis of vEDS promptly is of vital significance in order to ensure that patients receive appropriate treatment. Due to initial non-specific clinical presentation, EDS should always be included in the differential diagnoses of young patients with unexplained perforations of the gastrointestinal tract.
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Affiliation(s)
- Alexandra Menni
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Georgios Tzikos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Alexandros Sarafis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Athina Ververi
- Genetic Unit, 1st Department of Obstetrics & Gynaecology, Aristotle’s University of Thessaloniki, Papageorgiou University Hospital, 56429 Thessaloniki, Greece;
| | - George Chatziantoniou
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Vasileios Rafailidis
- Department of Radiology, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Stavros Panidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Patroklos Goulas
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54634 Thessaloniki, Greece;
| | - Stylianos Apostolidis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Olga Giouleme
- 2nd Propedeutic Department of Internal Medicine, Aristotle’s University of Thessaloniki, Hippokration University Hospital, 54642 Thessaloniki, Greece;
| | - Antonios Michalopoulos
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
| | - Daniel Paramythiotis
- 1st Propaedeutic Department of Surgery, AHEPA University Hospital, Aristotle’s University of Thessaloniki, 54636 Thessaloniki, Greece; (G.T.); (A.S.); (G.C.); (S.P.); (P.G.); (S.A.); (A.M.); (D.P.)
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Dhingra R, Bascom R, Thompson E, Francomano CA, Schubart JR. Gastrointestinal medication burden among persons with the Ehlers-Danlos syndromes. Neurogastroenterol Motil 2021; 33:e14077. [PMID: 33393191 DOI: 10.1111/nmo.14077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/04/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Ehlers-Danlos syndromes (EDSs) are a group of heritable disorders of connective tissue associated with an increased prevalence of both structural and functional GI conditions. METHODS We used 10 years (2005-2014) of administrative claims data comprised of 4294 people with clinician-diagnosed EDS, aged 5-62 years, and compared their frequency of GI drug prescription claims to their age-, sex-, state of residence-, and earliest claim date-matched controls. We categorized the GI medications into the following groups: acid suppressants, anti-emetics, irritable bowel syndrome drugs, and visceral hypersensitivity (VHS) medications. KEY RESULTS Compared to controls, a significantly higher proportion of persons with EDS had prescription claims for at least one GI drug group, as well as for drugs in each of the four GI drug groups included in our study. By age-group, 25.7% children and 45.1% adults with EDS had prescription claims for at least one GI drug group compared with only 7.4% and 21.0% of controls, respectively (p < 0.0001). By gender, 44.0% of women and 25.3% of men with EDS had prescription claims for at least one class of GI drugs compared with 19.2% and 9.6% of controls, respectively (p < 0.0001). CONCLUSIONS AND KEY INFERENCES Predominant medication burden occurs among women with EDS, beginning peri-pubertally for anti-emetics and VHS drugs. High GI medication burden underscores previous evidence that GI dysmotility is common among persons with EDS.
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Affiliation(s)
- Radha Dhingra
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Rebecca Bascom
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA.,Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Elizabeth Thompson
- Department of Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Clair A Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jane R Schubart
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA.,Department of Surgery, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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Speake D, Dvorkin L, Vaizey CJ, Carlson GL. Management of colonic complications of type IV Ehlers-Danlos syndrome: a systematic review and evidence-based management strategy. Colorectal Dis 2020; 22:129-135. [PMID: 31260161 DOI: 10.1111/codi.14749] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022]
Abstract
AIM Type IV Ehlers Danlos Syndrome (EDS) is a connective tissue disorder affecting approximately 1 per 100,000-200,000 people. Life expectancy is reduced secondary to spontaneous vascular rupture or colonic perforation. Surgery carries significant morbidity and mortality. While strategies to manage colonic perforation include primary repair with or without a defunctioning stoma, Hartmann's procedure, total abdominal colectomy with end ileostomy and ileorectal anastomosis, evidence is contradictory and has not previously been evaluated in order to form a treatment strategy. We aim to review the published literature and identify outcome data relating to operative management of colonic perforation in type IV EDS. METHODS Pubmed, EM-BASE, Cochrane library and Google Scholar were searched with the following details: Ehlers Danlos Syndrome AND colonic surgery. The main outcome measure was re-perforation rates following colonic surgery on patients with type IV EDS. If the nature of surgery and follow up were reported, data were recorded in a SPSS database according to PRISMA guidelines. RESULTS One hundred and nine operations have been described in 51 patients in 44 case series. There were 26 visceral re-perforations, 2 affecting the small intestine and 24 colonic. Survival analysis favoured total abdominal colectomy compared with operations where the colon was left in situ. CONCLUSIONS Total abdominal colectomy with end ileostomy or ileorectal anastomosis are the safest strategies after colonic perforation in type IV EDS. Anastomotic leak rates are high. End colostomy is high risk for colonic re-perforation and anastomotic leak rates are extremely high. Restoration of colonic continuity should be avoided.
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Affiliation(s)
- D Speake
- Department of Colorectal Surgery, The Western General Hospital, Edinburgh, UK
| | - L Dvorkin
- North Middlesex University Hospital, London, UK
| | - C J Vaizey
- Departments of Surgery and National Intestinal Failure Centre, St Marks Hospital, Harrow, Middlesex, UK
| | - G L Carlson
- Departments of Surgery and National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Park KY, Gill KG, Kohler JE. Intestinal Perforation in Children as an Important Differential Diagnosis of Vascular Ehlers-Danlos Syndrome. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1057-1062. [PMID: 31324749 PMCID: PMC6664867 DOI: 10.12659/ajcr.917245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 6 Final Diagnosis: Colonic perforation secondary to vascular Ehlers Danlos Syndrome Symptoms: Abdominal pain • constipation Medication: — Clinical Procedure: Loop colostomy followed by total colectomy and ileostomy Specialty: Surgery
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Affiliation(s)
- Keon Young Park
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Surgery, American Family Children's Hospital, Madison, WI, USA
| | - Kara G Gill
- Department of Surgery, American Family Children's Hospital, Madison, WI, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan Emerson Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Department of Surgery, American Family Children's Hospital, Madison, WI, USA
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Natural History and Surgical Management of Colonic Perforations in Vascular Ehlers-Danlos Syndrome: A Retrospective Review. Dis Colon Rectum 2019; 62:859-866. [PMID: 31188187 DOI: 10.1097/dcr.0000000000001383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Vascular Ehlers-Danlos syndrome is a rare and severe genetic condition leading to spontaneous, potentially life-threatening arterial and digestive complications. Colonic ruptures are a common feature of the disease, but clear recommendations on their management are lacking. OBJECTIVE This study aimed to identify surgery-related morbidity and 30-day postoperative mortality after colonic perforation. DESIGN This was a retrospective review. SETTING A large cohort of patients with vascular Ehlers-Danlos syndrome was followed in a tertiary referral center. PATIENTS Between 2000 and 2016, the French National Reference Centre for Rare Vascular Diseases (HEGP, AP-HP, Paris, France) followed 148 patients with molecularly proven vascular Ehlers-Danlos syndrome. MAIN OUTCOME MEASURES The primary outcomes measured were surgery-related morbidity and 30-day postoperative mortality. RESULTS Of 133 patients with molecularly proven vascular Ehlers-Danlos syndrome, 30 (22%) had a history of colonic perforation and 15 (50%) were males. These subjects were diagnosed with vascular Ehlers-Danlos syndrome at a younger age than patients with a history of GI events without colonic perforation (p = 0.0007). There were 46 colonic perforations, median 1.0 event per patient (interquartile range, 1.0-2.0). Reperforations occurred in 14 (47%) patients, mostly males. Surgical management consisted of Hartmann procedures or subtotal abdominal colectomies, with a nonnegligible rate of reperforation following partial colonic resection (11 patients, 41%). LIMITATIONS The main limitations of this work are its retrospective design and that the diagnosis of vascular Ehlers-Danlos syndrome was made after colonic perforations in a majority of patients. CONCLUSION Colonic perforations seem more severe in males, with a high rate of reperforation after Hartmann procedure. Subtotal colectomy may reduce digestive morbidity, particularly in male patients. Additional studies are required to identify other predictors of reperforation. See Video Abstract at http://links.lww.com/DCR/A937.
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Frank M, Adham S, Zinzindohoué F, Jeunemaitre X. Natural history of gastrointestinal manifestations in vascular Ehlers-Danlos syndrome: A 17-year retrospective review. J Gastroenterol Hepatol 2019; 34:857-863. [PMID: 30357907 DOI: 10.1111/jgh.14522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/17/2018] [Accepted: 10/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Vascular Ehlers-Danlos syndrome (vEDS) is a rare connective tissue disorder due to heterozygous mutations in the COL3A1 gene with a dominant negative effect. Spontaneous bowel perforation and intra-abdominal organ rupture are common complications of vEDS. Other gastrointestinal (GI) manifestations may occur but have not been extensively characterized. We herein describe the natural history of GI events and surgery-related complications in patients with vEDS. METHODS A retrospective review of GI events in a large cohort of molecularly proven vEDS patients was conducted, after exclusion of mild forms of the disease. RESULTS Of 133 patients, 41% had a history of GI manifestations with 112 events, mean 2.0 ± 1.3 events per patient. There was an earlier occurrence of GI events in men (P 0.008). Cumulative incidence was 58% for all patients, higher in men and in patients with splice-site variants. Recurrence of GI events was reported in more than 50% of patients. Colonic perforation was the first digestive event for 47% of patients. Of 85 GI surgeries, 37 (43%) were complicated with 43 events. Nine deaths were reported in this population. CONCLUSIONS Vascular Ehlers-Danlos syndrome is characterized not only by bowel perforation but also by a wide variety of GI complications that occur in close to half (41%) of patients. The pattern of GI fragility seems more severe in males and splice-site variants. Complications of GI surgery are common and are related with tissue fragility/friability.
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Affiliation(s)
- Michael Frank
- Service de génétique, Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Paris centre de Recherche Cardiovasculaire-PARCC, INSERM, U970, Paris, France
| | - Salma Adham
- Service de génétique, Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Franck Zinzindohoué
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service de chirurgie digestive, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Xavier Jeunemaitre
- Service de génétique, Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Paris centre de Recherche Cardiovasculaire-PARCC, INSERM, U970, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
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Shalhub S, Neptune E, Sanchez DE, Dua A, Arellano N, McDonnell NB, Milewicz DM. Spontaneous pneumothorax and hemothorax frequently precede the arterial and intestinal complications of vascular Ehlers-Danlos syndrome. Am J Med Genet A 2019; 179:797-802. [PMID: 30793832 DOI: 10.1002/ajmg.a.61094] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/26/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022]
Abstract
Vascular Ehlers-Danlos syndrome (vEDS) is a connective tissue disorder due to defective type III collagen production and is associated with arterial rupture, spontaneous intestinal perforation, and gravid uterine rupture. Spontaneous pneumothorax and/or hemothorax (P/HTX) also occurs in vEDS patients. The temporal relation of pulmonary manifestations to arterial and intestinal complications in vEDS has not been well described. This was investigated in a multi-institutional retrospective case series of vEDS patients with confirmatory testing for COL3A1 mutation between 2000 and 2012. Data abstracted included demographics, family histories, presentation, and management of associated complications. Ninety-six cases (39% males, mean age 38.6 ± 15.5 years, range 8-79) had confirmatory testing for vEDS. P/HTX was documented in 17 (17.7%) cases. Most P/HTX preceded the diagnosis of vEDS (81%). Diagnosis of vEDS was made after arterial or intestinal complications at a mean of 7 years (range 0-26) post the initial P/HTX. In conclusion, spontaneous P/HTX is an early manifestation of vEDS frequently preceding an arterial complication or intestinal perforation. Thus, a spontaneous P/HTX in a young patient should trigger a differential diagnosis that includes vEDS. This should lead to an investigation of other vEDS features and subsequent genetic testing if vEDS features are present.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Enid Neptune
- Pulmonary and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Desiree E Sanchez
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Anahita Dua
- Department of Surgery, Stanford University, Stanford, California
| | - Nelson Arellano
- Department of surgery, Centro Clinico Quirurgico Hospital Del Dia Norte, Guayaquil, Ecuador
| | | | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
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El Masri H, Loong TH, Meurette G, Podevin J, Zinzindohoue F, Lehur PA. Bowel perforation in type IV vascular Ehlers-Danlos syndrome. A systematic review. Tech Coloproctol 2018; 22:333-341. [PMID: 29700641 DOI: 10.1007/s10151-018-1783-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 03/05/2018] [Indexed: 12/31/2022]
Abstract
Spontaneous gastrointestinal (GI) perforation is a well-known complication occurring in patients suffering from Type IV vascular Ehlers-Danlos syndrome (EDS IV). The aim of the present study was to review the current literature on spontaneous GI perforation in EDS IV and illustrate the surgical management and outcome when possible. A systematic review of all the published data on EDS IV patients with spontaneous GI perforation between January 2000 and December 2015 was conducted using three major databases PUBMED, EMBASE, and Cochrane Central Register of Controlled Trails. References of the selected articles were screened to avoid missing main articles. Twenty-seven published case reports and four retrospective studies, including 31 and 527 cases, respectively, matched the search criteria. A case from our institution was added. Mean age was 26 years (range 6-64 years). The most frequent site of perforation was the colon, particularly the sigmoid, followed by small bowel, upper rectum, and finally stomach. The majority of cases were initially managed with Hartmann's procedure. In recurrent perforations, total colectomy was performed. The reperforation rate was considerably higher in the "partial colectomy with anastomosis" group than in the Hartmann group. Colonic perforation is the most common spontaneous GI perforation in EDS IV patients. An unexpected fragility of the tissues should raise the possibility of a connective tissue disorder and prompt further investigation with eventual management of these high-risk patients with a multidisciplinary team approach in dedicated centres. In the emergency setting, a Hartmann procedure should be performed.
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Affiliation(s)
- H El Masri
- Digestive and Endocrine Surgery Clinic, Institute of Digestive Diseases, University Hospital of Nantes, CHU Hôtel Dieu, 1, Place Alexis Ricordeau, 44035, Nantes, France
| | - T-H Loong
- Digestive and Endocrine Surgery Clinic, Institute of Digestive Diseases, University Hospital of Nantes, CHU Hôtel Dieu, 1, Place Alexis Ricordeau, 44035, Nantes, France
| | - G Meurette
- Digestive and Endocrine Surgery Clinic, Institute of Digestive Diseases, University Hospital of Nantes, CHU Hôtel Dieu, 1, Place Alexis Ricordeau, 44035, Nantes, France
| | - J Podevin
- Digestive and Endocrine Surgery Clinic, Institute of Digestive Diseases, University Hospital of Nantes, CHU Hôtel Dieu, 1, Place Alexis Ricordeau, 44035, Nantes, France
| | - F Zinzindohoue
- HEGP Paris, National Referral Centre for Rare Diseases "Ehlers-Danlos Syndrome", Paris, France
| | - P-A Lehur
- Digestive and Endocrine Surgery Clinic, Institute of Digestive Diseases, University Hospital of Nantes, CHU Hôtel Dieu, 1, Place Alexis Ricordeau, 44035, Nantes, France.
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Fikree A, Chelimsky G, Collins H, Kovacic K, Aziz Q. Gastrointestinal involvement in the Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:181-187. [DOI: 10.1002/ajmg.c.31546] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Yoneda A, Okada K, Okubo H, Matsuo M, Kishikawa H, Naing BT, Watanabe A, Shimada T. Spontaneous colon perforations associated with a vascular type of ehlers-danlos syndrome. Case Rep Gastroenterol 2014; 8:175-81. [PMID: 24932165 PMCID: PMC4049028 DOI: 10.1159/000363373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Ehlers-Danlos syndrome, vascular type (vEDS) (MIM #130050) is an autosomal dominant disorder caused by mutation in the type III collagen gene, COL3A1, leading to fragility of blood vessels, bowel and uterus that leads to spontaneous rupture. We report a previously undiagnosed vEDS patient with bowel complications. A 20-year-old female patient was referred to our hospital with abdominal pain. Computed tomography showed notable dilatation of the sigmoid colon with intraperitoneal fluid. Laparotomy revealed dilatation of the sigmoid colon, breakdown of serosa and muscularis propria of the sigmoid colon with impending perforation, and intra-abdominal hemorrhage caused by breakdown of the mesenterium. Resection of the sigmoid colon with Hartmann's pouch and an end colostomy were performed. Physical examination showed joint hypermobility, translucent skin with venous prominence and facial structure abnormalities. Genetic analysis using cDNA extracted from the patient's fibroblasts by reverse transcriptase polymerase chain reaction direct sequencing showed a missense mutation within the triple helix region of COL3A1 (c.2150 G>A; Gly717Asp).
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Affiliation(s)
- Akira Yoneda
- Department of Surgery, Kouseikai Hospital, Nagasaki, Japan
| | - Kazuya Okada
- Department of Surgery, Kouseikai Hospital, Nagasaki, Japan
| | - Hitoshi Okubo
- Department of Surgery, Kouseikai Hospital, Nagasaki, Japan
| | | | | | - Banyar Than Naing
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan
| | - Atsushi Watanabe
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan
| | - Takashi Shimada
- Department of Biochemistry and Molecular Biology, Nippon Medical School, Tokyo, Japan
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Foulkes AC, Pollitt R, Sobey G, Pope FM, Taylor AEM. Palmoplantar contractures in childhood: a rare complication of vascular Ehlers-Danlos syndrome. Clin Exp Dermatol 2013; 38:517-9. [PMID: 23672283 DOI: 10.1111/ced.12064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2012] [Indexed: 11/30/2022]
Abstract
Although catastrophic vascular complications in vascular Ehlers-Danlos Syndrome (EDS) are well recognized, other complications such as flexion contractures and tendon nodules are rarely reported and poorly characterized. We report a young man with vascular EDS, who developed flexion contractures and tendon nodules, causing considerable disability. Limited management strategies are available for these complications, which have continued to prove a challenge to management.
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Affiliation(s)
- A C Foulkes
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Sawayama H, Tomiyasu S, Kanemitsu K, Matsumoto T, Tanaka H, Baba H. Colonic perforation due to colorectal cancer: predicting postoperative organ failure with a preoperative scoring system and selecting the optimal surgical method based on the prognosis. Surg Today 2012; 42:1082-7. [PMID: 22714796 DOI: 10.1007/s00595-012-0220-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 09/08/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of this study was to predict the postoperative organ derangement before surgery and to select the optimal surgical methods for a perforation due to colorectal cancer. METHODS The Mannheim Peritonitis Index (MPI) was used to determine the preoperative status and Sequential Organ Failure Assessment (SOFA) score for postoperative status, retrospectively. RESULTS There were 25 cases of colorectal cancer-related colon perforation. These patients were classified as having a preoperative MPI ≤ 29 or ≥ 30 and the mean postoperative SOFA scores were 2.30 ± 2.45 and 7.93 ± 3.45 (p = 0.0002), respectively. Seven of 20 patients who underwent tumor resection received a bowel anastomosis without a stoma. The MPI of these seven patients was low (23.1 ± 7.47) and there were no severe postoperative organ disorders (SOFA score 1.86 ± 2.26). Eighteen of the 25 patients had no distant metastasis. Eight of these 18 patients underwent lymph node (LN) dissection, including intermediate LNs, while the other 10 cases only had the pericolic/perirectal LNs dissected. The average preoperative MPI was 23.9 ± 7.68 and 32.8 ± 5.77, and the postoperative SOFA scores were 3.75 ± 3.01 and 7.10 ± 5.34, respectively. CONCLUSION The MPI could be used to predict postoperative organ disorders and thus represents a useful index that can be used to determine the optimal surgical methods.
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Affiliation(s)
- Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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