Diverticular disease of the colon

Colostomy fistula caused by segmental absence of intestinal musculature: a case report

BACKGROUND

Segmental Absence of Intestinal Musculature (SAIM) is a rare condition associated with intestinal obstruction and perforation. Colostomy fistula as a presentation of SAIM and their association with anastomotic failure have not been previously reported. This case report aimed to raise awareness of this unique manifestation and its potential implications.

CASE PRESENTATION

A 58-year-old male with a history of type 2 diabetes, hypertension, and lumbar hernia presented with diarrhea. Lower gastrointestinal endoscopy revealed a tumor in the rectum, for which he was diagnosed with a well-differentiated adenocarcinoma. The patient underwent a laparoscopic Hartmann operation. After the operation, an entero-entero-fistula was identified at the sigmoid colostomy site. Subsequently, laparoscopic reconstruction of the colostomy was performed, and the patient had a favorable postoperative course without complications. Histopathological examination confirmed the localized absence of the muscularis propria in the resected colon, with fibrosis and nearby ganglion cells.

CONCLUSIONS

This case highlights the rarity of a colostomy fistula as a manifestation of SAIM and emphasizes the need to consider SAIM in the differential diagnosis for such cases. The presence of SAIM-affected lesions poses a risk of anastomotic failure, underscoring the importance of assessing the risk of complications during future surgeries. Surgeons should be aware of the etiology and potential implications of SAIM to ensure appropriate management and minimize postoperative morbidity. Further studies are warranted to explore the underlying mechanisms and optimize surgical strategies for patients with SAIM and its associated complications. Increased awareness among clinicians is crucial for timely diagnoses and tailored interventions to improve patient outcomes.

Long-term use of steroids protects from the development of symptomatic diverticulitis requiring hospitalization in the Asian population

OBJECTIVE

The pathophysiology of diverticulitis is poorly understood. Factors such as physical inactivity, constipation, obesity, smoking, and the use of nonsteroidal antiinflammatory drugs (NSAIDs) have been associated with an increased risk of diverticular disease. To evaluate whether patients exhibiting long-term steroid use are at increased risk of colonic diverticulitis.

METHOD

We conducted a population-based, nested case-control study. Data were retrospectively collected from the National Health Insurance Research Database. The study cohort comprised patients diagnosed with diverticulitis, identified using inpatient discharge records using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (562.11 and 562.13), and those who were administered one or more prescriptions for corticosteroids for systemic use. Control patients were matched to cases by age, sex, NSAID use, laxative drug use, and index date. We enrolled 690 patients with colonic diverticulitis and 2760 in the control group. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression.

RESULTS

Compared with steroid nonusers, the adjusted ORs were 0.60 (95% CI = 0.35-1.06) and 0.80 (95% CI = 0.64-1.008) in current steroid users and previous steroid users, respectively. In addition, the adjusted ORs were 0.55 (95% CI = 0.31-0.98), 0.57 (95% CI = 0.31-0.98), and 0.44 (95% CI = 0.22-0.86) for steroid use duration more than half time by an exposure period of 90 days, 180 days, and 365 days before the claim date of colonic diverticulitis, respectively.

CONCLUSIONS

The results indicated that long-term steroid use within one year is associated with lower risk of colonic diverticulitis.