1
|
Coulshed A, Soucisse M, Lansom JD, Morris D. Case report: Total enterectomy following complete small bowel ischaemia in the post-peritonectomy setting. Int J Surg Case Rep 2020; 76:247-250. [PMID: 33053482 PMCID: PMC7566207 DOI: 10.1016/j.ijscr.2020.09.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022] Open
Abstract
Small bowel resection following total ischaemia is feasible post-peritonectomy. VAC dressing and skin grafting was beneficial following wound dehiscence. Small bowel transplant is a potential means to avoid complications of long-term TPN.
Introduction This report presents the rare case of a patient with complete bowel ischaemia following parastomal hernia, leading to total bowel resection, with consideration of post-operative complications and wound management. Presentation of case A 59 year old female was found to have complete small bowel ischaemia on exploratory laparatomy, on a background of recurrent appendiceal adenomucinosis, for which she had received previous peritonectomy, cholecystectomy, total colectomy, and partial small bowel resection. The patient was managed with total enterectomy and post-operative total parenteral nutrition. Discussion Total enterectomy represents a significant challenge in the postperitonectomy setting, including consideration of wound management with the empty abdomen, and the potential of small bowel transplant in management. Conclusion Resection of the small bowel following total small bowel ischaemia is feasible in the post-peritonectomy setting, given appropriate post-operative care and wound management. However, long-term survival remains challenging, especially without small bowel transplant.
Collapse
Affiliation(s)
- A Coulshed
- Department of Surgery, St George Hospital, L3 Pitney Building, Short Street, Kogarah, NSW, 2217, Australia; St George & Sutherland Clinical School, University of New South Wales, Australia
| | - M Soucisse
- Department of Surgery, St George Hospital, L3 Pitney Building, Short Street, Kogarah, NSW, 2217, Australia; St George & Sutherland Clinical School, University of New South Wales, Australia
| | - J D Lansom
- Department of Surgery, St George Hospital, L3 Pitney Building, Short Street, Kogarah, NSW, 2217, Australia; St George & Sutherland Clinical School, University of New South Wales, Australia
| | - D Morris
- Department of Surgery, St George Hospital, L3 Pitney Building, Short Street, Kogarah, NSW, 2217, Australia; St George & Sutherland Clinical School, University of New South Wales, Australia.
| |
Collapse
|
2
|
Karpes JB, Lansom JD, Alshahrani M, Parikh R, Shamavonian R, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery with or without intraperitoneal chemotherapy for recurrent epithelial appendiceal neoplasms. BJS Open 2020; 4:478-485. [PMID: 32020757 PMCID: PMC7260401 DOI: 10.1002/bjs5.50262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background With recurrence rates after primary cytoreductive surgery (CRS) in excess of 50 per cent, repeat CRS is being performed increasingly, but survival outcomes have not been reported widely. This study examined the outcomes following repeat CRS for appendiceal cancer with peritoneal surface malignancy (PSM), and evaluated its feasibility and safety. Methods A retrospective cohort of patients who had surgery between 1996 and 2018 were analysed. Patients who underwent a single CRS procedure with or without heated intraperitoneal chemotherapy (HIPEC) were compared with those who had multiple procedures with or without HIPEC. Perioperative morbidity and survival outcomes were analysed. Results Some 462 patients were reviewed, 102 of whom had repeat procedures. For high‐grade tumours, patients who had a single CRS procedure had significantly reduced overall survival (OS) compared with those who had repeat CRS (55·6 versus 90·7 months respectively; P = 0·016). For low‐grade tumours, there was no difference in OS (P = 0·153). When patients who had a single procedure were compared with those who had multiple procedures, there was no significant difference in major morbidity (P = 0·441) or in‐hospital mortality (P = 0·080). For multiple procedures, no differences were found in major morbidity (P = 0·262) or in‐hospital mortality (P = 0·502) when the first procedure was compared with the second. For low‐grade cancers, the peritoneal carcinomatosis index was a significant prognostic factor for OS (hazard ratio (HR) 1·11, 95 per cent c.i. 1·05 to 1·17; P < 0·001), whereas for high‐grade cancers repeat CRS (HR 0·57, 0·33 to 0·95; P = 0·033), complete cytoreduction score (HR 1·55, 1·01 to 2·40; P = 0·046) and presence of signet ring cells (HR 2·77, 1·78 to 4·30; P < 0·001) were all significant indicators of long‐term survival. Conclusion In selected patients presenting with PSM from epithelial appendiceal neoplasms, repeat CRS performed in high‐volume centres could provide survival benefits.
Collapse
Affiliation(s)
- J B Karpes
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J D Lansom
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - M Alshahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Parikh
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Shamavonian
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - N A Alzahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - W Liauw
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,Cancer Care Clinic, St George Hospital, Sydney, New South Wales, Australia
| | - D L Morris
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|