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Dnyanmote AS, Jadhav S, Vasava K, Immadi S. Anorectal Melanoma: A Rare Cause of Large Bowel Obstruction. Cureus 2024; 16:e56128. [PMID: 38618462 PMCID: PMC11015112 DOI: 10.7759/cureus.56128] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Anorectal melanoma is a rare and aggressive malignancy with a challenging diagnosis and management. We present the case of a 69-year-old male with a history of chronic constipation and recent weight loss, who presented with symptoms suggestive of anorectal pathology. Despite initial diagnostic challenges, including an unsuccessful colonoscopy due to inadequate bowel preparation, the subsequent radiographic evaluation revealed a large bowel obstruction secondary to a protruding anorectal mass. Abdominal X-ray demonstrated significant colonic dilation while contrast-enhanced CT scan revealed a large hypodense mass protruding from the anal canal. Surgical intervention led to the excision of the mass, and histopathological examination confirmed malignant melanoma. Immunohistochemistry markers, including HMB 45, Melan A, and S100, supported the diagnosis. This case underscores the importance of considering anorectal melanoma in patients presenting with atypical anorectal symptoms, despite its rarity. Early recognition and intervention, supported by appropriate imaging modalities, are critical for optimizing patient outcomes in such cases.
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Affiliation(s)
- Anuradha S Dnyanmote
- Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Suhasini Jadhav
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Kinjal Vasava
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Saikumar Immadi
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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2
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Satheakeerthy S, Leow P, Hall B, Yen DA, Fischer J. Outcomes for sigmoid volvulus managed with and without early definitive surgery: 20-year experience in a tertiary referral centre. ANZ J Surg 2024; 94:169-174. [PMID: 37626456 DOI: 10.1111/ans.18671] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Sigmoid volvulus is rare in Western countries. Patients at risk of sigmoid volvulus are often older with significant co-morbidity. Without sigmoid colectomy there is a high recurrence rate, but indications for surgery are controversial. METHODS A retrospective observational study was conducted by reviewing clinical records of patients admitted to Waikato Hospital 1 January 2000 to 1 January 2020 with a diagnosis of sigmoid volvulus. Patient characteristics, clinical features, investigations, management, and outcomes were recorded. RESULTS One hundred and thirty-two patients (87 male) were included with 203 volvulus episodes. Median age 76 years, median Charlson co-morbidity index (CCI) 4. Median follow-up 11 years. 44/132 (33.3%) had surgery during the index admission, two had elective surgery and the remainder had planned non-operative management. 73/132 (55.3%) had surgery at any stage. 42/86 (48.8%) patients managed non-operatively recurred; 66.7% of recurrences were within 6 months. Forty-three (32.6%) died within 12 months of index admission; 28 (21.2%) died during an admission for volvulus. On univariate analysis higher age and abnormal vital signs were associated with inpatient and 12-month mortality; higher CCI was associated with 12-month mortality. On multi-variate analysis increasing age in years was associated with increased risk of death (HR 1.089 [1.052-1.128, P < 0.001]). Normal vital signs at presentation were associated with decreased risk of death (HR 0.147 [0.065-0.334, P < 0.001]). CONCLUSION Sigmoid colectomy should be considered at index presentation with sigmoid volvulus. Half of patients managed non-operatively recurred, with two-thirds recurring within 6 months. The mortality rate remains high for subsequent volvulus episodes.
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Affiliation(s)
| | - Priscilla Leow
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Benjamin Hall
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Damien Ah Yen
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Jesse Fischer
- Department of General Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, New Zealand
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3
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Lemi Yadeta G, Abdisa Tesso B, James Oriho L. Recurrent Transverse Colon Volvulus After Operative Detorsion: A Case Report. Cureus 2024; 16:e52419. [PMID: 38371026 PMCID: PMC10870081 DOI: 10.7759/cureus.52419] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Transverse colon volvulus is a rare type of colonic volvulus. Here, we present a case of a 40-year-old male patient with a recurrent transverse colon volvulus after operative detorsion. He presented with a history of intermittent crampy abdominal pain of three days duration associated with failure to pass both feces and flatus. He has a history of abdominal distention and vomiting. The patient has a history of repeated abdominal surgeries. His last surgery was two years before the presentation, laparotomy with operative detorsion without colopexy for viable transverse colon volvulus. The patient was explored, and transverse colectomy was done with two-stage procedures. The transverse colon volvulus can occur simultaneously or metachronously with other types of colonic volvulus. A high index of suspicion is needed for diagnosis. Management of transverse colon volvulus should be resection with or without primary anastomosis.
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Affiliation(s)
- Gemechu Lemi Yadeta
- Department of Surgery, Jimma University, College of Public Health and Medical sciences, Jimma, ETH
| | - Birhanu Abdisa Tesso
- Department of Surgery, Jimma University, College of Public Health and Medical sciences, Jimma, ETH
| | - Langa James Oriho
- Department of Surgery, Jimma University, College of Public Health and Medical sciences, Jimma, ETH
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Doudakmanis C, Baxevanidou K, Chatzikomnitsa P, Kolla C, Bouliaris K, Giaglaras A, Efthimiou M, Koukoulis GD. Palliative Treatment of Bowel Obstruction With Colostomy Under Local Anesthesia in Frail Patients: A Single-Site Experience. Cureus 2023; 15:e45698. [PMID: 37868559 PMCID: PMC10590149 DOI: 10.7759/cureus.45698] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Attendance of patients to the emergency department due to acute large bowel obstruction is a common phenomenon. Most of these patients are elderly, critically ill, and with high comorbidity. The literature suggests that more than 50% of these cases are due to colon cancer. Since this condition is considered to be an emergency, immediate intervention and response is imperative. PURPOSE The aim of the present study is to present our surgical technique of colostomy formation under local anesthesia in selected critically ill patients, with increased perioperative risk and acute large bowel obstruction. MATERIALS AND METHODS This is a retrospective study of 24 patients, with obstipation, who underwent emergency colostomy under local anesthesia, during the period from 2014 to 2021. RESULTS The mean age of the patients was 77 years. The vast majority of patients had an American Society of Anesthesiologists (ASA) score of ≥3 and a Charlson score of ≥7. The most common colostomy was transverse colostomy (21/24 patients). The patients' hospitalization ranged from four to 42 days. Only one patient died. All colostomies functioned properly in the immediate postoperative period. Only one patient required postoperative admission to the ICU. CONCLUSIONS Colostomy under local anesthesia in critically ill, elderly patients is an alternative option for the treatment of ileus.
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Affiliation(s)
- Christos Doudakmanis
- Department of Surgery, General Hospital of Larissa, Larissa, GRC
- Second Department of Propaedeutic Surgery, Laiko General Hospital of Athens, Athens, GRC
| | | | | | - Christina Kolla
- Department of Surgery, General Hospital of Larissa, Larissa, GRC
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5
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Michiels S, Engelholm JL. Bowel obstruction by sigmoid strangulation as complication after laparoscopic adjustable gastric banding. Acta Chir Belg 2023:1-5. [PMID: 37409986 DOI: 10.1080/00015458.2023.2234146] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has been widely performed in the past, however, given its limited weight loss compared to some other procedures, this technique is less often used. Furthermore, a number of complications leading to band removal have been reported in the past few years. METHODS We present a late acute bowel obstruction by sigmoid strangulation in a female patient with the LAGB performed 15 years ago. RESULTS The laparoscopic exploration displayed a post-LAGB intestinal strangulation of the sigmoid loop which was caused by the connecting tube. Since the bowel was still viable, the tube was cut and the obstruction has been successfully resolved. The patient was discharged three days after the surgery. CONCLUSION Although less often performed, knowledge of LAGB complications can be of importance. We believe that, the present strangulation of the sigmoid by the LAGB tubing is the world's first ever case reported. Nevertheless, when it is still proposed to selected patients, an adequate length of the intra-abdominal tubing could reduce the risk of loop formation and prevent this kind of obstruction by internal hernia.
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Affiliation(s)
- Sebastien Michiels
- Department of Digestive Surgery, IRIS Hospitals South, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Luc Engelholm
- Department of Radiology, IRIS Hospitals South, Université Libre de Bruxelles, Brussels, Belgium
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6
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Burgos-Torres MDM, Molina-Lopez VH, Perez Cruz NM, Perez Del Valle C, Sorrentino J. Multivitamin-Induced Pharmacobezoar: A Rare Entity of Large Bowel Obstruction. Cureus 2023; 15:e41688. [PMID: 37441102 PMCID: PMC10334454 DOI: 10.7759/cureus.41688] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
The term bezoar refers to a foreign object found like a mass of concretion in the gastrointestinal tract that results from an accumulation of undigested material. When the composition of the ingested material is a medication, it is known as a pharmacobezoar. A rare complication from pharmacobezoar is large intestinal obstruction. Here we present the case of a 77-year-old male who presented with progressive abdominal distension, involuntary guarding, and large bowel obstruction. Abdominal imaging studies were remarkable for radiopaque objects of uncertain etiology in the transverse colon and rectal ampulla. The patient underwent colonic decompression by sigmoidoscopy, where the pills were identified by direct visualization. He later underwent endoscopic removal of the pharmacobezoars. A detailed medication review identified the culprit to be multivitamins. This case portrays an unusual etiology of large bowel obstruction. At this moment, no cases have been reported of multivitamins as the culprit of pharmacobezoar with subsequent development of large bowel obstruction.
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Affiliation(s)
| | | | | | | | - Jose Sorrentino
- General Surgery, VA Caribbean Helathcare System, San Juan, PRI
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Mengistu S, Asnake M, Hassen S, Mekonnen B. Synchronous Volvulus of Ascending and Transverse Colon. Int Med Case Rep J 2023; 16:397-400. [PMID: 37408755 PMCID: PMC10319287 DOI: 10.2147/imcrj.s413600] [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: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Colonic volvulus is the torsion of a part of the colon causing large bowel obstruction by strangulation, which may lead to ischemia and then necrosis. Synchronous colonic volvulus is extremely rare; even if there are some case reports on synchronous colonic volvulus, there are no reported cases of synchronous ascending and transverse colon volvulus in the medical literature to our knowledge. Case Presentation A 25-year-old girl with a previous history of epilepsy presented with a one-day duration of abdominal cramps with associated symptoms of vomiting of bilious matter, failure to pass faeces, and flatus of the same duration. The patient underwent surgical intervention, and ascending and transverse volvulus were discovered. Conclusion In spite of ascending and transverse colon volvulus rarity, we advised including these in the differential diagnosis of patients associated with large bowel obstruction.
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Affiliation(s)
- Sisay Mengistu
- Department of Surgery, College of Medicine and health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Molla Asnake
- School of Medicine, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Suleman Hassen
- Department of Surgery, College of Medicine and health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Biruk Mekonnen
- School of Medicine, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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8
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Katamreddy Y, Fadeyi O, Konturek TJ. Subacute Appendicular Abscess Masquerading as Neoplasia Causing Large Bowel Obstruction. ACG Case Rep J 2023; 10:e01085. [PMID: 37389194 PMCID: PMC10306432 DOI: 10.14309/crj.0000000000001085] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Acute appendicitis is the most common reason for emergency abdominal surgery worldwide. Nonacute appendicitis variants include recurrent, subacute, and chronic appendicitis. Although these are not considered surgical emergencies, they are frequently overlooked, resulting in complications such as perforation or abscess formation. The presentation of nonacute forms is rare in the modern era because of sophisticated diagnostic modalities and treatment measures. We discuss a rare case of subacute appendicular abscess simulating a neoplasm with large bowel obstruction.
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Affiliation(s)
- Yamini Katamreddy
- Department of Internal Medicine, West Anaheim Medical Center, Anaheim, CA
| | - Olaniyi Fadeyi
- Department of Internal Medicine, West Anaheim Medical Center, Anaheim, CA
| | - Thomas J. Konturek
- Department of Gastroenterology, West Anaheim Medical Center, Anaheim, CA
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9
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Tran M, Song JK, Popovich J. Cecal Volvulus Through an Internal Hernia Created by an Elongated Fallopian Tube. Cureus 2023; 15:e34943. [PMID: 36938219 PMCID: PMC10017180 DOI: 10.7759/cureus.34943] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Internal hernias result from abdominal viscera protruding through a congenital or acquired defect in the peritoneum or the mesentery of the abdominal cavity. They are less common than external hernias, and the overall incidence is rare. Internal hernias carry a high mortality rate if there is no immediate surgical intervention and can lead to complications such as bowel perforation, ischemia, and necrosis. There are multiple classifications, and a rare subtype identified in only a select few cases involves the fallopian tube. This case documents the development of a cecal volvulus due to the cecum herniating through an aperture created by a normal-appearing fallopian tube attaching to the retroperitoneum. A 78-year-old female with multiple comorbidities was admitted for abdominal pain lasting 3-4 days, nausea, emesis, and poor oral tolerance. Computerized tomography imaging revealed a complete large bowel obstruction secondary to a cecal volvulus, and she was taken emergently for an exploratory laparotomy. Intra-operatively, a distended cecum was noted, herniated through a loop created by the right fallopian tube tethering its free end to the left pelvis. Upon decompression of the bowel, the fallopian tube released itself from the retroperitoneum. The cecum and right fallopian tube were noted to be ischemic and resected with an ileo-transverse anastomosis. Internal hernias that involve the fallopian tubes are a rare variation of an already uncommon condition. However, they should be included in the differential diagnosis when evaluating a female patient for intestinal obstruction since it can develop into a life-threatening condition that requires prompt surgical attention.
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Affiliation(s)
- Maianh Tran
- General Surgery, Mercy Medical Center, Des Moines, USA
| | - Justin K Song
- General Surgery, Des Moines University's College of Osteopathic Medicine, Des Moines, USA
| | - John Popovich
- General Surgery, Mercy Medical Center, Des Moines, USA
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10
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Muacevic A, Adler JR, Yglesias B, Phillips JK. Acute Large Bowel Obstruction Caused by Endometriosis Requiring Sigmoidectomy. Cureus 2022; 14:e32430. [PMID: 36644032 PMCID: PMC9833863 DOI: 10.7759/cureus.32430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Large bowel obstruction (LBO) accounts for nearly 25% of all bowel occlusions. LBO is managed as a surgical emergency due to its increased risk of bowel perforation. Nearly, 2% to 4% of all surgical admissions are a result of LBO. The most common pathological development of LBO remains colonic malignancy, representing approximately 60% of cases. Other etiology includes abdominal adhesions, diverticulosis, hernia, inflammatory bowel disease (IBD), and in rare cases endometriosis. In this report, the patient is a 36-year-old female with an LBO, originally thought to be a complication of diverticulitis. However, it was confirmed that the obstruction was a result of endometriosis tissue adherence to the colonic wall narrowing the intestinal lumen. The patient presented to the emergency department (ED) with nausea, vomiting, and abdominal pain that started six weeks prior. In this case report, we will discuss the rare complication of endometriosis causing LBO, clinical presentation, diagnosis, and management.
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11
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Farkas N, Kenny R, Conroy M, Harris H, Anele C, Simson J, Levy B. A single centre 20-year retrospective cohort study: Percutaneous endoscopic colostomy. Colorectal Dis 2022; 24:1390-1396. [PMID: 35656558 DOI: 10.1111/codi.16207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 02/08/2023]
Abstract
AIM Percutaneous endoscopic colostomy (PEC) represents an important intervention in specific patients. Limited data currently exist. We present the largest recorded study of patients undergoing PEC. METHODS Retrospective analysis of consultant logbooks highlighted all patients from 1997 to 2020. Two independent reviewers assessed records. Parameters measured were age, sex, indication, number of sites, complications, mortality and survival. Three subgroups were identified: recurrent sigmoid volvulus (RSV), pseudo-obstruction and neurogenic. ANOVA, chi-squared and Fischer's exact tests were utilized; Kaplan-Meier curves estimated survival and the log-rank test was applied. A p value of <0.05 was considered statistically significant. RESULTS Ninety-six PEC insertions were done on 91 patients (five reinsertions). There were 66 men (69%) and the mean age was 73.1 years (interquartile range 23). The indications were RSV n = 72, pseudo-obstruction n = 13, neurogenic n = 11. The 30-day complication rate was overall n = 27 (28%), RSV n = 23, pseudo-obstruction n = 4. Nine patients leaked (9.9%) (eight RSV, one pseudo-obstruction), of whom five died. 90-day mortality was 14.6% (14 patients), 18.5% (13/72) for RSV, 7.7% (1/13) for pseudo-obstruction. Overall recurrence following PEC was 10.4%. The median follow-up was 25 months (interquartile range 4.6-62.2 months). At 3, 5 and 10 years survival was 46%, 34% and 26% for RSV, 70%, 55% and 15% for pseudo-obstruction and 91%, 91% and 81% for neurogenic respectively. CONCLUSION Recurrent sigmoid volvulus and pseudo-obstruction patients undergoing PEC compared to neurogenic patients have poorer outcomes with higher complication rates and shorter life expectancy. We advocate that high volume specialist units undertake PEC. The significant associated risks of PEC require careful consideration when determining patient suitability. Utilizing risk stratification scores may help guide shared decision making between patients, relatives and clinicians.
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Affiliation(s)
- Nicholas Farkas
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Ross Kenny
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Michael Conroy
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Holly Harris
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Chukwuemeka Anele
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Jay Simson
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
| | - Bruce Levy
- Western Sussex Hospitals NHS Trust, Worthing, UK.,General Surgical Department, St Richards Hospital, Chichester, UK
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Abstract
Acute colonic pseudo-obstruction (ACPO) is a functional disorder of the large intestine distinguished by colonic dysmotility resulting in colonic distension in the absence of mechanical obstruction. The underlying pathophysiology of ACPO remains unclear despite technological advances in understanding the physiology of colonic motility, such as spatio-temporal mapping and high-resolution manometry. In many ways, the management of ACPO has remained relatively unchanged for 40 years. Patients with perforation or suspected ischemia undergo operative intervention, while patients without undergo initial conservative management with bowel rest, correction of electrolyte disturbances, and mobilization. Patients who fail conservative management or have prominent cecal dilatation undergo decompression with either neostigmine or colonoscopy. A subset of patients with ACPO will have recurrent symptoms despite endoscopic and medical management. For these patients who are difficult to manage, an underlying colonic functional disorder, such as slow-transit dysmotility or chronic intestinal pseudo-obstruction may be considered. The following review of ACPO aims to provide a concise update of the causes, diagnosis, and management of this emergency surgical condition.
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Affiliation(s)
- Thomas Arthur
- Department of Colorectal Surgery, Austin Hospital, Melbourne, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Adele Burgess
- Department of Colorectal Surgery, Austin Hospital, Melbourne, Australia
- School of Medicine, University of Melbourne, Melbourne, Australia
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13
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Siddiqui A, Ahmed H, Nazim MH, Soliman B, Obokhare I. Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction. Cureus 2022; 14:e24599. [PMID: 35651476 PMCID: PMC9138192 DOI: 10.7759/cureus.24599] [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] [Accepted: 04/29/2022] [Indexed: 11/05/2022] Open
Abstract
A 41-year-old female with a previous history of chronic obstructive pulmonary disease (COPD) and polycythemia presented to the emergency department with worsening shortness of breath and cough which progressed to respiratory distress requiring mechanical ventilation. During her hospital stay, she developed abdominal distention followed by a fever and a four-point decrease in hemoglobin. A non-contrasted abdominopelvic CT scan was ordered which showed a very large retroperitoneal hematoma adjacent to the right colon with subtle active bleeding. Selective angioembolization of a distal segment of the right colic artery was performed by Interventional Radiology (IR) to achieve hemostasis and hemodynamic stability. Due to the persistent and worsening abdominal distention, a CT scan with contrast was ordered which clearly showed a submucosal hematoma in the region of the right colon extending from the hepatic flexure to the cecum. The hematoma was completely obstructing the proximal and mid ascending colon leading to a large bowel obstruction. Exploration of the abdomen showed severe bowel dilation, and frank ischemia of the hepatic flexure of the colon. Right hemicolectomy with primary ileocolonic anastomosis to evacuate the right retroperitoneal hematoma was subsequently performed. The patient was discharged on post-operative day 16 with no major complications.
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Affiliation(s)
- Arham Siddiqui
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Hijab Ahmed
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Muhammad H Nazim
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Basem Soliman
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Izi Obokhare
- General Surgery, Texas Tech University Health Sciences Center, Amarillo, USA
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14
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Schwartzberg DM, Valente MA. Surgical Dilemmas Associated with Malignant Large Bowel Obstructions. Clin Colon Rectal Surg 2022; 35:197-203. [PMID: 35966387 PMCID: PMC9374526 DOI: 10.1055/s-0042-1742589] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Despite an increase in screening colonoscopy, with the objective to decrease the incidence of colorectal cancer, a third of patients will present with an obstructing cancer. Malignant large bowel obstructions (MLBO) pose a challenging workup and treatment paradigm where an oncologic primary tumor resection must be balanced with relieving the obstruction, functional outcomes, palliation, and consideration for adjuvant therapy. A thorough work up with cross-sectional imaging and medical optimization should be attempted; however, patients may present in extremis and require emergent intervention. The onset of MLBO can be insidious, but result in electrolyte derangements, perforation, small bowel obstruction, hemorrhage, and ischemia. Self-expandable metallic stents have been used as palliation or as a bridge to surgery and have allowed for minimally invasive surgical options as well as a decrease in stoma rates. Patients with signs of colon ischemia or perforation require emergent surgery, which is associated with an increase in stoma formation, morbidity, mortality, and a decrease in overall survival.
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Affiliation(s)
- David M. Schwartzberg
- Mather Colorectal Surgery, Mather Hospital-Northwell Health, Port Jefferson, New York
| | - Michael A. Valente
- Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio,Address for correspondence Michael A. Valente, DO, FACS, FASCRS Department of Colorectal Surgery, Digestive Disease Institute9500 Euclid Avenue, A30, Cleveland, OH 44195
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15
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Alshehri AO, Aljuhani TS, Alotaibi SS, Almughamisi SA, Ageel MM, Alameer AH, Alqahtani KM, Alhumaid ZA, Alsuwayeh AS, Almarri MS, Almotadaris SF, Alsaeed HY, Alatwai AM, Alatawi AM, Al-Hawaj F. Colonic Gallstone Ileus: A Rare Etiology of Large Bowel Obstruction. Cureus 2021; 13:e20338. [PMID: 35036183 PMCID: PMC8752347 DOI: 10.7759/cureus.20338] [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] [Accepted: 12/10/2021] [Indexed: 11/05/2022] Open
Abstract
Large bowel obstruction is a surgical emergency that requires prompt diagnosis and management. It is frequently caused by colon cancer. However, the common benign etiologies include volvulus, hernia, adhesions, and strictures. Imaging studies are essential to establish the diagnosis and identify the etiology. We present the case of a 44-year-old female who presented to the emergency department with abdominal pain and distension for a one-week duration. The pain was associated with decreased bowel motions and vomiting. Her past medical history was significant for diabetes mellitus, dyslipidemia, polycystic ovarian syndrome, and recurrent episodes of biliary colic. Upon examination, she had tachycardia, normal temperature, and normal blood pressure. Abdominal examination revealed a distended abdomen with generalized tenderness and increased intensity of bowel sounds. The laboratory markers were noncontributory. Abdominal computed tomography (CT) scan of the abdomen with intravenous contrast demonstrated the presence of an oval-shaped hypodense intraluminal mass in the sigmoid colon where there was a transition point with proximal colonic dilatation. There was an abnormal communication between the gallbladder and the colon at the hepatic flexure, representing a cholecystocolic fistula tract. This represents a mechanical obstruction of the large bowel due to migrated gallstone through a cholecystocolic fistula tract. The patient was prepared for an emergency laparotomy. The gallstone was removed, and the sigmoid colon was sutured primarily. Resection of the gallbladder was made with the closure of the fistula tract. Following the surgery, the patient reported a resolution of her abdominal pain. Oral feeding was started gradually. After six months of close follow-up, the patient remained asymptomatic with no new complaints. Cholecystocolic fistula is a very rare complication of gallbladder disease. Despite its rarity, surgeons should remember this etiology of large intestinal obstruction when they encounter a patient with gallbladder disease.
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Affiliation(s)
| | | | | | | | - Mariam M Ageel
- College of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | - Ziyad A Alhumaid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | | | - Abdallh M Alatwai
- College of Medicine, Jordan University of Science and Technology, Irbid, SAU
| | | | - Faisal Al-Hawaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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16
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Eskarous H, Krishnamurthy M, Habtesilassie E. Colon stenting in benign diverticular stricture - a case report and review of literature. J Community Hosp Intern Med Perspect 2021; 11:863-865. [PMID: 34804408 PMCID: PMC8604465 DOI: 10.1080/20009666.2021.1969079] [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] [Indexed: 10/28/2022] Open
Abstract
Background: Colonic stricture is a feared complication with varied etiology ranging from malignant obstruction to benign diseases. One such condition is recurrent diverticulitis-related strictures. Objectives & Methods: We report a case of a 48-year-old male patient with stricture of the sigmoid colon. The patient refused Sigmoid colon resection. He underwent stent placement and Two weeks later presented with constipation and abdominal discomfort. On Computed Tomography (CT) we discovered stent migration and consequent large bowel obstruction. Patient agreed on undergoing sigmoidectomy with a colostomy. Conclusion: Indication of SEMS for benign lesions remains unclear. Based on the current data, in benign colorectal obstructive lesions, SEMS is a viable option as a bridge to surgery when no other alternative option is available. However, the ASCRS 2020 guidelines did not point to SEMS as an option given the high rate of complications. Our patient was treated with a stent because he refused the resection surgery and found relief for a certain period before developing stent migration. Hence, the patients should be educated about the short and long-term potential effects of stenting before performing the procedure in benign strictures.
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Affiliation(s)
- Hany Eskarous
- Internal Medicine Department, St. Luke's University Hospital, Easton, PA, USA
| | | | - Endeshaw Habtesilassie
- Internal Medicine Department , Jimma University College of Public Health and Medical Sciences, Jimma, Ethiopia
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17
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Doll A, Grimm L. Congenital Incomplete Rotation of the Colon With Adhesive Obstruction in an Adult. Am Surg 2021:31348211054550. [PMID: 34755557 DOI: 10.1177/00031348211054550] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intestinal obstruction is an entity commonly encountered by general and colorectal surgeons. Anatomic abnormalities account for only a small fraction of cases of complete or partial obstruction. This case report focuses on a 51-year-old female presenting with acute on chronic large bowel obstruction. Workup revealed an exceedingly rare anatomic abnormality: a medialized descending colon, traveling adjacent to the abdominal aorta, with a transition point and dense bands just distal to the splenic flexure. She underwent exploratory laparotomy with division of the constrictive bands and subsequently experienced near-complete resolution of her chronic obstructive symptoms.
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Affiliation(s)
- Alissa Doll
- Department of Surgery, 5557University of South Alabama, Mobile AL, USA
| | - Leander Grimm
- Department of Surgery, 5557University of South Alabama, Mobile AL, USA
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18
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Fleming AM, Scheckel BV, Harmon KE, Yakoub D. Giant Paraesophageal Hernia With Obstructing Splenic Flexure Mass in the Left Hemithorax. Am Surg 2021:31348211050814. [PMID: 34734534 DOI: 10.1177/00031348211050814] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Giant paraesophageal hernias contain greater than fifty percent of the stomach above the diaphragm. Over fifty percent of large bowel obstructions are due to colorectal adenocarcinoma. Here, we present a rare case of a 69-year-old female patient who developed a closed loop colonic obstruction caused by a colonic mass in the distal transverse colon within a giant paraesophageal hernia. We successfully performed emergent paraesophageal hernia reduction and mesh repair with extended right hemicolectomy and ileocolonic anastomosis. Emergent hernia repair via an abdominal approach can be used in this setting.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, Division of Surgical Oncology, and College of Medicine, 430482The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Brent V Scheckel
- Department of Surgery, Division of Surgical Oncology, and College of Medicine, 430482The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kristin E Harmon
- Department of Surgery, Division of Surgical Oncology, and College of Medicine, 430482The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Division of Surgical Oncology, and College of Medicine, 430482The University of Tennessee Health Science Center, Memphis, TN, USA
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19
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Adesunkanmi AO, Olasehinde O, Ndegbu CU, Odunafolabi TA, Mustapha B, Lawal AO, Olorunsola IS. Rectal gastrointestinal stromal tumor: an unusual presentation of an uncommon pathology (a case report). Pan Afr Med J 2021; 39:234. [PMID: 34659607 PMCID: PMC8498667 DOI: 10.11604/pamj.2021.39.234.26727] [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: 10/29/2020] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
Gastrointestinal stromal tumours (GIST) are a rare form of neoplasm. The stomach is the commonest location while gastrointestinal bleeding and pain are the usual presentations. Rectal GIST has been reported in literature as a rare occurrence. We report the rare case of a 37-year-old man who presented with large bowel obstruction and acute urinary retention arising from a rectal GIST. Radiological investigations showed features in keeping with intestinal obstruction. He had a divided colostomy and tumour debulking. Histology of tumour revealed a rectal GIST and immunohistochemical staining was positive for CD34 and CD117. Postoperatively Imatinib was commenced and patient did well. We report this case to highlight the unusual symptoms that may arise from a rare pathology like rectal GIST and the need to consider an alternative diagnosis-such as GIST, in a young adult presenting with large bowel obstruction in the absence of risk factors for bowel adenocarcinoma.
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Affiliation(s)
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria.,Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Chinedu Udochukwu Ndegbu
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | | | - Babatunde Mustapha
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Adedayo Olaitan Lawal
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Ifeoluwa Seun Olorunsola
- Department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
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20
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Huerta S, Pickett ML, Mottershaw AM, Gupta P, Pham T. Volvulus of the Transverse Colon. Am Surg 2021:31348211041564. [PMID: 34461758 DOI: 10.1177/00031348211041564] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the United States, the third leading cause of a large bowel obstruction (LBO) is colonic volvulus with torsion occurring most commonly in the sigmoid and the cecum. Transverse colonic volvulus (TCV) is exceedingly rare and specific involvement of the splenic flexure (SFV) is even less common. The present analysis was undertaken to interrogate current trends in presentation, management, and outcomes of TCV. METHODS In the present report, the world literature was reviewed for the past 90 years (1932 to 2021). We conducted a systematic review to identify all cases of TCV following the PRISMA guidelines. RESULTS We identified 317 cases of TCV. This included SFV (n = 75), TCV in pediatric patients (n = 63), TCV in pregnant patients (n = 8), and TCV associated with other pathology such as Chilaiditi's syndrome (n = 11). Compared to sigmoid and cecal volvulus, TCV was rare (.94%). It affected slightly more women (54%) than men, commonly in their third decade of life (37.7 ± 23.8). The clinical presentation and diagnostic imaging were consistent with LBO. Compared to sigmoid volvulus, there was a limited role for conservative management and colonoscopic decompression was less effective. The most common operation was segmental resection (25%). Mortality was (20%) commonly because of cardiopulmonary complications and affected more women (63%). The average age of this cohort was 55.7±24.6 years old. DISCUSSION Our review showed that TCV is an uncommon surgical entity. The diagnosis is likely to be made at laparotomy. Prompt recognition is paramount in preventing ischemia necrosis and perforation. Compared to sigmoid and cecal volvulus, the mortality for TCV remains high.
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Affiliation(s)
- Sergio Huerta
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Maryanne L Pickett
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Ann M Mottershaw
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Pramod Gupta
- Radiology, 20115VA North Texas Health Care System, Dallas, TX, USA
| | - Thai Pham
- Department of Surgery, 20115VA North Texas Health Care System, Dallas, TX, USA
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21
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Abstract
Acute colonic pseudo-obstruction (ACPO) and volvulus are two disease processes that affect the colon causing abdominal distension and may necessitate operation intervention. ACPO may be associated with multiple comorbidities, infectious diseases, and cardiac dysfunction. It may be treated with conservative management including endoscopic decompression or neostigmine. If the distension is not addressed, high mortality may result if peritonitis develops. Volvulus most commonly occurs in the sigmoid colon or cecum. If left-sided, endoscopic decompression may resolve the obstruction if detorsion is successful, although sigmoid colectomy should be performed during the admission. If cecal volvulus is identified, right hemicolectomy should be performed.
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Affiliation(s)
- Joshua Underhill
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Emily Munding
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
| | - Dana Hayden
- Department of General Surgery, Rush University Medical Center, Chicago, Illinois
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22
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Abstract
Nearly one-quarter of bowel obstructions occur in the large bowel. As with all bowel obstructions, large bowel obstructions have three defining characteristics: partial or complete, intrinsic or extrinsic, benign or malignant. The work-up for a large bowel obstruction should focus on the etiology of the obstruction as well as severity. Management strategy is contingent on the previous characteristics and can include endoscopy, diversion, or resection. This chapter will discuss common and rare etiologies of large bowel obstructions as well as management strategies for clinical guidance.
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Affiliation(s)
- Wali R Johnson
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexander T Hawkins
- Department of Surgery, Section of Colon & Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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23
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Abstract
It is essential for the colon and rectal surgeon to understand the evaluation and management of patients with both small and large bowel obstructions. Computed tomography is usually the most appropriate and accurate diagnostic imaging modality for most suspected bowel obstructions. Additional commonly used imaging modalities include plain radiographs and contrast imaging/fluoroscopy, while less commonly utilized imaging modalities include ultrasonography and magnetic resonance imaging. Regardless of the imaging modality used, interpretation of imaging should involve a systematic, methodological approach to ensure diagnostic accuracy.
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Affiliation(s)
- David W Nelms
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
| | - Brian R Kann
- Department of Colon and Rectal Surgery, Ochsner Medical Center, New Orleans, Louisiana
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24
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Shah T, Shakya A. An unusual cause of large bowel obstruction: To keep an open mind. Clin Case Rep 2020; 8:3592-3593. [PMID: 33363993 PMCID: PMC7752416 DOI: 10.1002/ccr3.3292] [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: 04/08/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
Enterolithiasis or formation of gastrointestinal concretions is an uncommon medical condition that develops in the setting of intestinal stasis due to various pathologies. Its prevalence ranges upto 10% and can present in different clinical pictures to challenge a clinician.
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Affiliation(s)
- Tuhin Shah
- Department of SurgeryAsia Pacific Medical CollegeBirgunjNepal
| | - Arjana Shakya
- Department of OphthalmologyAsia Pacific Medical CollegeBirgunjNepal
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25
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Azin A, Hirpara DH, Draginov A, Khorasani M, Patel SV, O'Brien C, Quereshy FA, Chadi SA. Adequacy of lymph node harvest following colectomy for obstructed and nonobstructed colon cancer. J Surg Oncol 2020; 123:470-478. [PMID: 33141434 DOI: 10.1002/jso.26274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/06/2020] [Accepted: 10/10/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Technical and clinical differences in resection of obstructed and non-obstructed colon cancers may result in differences in lymph node retrieval. The objective of this study is to compare the lymph node harvest following resection of obstructed and nonobstructed colon cancer patients. METHODS A retrospective analysis utilizing the 2014-2018 NSQIP colectomy targeted data set was conducted. One-to-one coarsened exact matching (CEM) was utilized between patients undergoing resection for obstructed and non-obstructed colon cancer. The primary outcome was the adequacy of lymph node retrieval (LNR, ≥12 nodes). RESULTS CEM resulted in 9412 patients. Patients with obstructed tumors were more likely to have inadequate LNR (13.3% vs 8.2%, p < .001) compared to those with nonobstructed tumors. Multivariate analysis demonstrated that patients with obstructing tumors had worse LNR compared to non-obstructed tumors (odds ratio [OR]: 0.74, 95% confidence interval [CI]: 0.62-0.87; p < .005). Increased age (OR: 0.99, 95% CI: 0.098-0.99), presence of preoperative sepsis (OR: 0.70, 95% CI: 0.055-0.90), left-sided and sigmoid tumors compared to right-sided (OR: 0.64, 95% CI: 0.51-0.81; OR: 0.69, 95% CI: 0.58-0.82, respectively), and open surgical resection compared to an minimally invasive surgical approach were associated with inadequate LNR (p < .05). CONCLUSION This study demonstrated that resection for obstructing colon cancer compared to non-obstructed colon cancer is associated with increased odds of inadequate lymph node harvest.
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Affiliation(s)
- Arash Azin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dhruvin H Hirpara
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arman Draginov
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Sunil V Patel
- Division of General Surgery, Queens University, Kingston, Ontario, Canada
| | - Catherine O'Brien
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sami A Chadi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Colorectal Cancer Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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26
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Olecki EJ, Puleo FJ. Young Patients Presenting With Large Bowel Obstruction Due to Gynecological Malignancy. Am Surg 2020; 88:2053-2055. [PMID: 32993320 DOI: 10.1177/0003134820950284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Frances J Puleo
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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27
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Shah R, Klumpp L, Negron-Diaz J, Carmain T, Jordan J. Transverse colon volvulus in a patient with autism. J Surg Case Rep 2020; 2020:rjaa284. [PMID: 32934786 PMCID: PMC7479646 DOI: 10.1093/jscr/rjaa284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Transverse colon volvulus is an extremely rare cause of bowel obstruction with approximately 100 cases reported in literature. Transverse colon volvulus presents with signs and symptoms of large bowel obstruction, but it can become a surgical emergency due to bowel infarction or peritonitis. We present a rare case of transverse colon volvulus in a 36-year-old male patient with severe autism. We hope this case report will raise awareness of this disease.
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Affiliation(s)
- Rony Shah
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Linda Klumpp
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Juan Negron-Diaz
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Torr Carmain
- Department of Surgery, Citrus Memorial Hospital, Inverness, FL 34452, USA
| | - Jeffrey Jordan
- Department of Internal Medicine, Citrus Memorial Hospital, Inverness, FL 34452, USA
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28
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Cheng AW, Abdeljaber M, Lima NA, Shebrain S. Large Bowel Obstruction in the Setting of Small Lymphocytic Lymphoma. Cureus 2020; 12:e9640. [PMID: 32923240 PMCID: PMC7480891 DOI: 10.7759/cureus.9640] [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: 07/22/2020] [Accepted: 08/09/2020] [Indexed: 11/05/2022] Open
Abstract
Large bowel obstruction (LBO) is a potential surgical emergency, commonly caused by colorectal carcinoma, diverticular stricture, and volvulus. LBO secondary to chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) is a rare occurrence. We report an 81-year-old man with a history of CLL/SLL who presented to the emergency department with episodes of abdominal cramps and discomfort, diarrhea, vomiting, subjective flushes, and sweats. After a thorough evaluation, the patient was found to have a malignancy-mediated mechanical LBO at the hepatic flexure due to colonic compression by extensive pericolic lymphadenopathy. After resuscitation and medical optimization, an urgent laparotomy with oncologic right hemicolectomy was performed. Analysis of resected specimens, including lymph nodes, revealed atypical CD23- CLL/SLL cells. Postoperatively, aside from temporary ileus, the patient recovered well and was discharged home.
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Affiliation(s)
- Abigail W Cheng
- Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Mahmuod Abdeljaber
- Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Neiberg A Lima
- Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
| | - Saad Shebrain
- Surgery, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA
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29
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Abstract
Cecal volvulus is a very rare cause of large bowel obstruction (LBO) that develops when a part of the bowel twists around the mesentery. Cases of acute abdomen, regardless of age, race, and ethnicity, should be examined to exclude volvulus from differential diagnoses. Surgery is the only confirmatory method to diagnose and treat this life-threatening condition. Here, we report a case of a 35-year-old female patient who presented with abdominal pain, distension, constipation, and vomiting. Abdominal computed tomography (CT) aided in accurately diagnosing the cecal volvulus, and the patient immediately underwent an exploratory laparotomy.
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30
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Bhandari TR, Shahi S, Poudel R. Colonic Volvulus: An Experience at Tertiary Care Hospital in Nepal. Cureus 2019; 11:e5165. [PMID: 31528515 PMCID: PMC6743661 DOI: 10.7759/cureus.5165] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Colonic volvulus is not an uncommon cause of large bowel obstruction. Limited research has been done about colonic volvulus in our part of the world which has been regarded as "volvulus belt." The aim of this study is to evaluate the clinical features, management, and factors affecting perioperative outcomes in patients with colonic volvulus. Methods: A retrospective review of medical records of all patients managed for colonic volvulus in Universal College of Medical Sciences, Bhairahawa from January 2012 to December 2016 was done. Data on patient demographics, clinical course, methods of treatment, and outcomes were analyzed. Results: A total of 62 patients (46 males) were studied. Mean age was 57.9 ± 10.4 years. The most common site involved was sigmoid (85.5%). The diagnosis was made by abdominal x-rays in 39 patients (62.2%), CT scan in 13 patients (21%), and laparotomy in 10 patients (16.1%). Fifty-eight patients (93.5%) were treated surgically. Resection and ostomy was the commonest operation performed in 30 patients (48.7%) followed by resection with anastomosis in 24 patients (38.7%). The overall complication was 38.7%. There were 9.7% of deaths. In multivariate analysis, age ( ≥ 60 years) (odds ratio (OR); 27.0, confidence interval (CI); (1.92-403), P; 0.01), preoperative hypotension (systolic blood pressure <90 mmHg) (OR; 7.82, CI; (1.19-51.2), P; 0.03), and gangrenous bowel (OR; 76.7, CI (3.60-1632), P; 0.005) were significant predictors of postoperative complications . Conclusions: Volvulus of the colon is common in males and constipation is being commonest risk factors for volvulus. Surgeons should have a high index of suspicion and should be aware of these problems to make the early diagnosis with prompt treatment and to ensure better patient outcomes in volvulus endemic areas like ours.
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Affiliation(s)
- Tika R Bhandari
- Surgery, People's Dental College and Hospital, Kathmandu, NPL
| | - Sudha Shahi
- Otorhinolaryngology, National Academy of Medical Sciences, Kathmandu, NPL
| | - Rajesh Poudel
- Surgery, Universal College of Medical Sciences, Bhairahawa, NPL
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31
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Young CJ, Zahid A. Randomized controlled trial of colonic stent insertion in non-curable large bowel obstruction: a post hoc cost analysis. Colorectal Dis 2018; 20:288-295. [PMID: 29091349 DOI: 10.1111/codi.13951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
AIM In view of the increasing burden on the healthcare system, this study aims to perform a cost-effectiveness analysis of the management of incurable large bowel obstruction comparing the cost of a stent vs surgery. METHOD A prospective randomized controlled trial was conducted at two major teaching hospitals in Australia between September 2006 and November 2011. Fifty-six patients with malignant incurable large bowel obstruction were randomized to stent insertion or surgical decompression, of whom 52 were included in the final analysis. Data were collected at all points during the patient journey and quality of life data were obtained by patient surveys. All data points were analysed and a cost-effectiveness study was performed to compare the costs between the two treatment groups. RESULTS Stenting as a procedure was significantly more expensive than surgery (A$4462.50 vs A$3251.50; P < 0.001). Post-procedure stay for stented patients was significantly lower (median 7 vs 11 days; P = 0.03). Combined costs of stent group ward stay, multidisciplinary team discussion and complication management were significantly lower (P = 0.013). Overall cost difference between the two treatment groups was A$3902.44 (P = 0.101). European Quality of Life - 5 Dimensions (EQ-5D) scores for the first 4 weeks gave mean area under the curve adjusted weeks of 2.411 vs 2.271 for the stent and surgery groups respectively (P = 0.603). The incremental cost-effectiveness ratio between the surgery and the stent group was $22 955.53 in favour of stenting. CONCLUSIONS Treatment with stenting is cheaper than open surgery and provides quicker discharge from hospital.
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Affiliation(s)
- C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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32
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Abstract
RATIONALE Accessory spleen torsion is a rare cause of the acute abdomen. The complications of accessory spleen torsion, such as intestinal obstruction, are rarer. We herein report a case of colonic obstruction caused by accessory spleen torsion because of the unusual condition. PATIENT CONCERNS A 15-year-old patient presented with acute intestinal obstruction with signs of peritoneal irritation. Abdominal computed tomography (CT) and ultrasonography examinations revealed a soft tissue mass in the left midabdomen. Systemic inflammatory response syndrome (SIRS) was observed in this case. DIAGNOSES The diagnosis of peritonitis and colonic obstruction secondary to accessory spleen torsion was made. Pathologic examination showed infracted splenic tissue. INTERVENTIONS We performed emergency laparotomy and found that accessory spleen torsion pressured against splenic flexure and descending colon, and caused colon obstruction. The patient underwent accessory splenectomy and enteral decompression. OUTCOMES At 6 months follow-up, the patient recovered well with perfect digestion. LESSONS Accessory spleen torsion and its complications are extremely rare. This entity should be considered in differential diagnosis of acute abdomen. However, in case of acute abdomen with critical clinical situation, emergency surgical intervention is necessary for timely diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | | | - Zhili Pan
- Department of Radiology, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui, China
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Lukovich P, Csibi N, Rigó J, Bokor A. [Bowel endometriosis: new challenge for gastroenterology and surgery? Three cases of endometriosis caused large bowel ileus and review of the literature]. Orv Hetil 2017; 157:1960-1966. [PMID: 27917676 DOI: 10.1556/650.2016.30611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A number of the patients suffer from endometriosis increased in the past decades and the cases have became more serious. The most critical complication of bowel endometriosis is the large bowel obstruction. Up to recently, 16 similar case reports of large bowel endomteriosis causing obstruction, with detailed medical history have been published in the literature in English language. PATIENTS Since 2007 535 female have been treated in the 1st Gynaecological Department with endometriosis, out of them three patients from emergency surgery in the history because of large bowel obstruction. RESULTS Symptoms suggesting endometriosis or previous intervention due to endometriosis were detected in 59% (13/21) of the cases. Preoperative ultrasound, computertomography, magnetic resonance imaging did not give correct diagnosis. Colonoscopy was carried out before the primary operation in 61% (13/21) and after the surgery in 24% (5/21) of the cases, but none of them confirmed endometriosis. Although all the patients developed obstruction, only in 5% (1/19) of the patients was the mucosa infiltrated by the endometriosis. CONCLUSIONS In a young female patient, intestinal obstruction can be caused by bowel endometriosis. Identification of colonoscopic signs (rigidity, impression, kinking) of endometriosis may help to avoid unnecessary extension of intestinal resection. Gynaecologists should take part in the operations. Orv. Hetil., 2016, 157(49), 1960-1966.
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Affiliation(s)
- Péter Lukovich
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Üllői út 78., 1082
| | - Noémi Csibi
- I. Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - János Rigó
- I. Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Attila Bokor
- I. Nőgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic. Acad Radiol 2017; 24:521-529. [PMID: 28268146 DOI: 10.1016/j.acra.2017.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of intussusception and methods used in the treatment of ileocolic intussusception. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome (PICO) method comparing radiography, ultrasound, and computed tomography in the detection of intussusception. The same methods were used to compare pneumatic (gas) reduction and hydrostatic (liquid) reduction using saline, water-soluble contrast, and barium. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS The retrieved sensitivity for the diagnosis of intussusception using plain radiography is 48% (95% confidence interval [CI], 44%-52%), with a specificity of 21% (95% CI, 18%-24%). The retrieved sensitivity for the diagnosis of intussusception using ultrasound is 97.9% (95% CI, 95%-100%), with a specificity of 97.8% (95% CI, 97%-99%). Based on a good quality meta-analysis, the combined success rate of gas enema reduction was shown to be 82.7% (95% CI, 79.9%-85.6%) compared to a combined success rate of 69.6% (95% CI, 65.0%-74.1%) for liquid enema reduction. CONCLUSIONS The best available evidence recommends ultrasound as the diagnostic modality of choice for the diagnosis of ileocolic intussusception in children. In stable children without signs of peritonism, nonoperative reduction is the treatment of choice. Pneumatic (gas) reduction enema has been shown to be superior to hydrostatic (liquid) enema reduction.
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Affiliation(s)
- Anne G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Richard G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | - Noelle M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Dublin, Ireland
| | - Lisa P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Dermot E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci 2017; 7:15. [PMID: 28480123 PMCID: PMC5404618 DOI: 10.4103/jcis.jcis_6_17] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 01/22/2017] [Accepted: 03/01/2017] [Indexed: 12/18/2022] Open
Abstract
Although large bowel obstruction (LBO) is less common than small bowel obstruction, it is associated with high morbidity and mortality due to delayed diagnosis and/or treatment. Plain radiographs are sufficient to diagnose LBO in a majority of patients. However, further evaluation with multidetector computed tomography (MDCT) has become the standard of care to identify the site, severity, and etiology of obstruction. In this comprehensive review, we illustrate the various causes of LBO emphasizing the role of MDCT in the initial diagnosis and detection of complications along with the tips to differentiate from disease which can mimic LBO.
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Affiliation(s)
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229, USA
| | - Ravi Vassa
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210, USA
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Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative Effectiveness of Imaging Modalities for the Diagnosis of Intestinal Obstruction in Neonates and Infants:: A Critically Appraised Topic. Acad Radiol 2016; 23:559-68. [PMID: 26857524 DOI: 10.1016/j.acra.2015.12.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 12/09/2015] [Accepted: 12/27/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of upper and lower gastrointestinal (GI) tract obstruction in neonates and infants. METHODS A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome method comparing radiography, upper GI contrast study, and ultrasound in the detection of upper GI tract obstruction such as duodenal atresia and stenosis, jejunal and ileal atresia, and malrotation and volvulus. The same methods were used to compare radiography and contrast enema in the detection of lower GI tract obstruction such as meconium plug syndrome, meconium ileus, Hirschsprung disease, and imperforate anus. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies. RESULTS There were no sensitivities/specificities available for the imaging diagnosis of duodenal atresia or stenosis, jejunal or ileal atresias, meconium plug, and meconium ileus or for the use of cross-table lateral radiography for the diagnosis of rectal pouch distance from skin in imperforate anus. The retrieved sensitivity for the detection of malrotation on upper GI contrast study is 96%, and the sensitivity for the diagnosis of midgut volvulus on upper GI contrast study is 79%. The retrieved sensitivity and specificity for the detection of malrotation with volvulus on ultrasound were 89% and 92%, respectively. The retrieved sensitivity and specificity for the detection of Hirschsprung disease on contrast enema were 70% and 83%, respectively. The retrieved sensitivity of invertogram for the diagnosis of rectal pouch distance from skin in imperforate anus is 27%. The retrieved sensitivities of perineal ultrasound and colostography for the diagnosis of rectal pouch distance from skin in imperforate anus were 86% and 100%, respectively. CONCLUSIONS There is limited evidence for the imaging diagnosis of duodenal atresia and stenosis, jejunal and ileal atresias, meconium plug, meconium ileus, and imperforate anus, with recommended practice based mainly on low-quality evidence or expert opinion. The available evidence supports the use of upper GI contrast study for the diagnosis of malrotation and volvulus, with ultrasound as an adjunct to diagnosis. Contrast enema is useful in the investigation of suspected Hirschsprung disease, but a negative study does not outrule the condition. Colostography is the investigation of choice for the work-up of infants with complex anorectal malformations before definitive surgical repair.
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Affiliation(s)
- A G Carroll
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - R G Kavanagh
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - C Ni Leidhin
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - N M Cullinan
- Department of Pediatrics, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - L P Lavelle
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
| | - D E Malone
- Department of Radiology, St. Vincent's University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland
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Abstract
The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease.
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Affiliation(s)
- Steven Lee-Kong
- Department of Surgery, CUMC, New York Presbyterian Hospital, Columbia University, New York, New York
| | - David Lisle
- Department of General Surgery, New York Presbyterian Hospital, Columbia University, New York, New York
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Abstract
Acute colonic pseudoobstruction (ACPO), often referred to as Ogilvie syndrome, is a clinical entity characterized by severe colonic distension (adult acute megacolon) in the absence of mechanical obstruction. It can result in abdominal ischemia and perforation if left untreated. This article discusses the epidemiology and current pathophysiologic theories of ACPO as well as the clinical presentation and diagnostic modalities utilized to identify the disease. In addition, this article describes the current treatment options for ACPO, which range from conservative medical therapy, therapeutic endoscopy, to subtotal colectomy.
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Affiliation(s)
- Allen P Chudzinski
- Colorectal Surgery Program, Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Earl V Thompson
- Department of Surgery, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jennifer M Ayscue
- Colorectal Surgery Program, Department of Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia ; Section of Colon and Rectal Surgery, Washington Hospital Center, Washington, District of Columbia
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OCCHIONORELLI S, TARTARINI D, CAPPELLARI L, STANO R, VASQUEZ G. Colonic stent placement as a bridge to surgery in patients with left-sided malignant large bowel obstruction. An observational study. G Chir 2014; 35:283-289. [PMID: 25644730 PMCID: PMC4321507] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Acute left-sided malignant colonic obstruction is common in elderly patients, in which emergency surgery is related with high morbidity and mortality rates, and often necessitates a two-step resection. Although the use of self-expanding metallic stents (SEMS) in elderly patients has not been adequately described yet, there are almost two international important trials which are still in progress, the stenting technique is established to be, by the international literature, an useful treatment with low morbidity and mortality. It's also a bridge to surgery, since the insertion of a SEMS can decompress the obstruction, making bowel and patient preparation possible and facilitating singlestage surgical resection. Palliative stenting can improve quality of life when compared to surgery in patients with metastasis or high co-morbidity. The aim of this study is to analyze mortality, avoidance of stoma, short- and long-term survival in patient with malignant left-sided large bowel obstruction who underwent to stent placement in our Emergency Surgery Unit, which is operative since November 2010 in our city Hospital in Ferrara. PATIENTS AND METHODS Between November 2010 and December 2012 a total of 15 patients with acute left-sided malignant large bowel obstruction suitable for colonic stent application were admitted to Emergency Surgery Unit. Among these patients, 9 underwent to self-expanding metallic stent placement (group A), the other (group B) 6 patient underwent to emergency surgery. In this observational not-randomized study we analyzed the efficacy and safety of SEMS placement for patients either as a bridge to surgery or as a palliation, beside the short term and long term outcomes, versus those patients operated straight. RESULTS Self-expanding metallic stents were successfully implanted in 9 of the 15 patients with acute left-sided malignant large bowel obstruction. No acute procedure-related complication was observed. All the patients in group A kept the stent in place for an average of 7,7 days, then everyone underwent to surgery. A large bowel resection with one-time recanalization was performed in 8 of the 9 patients. None Hartmann resection was necessary. Only one underwent again to surgery because of a dehiscence, a stoma was necessary. Between the other 6 patients in group B who underwent directly to surgery, In one case was necessary an Hartmann resection, another one incurred in dehiscence of the anastomosis that required reoperation with stoma creation. CONCLUSIONS Placement of SEMS seems to be an useful alternative to emergent surgery in the management of acute left-sided bowel obstruction, both as a bridge to surgery and as a palliative procedure. SEMS can provide an effective and safe therapeutic option compared to emergency surgery, most of all in elderly patients, with a lower mortality rate, a significantly higher rate of primary anastomosis and the avoidance of stoma. However, to fully determine their role for these indications, more data and more high level evidence is required.
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Affiliation(s)
- S. OCCHIONORELLI
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - D. TARTARINI
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - L. CAPPELLARI
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
| | - R. STANO
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
| | - G. VASQUEZ
- Emergency Surgery Service, “AOU S. Anna”, Ferrara, Italy
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Geraghty J, Sarkar S, Cox T, Lal S, Willert R, Ramesh J, Bodger K, Carlson GL. Management of large bowel obstruction with self-expanding metal stents. A multicentre retrospective study of factors determining outcome. Colorectal Dis 2014; 16:476-83. [PMID: 24506142 DOI: 10.1111/codi.12582] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/18/2013] [Indexed: 12/12/2022]
Abstract
AIM UK cancer guidelines recommend patients with colonic obstruction due to suspected malignancy be considered for stenting with a self-expanding metal stent (SEMS). Considerable variation in practice exists due to a lack of expertise, technical difficulties and other, as yet ill-defined features. This retrospective multi-centre study aims to determine the outcome following colonic stenting for large bowel obstruction and identify factors associated with successful intervention. METHOD A regional programme of colonic stenting for large bowel obstruction, in five UK centres from 2005 to 2010 was evaluated for outcome including technical and clinical success, survival, complications and reoperation. RESULTS A SEMS was inserted in 334 patients, including 264 (79.0%) for palliation and 52 (15.6%) as a bridge to surgery. Technical success was achieved in 292 (87.4%) patients, with 46 (13.8%) experiencing a complication or technical failure. Reoperation was required in 39 (14.8%) patients stented for palliation of colorectal cancer of whom 16 (6.1%) subsequently required a colostomy. A one-stage primary anastomosis was achieved in 35 (67.3%) of the 52 patients undergoing stenting as a bridge to resection. Technical success did not vary by indication or site of obstruction (P = 0.60) but was higher for operators who had performed more than 10 procedures (OR 3.34, P = 0.001). ASA grade ≥3 predicted a worse clinical outcome (OR 0.43, P = 0.04). The through-the-scope (TTS) endoscopy technique was more successful than radiological placement alone (90.3% vs 74.8%, P < 0.001). CONCLUSION Experienced operators using a TTS technique achieved a better outcome for the emergency management of large bowel obstruction. Older, sicker patients and those with extracolonic and benign strictures fared less well.
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Affiliation(s)
- J Geraghty
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
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Abstract
Large bowel obstruction is a common problem with many different causes, the most common being colorectal adenocarcinoma, extracolonic adenocarcinoma, diverticular disease, volvulus, and inflammatory bowel disease. The nature of the obstruction can influence the best management. Historically, treatment of obstruction consisted of surgical removal of the obstruction if possible and decompression of the bowel with an ostomy. Other strategies for managing obstruction have evolved as alternatives to stomas, including primary resection with anastomosis and endoscopic stent placement. The choice of treatment can therefore be tailored to the individual patient with good success.
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Affiliation(s)
- Rebecca S Sawai
- Department of General Surgery, Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii
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Abstract
The manuscript deals with the case of a 53-year-old woman who developed large bowel obstruction. Per-rectal examination revealed a pedunculated lesion in the rectum; rigid sigmoidoscopy revealed a prolapsing pedunculated mass with a necrotic surface. The patient recovered well following anterior resection. Histology confirmed a pedunculated sub mucosal lipoma as the lead point for intussusception. Colonic intussusception is a rare cause of adult large bowel obstruction, and the preoperative clinical diagnosis of this condition can be difficult. Resection of the involved segment of the colon is the most appropriate choice of treatment in most such cases.
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Affiliation(s)
- Justin James
- Department of Surgery, Central Gippsland Health Service, Sale, Victoria, Australia
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Cadwallader RA, Shabalala N, Thirsk I. Intestinal schistosomiasis presenting as large bowel perforation in an HIV-positive individual. Res Rep Trop Med 2011; 2:105-107. [PMID: 30881183 DOI: 10.2147/rrtm.s18797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endemic to over 70 countries and resulting in 200 million infected individuals and 500,000 deaths each year, the Schistosoma trematode worm can result in multisystem morbidity. Bowel obstruction secondary to this parasite has previously been described, but we report the first case of schistosomiasis affecting the sigmoid colon and resulting in perforation in a male positive for human immunodeficiency virus.
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Affiliation(s)
| | - N Shabalala
- Ngwelezana Hospital, Empangeni, South Africa,
| | - I Thirsk
- Ngwelezana Hospital, Empangeni, South Africa,
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