Proposed clinical operative synoptic report for ileocolic resection for Crohn's disease

BACKGROUND

Crohn's disease patients may require multiple surgeries during their lifetime. Because operative reports are not standardized, information relevant to future management may not be documented. Synoptic reports used in other fields such as histopathology have proven to be effective and allow consistent documentation of results. The aim of this study was to retrospectively review the completeness of the operative reports for ileocolic Crohn's resections (ICR) and to propose a synoptic report.

METHODS

A draft synoptic operative report for ICR for Crohn's disease was presented in the IBD multidisciplinary meeting and a Delphi process used to gain consensus for inclusion in the synoptic report. Retrospective analysis of consecutive ICR from January 2010 to April 2023 was undertaken to determine the presence of the standardized criteria.

RESULTS

A total of 66 ICR were performed in 63 patients during the study period. No operation reports were excluded. The examination of bowel for macroscopic disease was partially documented in 88% cases. The extent of mesenteric resection and any difficulty encountered during dissection were poorly documented. The remaining length of small and large intestines was not documented in most operative reports. The clinical sections that were compulsory entrance in the electronic operative report achieved 100% compliance.

CONCLUSION

This study has demonstrated that key information was often deficient in the operative report. This may have a significant impact on the future management of Crohn's patients and affects the interpretation of research outcomes. A proposed clinical synoptic operative report is easy to use and ensures compliance.

Intestinal Intussusception Due to Entrapped Ascaris lumbricoides in a 13-Year-Old Male Patient

Ascaris lumbricoides is a fairly common intestinal nematode affecting children worldwide, leading to major medical and surgical complications. Although most of the cases are asymptomatic, heavy infestation causes various acute abdominal complications. Ascaris-induced intestinal intussusception is one of the rare presentations. We report a case of a 13-year-old boy with Ascaris lumbricoides infestation presenting with ileocolic intussusception. The patient presented to the emergency unit with colicky abdominal pain, vomiting, and constipation for two days. He was sick-looking and dehydrated. Further examination revealed diffuse abdominal distension with tenderness, guarding, and palpable mass in the right lower quadrant. Ultrasonography showed long-segment ileocolic intussusception with several worms in the intestinal lumen and adjacent mesenteric lymphadenopathy. An exploratory laparotomy was performed, which revealed ileocolic intussusception. The telescopic loop of the ileum was found to be gangrenous and was resected, and a loop ileostomy was performed. The patient was discharged on the seventh day postoperatively without any complications. Physicians in tropical and subtropical countries should consider this condition in the differential diagnosis when they encounter similar presentations in their clinical practice. Sonography is a non-invasive, easy-to-use, and widely available imaging modality that can be employed to diagnose entrapped Ascaris in cases presenting with acute gastrointestinal complications. Early diagnosis and prompt surgical intervention can prevent bowel ischemia/gangrene and significantly reduce morbidity and mortality associated with such cases.

Ileocolic Anastomoses

Ileocolic anastomoses are commonly performed by surgeons in both open and minimally invasive settings and can be created by using many different techniques and configurations. Here the authors review both current literature and the author's preference for creation of ileocolic anastomoses in the setting of malignancy, inflammatory bowel disease, and colonic inertia. The authors also review evidence surrounding adjuncts to creation of anastomoses such as use of indocyanine green and closing mesenteric defects. While many techniques of anastomotic creation have adapted with new evidence and technologies, several key principles still provide the foundation for current practice.

Management of ileocolic intussusception in the Czech Republic

INTRODUCTION

Ileocolic intussusception is one of the most frequent causes of acute abdomen in infants and toddlers. The purpose of this study was to evaluate the treatment of ileocolic intussusception in the Czech Republic in 2019.

METHODS

Fourteen departments of paediatric surgery participated in this multicentre retrospective study. A SurveyMonkey Inc. questionnaire was used for anonymous data collection of patients with ileocolic intussusception.

RESULTS

In 2019, ileocolic intussusception was diagnosed in 162 patients; median age was 30 months (3 months to 9.5 years). Contrast enema was indicated in 133 patients, primary surgery in 14 patients and spontaneous reduction was found in 15 patients. All departments using contrast enema had a success rate of 89.5%; 12 departments approached the contrast enema procedure under general anaesthesia (including myorelaxation at 7 departments) and 2 departments under sedation. Contrast enema under general anaesthesia with/without myorelaxation was significantly more successful than contrast enema under sedation (108/113, 95.6% vs 11/20, 55%; p.

Ileocolic intussusception due to intestinal lipoma in an adult patient

Intestinal obstruction due to intussusception caused by intestinal lipomas is a rare condition in adults that needs urgent treatment. CT (Computerised Tomography) is the radiologic modality of choice for diagnosis. Surgery is the treatment of choice and has excellent outcome.

Ileocolic intussusception caused by ileal lipoma: A case report

RATIONALE

Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma.

PATIENT CONCERNS

A 27-year-old woman complaints of intermittent abdominal pain for 10 days.

DIAGNOSIS

Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made.

INTERVENTIONS

The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed.

OUTCOMES

Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications.

LESSONS

We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.

The use of ileocolic segment for esophageal replacement in children

AIMS

To evaluate and describe the procedure and outcome of ileocolic replacement of esophagus.

MATERIALS AND METHODS

We review 7 children with esophageal injuries, who underwent esophageal replacement using ileocolic segment in Christian Medical College, Vellore, India between 2006 and 2014.

RESULTS

The ileocolic segment was used in 7 children with scarred or inadequate esophagus. There were 4 girls and 3 boys, who underwent esophageal replacement using isoperistaltic ileocolic segment in this period. Age at presentation varied from 1 month to 14 years with an average of 4.6 years. The indications for ileocolic replacements were corrosive strictures in 5, failed esophageal atresia repair in one and gastric volvulus related esophageal stricture in another. The average follow-up duration was 37 months. One child with corrosive stricture lost to follow-up and died 2 years later in another center. Other 6 children were free of dysphagia till the last follow-up.

CONCLUSIONS

Although the ileocolic segment is not commonly used for esophageal substitution, it can be useful in special situations where the substitution needs to reach the high cervical esophagus and also where the stomach is scarred and not suitable for gastric pull-up.