Successful transanal removal of unusual foreign body self-inserted in the rectum A case report and review of literature

Foreign bodies in the rectum are a true proctological emergency. The incidence of these cases is increasing in recent years mostly due to auto-erotic acts and behavior disordes and is mainly observed in young patients. Most patients with rectal foreign bodies present to the emergency room usually exhausted after efforts of removingothe object at home. Many endoscopic and surgical techniques to get such removal have been described in the literature and the reported variety of in foreign bodies is as large as the number of techniques used to remove them. Authors report a case of unusual foreign body in the rectum that required multiple attempts to be removed and an original solution. KEY WORDS: Emergency surgery, Rectal foreign body, Transanal Extraction.

Small bowel intussusception due to malignant melanoma: primary lesion or metastases? A case report

Intussusception is a rare condition in the adult population: it is responsible for 1% of all bowel obstructions. In most of intussusceptions a malignant tumor is involved; a lot of studies show that approximately 50% of malignant metastases causing small bowel intussusception are metastatic melanomas. In present paper a case of a small bowel intussusception probably due to metastases of an occult melanoma, in a 69-year-old patient, is presented. Surgery resection, careful research of possible primitive neoplasms and an accurate follow-up program has been the treatment of choice. All the investigations carried out did not allow to identify a possible primitive neoplasm. The last whole body PET carried out 44 months after surgery resulted disease-free.

Internal Delorme vs. STARR procedure for correction of obstructed defecation from rectocele and rectal intussusception

PURPOSE

"Outlet obstruction" is a complex functional disorder compelling patients to exhausting uneffective attempts to void. This study was designed to compare the effectiveness and a safety of the endorectal proctopexy (internal Delorme) vs STARR procedure in two groups of patients.

METHODS

A total of 66 patients with rectocele and associated mucosal prolapse or anorectal intussusception between January 2006 and June 2010 were randomly assigned to Group # 1 Endorectal proctopexy with levatorplasty (ERPP) and Group # 2 STARR. Patients were assessed one week, six and twelve months after the operation. Operative time, postoperative pain, day of discharge and late complications was recorded. The time of recovery of work was also assessed. The continence score was updated with a constipation questionnaire. Quality of life after the operation and the overall grade of satisfaction were assessed and compared with radiological findings. All patients were reassessed after one year.

RESULTS

The results in the two groups of patients show no significant difference between ERPP and STARR: the improvement in symptoms is similar but significant and well definite in both groups with a low incidence of postoperative complications. STARR procedure is just faster to perform even if more expensive. Dyspareunia slightly improved mainly in ERPP group, due probably to scar distention.

CONCLUSION

The results of our experience indicate a significant improvement of symptoms with both techniques. The overall incidence rate of postoperative complications is low and similar between the two groups. As economical consideration, ERPP is less expensive.

Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

BACKGROUND

Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses.

METHODS

From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications.

RESULTS

In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9 months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146 days (range 9-483 days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications.

CONCLUSIONS

This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up.