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Subramanian P, Sharma A, Soundararajan R, Singhal M. Spectrum of Multidetector Computed Tomography Imaging Findings in Iatrogenic Abdominopelvic Injuries: A Comprehensive Pictorial Review. Indian J Radiol Imaging 2024; 34:139-149. [PMID: 38106862 PMCID: PMC10723973 DOI: 10.1055/s-0043-1775736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.
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Affiliation(s)
- Pavithra Subramanian
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Manzo CA, Celentano V. Stapled disc excision for the repair of intraoperative rectal injury during robotic surgery for deep infiltrating endometriosis. Langenbecks Arch Surg 2023; 408:153. [PMID: 37079139 DOI: 10.1007/s00423-023-02890-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/06/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Intraoperative rectal perforation is an uncommon complication of pelvic surgery, which can be life-threatening and often leads to high morbidity and stoma formation rate. PURPOSE No consensus has been reached regarding a standard of care for intraoperative iatrogenic pelvic injury. This article presents a technique for a stapled repair to completely resect a full-thickness low rectal perforation during robotic surgery for advanced endometriosis and avoid a high-risk colorectal anastomosis and the possible need for stoma formation. CONCLUSION Stapled discoid excision is a novel and safe technique for the repair of intraoperative rectal injuries, showing multiple benefits compared to the standard colorectal resection with or without anastomosis.
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Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC. Rectal Perforation During Pelvic Surgery. EUR UROL SUPPL 2022; 44:54-59. [PMID: 36093319 PMCID: PMC9449548 DOI: 10.1016/j.euros.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Rectal perforations during pelvic surgery are rare but serious complications. The occurrence of rectal involvement is generally lower than that of the involvement of other portions of the bowel. The urologic field is responsible for the majority of iatrogenic rectal injuries from pelvic surgery; general and gynecologic surgeries are prone to the occurrence as well, the latter especially in the case of rectal shaving for deep infiltrating endometriosis. Attention should be posed to the prevention of rectal injuries, especially in case of challenging or salvage procedures; some tricks may be recommended to avoid thermal and mechanical damages and to realize a safe dissection. Intraoperative detection of rectal injuries is of paramount importance; once confirmed, immediate management with the closure of the defect is recommended. In general, rectal injuries diagnosed after surgery are liable to significantly worse outcomes than those detected and managed intraoperatively. Patient summary Rectal perforation is a rare but possible complication of pelvic surgeries. The more challenging the procedure (ie, surgery for locally advanced tumors or after radiation therapy), the higher the risk of rectal lesion. Intraoperative management of the injury should be attempted, with direct repair of the defect with or without fecal diversion.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Corresponding author. Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy. Tel. +39 335 830 6522.
| | - Gaia Giorgia
- Department of Gynecology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Assumma Simone
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Calcagnile Tommaso
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sangalli Mattia
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Terzoni Stefano
- SIG Group on Continence Care, European Association of Urology Nurses, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Eissa Ahmed
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Antonio Celia
- San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Micali Salvatore
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Wasanwala H, Neychev V. Perforated Colon Cancer Associated With Post-operative Recurrent Bowel Perforations. Cureus 2021; 13:e17655. [PMID: 34646700 PMCID: PMC8486625 DOI: 10.7759/cureus.17655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/05/2022] Open
Abstract
Colon perforation is a major life-threatening condition associated with high morbidity and mortality, which often develops secondary to complicated diverticulitis and, less commonly, colon cancer. We describe the case of a 51-year-old female who had perforated colon cancer with concurrent diverticulosis. Based on history, physical exam, laboratory, and computed tomography (CT) findings on initial presentation, the patient was diagnosed with acute complicated diverticulitis. Despite medical treatment, the patient’s condition worsened, warranting exploratory laparotomy and a left hemicolectomy with transverse end colostomy creation. Surgical pathology revealed stage IIIC colon cancer without evidence of diverticulitis. The patient underwent eight cycles of adjuvant chemotherapy with FOLFOX (folinic acid, fluorouracil, and oxaliplatin). Over the next year, the patient experienced recurrent bowel perforations requiring repeated surgeries. Perforations were identified in both the small and large bowel on different occasions. Even though neither presented with a clear etiology, possible ischemic, infectious, erosive, and iatrogenic etiologies were on the differential. Our case exemplifies the mounting complications we should be wary of when performing repeated invasive abdominal operations.
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Affiliation(s)
- Huzaifa Wasanwala
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Vladimir Neychev
- General Surgery, University of Central Florida College of Medicine, Orlando, USA
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