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Salman R, Seghers VJ, Schiess DM, Nguyen HN, Sher AC, Mertiri L, Sammer MBK. Ultrasound imaging of bowel obstruction in infants and children. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01854-3. [PMID: 39017759 DOI: 10.1007/s11547-024-01854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
We review the etiologies of bowel obstruction in infants and children that can be identified on ultrasound (US) including perforated appendicitis, intussusception, foreign body ingestion, colonic volvulus, intra-abdominal mass lesions, internal hernia, and stricturing inflammatory bowel disease. US can potentially identify the cause of bowel obstruction in these age groups, without the need for additional cross-sectional imaging, and can aid in patient management including interventional and surgical planning. Hence, it is important to be familiar with the sonographic imaging findings of bowel obstruction in infants and children.
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Affiliation(s)
- Rida Salman
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Victor J Seghers
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Desi M Schiess
- Pediatric Section, Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - HaiThuy N Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew C Sher
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Livja Mertiri
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA
| | - Marla B K Sammer
- Edward B. Singleton Department of Radiology, Division of Body Imaging, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin St. Suite 470, Houston, TX, 77030, USA.
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Blokhuis AM, Tytgat K, Groothuis JT, Houwen-van Opstal S. Severe gastrointestinal problems in Duchenne muscular dystrophy: A case series. Neuromuscul Disord 2024; 40:31-37. [PMID: 38823288 DOI: 10.1016/j.nmd.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024]
Abstract
Due to improved supportive care, survival of patients with Duchenne muscular dystrophy (DMD) has increased significantly. Consequently, new challenges emerge in adult patients with DMD. In clinical practice we increasingly see patients with serious, even life-threatening, gastrointestinal (GI) problems in advanced disease stages. Little is known about the longitudinal course of GI problems and the appropriate management. We present a case-series of six adult patients with DMD with (recurrent) GI problems that required hospital admission. The most prevalent reported serious GI symptoms were gastrointestinal pseudo-obstruction, (sub)ileus and gastric dilatation. Besides, an overview is presented of the therapeutic options for GI problems in DMD. The current study provides insight in possible treatment options, however, there is a clear need for more research and an integral guideline on treatment of GI problems in adult patients with DMD in order to reduce associated morbidity and mortality.
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Affiliation(s)
- A M Blokhuis
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Kmaj Tytgat
- Department of Gastroenterology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc Center of Expertise for neuromuscular disorders (Radboud-NMD), Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD)
| | - Sls Houwen-van Opstal
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Amalia Children's Hospital, Postbus 9101, Huispostnr 898 HB, Nijmegen 6500, the Netherlands; Radboudumc Center of Expertise for neuromuscular disorders (Radboud-NMD), Netherlands Neuromuscular Center (NL-NMD) and the European Reference Network for rare neuromuscular diseases (EURO-NMD).
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Charo DC, Mohammad FM, Ghmera MI, Saker BA, Ghosnah AA. Sigmoid and cecum colon volvulus: a case report. J Med Case Rep 2024; 18:297. [PMID: 38943209 PMCID: PMC11214250 DOI: 10.1186/s13256-024-04622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/03/2024] [Indexed: 07/01/2024] Open
Abstract
INTRODUCTION Colon volvulus is the twisting of a segment of colon on its mesenteric axis, which can lead to the obstruction of the lumen and the blood supply. Colon volvulus is common in "volvulus belt" countries and can involve the sigmoid (60-70%) and cecum (25-40%). CASE PRESENTATION We report a case of a 47-year-old male, Alawites, who presented with bowel obstruction and dilated abdomen without any specific abdominal pain. Abdominal laparotomy showed both sigmoid and cecum volvulus with no signs of perforation or ischemia. DISCUSSION AND CONCLUSION One of the possible risk factors of sigmoid colon volvulus is the length of the rectum and sigmoid, while mobile cecum is considered as a possible reason for cecum volvulus. The management remains controversial and is specific for every case, depending mainly on the vitality of the colonic walls and the general condition of the patient.
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Affiliation(s)
- Dilawer Chofan Charo
- General Surgery Department, Ministry of Health, Latakia, Syria.
- Medical Research Group of Egypt (MRGE), Negida Academy, Arlington, MA, USA.
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Masui H, Kawada K, Inamoto S, Wada T, Sakai Y, Obama K. Laparoscopic redo surgery for sigmoid volvulus following laparoscopic sigmoidectomy. Surg Case Rep 2024; 10:163. [PMID: 38937390 PMCID: PMC11211295 DOI: 10.1186/s40792-024-01961-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/20/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Sigmoid volvulus (SV) is an acute abdominal condition characterized by torsion of the sigmoid colon around the mesentery, and often results in intestinal obstruction that may progress to bowel ischemia, necrosis, or perforation. Although SV commonly occurs due to predisposing factors like anatomic variations, age-related motility disorders, chronic constipation, and neurologic diseases, its incidence following sigmoid colon cancer surgery has rarely been reported. Herein, we report a rare case of recurrent SV following laparoscopic sigmoidectomy, which was successfully treated by laparoscopic redo surgery. CASE PRESENTATION The patient was a 77-year-old man who had previously undergone laparoscopic sigmoidectomy for sigmoid colon cancer. Sixteen months postoperatively, he developed an incisional hernia at the umbilical site, which was treated with a laparoscopic repair using an intraperitoneal onlay mesh. After the hernia surgery, the patient had no anastomotic leakage or stenosis on regular follow-ups. However, 65 months after the first surgery, he presented with abdominal pain and distension. A computed tomography revealed that the remnant sigmoid colon was distended in a twisting manner around the anastomosis, leading to the diagnosis of SV. Although endoscopic de-torsion was successful, the SV recurred 2 months later, requiring elective laparoscopic redo surgery. The procedure involved resection of the sigmoid colon including the prior anastomosis with a left pararectal incision and DST re-anastomosis using a 25-mm circular stapler. The operation lasted 165 min with minimal bleeding and no complications. The postoperative course was uneventful. Pathological analysis confirmed fibrosis without malignancy. The patient remains well without recurrence of SV and anastomotic stenosis more than 5 years after surgery. CONCLUSION SV following sigmoid colon cancer surgery has rarely been reported. This case illustrates the potential need for prophylaxis against postoperative SV, especially in patients with long sigmoid colon undergoing laparoscopic surgery for colorectal cancer. Further, laparoscopic redo surgery following initial laparoscopic surgery for colorectal cancer can be performed with minimal invasiveness, especially if patient selection is properly managed.
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Affiliation(s)
- Hideyuki Masui
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Departments of Surgery, Hirakata Kohsai Hospital, Osaka, Japan
| | - Kenji Kawada
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
- Department of Surgery, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Susumu Inamoto
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Toshiaki Wada
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yoshiharu Sakai
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Kazutaka Obama
- Departments of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Sobrado LF, Foley NM, Lincango EP, Liska D, Gorgun E, Hull TL, Kessler H, Valente MA, Steele SR, Holubar SD. Acute colonic pseudo-obstruction: a retrospective review of the surgical outcomes. Langenbecks Arch Surg 2024; 409:178. [PMID: 38850452 DOI: 10.1007/s00423-024-03356-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE Limited data exist regarding the surgical outcomes of acute colonic pseudo-obstruction (ACPO), commonly referred to as Ogilvie syndrome, in modern clinical practice. The prevailing belief is that surgery should be avoided due to previously reported high mortality rates. We aimed to describe the surgical results of ACPO treated within our institution. METHODS Our prospectively maintained colorectal surgery registry was queried for patients diagnosed with ACPO, who underwent surgery between 2009 and 2022. Postoperative complications were graded according to Clavien-Dindo (CD) classification. The primary outcome was postoperative mortality. RESULTS A total of 32 patients who underwent surgery for ACPO were identified. Overall, nonoperative therapy was initially administered to 21 patients (65.6%). The surgeries performed included total abdominal colectomy (15, 43.1%), ascending colectomy with end ileostomy (8, 25%), transverse colostomy (5, 15.6%), ileostomy and transverse colostomy (3, 9.4%), and Hartmann's operation (1, 3.1%). Severe postoperative complications (CD grade 3 or 4) occurred in five patients (15.6%). No recurrence of ACPO was observed and no patient required reoperation. The average postoperative length of stay was 14.5 days, 30-day mortality was 6.3% (n = 2), and 90-day mortality was 15.6% (n = 5) due to complications of underlying comorbidities. CONCLUSIONS Surgical treatment was effective for patients with ACPO refractory to medical therapy or presenting with acute complications. Although postoperative complications were frequent, both the 30- and 90-day mortality rates were lower than previously documented in the literature. Further investigations are warranted to determine the optimal surgical strategy, which may involve total or segmental colectomy, or diversion alone without resection.
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Affiliation(s)
- Lucas F Sobrado
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA.
| | - Niamh M Foley
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Eddy P Lincango
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - David Liska
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Tracy L Hull
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Hermann Kessler
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Michael A Valente
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
| | - Stefan D Holubar
- Department of Colon & Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, A30, Cleveland, OH, 44195, USA
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Pfeiffer AF, Clark RE, Sullivan J, Rizvi SAA, Byrne JJ, Boyd AR. Response: Sigmoid volvulus in pregnancy: A rare case report. Int J Gynaecol Obstet 2024; 165:1308-1309. [PMID: 38488275 DOI: 10.1002/ijgo.15477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Alixandria F Pfeiffer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Reece E Clark
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Jana Sullivan
- Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Syed A A Rizvi
- College of Biomedical Sciences, Larkin University, Miami, Florida, USA
| | - John J Byrne
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Angela R Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, San Antonio, Texas, USA
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Arnold SC, Rafaqat W, Abiad M, Lagazzi E, Hoekman AH, Panossian VS, Nzenwa IC, Paranjape CN, Velmahos GC, Kaafarani HMA, Hwabejire JO. Patience is key: Association of surgical timing with clinical outcomes in elderly patients with sigmoid volvulus. Am J Surg 2024; 232:81-86. [PMID: 38278705 DOI: 10.1016/j.amjsurg.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Current guidelines for sigmoid volvulus recommend endoscopy as a first line of treatment for decompression, followed by colectomy as early as possible. Timing of the latter varies greatly. This study compared early (≤2 days) versus delayed (>2 days) sigmoid colectomy. METHODS 2016-2019 NRD database was queried to identify patients aged ≥65 years admitted for sigmoid volvulus who underwent sequential endoscopic decompression and sigmoid colectomy. Outcomes included mortality, complications, hospital length of stay, readmissions, and hospital costs. RESULTS 842 patients were included, of which 409 (48.6 %) underwent delayed sigmoid colectomy. Delayed sigmoid colectomy was associated with reduced cardiac complications (1.1 % vs 0.0 %, p = 0.045), reduced ostomy rate (38.3 % vs 29.4 %, p = 0.013), an increased overall length of stay (12 days vs 8 days, p < 0.001) and increased overall costs (27,764 dollar vs. 24,472 dollar, p < 0.001). CONCLUSION In geriatric patient with sigmoid volvulus, delayed surgical resection after decompression is associated with reduced cardiac complications and reduced ostomy rate, while increasing overall hospital length of stay and costs.
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Affiliation(s)
- Suzanne C Arnold
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Division of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wardah Rafaqat
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - May Abiad
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Emanuele Lagazzi
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Anne H Hoekman
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Vahe S Panossian
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Ikemsinachi C Nzenwa
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Charudutt N Paranjape
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - George C Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - John O Hwabejire
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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Smith T, Howick V JF, Sweetser S. 75-Year-Old Woman With Abdominal Distention. Mayo Clin Proc 2024; 99:832-835. [PMID: 38520449 DOI: 10.1016/j.mayocp.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 03/25/2024]
Affiliation(s)
- Thomas Smith
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - James F Howick V
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Seth Sweetser
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Nakamura K, Sakuraba S, Koido K, Hazama H, Ohata K. A Case of Acute Colonic Pseudo-Obstruction and Anastomotic Leakage After Sigmoidectomy for Sigmoid Volvulus. Cureus 2024; 16:e61133. [PMID: 38800775 PMCID: PMC11128311 DOI: 10.7759/cureus.61133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 05/29/2024] Open
Abstract
Acute colonic pseudo-obstruction (ACPO) is characterized by significant colonic distension without a mechanical obstruction. We present a case of an 83-year-old male who developed ACPO following laparoscopic surgery for sigmoid volvulus. This report details the patient's postoperative journey, highlighting the diagnostic and management challenges encountered. Despite various medical interventions, the patient's condition necessitated further surgical attention due to complications. This case underscores the importance of early diagnosis and aggressive management in ACPO to prevent life-threatening consequences and improve patient outcomes.
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Affiliation(s)
| | | | - Kohei Koido
- Gastrointestinal Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Hiroyuki Hazama
- Gastrointestinal Surgery, Shizuoka General Hospital, Shizuoka, JPN
| | - Kou Ohata
- Gastrointestinal Surgery, Shizuoka General Hospital, Shizuoka, JPN
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10
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Yang P, Ang ZH, Berney CR. Restoration of intestinal continuity following emergency sigmoid colectomy for sigmoid volvulus: An American College of Surgeons National Surgical Quality Improvement Program analysis using coarsened exact matching. World J Surg 2024; 48:1252-1260. [PMID: 38488859 DOI: 10.1002/wjs.12138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND There is limited data to guide decision-making between performing a primary anastomosis and fashioning an end colostomy following emergency sigmoid colectomy for patients with sigmoid volvulus. The aim of this study was to compare the outcomes of these two approaches. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2021 was retrospectively analyzed. Missing data were multiply imputed, and coarsened exact matching was performed to generate matched cohorts. Rates of major complications and other postoperative outcomes were evaluated among patients who had a primary anastomosis as compared with matched controls who had an end colostomy following emergency sigmoid colectomy. RESULTS Overall, 4041 patients who had a primary anastomosis and 1240 who had an end colostomy met the inclusion criteria. After multiple imputation and coarsened exact matching, 895 patients who had a primary anastomosis had a matched control. The rate of major complications was lower in patients who had an end colostomy (33.2% vs. 36.7%), but this difference was not statistically significant (OR 0.86, 95% CI 0.70-1.05). Results were similar in subgroup analyses of higher-risk patients. There were no significant differences in overall complication rate, mortality, length of hospital stay, or readmission rate. Patients with a colostomy were more likely to be discharged to a care facility (OR 1.35, 95% CI 1.09-1.67). CONCLUSION Differences in rates of major complications and many other outcomes after primary anastomosis as compared with end colostomy were not statistically significant following emergency sigmoid colectomy for sigmoid volvulus.
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Affiliation(s)
- Phillip Yang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhen Hao Ang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christophe R Berney
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
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11
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Reynolds IS, McDermott E, Liddy R, Aird JJ, Flood K, McCormack O, Geoghegan T, Brannigan AE. Acute colonic pseudo-obstruction post-cesarean section is not a benign entity: A case series and review of the literature. Int J Gynaecol Obstet 2024; 165:59-66. [PMID: 37675884 DOI: 10.1002/ijgo.15086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/06/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO) is an infrequent occurrence after cesarean section. Anecdotal evidence suggests that the clinical course of ACPO in the obstetric setting is different to that seen in non-pregnant adult patients with ACPO secondary to alternative causes, such as systemic illnesses, the use of certain medications, and after non-abdominal surgery. The risk of progression to ischemia and perforation, as well as the need for emergency surgery, appears to be higher after cesarean section. Here we describe the clinical course of ACPO in four patients after cesarean section from our institution, followed by a review of the literature and a discussion of the important issues surrounding this condition in the postpartum time period. The findings from our cohort of patients and the reports from the medical literature support a hands-on combined approach from a group of specialists including obstetricians, surgeons, radiologists, and enterostomal therapists. Immediate imaging followed by regular observation is mandatory for any patient being managed conservatively. Early use of endoscopic decompression should be considered for patients who are not resolving with a conservative approach. Clinical signs of peritonism or radiological signs of ischemia or perforation in patients with ACPO mandate immediate surgical intervention. Appropriate postoperative care is necessary to deal with the complex physiological and psychological consequences of emergency surgery and potential stoma formation so soon after cesarean section.
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Affiliation(s)
- Ian S Reynolds
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Edward McDermott
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Richard Liddy
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - John J Aird
- Department of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Karen Flood
- Department of Obstetrics and Gynaecology, Royal College of Surgeons, Rotunda Hospital, Dublin, Ireland
| | - Orla McCormack
- Department of Upper Gastrointestinal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Tony Geoghegan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ann E Brannigan
- Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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Yamani AS, Morris MC, Schrager JJ, Athota KP, Sams VG. A case of acute colonic pseudo-obstruction, sigmoid volvulus, and massive pneumoperitoneum in a young female patient. Int J Surg Case Rep 2024; 117:109558. [PMID: 38518469 PMCID: PMC10972842 DOI: 10.1016/j.ijscr.2024.109558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute colonic pseudo-obstruction (ACPO) is an uncommon phenomenon that is especially rare in young patients and can result in bowl ischemia and perforation if left untreated. Furthermore, pneumoperitoneum is almost always a concerning imaging finding and in the context of recent colonic resection may be a sign of anastomotic leakage. CASE PRESENTATION We describe a case of a young female patient with postpartum ACPO who subsequently underwent a hemicolectomy with colorectal anastomosis. The patient's hospital course was complicated by massive postoperative pneumoperitoneum that resulted in resection of the anastomosis and creation of an end colostomy. However, despite this measure, there was recurrent pneumoperitoneum on cross-sectional imaging 36 h later. This was treated non-operatively and the remainder of their hospital course was uneventful. CLINICAL DISCUSSION A potential etiology for ACPO during pregnancy may be due to compression of parasympathetic plexus nerves by the gravid uterus. Idiopathic pneumoperitoneum has been documented on a number of occasions, though this is generally in older patients. It can present with signs of peritonitis or can be asymptomatic. Simultaneous pneumothorax and pneumoperitoneum is rare and may be due to the transmission of air from the peritoneum to the mediastinum and thorax. The pneumoperitoneum itself may be due the air leakage through the significantly distended colon into the peritoneum. CONCLUSION The combination of ACPO following pregnancy and associated pneumothorax, pneumomediastinum, and recurrent pneumoperitoneum suggest a communicating defect between the thoracic, mediastinal, and peritoneal cavities. Furthermore, the possibility of underlying colonic dysmotility should be considered prior to the restoration of large bowel continuity.
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Affiliation(s)
- Ali S Yamani
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA.
| | - Mackenzie C Morris
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Jason J Schrager
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Krishna P Athota
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Valerie G Sams
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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13
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Khan Z, Challand CP, Lee MJ. Management of acute colonic pseudo-obstruction: opportunities to improve care? Ann R Coll Surg Engl 2024. [PMID: 38445579 DOI: 10.1308/rcsann.2024.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Acute colonic pseudo-obstruction (ACPO) is a functional bowel obstruction characterised by colonic dilatation in the absence of mechanical obstruction on imaging. Complications include bowel ischaemia, perforation and death. The aim of this study was to explore outcomes for patients treated for ACPO and to assess adherence to current ACPO treatment guidelines. METHODS This is a retrospective service evaluation and included patients with a diagnosis of ACPO between 1 March 2018 and 31 March 2023. Process measures were identified following discussion with the clinical team from published guidance. Patients were identified using clinical coding and radiological text reports. Cases were eligible for inclusion if they had radiologically confirmed ACPO. Data were collected following review of patient notes into Microsoft Excel. Descriptive analysis was performed with no formal statistical assessment. RESULTS A total of 45 patients were identified, of whom 13 were admitted under general surgery. All patients received admission bloods (n=45). Nearly all patients had computed tomography imaging (43/45, 96%). Only 3/45 (6.7%) of the patients received optimal conservative management (intravenous infusion, nil by mouth, flatus tube, treatment of reversible causes). In all, 11/45 (24%) required further treatment, of whom 7 received this within 72 h. The leading (11/45) complication following diagnosis of ACPO was hospital-acquired pneumonia. Mortality was seen in 9/45. CONCLUSIONS ACPO is often managed remotely by general surgeons. This may impact on the quality of conservative management, and timeliness of endoscopic or pharmacological intervention. Further work is needed to optimise management.
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Affiliation(s)
- Z Khan
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
| | | | - M J Lee
- University of Sheffield, UK
- Sheffield Teaching Hospitals, UK
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14
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Celdran-Bonafonte D, O'Connell KA, Gothard KM, Ghaderi I, Besselsen D, Doane CJ. Dolichocolon (redundant colon) in a rhesus macaque (Macaca mulatta). J Med Primatol 2024; 53:e12664. [PMID: 37480218 DOI: 10.1111/jmp.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/07/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
Dolichocolon (redundant colon) is an underdiagnosed cause of severe constipation in humans. The clinical presentation reported here in a rhesus macaque closely resembles that of intestinal adenocarcinoma, the most common neoplasia in macaques. Dolichocolon should be considered in differential diagnosis of macaques with anorexia, weight loss, and constipation.
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Affiliation(s)
| | | | | | - Iman Ghaderi
- Department of Surgery, The University of Arizona, Tucson, USA
| | - David Besselsen
- University Animal Care, The University of Arizona, Tucson, USA
| | - Cynthia J Doane
- University Animal Care, The University of Arizona, Tucson, USA
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15
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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] [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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16
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Loria A, Cai X, Gao S, Zhao T, Juviler P, Li Y, Cupertino P, Fleming FJ. Development and validation of multivariable predictive models for recurrence and mortality following nonoperative management of sigmoid volvulus. Colorectal Dis 2024; 26:356-363. [PMID: 38151763 DOI: 10.1111/codi.16849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023]
Abstract
AIM Sigmoid volvulus is a challenging condition, and deciding between elective surgery or expectant management can be complex. The aim of this study was to develop a tool for predicting the risk of recurrent sigmoid volvulus and all-cause mortality within 1 year following initial nonoperative management. METHOD This is a retrospective cohort study using Medicare claims data from 2016 to 2018 of beneficiaries admitted urgently/emergently for volvulus, undergoing colonic decompression and discharged alive without surgery (excluding those discharged to hospice). The primary outcomes were recurrent sigmoid volvulus and all-cause mortality within 1 year. Proportional hazards models and logistic regression were employed to identify risk factors and develop prediction equations, which were subsequently validated. RESULTS Among the 2078 patients managed nonoperatively, 36.1% experienced recurrent sigmoid volvulus and 28.6% died within 1 year. The prediction model for recurrence integrated age, sex, race, palliative care consultations and four comorbidities, achieving area under the curve values of 0.63 in both the training and testing samples. The model for mortality incorporated age, palliative care consultations and nine comorbidities, with area under the curve values of 0.76 in the training and 0.70 in the testing sample. CONCLUSION This study provides a straightforward predictive tool that utilizes easily accessible data to estimate individualized risks of recurrent sigmoid volvulus and all-cause mortality for older adults initially managed nonoperatively. The tool can assist clinicians and patients in making informed decisions about such risks. While the accuracy of the calculator was validated, further confirmation through external validation and prospective studies would enhance its clinical utility.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Xueya Cai
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Shan Gao
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Tony Zhao
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Peter Juviler
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Yue Li
- Division of Health Policy and Outcomes Research, Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Paula Cupertino
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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17
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Schabl L, Holubar SD, Erozkan K, Alipouriani A, Sancheti H, Steele SR, Kessler H. Epidemiology and age-related trends in surgical outcomes for sigmoid volvulus: a 17-year analysis. Langenbecks Arch Surg 2024; 409:37. [PMID: 38217626 DOI: 10.1007/s00423-024-03228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND Sigmoid volvulus, a gastrointestinal disorder characterized by twisted bowel, often requires medical intervention, either through endoscopic or surgical means, to avoid potentially severe outcomes. This study examined the challenges elderly patients face in undergoing surgical treatment, encompassing both mortality and morbidity. Furthermore, it aimed to determine how medical practices and outcomes have changed over a period of 17 years. METHODS We utilized data from the National Surgical Quality Improvement Project, which covers the period from 2005 to 2021, to identify patients who underwent left hemicolectomy for colonic volvulus. The patients were categorized into three age groups: < 60 years, 60-75 years, and > 75 years. We performed a meticulous logistic regression analysis, carefully adjusted for risk factors, to compare mortality, morbidity, and types of surgical treatment administered among the different age groups. RESULTS Our study included 6775 patients. The breakdown of the patient population was as follows: 2067 patients were < 60 years of age, 2239 were between 60 and 75 years of age, and 2469 were > 75 years of age. The elderly cohort, those aged above 75 years, were predominantly male, had lower BMIs, underwent fewer laparoscopic surgeries, required more diverting stomas and end-ostomies, and had longer hospital stays. Notably, the elderly population faced a mortality risk that was 5.67 times (95% CI 3.64, 9.20) greater than that of their youngest counterparts, with this risk increasing by 10% (95% CI 1.06, 1.14) for each additional year of age. Furthermore, the odds of mortality associated with emergency surgery were 1.63 times (95% CI 1.21, 2.22) higher than those associated with elective surgery. The postoperative morbidity odds were also elevated for emergency surgeries, 1.30 times (95% CI 1.08, 1.58) greater than that for elective cases. Over the 17-year period, we observed a decline in mortality rates, an increase in the utilization of laparoscopic procedures, and overall stability of morbidity rates. CONCLUSION Our findings highlight the increased vulnerability of patients over 75 years of age, who are not only at an elevated risk of mortality compared to their younger counterparts, but also a continuously increasing risk with age. By focusing on elective surgeries for younger patients and minimizing emergency surgeries for the elderly, it may be possible to reduce the mortality risk associated with surgical interventions in this population.
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Affiliation(s)
- Lukas Schabl
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
- Department for General, Visceral, and Thoracic Surgery, University Hospital Salzburg, Salzburg, Austria.
| | - Stefan D Holubar
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kamil Erozkan
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Alipouriani
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Himani Sancheti
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Scott R Steele
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hermann Kessler
- Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
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18
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Salada KO, Jacobson E. Seeds of Discomfort: An Unusual Case of Pediatric Abdominal Pain. Cureus 2023; 15:e50625. [PMID: 38226100 PMCID: PMC10789304 DOI: 10.7759/cureus.50625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/17/2024] Open
Abstract
This case describes a seven-year-old healthy boy who presented with seven days of abdominal pain, small-volume liquid stools, tenesmus, fevers, and dehydration after consuming an unknown amount of shelled watermelon seeds. He was ultimately found to have a large rectal seed bezoar that caused irritation, resulting in stercoral colitis with rectal inflammation. He was additionally found to have sigmoid volvulus during one of his disimpactions, which was also likely secondary to his rectal seed bezoar. This case uniquely highlights the importance of maintaining an index of suspicion for rectal seed bezoars, discusses previously unreported pediatric complications of rectal seed bezoars, including stercoral colitis and sigmoid volvulus, and addresses the management of this rare presentation.
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Affiliation(s)
- Katherine O Salada
- Division of Pediatric Hospital Medicine, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA
| | - Emily Jacobson
- Division of Pediatric Hospital Medicine, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, USA
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19
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Pantel H, Reddy VB. Management of Colonic Emergencies. Surg Clin North Am 2023; 103:1133-1152. [PMID: 37838460 DOI: 10.1016/j.suc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
The etiology of colonic emergencies includes a wide-ranging and diverse set of pathologic conditions. Fortunately, for the surgeon treating a patient with one of these emergencies, the surgical management of these various causes is limited to choosing among proximal diversion, segmental colectomy with or without proximal diversion, or a total abdominal colectomy with end ileostomy (or rarely, an ileorectal anastomosis). The nuanced complexity in these situations usually revolves around the nonsurgical and/or endoscopic options and deciding when to proceed to the operating room.
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Affiliation(s)
- Haddon Pantel
- Colon and Rectal Surgery, Yale University School of Medicine, 450 George Street, New Haven, CT 06510, USA
| | - Vikram B Reddy
- Colon and Rectal Surgery, Yale University School of Medicine, 450 George Street, New Haven, CT 06510, USA.
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20
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Ahmad A, Najeeb E, Ul Haq MB, Altaf A, Moiz A, Bashir H, Uzair M, Inam A. Cecal volvulus with acute appendicitis in a 33-year-old male managed by manual detorsion, cecopexy, and appendectomy: A case report. Int J Surg Case Rep 2023; 112:108904. [PMID: 37844385 PMCID: PMC10697277 DOI: 10.1016/j.ijscr.2023.108904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION A volvulus is a serious surgical emergency caused by torsion or hyper-flexion of the bowel loop and its mesentery on a fixed point. Cecal volvulus is an uncommon cause of intestinal obstruction, accounting for just 1-1.5 % of all cases of bowel obstruction. CASE PRESENTATION A 33-year-old intellectually disabled male presented to the emergency department with complaints of generalized abdominal pain, absolute constipation, and non-projectile vomiting. He had a grossly distended and rigid abdomen with generalized tenderness and guarding. The abdomen was hyper-resonant. Bowel sounds were hypoactive. Digital rectal examination revealed an empty and collapsed rectum with no stool staining of the finger. Laboratory reports showed leukocytosis and neutrophilia. Radiographic imaging was consistent with acute intestinal obstruction. Laparotomy was performed, and cecal volvulus with viable bowel and acute appendicitis was diagnosed intra-operatively. Manual detorsion, cecopexy, and appendectomy were performed. The patient had an uneventful postoperative course. The patient is still on follow-up since June 2023, and no complication has occurred. CLINICAL DISCUSSION Cecal volvulus is an uncommon cause of intestinal obstruction with multiple etiologies. The annual incidence of cecal volvulus is estimated to be between 2.8 and 7.1 cases per million. Cecal volvulus may lead to life-threatening complications such as bowel ischemia and perforation. CONCLUSION Diagnosis of cecal volvulus must be made promptly to prevent bowel gangrene and perforation. In this case, manual detorsion and cecopexy were performed as the bowel was viable per-operatively due to early surgical intervention.
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Affiliation(s)
- Afaq Ahmad
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan.
| | - Erum Najeeb
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Muhammad Burhan Ul Haq
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Aatiqa Altaf
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Abdul Moiz
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
| | - Humaira Bashir
- FCPS Gynaecology and Obstetrics, Pakistan; College of Physicians and Surgeons, Pakistan
| | | | - Aatif Inam
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Department of General Surgery, Pakistan
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21
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Landolsi S, Trabelsi M, Dziri W, Firas J, Ridene I, Chebbi F. Reversed midgut rotation revealed by cecal volvulus in the elderly: A case report. Int J Surg Case Rep 2023; 111:108881. [PMID: 37793228 PMCID: PMC10551644 DOI: 10.1016/j.ijscr.2023.108881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Reverse midgut rotation constituted an extremely rare intestinal malrotation. Its recognition in the elderly was challenging as in our case revealed by cecal volvulus. CASE PRESENTATION A 78-years old man consulted for diffuse abdominal, vomiting, bowel movement and passing gas inability. Computed tomography concluded to cecal and last ileum loop volvulus with small intestine dilation upstream. Emergent laparotomy confirmed the existence of a cecal volvulus associated to a reversed midgut rotation non diagnosed at computed tomography before surgery. A Ladd' procedure was carried out. An isoperistaltic side-by-side ileocolic manual anastomosis was performed. DISCUSSION Our case illustrated an extremely rare reversed midgut rotation in the elderly accounting for 2 to 7 % of all embryologic midgut malrotation anomalies. It could be revealed by mobile right colon volvulus as in our case, whole midgut volvulus, retro-arterial tunnel pressure transverse colon stenosis, or Ladd' bands duodenojejunal obstruction. Its recognition at the elderly was challenging and needed careful computed tomography combined signs determination. Surgical treatment accounted for the treatment of choice for reversed midgut rotation especially in emergency settings as in our case. Ladd' procedure is still the most performed procedure. CONCLUSIONS Reverse midgut rotation constituted an extremely rare congenital intestinal malrotation. Its diagnosis in the elderly was challenging implicating careful interpretation of computed tomography.
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Affiliation(s)
- Sana Landolsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia.
| | - Mehdi Trabelsi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Wassim Dziri
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Jaoued Firas
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Imen Ridene
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Radiology, Mahmoud El Matri Hospital, Ariana, Tunisia
| | - Faouzi Chebbi
- University of Tunis El Manar, Faculty of Medicine of Tunis, Department of Surgery, Mahmoud El Matri Hospital, Ariana, Tunisia
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22
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Vanek P, Urban O, Falt P. Percutaneous endoscopic cecostomy for management of Ogilvie's syndrome: a case series and literature review with an update on current guidelines (with video). Surg Endosc 2023; 37:8144-8153. [PMID: 37500922 PMCID: PMC10519870 DOI: 10.1007/s00464-023-10281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/02/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Percutaneous endoscopic cecostomy (PEC) is a viable treatment option for patients with persistent or recurrent acute colonic pseudo-obstruction (ACPO; Ogilvie's syndrome). It should be generally considered in patients that are refractory to pharmacologic and endoscopic decompression, especially those not amenable to surgical intervention due to an increased perioperative risk. Physicians are rather unfamiliar with this approach given the limited number of reports in the literature and paucity of guideline resources, although guidelines concerning ACPO and covering the role of endoscopy were recently published by three major expert societies, all within the last 2 years. PATIENTS AND METHODS We retrospectively identified three consecutive patients who underwent PEC placement at a Czech tertiary referral center between May 2018 and December 2021: all for recurrent ACPO. In addition, we summarized the current guidelines in order to present the latest knowledge related both to the procedure and management approach in patients with ACPO. RESULTS The placement of PEC was successful and resulted in clinical improvement in all cases without any adverse events. CONCLUSION The results of our experience are in line with previous reports and suggest that PEC may become a very useful tool in the armamentarium of modalities utilized to treat ACPO. Furthermore, the availability of guideline resources now offers comprehensive guidance for informed decision-making and the procedural aspects.
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Affiliation(s)
- Petr Vanek
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic.
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic.
| | - Ondrej Urban
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
| | - Premysl Falt
- Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 976/3, 77515, Olomouc, Czech Republic
- Department of Internal Medicine II - Gastroenterology and Geriatrics, University Hospital Olomouc, Olomouc, Czech Republic
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23
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Numan L, Brotherton T, Baliss M, Ghosh S, Lamm V, Klos C, Sayuk G, Presti M, Elwing J. A Percutaneous Endoscopic Colostomy Tube to the Rescue. ACG Case Rep J 2023; 10:e01186. [PMID: 37868365 PMCID: PMC10586846 DOI: 10.14309/crj.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Percutaneous endoscopic colostomy (PEC) tube placement is a minimally invasive procedure used to treat recurrent colonic pseudo-obstruction, sigmoid volvulus, chronic intractable constipation, and neurogenic bowel. PEC is a viable treatment alternative for patients who have failed conservative therapies and are deemed high risk for surgical management. We present a case of acute colonic pseudo-obstruction after Clostridioides difficile infection that was unresponsive to medical treatment or endoscopic decompression. A PEC tube was placed into the transverse colon with successful resolution of the colonic distension.
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Affiliation(s)
- Laith Numan
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Tim Brotherton
- Department of Internal Medicine, St. Louis University, St. Louis, MO
| | - Michelle Baliss
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Soumojit Ghosh
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
| | - Vladimir Lamm
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
| | - Coen Klos
- Department of Surgery, St. Louis Veteran Affairs, St. Louis, MO
| | - Gregory Sayuk
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Michael Presti
- Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
| | - Jill Elwing
- Department of Gastroenterology, Washington University in St. Louis, St. Louis, MO
- Department of Gastroenterology, St. Louis Veteran Affairs, St. Louis, MO
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24
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Wilkie BD, Noori J, Johnston M, Woods R, Keck JO, Behrenbruch C. Pyridostigmine in chronic intestinal pseudo-obstruction - a systematic review. ANZ J Surg 2023; 93:2086-2091. [PMID: 37132128 DOI: 10.1111/ans.18478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/08/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Chronic intestinal pseudo-obstruction (CIPO) may be a primary or secondary phenomenon and is often multifactorial. Treatment is largely directed at improving colonic motility. The use of cholinesterase inhibitors such as pyridostigmine has been hypothesized to increase acetylcholine in the bowel, improving symptoms and transit times. METHODS A systematic review of the use of pyridostigmine in CIPO was conducted using scientific and commercial search engines identifying scientific studies enrolling adult human subjects, published from 2000 to 2022 in the English language. RESULTS Four studies were identified including two randomized controlled trials (RCT) and two observational studies. The studies had heterogenous inclusion criteria, dosing regimens and reported outcomes. Two studies were identified as being at high risk of bias. All studies reported improved patient outcomes with use of pyridostigmine, and low rates (4.3%) of mild cholinergic side effects. No major side effects were reported. CONCLUSION The use of pyridostigmine in management of CIPO is biologically plausible due to its ability to increase colonic motility, and early studies on its role are uniformly suggestive of benefit with low side-effect profile. Four clinical studies have been conducted to date, with small sample sizes, heterogeneity and high risk of bias. Further high-quality studies are required to enable assessment of pyridostigmine's utility as an effective management strategy in CIPO.
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Affiliation(s)
- Bruce D Wilkie
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Jawed Noori
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Johnston
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Rodney Woods
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - James O Keck
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Corina Behrenbruch
- Department of Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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25
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Sen A, Chokshi R. Update on the Diagnosis and Management of Acute Colonic Pseudo-obstruction (ACPO). Curr Gastroenterol Rep 2023; 25:191-197. [PMID: 37486594 DOI: 10.1007/s11894-023-00881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Acute Colonic Pseudo-obstruction (ACPO) is a cause of large intestinal dilation and obstruction without any physical transition point. It remains difficult to diagnose and treat. We review the recent updates on diagnosis and management of ACPO. RECENT FINDINGS Recent guidelines have posited that conservative management can be tried in most cases of ACPO, but that early decompression and surgery should be considered. Use of neostigmine is still a viable option but there is also promising data on pyridostigmine as well as prucalopride. Resolution of ACPO should be followed by daily use of polyethylene glycol (PEG) to help prevent recurrence. ACPO warrants early and accurate diagnosis with exclusion of alternate causes of large bowel dilation. Conservative management can be attempted for 48-72 h in those with cecal diameters < 12 cm and without signs of peritonitis and perforation. Early escalation of management should be attempted with neostigmine followed by endoscopy and/or surgery as needed, given that longer periods of dilation are associated with worse outcomes. There is promising new evidence for use of pyridostigmine and prucalopride, but further trials are needed prior to incorporating them into regular use. Finally, studies are lacking regarding prevention of ACPO after initial resolution.
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Affiliation(s)
- Ahana Sen
- Department of Medicine, Section of Gastroenterology & Hepatology, Baylor College of Medicine, 7200 Cambridge Avenue, Suite 8B, Houston, TX, 77030, USA
| | - Reena Chokshi
- Department of Medicine, Section of Gastroenterology & Hepatology, Baylor College of Medicine, 7200 Cambridge Avenue, Suite 8B, Houston, TX, 77030, USA.
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26
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Sapkota A, Batajoo A, Lamichhane S, Shrestha A, Bhatt N. Twists and turns: A case report of cecal volvulus. Clin Case Rep 2023; 11:e7936. [PMID: 37736477 PMCID: PMC10509340 DOI: 10.1002/ccr3.7936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/02/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
We present a case of a 22-year-old male presenting in the emergency room with colicky abdominal pain, vomiting, and abdominal distension for which an early computed tomography scan was done and diagnosed as cecal volvulus. Following diagnosis case was managed promptly by laparotomy with right hemicolectomy and primary anastomosis.
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27
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Al Khalifa A, Sedik A. Cecal Volvulus: A Report of a Challenging Case. Cureus 2023; 15:e45753. [PMID: 37872938 PMCID: PMC10590477 DOI: 10.7759/cureus.45753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Cecal volvulus represents a rare form of acute intestinal obstruction caused by an axial twist of the terminal ileum, ascending colon, and cecum surrounding the mesenteric pedicle. It is responsible for 1%-1.5% of all intestinal obstruction cases in adults. Radiological imaging assists in the diagnosis of cecal volvulus, particularly a CT scan with contrast as the gold standard for both diagnosis and risk assessment. In this case report, we present a challenging case of cecal volvulus seen in a 75‑year‑old male patient with multiple comorbidities who presented with abdominal guarding/tenderness and high WBC and lactate, which evolved into septic shock. The purpose of this study is to underline the significance of early diagnosis and effective treatment of this uncommon condition in abdominal surgeries.
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Affiliation(s)
- Ahmed Al Khalifa
- College of Medicine, Sulaiman Alrajhi University, Al Bukayriyah, SAU
| | - Alaa Sedik
- General Surgery, King Khalid General Hospital, Hail, SAU
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28
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M S V, S VS, Viswanathan VM, Palit SR, Kevin C. Caecal Volvulus Presenting as an Obstructed Inguinal Hernia: A Case Report. Cureus 2023; 15:e45963. [PMID: 37900401 PMCID: PMC10600403 DOI: 10.7759/cureus.45963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/31/2023] Open
Abstract
Caecal volvulus (CV) is an uncommon cause of large intestinal obstruction due to the axial torsion of the caecum, ascending colon, and terminal ileum. We describe the case of a 37-year-old man who presented with bilateral inguinal hernias (the left larger than the right), diffuse abdominal pain, vomiting, difficulty passing stool, and flatus that were comparable to those of an obstructed hernia. Imaging tests revealed a collapsed ascending colon, free fluid collection, and a significantly dilated proximal ileum. An urgent laparotomy showed a perforated, clockwise-twisted caecum that required a right hemicolectomy. Postoperatively, the patient had a good recovery. CV is uncommon, and its symptoms are vague, making diagnosis difficult. For an accurate diagnosis and prompt action, imaging tools and a high index of suspicion are essential. This case serves as a reminder of the significance of taking rare entities into consideration in developing a differential diagnosis of complex abdominal presentations and the necessity for a differential diagnostic approach to choose the most suitable surgical course of action.
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Affiliation(s)
- Viswanathan M S
- General and Plastic surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Vidhya Sree S
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Varun M Viswanathan
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Sandhya R Palit
- General and Colorectal Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
| | - Chris Kevin
- General Surgery, Employees' State Insurance Corporation (ESIC) Medical College & Hospital, Chennai, IND
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29
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Tasleem A, Finkelstein A, Waheed A. Ogilvie Syndrome, Bradycardia, and Neostigmine. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231184929. [PMID: 37457317 PMCID: PMC10338651 DOI: 10.1177/11795476231184929] [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] [Received: 03/27/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
Acute colonic pseudo-obstruction (ACPO), known as Ogilvie Syndrome, is an acute dilation of the colon in the absence of an underlying mechanical or anatomic cause. Neostigmine treatment is indicated following failed conservative management of ACPO, however neostigmine has its contraindications. This is a report of a unique case of a patient with a past medical history of symptomatic first degree heart block with a permanent pacemaker who received a bolus dosage of neostigmine treatment for ACPO in an ICU setting.
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Affiliation(s)
- Asna Tasleem
- Family and Community Medicine, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
| | - Adam Finkelstein
- Family Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Abdul Waheed
- Family and Community Medicine, WellSpan Good Samaritan Hospital, Lebanon, PA, USA
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Soares Miranda L, Silva Gonçalves C, Silva E, Ferreira Á, Araújo Correia J, Cruz AR. A Challenge Called Ogilvie´s Syndrome. Cureus 2023; 15:e40233. [PMID: 37435268 PMCID: PMC10332819 DOI: 10.7759/cureus.40233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/13/2023] Open
Abstract
Ogilvie´s syndrome is a colonic dilation without any existing mechanical obstruction. The risk factors that cause it are not completely understood, but if untreated, the distension can result in rupture or ischaemic bowel perforation. Additionally, the existing guidelines do not agree with each other about the next steps if conservative treatment fails. We report the case of a 71-year-old woman in whom Ogilvie´s syndrome was particularly difficult to manage, and with it, we try to add clinical data to a field with scarce evidence.
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Affiliation(s)
- Luisa Soares Miranda
- Department of Medical Oncology, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Carla Silva Gonçalves
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ezequiel Silva
- Department of General Surgery, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Álvaro Ferreira
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - João Araújo Correia
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
| | - Ana Rita Cruz
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT
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31
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Westfall K, Cleary R. Reply. Dis Colon Rectum 2023; 66:e229. [PMID: 36825871 DOI: 10.1097/dcr.0000000000002785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Kristen Westfall
- Department of Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan
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32
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Greenwald ML. Pearls Regarding the Surgical Management of Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2023; 66:e228. [PMID: 36825898 DOI: 10.1097/dcr.0000000000002786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Schudrowitz N, Shahan CP, Moss T, Scarborough JE. Bowel Preparation Before Nonelective Sigmoidectomy for Sigmoid Volvulus: Highly Beneficial but Vastly Underused. J Am Coll Surg 2023; 236:649-655. [PMID: 36695556 DOI: 10.1097/xcs.0000000000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Although strong evidence exists for combined mechanical and oral antibiotic bowel preparation before elective colorectal resection, the utility of preoperative bowel preparation for patients undergoing sigmoid resection after endoscopic decompression of sigmoid volvulus has not been previously examined. The goal of this study was to evaluate the association between bowel preparation and postoperative outcomes for patients undergoing semielective, same-admission sigmoid resection for acute volvulus. STUDY DESIGN Patients from the 2012 to 2019 Colectomy-Targeted American College of Surgeons NSQIP dataset who underwent sigmoid resection with primary anastomosis after admission for sigmoid volvulus were included. Multivariable logistic regression was used to compare the risk-adjusted 30-day postoperative outcomes of patients who received combined preoperative bowel preparation with those of patients who received either partial (mechanical or oral antibiotic alone) or incomplete bowel preparation. Effort was made to exclude patients whose urgency of clinical condition at hospital admission precluded an attempt at preoperative decompression and subsequent bowel preparation. RESULTS Included were 2,429 patients, 322 (13.3%) of whom underwent complete bowel preparation and 2,107 (86.7%) of whom underwent partial or incomplete bowel preparation. Complete bowel preparation was protective against several postoperative complications (including anastomotic leak), mortality, and prolonged postoperative hospitalization. CONCLUSIONS This study demonstrates a significant benefit for complete bowel preparation before semielective, same-admission sigmoid resection in patients with acute sigmoid volvulus. However, only a small percentage of patients in this national sample underwent complete preoperative bowel preparation. Broader adoption of bowel preparation may reduce overall rates of complication in patients who require sigmoid colectomy due to volvulus.
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Affiliation(s)
- Natalie Schudrowitz
- From the Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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34
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Stage IV Colorectal Cancer Management and Treatment. J Clin Med 2023; 12:jcm12052072. [PMID: 36902858 PMCID: PMC10004676 DOI: 10.3390/jcm12052072] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/08/2023] Open
Abstract
(1) Background: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related mortality worldwide. Up to 50% of patients with CRC develop metastatic CRC (mCRC). Surgical and systemic therapy advances can now offer significant survival advantages. Understanding the evolving treatment options is essential for decreasing mCRC mortality. We aim to summarize current evidence and guidelines regarding the management of mCRC to provide utility when making a treatment plan for the heterogenous spectrum of mCRC. (2) Methods: A comprehensive literature search of PubMed and current guidelines written by major cancer and surgical societies were reviewed. The references of the included studies were screened to identify additional studies that were incorporated as appropriate. (3) Results: The standard of care for mCRC primarily consists of surgical resection and systemic therapy. Complete resection of liver, lung, and peritoneal metastases is associated with better disease control and survival. Systemic therapy now includes chemotherapy, targeted therapy, and immunotherapy options that can be tailored by molecular profiling. Differences between colon and rectal metastasis management exist between major guidelines. (4) Conclusions: With the advances in surgical and systemic therapy, as well as a better understanding of tumor biology and the importance of molecular profiling, more patients can anticipate prolonged survival. We provide a summary of available evidence for the management of mCRC, highlighting the similarities and presenting the difference in available literature. Ultimately, a multidisciplinary evaluation of patients with mCRC is crucial to selecting the appropriate pathway.
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35
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Chinnappan J, Parajuli A, Marcus H, Bachuwa G. Constipation in transverse myelitis. BMJ Case Rep 2023; 16:16/3/e254409. [PMID: 36878618 PMCID: PMC9990615 DOI: 10.1136/bcr-2022-254409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Transverse myelitis is an extremely rare neuroinflammatory disorder. About half of the affected patients develop paraplegia associated with urinary and bowel dysfunction. The bowel dysfunction is thought to be benign and is usually managed with dietary management and laxatives. We report a case of a man in his 60s presenting with transverse myelitis and the acute disease course complicated with treatment refractory intestinal dysfunction resulting in intestinal perforation, eventually leading to his death. Thus, this case helps us weigh the fact that intestinal dysfunction in the case of transverse myelitis is not always benign but can lead to deadly outcomes as well.
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Affiliation(s)
- Justine Chinnappan
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Abinash Parajuli
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Huda Marcus
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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36
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Luo S, Wang Y. Value of Humanized Nursing under Emergency Green Channel on Gastrointestinal Function Recovery in Patients with Acute Intestinal Obstruction after Operation. Emerg Med Int 2023; 2023:2303766. [PMID: 36776479 PMCID: PMC9918356 DOI: 10.1155/2023/2303766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 02/05/2023] Open
Abstract
Acute intestinal obstruction (AIO) is one of the most common surgical acute abdomens. Emergency green channel refers to a fast and efficient service system provided by hospitals for critically ill patients. It is the key to ensure that emergency patients receive timely, standardized, efficient and thoughtful medical services, improve the success rate of rescue, and reduce medical risks. Acute intestinal obstruction is mainly treated by surgery in the clinic. Previous reports have shown that the application of different nursing methods in the operation of acute intestinal obstruction has different effects on the results of surgical treatment. In this study, the clinical data of 80 patients with AIO were retrospectively analyzed to explore the value of humanistic care under the emergency green channel in promoting the recovery of gastrointestinal function after AIO surgery.
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Affiliation(s)
- Siqi Luo
- The Nanhua Affiliated Hospital, Department of Operating Room, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Yan Wang
- The Nanhua Affiliated Hospital, Department of Operating Room, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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37
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Loria A, Jacobson T, Melucci AD, Bartell N, Nabozny MJ, Temple LK, Fleming FJ. Sigmoid volvulus: Evaluating identification strategies and contemporary multicenter outcomes. Am J Surg 2023; 225:191-197. [PMID: 35934559 DOI: 10.1016/j.amjsurg.2022.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is limited epidemiologic data on sigmoid volvulus (SV) from non-endemic regions. Therefore, we performed a multicenter study to report contemporary outcomes and appraise literature-based methods that pair diagnostic and procedural codes to identify SV. METHOD Using an automated search for patients with 'volvulus' in our system from 2011 to 2021, we reviewed electronic charts to clarify the diagnosis, automatically replicate three strategies to identify SV, and retrieved 6-month outcomes. RESULTS Of 895 patients, 109 had SV. Literature-based strategies poorly identified SV. At the index admission, patients underwent endoscopic reduction alone (33%), emergent (16.5%), semi-elective (34%), or elective (16.5%) surgery. Endoscopic reduction alone had high recurrence rates and delayed surgery was associated with worse outcomes. CONCLUSION Literature-based strategies to identify SV suffer from misclassification bias which affects patient counseling. In this large series, one-third of patients do not undergo during their index admission despite improved outcomes with earlier surgery.
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Affiliation(s)
- Anthony Loria
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Tricia Jacobson
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Alexa D Melucci
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Nicholas Bartell
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY, 146242, USA
| | - Michael J Nabozny
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Larissa K Temple
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Fergal J Fleming
- Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA; Department of Surgery, University of Rochester Medical Center, Rochester, NY, 14642, USA
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38
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Westfall KM, Cleary RK. Acute Colonic Pseudo-Obstruction. Dis Colon Rectum 2022; 65:1431-1434. [PMID: 36194654 DOI: 10.1097/dcr.0000000000002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
CASE SUMMARY A 33-year-old man with a history of chronic alcohol use, generalized anxiety disorder, and hypertension presented to the emergency department after a syncopal event. He was admitted to the medical intensive care unit for alcohol withdrawal, requiring intubation and sedation. On hospital day 7, abdominal x-ray image demonstrated a dilated cecum to 12 cm, transverse colon dilation to 7 cm, and decompressed distal colon ( Fig. 1 ). CT scan of the abdomen and pelvis confirmed dilation of the cecum and ascending and transverse colons ( Fig. 2 ). Colonoscopy showed no evidence of distal obstruction, but colonic distension persisted, and he subsequently underwent cecal decompression with an open "blow-hole" cecostomy fully matured at skin level via a small right lower quadrant incision. The nasogastric tube was removed on postoperative day 2, and his diet was slowly advanced. Abdominal x-ray image on postoperative day 5 demonstrated no colonic dilation. He was discharged home on postoperative day 7. The patient re-presented to the hospital 3 months later with cecostomy prolapse. He underwent cecostomy takedown with ileocecectomy via circumstomal incision. He was discharged home on postoperative day 2.
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Affiliation(s)
- Kristen M Westfall
- Department of Colon & Rectal Surgery, St. Joseph Mercy Ann Arbor, Ann Arbor, Michigan
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39
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Is Laparoscopy Underutilized for Sigmoid Volvulus? SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:564-570. [PMID: 35960695 DOI: 10.1097/sle.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/23/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus. MATERIALS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program and colectomy-targeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay. RESULTS Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104 min, P<0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when >7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach. CONCLUSIONS Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.
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40
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Zhao ZY, Zhang QW, Wang CL, Yu ED, Xing JJ. Recurrent sigmoid volvulus relieved by transanal ileus tube implantation. Gastroenterol Rep (Oxf) 2022; 10:goac030. [PMID: 35785265 PMCID: PMC9245925 DOI: 10.1093/gastro/goac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zi-Ye Zhao
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Qian-Wen Zhang
- Department of Radiology, Changhai Hospital, Shanghai, P. R. China
| | - Cheng-Long Wang
- Department of Gastroenterology, Xiamen University Affiliated Chenggong Hospital (Chinese PLA 73rd Army Corps Hospital), Xiamen, Fujian, P. R. China
| | - En-Da Yu
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
| | - Jun-Jie Xing
- Department of Colorectal Surgery, Changhai Hospital, Shanghai, P. R. China
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41
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Back Propagation Neural Network-Based Magnetic Resonance Imaging Image Features in Treating Intestinal Obstruction in Digestive Tract Diseases with Chengqi Decoction. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2021:1667024. [PMID: 35024009 PMCID: PMC8719996 DOI: 10.1155/2021/1667024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
This study was to explore the adoption effect of magnetic resonance imaging (MRI) image features based on back propagation neural network (BPNN) in evaluating the curative effect of Chengqi Decoction (CD) for intestinal obstruction (ileus), so as to evaluate the clinical adoption value of this algorithm. Ninety patients with ileus were recruited, and the patients were treated with CD and underwent MRI scans of the lower abdomen. A BPNN model was fabricated and applied to segment the MRI images of patients and identify the lesion. As a result, when the overlap step was 16 and the block size was 32 × 32, the running time of the BPNN algorithm was the shortest. The segmentation accuracy was the highest if there were two hidden layer (HL) nodes, reaching 97.3%. The recognition rates of small intestinal stromal tumor (SIST), colon cancer, adhesive ileus, and volvulus of MRI images segmented by the algorithm were 91.5%, 88.33%, 90.3%, and 88.9%, respectively, which were greatly superior to those of manual interpretation (P < 0.05). After the intervention of CD, the percentages of patients with ileus that were cured, markedly effective, effective, and ineffective were 65.38%, 23.16%, 5.38%, and 6.08%, respectively. The cure rate after intervention of CD (65.38%) was much higher in contrast to that before intervention (13.25%) (P < 0.05). In short, CD showed a good therapeutic effect on ileus and can effectively improve the prognosis of patients. In addition, MRI images based on BPNN showed a good diagnostic effect on ileus, and it was worth applying to clinical diagnosis.
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42
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Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1072519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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43
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Recommendations for the Management of Sigmoid Volvulus. Dis Colon Rectum 2022; 65:e85. [PMID: 34775403 DOI: 10.1097/dcr.0000000000002324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mahendran V, Reddy B, Jaradat I. The Unfolding Situation of Caecal Volvulus: A Retrospective Analysis of 36 Cases From a Single Center. Cureus 2022; 14:e21071. [PMID: 35028246 PMCID: PMC8744366 DOI: 10.7759/cureus.21071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Caecal volvulus (CV) is a rare cause of bowel obstruction. However, there has been a steady rise in the number of cases over the decades. The demographic profile of patients developing CV has changed to a much older population. We conducted a retrospective review to determine the incidence, demographic profile, management, and outcomes of CV patients in our institution during the last nine years. Methodology A retrospective audit of all patients diagnosed with CV at Worcestershire Acute Hospitals NHS Trust between 01 January 2011 and 31 March 2020 was performed. Patients admitted with any other type of volvuli such as sigmoid volvulus, small bowel volvulus, and gastric volvulus were excluded. A systematic search of the electronic medical records for all patients admitted under the International Classification of Diseases, Tenth Revision code K562: volvulus was performed for the study duration. It yielded a total of 1,019 patients. After excluding all patients who did not have either a CV or caecal bascule, we included 36 patients in the final analysis. Results Most of our patients were females (78%) with a median age was 76 years. The majority (86%) had at least one medical comorbidity, and 36% had a previous abdominal operation. Abdominal pain was the main complaint in 94% of patients. All patients had undergone a computed tomography (CT) scan to confirm their diagnosis. Most of our patients (84%) underwent surgery. Open right hemicolectomy was the most commonly performed operation (87%). Out of the six patients who did not undergo surgery, three responded to bowel rest and nasogastric tube decompression; one patient underwent successful colonoscopic decompression. In contrast, two patients, unfortunately, passed away. The median length of hospital stay was nine days, with a 30-day mortality of 3%. Conclusions CV remains a rare cause of bowel obstruction. Most of our patients were old, frail, and had medical comorbidities. More than one-third of patients had undergone previous abdominal surgery. Early CT scan followed by right hemicolectomy was associated with low mortality.
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Atamanalp SS, Peksoz R. Sigmoid volvulus: Treatment options and volvulus recurrence. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sigmoid Volvulus (SV) is principally treated with non-operative decompression, whereas it may require surgical management in some situations. Depending upon the treatment method, SV recurs in about one fourth of the cases, which doubles the mortality and morbidity rates. In this paper, we discuss the management and related recurrence of SV in the light of the largest single-center SV series over the world.
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Atamanalp SS. Comments on 'Sigmoidectomy following sigmoid volvulus: who is at risk of anastomotic failure?'. Tech Coloproctol 2021; 26:83. [PMID: 34697687 DOI: 10.1007/s10151-021-02541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S S Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey.
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