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Hernandez Dominguez O, Lincango EP, Spivak R, Almonacid-Cardenas F, Prien C, Uchino T, Spivak A, Hull TL, Steele SR, Holubar SD. Colosplenic fistula diagnosis and management: a case series and review of literature. Int J Surg 2024; 110:2381-2388. [PMID: 38668664 PMCID: PMC11020030 DOI: 10.1097/js9.0000000000001128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND A colosplenic fistula (CsF) is an extremely rare complication. Its diagnosis and management remain poorly understood, owing to its infrequent incidence. Our objective was to systematically review the etiology, clinical features, diagnosis, management, and prognosis to help clinicians gain a better understanding of this unusual complication and provide aid if it is to be encountered. METHODS A systematic review of studies reporting CsF diagnosis in Ovid MEDLINE, Ovid EMBASE, Scopus, Web of Science, and Wiley Cochrane Library from 1946 to June 2022. Additionally, a retrospective review of four cases at our institution were included. Cases were evaluated for patient characteristics (age, sex, and comorbidities), CsF characteristics including causes, symptoms at presentation, diagnosis approach, management approach, pathology findings, intraoperative complications, postoperative complications, 30-day mortality, and prognosis were collected. RESULTS Thirty patients with CsFs were analyzed, including four cases at our institution and 26 single-case reports. Most of the patients were male (70%), with a median age of 56 years. The most common etiologies were colonic lymphoma (30%) and colorectal carcinoma (17%). Computed tomography (CT) was commonly used for diagnosis (90%). Approximately 87% of patients underwent a surgical intervention, most commonly segmental resection (81%) of the affected colon and splenectomy (77%). Nineteen patients were initially managed surgically, and 12 patients were initially managed nonoperatively. However, 11 of the nonoperative patients ultimately required surgery due to unresolved symptoms. The rate of postoperative complications was (17%). Symptoms resolved with surgical intervention in 25 (83%) patients. Only one patient (3%) had had postoperative mortality. CONCLUSIONS Our review of 30 cases worldwide is the largest in literature. CsFs are predominantly complications of neoplastic processes. CsF may be successfully and safely treated with splenectomy and resection of the affected colon, with a low rate of postoperative complications.
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Affiliation(s)
| | - Eddy P. Lincango
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Rebecca Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | | | - Christopher Prien
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tairin Uchino
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Anna Spivak
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Tracy L. Hull
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Scott R. Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
| | - Stefan D. Holubar
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute
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Zhang C, Calderon E, Chang YH, Han GR, Kelley SR, Merchea A, Brady JT, Young-Fadok TM, Etzioni DA, Mishra N. Short and long-term oncologic outcomes of patients with colon cancer of the splenic flexure. Am J Surg 2023:S0002-9610(23)00056-9. [PMID: 36858866 DOI: 10.1016/j.amjsurg.2023.02.005] [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: 11/17/2022] [Revised: 01/18/2023] [Accepted: 02/04/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND There is currently no consensus on surgical management of splenic flexure adenocarcinoma (SFA). METHODS Patients undergoing surgical resection for SFA between 1993 and 2015 were identified. Postoperative outcomes were compared between patients who underwent segmental (SR) vs. anatomical resection (AR). RESULTS One-hundred and thirteen patients underwent SR and 89 underwent AR. More patients in the SR group had open resections, but there were otherwise no differences in demographics or surgical characteristics between the two groups. There were no differences in overall (p = 0.29) or recurrence-free(p = 0.37) survival. On multivariable analysis, increased age (HR 1.04, 1.01-1.07, p = 0.005), higher American Society of Anesthesiology classification (HR 3.1, 1.7-5.71, p < 0.001), and higher tumor stage (HR 8.84, 3.76-20.82, p < 0.001) were predictive of mortality. CONCLUSIONS Short and long-term outcomes after SR and AR for SFA are not different, making SR a viable option for SFA surgical management.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, MN, USA
| | | | - Yu Hui Chang
- Department of Quantitative Health Sciences, Scottsdale, AZ, USA
| | - Ga-Ram Han
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic Rochester, Rochester, MN, USA
| | - Amit Merchea
- Department of Colon and Rectal Surgery, Mayo Clinic Florida Jacksonville, FL, USA
| | - Justin T Brady
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Tonia M Young-Fadok
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David A Etzioni
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nitin Mishra
- Department of Colon and Rectal Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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Oyamada T, Nabeta R, Azakami D. A canine case of splenic hemangiosarcoma complicated with infectious splenic abscess. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2022; 13:451-454. [PMID: 36320301 PMCID: PMC9548233 DOI: 10.30466/vrf.2021.526184.3148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
A 12-year-old spayed female Yorkshire Terrier presented with anorexia, and an intra-abdominal mass was examined at the Animal Medical Center, Tokyo University of Agriculture and Technology, Tokyo, Japan. Abdominal ultrasonography revealed that the mass originated from the spleen. Total splenectomy was performed the following day, where evidence of past rupture of the splenic mass and a small amount of purulent ascites were found. No gastrointestinal perforation or abscess formation in other tissues was noted during the surgery. Intra-operative cytological examination of the ascites revealed a large number of degenerated neutrophils and macrophages phagocytosing cocci. The splenic mass was histopathologically diagnosed as a splenic abscess, concurrent with a splenic hemangiosarcoma. Bacterial culture examination of the ascites identified Staphylococcus schleiferi. Although surgical management had been successful, the dog eventually developed clinical signs suggestive of intra-abdominal hemorrhage attributable to hemangiosarcoma approximately five months after surgery. This clinical report describes that splenic hemangiosarcoma might have created a milieu favorable for the development of splenic abscess.
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Affiliation(s)
- Tomohiro Oyamada
- Animal Medical Center, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Rina Nabeta
- Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan; ,Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Daigo Azakami
- Laboratory of Veterinary Clinical Oncology, Cooperative Department of Veterinary Medicine, Faculty of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan.,Correspondence Daigo Azakami. DVM, PhD Laboratory of Veterinary Surgery, Tokyo University of Agriculture and Technology, Tokyo, Japan . E-mail:
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Pavlidis ET, Martzivanou EK, Symeonidis NG, Psarras KK, Marneri AG, Stavrati KE, Pavlidis TE. A case of acute abdomen caused by spontaneous rupture of a splenic abscess secondary to cancer of the splenic flexure. J Surg Case Rep 2021; 2021:rjab048. [PMID: 33868635 PMCID: PMC8043107 DOI: 10.1093/jscr/rjab048] [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] [Received: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 02/05/2023] Open
Abstract
Splenic abscesses are rare, difficult to diagnose, difficult to treat and usually appear in immunosuppressed patients. We present the case of a 64-year-old patient with left pleuritic chest pain, anorexia and fever with rigors diagnosed with splenic abscess due to splenic flexure colon cancer. The abscess spontaneously ruptured and the patient was operated on for acute abdomen. Splenectomy and Hartmann's hemicolectomy were performed. The patient was discharged from the hospital and referred to the oncologic department. Continuous spread of infection and especially initiating from a cancer lesion is a usual mechanism of splenic abscess formation. Although computed tomography-guided percutaneous drainage is the treatment of choice, an exploratory laparotomy was necessary in this case because of the rupture of the abscess. It is important for the clinicians to include splenic abscesses and their complications in the differential diagnosis of acute abdomen.
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Affiliation(s)
- Efstathios T Pavlidis
- Correspondence address. Aristotle University of Thessaloniki, School of Medicine, 8 Iereos Kazika Str. 55132 Thessaloniki, Greece. Tel: ++302310992933; Fax: ++302310992932; E-mail:
| | - Eirini K Martzivanou
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Nikolaos G Symeonidis
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Kyriakos K Psarras
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Alexandra G Marneri
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Kalliopi E Stavrati
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- Aristotle University of Thessaloniki, School of Medicine, Second Surgical Propedeutic Department, Hippocration Hospital, Thessaloniki, Greece
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Fitzsimmons E, Torrico TJ, Bajaj T, Ragland AS. Colonic Adenocarcinoma Presenting as Splenic Abscess Secondary to Suspected Microperforation. J Investig Med High Impact Case Rep 2020; 8:2324709620978317. [PMID: 33283530 PMCID: PMC7724399 DOI: 10.1177/2324709620978317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Splenic abscesses are a rare infection that usually requires seeding from another
primary source; however, direct contact of bacteria can occur with
microperforation secondary to colon cancer leading to abscess formation. This
occurrence is rare, and through literature review only 12 previous cases have
been reported with associated bacteremia. Our patient is a 62-year-old female
who presented with left upper quadrant pain with a history of tobacco and
alcohol abuse that was febrile and hypoxic. Blood cultures were obtained that
eventually grew Fusobacterium mortiferum. Computed tomography
of the abdomen and the pelvis revealed 2 splenic abscesses that were cultured to
grow Escherichia coli and β-hemolytic
Streptococcus group C. Colonoscopy was performed, which
identified 2 masses that were biopsied, and histopathology confirmed
well-differentiated adenocarcinoma with possible muscular invasion. The patient
had no other identifiable risk factors for bacterial seeding from another
primary source. We present the first reported case report of splenic abscess
secondary to colonic adenocarcinoma suspected microperforation associated with
Fusobacterium mortiferum bacteremia.
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Massaut E, Hendlisz B, Klastersky JA. The close interrelation between colorectal cancer, infection and microbiota. Curr Opin Oncol 2020; 31:362-367. [PMID: 31090550 DOI: 10.1097/cco.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Evaluate the recent literature about the relation of clinical infection and colorectal cancer in terms of diagnosis of an occult infection and possible impact on oncological outcome and review the possible role of the gut microbiota in the role of colorectal cancer oncogenesis. RECENT FINDINGS Data published within the 2 last years have been reviewed and the conclusions, mostly supporting previously published information, have been critically discussed. SUMMARY Infection (bacteremia, cellulitis) might be a surrogate of occult colorectal cancer and postoperative infection complications might jeopardize long-term survival after potentially curative surgery. The role of the gut microbiota in the genesis of colorectal cancer remains an exciting though unresolved question.
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Affiliation(s)
- Edouard Massaut
- Service de Chirurgie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Barbara Hendlisz
- Service d'Oncologie Médicale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean A Klastersky
- Service d'Oncologie Médicale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Yokoyama Y, Kashyap S, Ewing E, Bloch R. Gastrosplenocolic fistula secondary to non-Hodgkin B-cell lymphoma. J Surg Case Rep 2020; 2020:rjz376. [PMID: 31976059 PMCID: PMC6963169 DOI: 10.1093/jscr/rjz376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Gastrocolic fistula (GSF) is a rare entity that arises mainly from splenic or gastric lymphoma. Gastric and splenic lymphomas can also fistulate with other organs, including the pleura and the colon, but there has been no reported case to best of our knowledge of a fistula involving three different organs. We hereby present the case of a female patient with gastrosplenocolic fistula secondary to non-Hodgkin B-cell lymphoma. We performed an en bloc partial gastrectomy with splenectomy and partial left colon resection with colostomy. GSF can be treated with chemotherapy. However, when the definite diagnosis is unclear or GSF is causing serious complications such as bleeding or active infection, we believe surgical excision is the treatment of choice.
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Affiliation(s)
- Yujiro Yokoyama
- General Surgery Department, Easton Hospital, Easton, PA, USA
| | - Sarang Kashyap
- General Surgery Department, Easton Hospital, Easton, PA, USA
| | - Edward Ewing
- Pathology Department, Easton Hospital, Easton, PA, USA
| | - Robert Bloch
- General Surgery Department, Easton Hospital, Easton, PA, USA
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Fekaj EH. Concomitant necrobiosis lipoidica and splenic abscess. J Surg Case Rep 2019; 2019:rjz088. [PMID: 30949338 PMCID: PMC6439504 DOI: 10.1093/jscr/rjz088] [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] [Received: 01/28/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
Necrobiosis lipoidica is an idiopathic dermatosis of unknown origin, occurring mainly in patients with diabetes. Splenic abscesses are rare entities. We report a case with concomitant necrobiosis lipoidica and splenic abscess. A 58-year-old man presented to emergency center with a two day history of left upper abdominal pain, general malaise, and pyrexia. On both lower legs the patient had skin lesions. The contrast-enhanced computed tomography of the abdomen revealed splenomegaly and splenic abscess in the upper pole of the spleen. On the fourth day after admission, patient underwent open splenectomy. For the lesions on lower legs, by clinical examination, necrobiosis lipoidica was confirmed. The patient was treated by topical administration of steroid cream. After a 2 months follow-up, this treatment was not effective. Left upper abdominal pain and pyrexia in patient with necrobiosis lipoidica may suggest splenic abscess.
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Affiliation(s)
- Enver H Fekaj
- Department of Abdominal Surgery, University Clinical Center of Kosovo, Str. 'Bulevardi i Deshmoreve', Prishtina, Republic of Kosovo
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How we do it: totally laparoscopic complete mesocolon excision for splenic flexure cancer. Langenbecks Arch Surg 2018; 403:769-775. [PMID: 30083837 DOI: 10.1007/s00423-018-1699-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/27/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Splenic flexure (SF) cancer is not a common condition and its treatment is still under discussion. Although laparoscopic surgery is well accepted for the treatment of colon cancer at any stage, complete mesocolon excision (CME) with selective vascular ligation using the laparoscopic approach for SF cancer remains technically demanding and represents a real challenge for surgeons. METHODS We present a single-institution experience of laparoscopic CME for SF cancer. Intra-operative, pathologic, and post-operative data of patients who underwent laparoscopic SF resection were reviewed to assess the technical feasibility and oncologic safety. Technical features, histopathology, morbidity, and mortality were evaluated. RESULTS From February 2015 to October 2017, a minimally invasive approach was proposed to 17 patients (M/F 14/3) affected by splenic flexure cancer. In all patients, the procedure was completed by laparoscopy. The anastomosis was completed intra-corporeally in 89% of cases. The distal margin was 3.1 ± 2.6 cm and the proximal margin was 6.5 ± 3.3 cm from the tumor site. The number of mean harvested nodes was 13.9 ± 7. The mean operative time was 215.5 ± 65 min, and blood loss was 80 ± 27. In one case, a laparoscopic partial gastrectomy was associated due to tumor invasion. The mean post-operative stay was 6.7 ± 3.3 days. Readmission was necessary for two patients. No major morbidity was recorded. CONCLUSIONS Despite the wide spread and increasing confidence in laparoscopic colectomy, SF resection remains one of the most challenging procedures in colorectal surgery with a complex learning curve. SF resection with CME and CVL is feasible and safe for the treatment of early-stage and locally advanced SF cancer.
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