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Molina-Valencia JL, Delgado-López CA. Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El linfoma puede afectar el tracto gastrointestinal de manera primaria o secundaria, y representa hasta el 2 % de todas las neoplasias malignas del intestino delgado y colon. El tracto gastrointestinal es la ubicación extraganglionar primaria más común en el linfoma no Hodgkin.
Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos académicas, con revisión de textos publicados sobre el tema en los últimos 5 años.
Discusión. La presentación clínica del linfoma con compromiso gastrointestinal es inespecífica y, hasta en la mitad de los pacientes, se puede presentar de manera inicial con complicaciones que requieran manejo quirúrgico. Entre las principales se encuentran la perforación intestinal, el sangrado digestivo y la obstrucción intestinal.
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Panneerselvam K, Goyal S, Shirwaikar Thomas A. Ileo-colonic lymphoma: presentation, diagnosis, and management. Curr Opin Gastroenterol 2021; 37:52-58. [PMID: 33105251 DOI: 10.1097/mog.0000000000000687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The gut-associated lymphoid tissue (GALT), the bulk of which is located in the ileo-colonic region comprises the lymphoid cells of the gastrointestinal tract and confers specific immunological responses. Repetitive antigenic stimulation of these cells predispose to a monoclonal proliferation of this tissue and the eventual development of lymphoma. The gastrointestinal tract is the most commonly involved site of extranodal lymphomas. This review will focus primarily on lymphomas of the ileo-colonic region (defined as the terminal ileum, the colon, and the rectum). We will discuss the epidemiology, pathogenesis, and presentation as well as current practices in diagnosis and management. RECENT FINDINGS Despite the majority of the GALT to be located in the ileo-colonic region of the gut, the lymphomas in this location are relatively rare. However, the overall annual incidence of ileo-colonic lymphomas is steadily increasing. This entity has a varied spectrum of clinical presentations. Ileo-colonoscopy with adequate targeted biopsies can serve as a gold standard for definitive diagnosis. Ileo-colonic lymphomas may be managed with chemotherapy alone while surgery is reserved for highly aggressive tumors or clinical emergencies. Radiation is not a preferred adjuvant treatment for lymphomas in this location of the gut. Adequate endoscopic surveillance measures and tools to potentially prevent recurrence and improve the overall prognosis of this disease are lacking. SUMMARY Ileo-colonic lymphomas are rare and can present with varied symptoms and signs. Endoscopy with adequate sampling can aid in making a definitive diagnosis. Chemotherapy can be highly effective in management while surgery is indicated for emergency presentations. Adequate endoscopic surveillance tools are lacking, yet imperative to prevent recurrence and improve prognosis.
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Affiliation(s)
| | - Shreya Goyal
- Department of Internal Medicine, Baylor College of Medicine
| | - Anusha Shirwaikar Thomas
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Kang S, Lee SI, Min BW, Lee TH, Baek SJ, Kwak JM, Kim J, Kim SH, Kim JS, Ji WB, Um JW, Hong KD. A multicentre comparative study between laparoscopic and open surgery for intussusception in adults. Colorectal Dis 2020; 22:1415-1421. [PMID: 32356391 DOI: 10.1111/codi.15102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/10/2020] [Indexed: 02/08/2023]
Abstract
AIM Intussusception in adults is rare and requires surgery in most cases. While abdominal laparoscopic surgery (LS) is becoming more popular, there are few reports on the outcomes of adult intussusception treated with LS. This study compared the feasibility of LS vs open surgery (OS) for adult intussusception. METHOD We reviewed retrospectively the medical records of adult patients with intussusception from three tertiary hospitals between 2000 and 2016. The patients were divided into LS and OS groups, and their surgical outcomes were compared. RESULTS Surgery was indicated in 71 patients with intussusception (41 LS and 30 OS). The median age of the patients was 49.0 and 51.5 years in the LS and OS groups, respectively (P = 0.930). Overall, nine (12.7%) patients had a negative laparotomy or laparoscopy with spontaneous reduction of the intussusception. Conversion to OS from LS was necessary in one patient (2.4%). The operative time and intra-operative and postoperative complication rates were not significantly different. However, there were more serious complications such as bowel perforation and major vessel injury in the LS group. The patients in the LS group had a shorter time to first food intake and hospital stay vs patients in the OS group (4.0 vs 6.0 days, P < 0.001, and 7.0 vs 10.5 days, P < 0.001, respectively). CONCLUSION LS may be feasible for adult intussusception; there may be more severe intra-operative complications than in OS.
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Affiliation(s)
- S Kang
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - S I Lee
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - B W Min
- Department of Colorectal Surgery, Korea University Anam Hospital, Seoul, Korea
| | - T H Lee
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-J Baek
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J-M Kwak
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - S-H Kim
- Department of Colorectal Surgery, Korea University Guro Hospital, Seoul, Korea
| | - J S Kim
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - W-B Ji
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - J W Um
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
| | - K D Hong
- Department of Colorectal Surgery, Korea University Ansan Hospital, Gyeonggi-do, Korea
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Wang A, Prieto JM, Ward E, Bickler S, Henry M, Kling K, Thangarajah H, Ignacio R. Operative treatment for intussusception: Should an incidental appendectomy be performed? J Pediatr Surg 2019; 54:495-499. [PMID: 30583859 DOI: 10.1016/j.jpedsurg.2018.10.099] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES An incidental appendectomy is performed by some surgeons during operative treatment for intussusception to eliminate future appendicitis as a diagnostic consideration. However, an appendectomy can increase the risk of infection and other noninfectious complications making an incidental appendectomy controversial. We examined outcomes for surgical intervention for intussusception with appendectomy (SWA) compared to surgical reduction alone (SRA). METHODS The Pediatric Health Information System database, 8/2008-9/2015, was retrospectively analyzed for patients under the age of five who required an operative intervention for intussusception without bowel resection. Demographic data and postoperative outcomes were analyzed. Available data included need for postoperative enema, subsequent small bowel obstruction, recurrent intussusception, length of stay (LOS), and adjusted total cost (ATC). RESULTS Fifty-seven percent (748/1312) of patients had appendectomy performed during surgical reduction, 564 (43%) did not. ATC ($10,594 vs. $8939, p < 0.001) and LOS (3.0 vs. 2.48, p < 0.001) are higher in the SWA group. Rates of readmission are similar, but post-operative small bowel obstruction may be higher in the SWA group (1.3% vs. 0.35%, p = 0.06). CONCLUSION There is a higher mean LOS and ATC in the SWA group. This study suggests that appendectomy during surgery for uncomplicated intussusception should be reconsidered and requires further investigation. TYPE OF STUDY retrospective comparative study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew Wang
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - James M Prieto
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Erin Ward
- Department of Surgery, School of Medicine, University of California, La Jolla, CA 92093, USA
| | - Stephen Bickler
- Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA 92123, USA
| | - Marion Henry
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Karen Kling
- Division of Pediatric Surgery, Rady Children's Hospital, San Diego, CA 92123, USA
| | | | - Romeo Ignacio
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA.
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Paramythiotis D, Goulas P, Moysidis M, Papavramidis T, Michalopoulos A. Bowel intussusception in adults: a report of three interesting cases and current trends for diagnosis and surgical management. Hippokratia 2019; 23:37-41. [PMID: 32256038 PMCID: PMC7124870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Bowel intussusception in adults remains a rare and constant diagnostic challenge for surgeons. It has an incidence of around 2-3 new cases per million per year, and its primary cause is benign or malignant neoplasms of the small bowel and colon. This report aims to outline the importance of high clinical suspicion regarding intussusception in adults presenting with abdominal pain in the emergency department. Case report: This is a retrospective review of three cases of adult ileocecal intussusception that were treated in a single surgical department in three years (2015-2018). All patients underwent right hemicolectomy in keeping with the principles of surgical oncology. Each patient had a different clinical presentation, while, in terms of the underlining pathology, the first had an adenocarcinoma of the ascending colon, the second an adenocarcinoma of the ileocecal valve, and the third one an inflammatory fibroid polyp of the ileocecal valve, also known as Vanek's tumor. CONCLUSION Large bowel intussusception in adults is quite an interesting entity, not only for its rarity but for its non-specific and atypical clinical presentation as well. High suspicion from the clinician's part and availability of a computed tomography scan is the key to diagnosis. It is not unusual for imaging modalities to be unable to identify the cause of the intussusception. Thus, surgery is always the preferred method of treatment, as, more often than not, a neoplasm of the small or the large bowel is the underlining pathology. HIPPOKRATIA 2019, 23(1): 37-41.
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Affiliation(s)
- D Paramythiotis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - P Goulas
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - M Moysidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - T Papavramidis
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Michalopoulos
- 1 Propaedeutic Surgical Department, AHEPA University General Hospital of Thessaloniki, Thessaloniki, Greece
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Takahashi N, Narita K, Sato R, Suzuki H, Machishi H, Okada Y. Manual laparoscopy-assisted intraoperative reduction for adult ileocolic intussusception with ileal adenoma: A case report. Int J Surg Case Rep 2017; 36:116-118. [PMID: 28554107 PMCID: PMC5447511 DOI: 10.1016/j.ijscr.2017.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/02/2017] [Accepted: 05/06/2017] [Indexed: 12/05/2022] Open
Abstract
Adult intussusception is a rare condition with a pathological lead point. Manual intraoperative reduction of adult intussusception is safe and can eliminate the need for extensive or invasive resection. Laparoscopy is a beneficial and minimally invasive technique for patients with intussusception.
Introduction Adult intussusception is a rare condition with a pathological lead point. Intraoperative reduction of adult intussusception can eliminate the need for extensive or invasive resection. We safely performed a manual laparoscopy-assisted intraoperative reduction that allowed functional preservation of tissue. Presentation of case A 70-year-old woman with dull right lumbar pain at regular intervals and right lower quadrant abdominal tenderness was admitted to our hospital. The ileum exhibited enhanced wall thickening and invagination into the ascending colon on computed tomography. Emergency laparoscopic surgery was chosen to treat the ileocolic intussusception. First, the right colon was mobilized. Second, the ileocecal region was pulled through a 4-cm right pararectus incision. Third, the edge of the intussusceptum was gently manipulated back upstream without tearing. After reduction, a soft mass was recognized on palpation at the lead point, located 10 cm proximal to the ileocecal valve. Ileocecal resection was performed, and a laterally spreading tumor was observed in the resected specimen. The histological diagnosis was high-grade tubular adenoma. The postoperative course was uneventful. Discussion Adult intussusception has a pathological lead point, and curative treatment generally includes resection of the lesion. Complete or partial intraoperative reduction can avoid or shorten bowel resection and allow functional preservation of the tissue. Conclusion Manual laparoscopy-assisted intraoperative reduction with a minilaparotomy was safely performed, which eliminated the need for extensive or invasive resection.
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Affiliation(s)
- Naoki Takahashi
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
| | - Kiyoshi Narita
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
| | - Rie Sato
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
| | - Hideo Suzuki
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
| | - Hideki Machishi
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
| | - Yoshikatsu Okada
- Department of Surgery, Kuwana East Medical Center, 3-11 Kotobukicho, Kuwana, Mie, 511-0061, Japan.
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Laparoscopic surgery for adult enterocolic intussusception: Case report and literature review. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 41:255-257. [PMID: 28528006 DOI: 10.1016/j.gastrohep.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/18/2017] [Indexed: 12/13/2022]
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