Femur Osteomyelitis and Associated Fracture as an Initial Presentation of Aortoenteric Fistula

Aortoenteric fistula is a rare condition. Atypical presentations may cause significant management delays. We present the case of a 64-year-old male who experienced a pathological femoral fracture as an initial presentation of an underlying aortoenteric fistula. The aortoenteric fistula, possibly related to a poor graft tunneling technique, induced femur osteomyelitis and the associated pathological fracture.

Validation and comparative assessment of low anterior resection syndrome questionnaires in Greek rectal cancer patients

Background

Our study validated the low anterior resection syndrome (LARS) score questionnaire, the colorectal functional outcome (COREFO) questionnaire, and the Memorial Sloan-Kettering Cancer Center bowel function instrument (MSKCC-BFI) in Greek rectal cancer patients.

Methods

Internal consistency, repeatability, construct and discriminant validity were evaluated for LARS, COREFO, and MSKCC-BFI questionnaires. The convergent validity was assessed by correlations with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR29 domains.

Results

The internal consistency of the questionnaire's subscales was satisfactory (Cronbach's a>0.6). The repeatability test showed extremely high reproducibility (intraclass correlation coefficient >0.9). High positive correlation was detected between the 3 questionnaires' total scores and each of their questions (rho>0.5), indicating their valid construction. All questionnaires demonstrated a good convergent validity through correlations with comparable domains of the EORTC QLQ-C30 and CR29. Statistically significant associations were detected between LARS, COREFO, MSKCC-BFI scores and tumor distance and temporary stoma (P<0.001 and P=0.009, P<0.001 and P=0.005, P<0.001 and P=0.002 respectively). In addition, COREFO and MSKCC-BFI scores were significantly associated with radiation therapy. LARS score was significantly correlated to all COREFO and MSKCC-BFI subscales.

Conclusions

The Greek versions of the LARS score, COREFO and MSKCC-BFI questionnaires were proven to have good psychometric properties and can be used as specific and valid instruments for measuring LARS. Since the COREFO and MSKCC-BFI questionnaires, which are more extensive and possibly less applicable in routine clinical practice, showed no advantages in relation to the LARS score, the latter may be established as the simplest, fastest to complete and most targeted tool for assessing LARS.

Use of a biological mesh for the treatment of perineal fistula following radical colorectal resection

Patients with postradiation therapy for malignancies and/or extensive colorectal surgery are prone to the development of enteroperineal fistulas. Application of biological meshes may prove beneficial in treating complicated enteroperineal fistulas as they provide a stable ground for closing pelvic defects even in contaminated fields.

Bowel perforation by lumbar-peritoneal (LP) shunt: A rare complication of neurosurgery

INTRODUCTION

Lumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity. This invasive procedure has been associated with several complications, most commonly infection and obstruction. Perforation of the bowel is an extremely rare complication.

CASE PRESENTATION

We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus. This was due to bowel perforation in the recto-sigmoid junction by the distal tip of lumbar-peritoneal shunt. She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation.

DISCUSSION

The mortality after perforation is relatively high, approaching 15-18%, and it is further increased when infection is present up to 22% with central nervous system (CNS) infection such as meningitis, encephalitis, or brain abscesses (Vinchon, 2006) and 33% with intra-abdominal infection.

CONCLUSION

Clinical suspicion of abdominal complications by the LP should be raised when patient with hydrocephalus develops acute abdominal symptoms or infection with unusual positive CSF cultures.

Transanal evisceration of the small bowel a rare complication of rectal prolapse

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A 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus.

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In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20 cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed.

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Additionally a 2 cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed.

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The patient was discharged after 10 days.

Introduction

Transanal evisceration of small bowel is an extremely rare surgical emergency. Of the nearly 70 cases reported in the literature, rectal prolapse is the predisposing factor that has been most frequently related to this pathology.

Presentation of case

We report a 78-year-old female with history of chronic rectal prolapse who presented in our emergency department with evisceration of small intestinal loops through the anus. In surgery after complete reduction of the eviscerated bowel into the peritoneal cavity, almost 20 cm of the terminal ileum up to the ileocecal valve were necrotic and therefore a right hemicolectomy with primary anastomosis was performed. Additionally a 2 cm craniocaudally tear was revealed in the antimesenteric border of the upper rectum and a Hartman procedure was also performed. The patient was discharged after 10 days.

Discussion

Early recognition and timely surgical intervention offers the best prognosis, avoiding a fatal conclusion or an extensive intestinal resection.