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Kulvatunyou N, Zimmerman SA, Joseph B, Friese RS, Gries L, O'Keeffe T, Stroster JA, Tang AL. Risk Factors for Perforated Appendicitis in the Acute Care Surgery Era-Minimizing the Patient's Delayed Presentation Factor. J Surg Res 2019; 238:113-118. [PMID: 30769247 DOI: 10.1016/j.jss.2019.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Numerous factors contribute to advanced disease or increased complications in patients with acute appendicitis (AA). This study aimed to identify risk factors associated with AA perforation, including the effect of system time (ST) delay, after controlling for patient time (PT) delay. In this study, PT was controlled (to less than or equal to 24 h) to better understand the effect of ST delay on AA perforation. METHODS Medical records of patients who underwent surgery for AA at a tertiary referral hospital from October 2009 through September 2013 were reviewed. Data collected included demographics, body mass index, presence of fecalith, PT (i.e., duration of time from symptom onset to arrival in emergency department), and ST (i.e., duration of time from arrival in emergency department to operating room). AA was classified as simple (acute, nonperforated) versus advanced (gangrenous, perforated). RESULTS Seven hundred forty-seven patients underwent surgery for AA. After excluding patients with PT > 24 h, 445 patients fit the study criteria, of which 358 patients with simple AA and 87 patients with advanced disease. Advanced appendicitis patients were older and had higher body mass index, longer PT, higher WBC, and higher incidence of fecaliths. Both groups had similar ST. Risk factors for advanced appendicitis after multiple regression analysis are age >50 y old, WBC >15,000, the presence of fecaliths, and PT delay >12 h. CONCLUSIONS Once PT delay was limited to ≤24 h, the ST delay of >12 h did not adversely affect the incidence of advanced AA. Age >50 y, WBC >15,000, PT delay >12 h, and the presence of fecaliths were identified as risk factors associated with advanced AA.
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Affiliation(s)
- Narong Kulvatunyou
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Steven A Zimmerman
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona.
| | - Bellal Joseph
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Randall S Friese
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Lynn Gries
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Terence O'Keeffe
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - John A Stroster
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Andrew L Tang
- Division of Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
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2
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Rosolem Lima S, da Silva Barbosa JM, Gomes Ferreira Padilha F, Veiga Saracchini PG, de Almeida Braga M, da Silva Leite J, Reis Ferreira AM. Physical characteristics of free-living sea turtles that had and had not ingested debris in Microregion of the Lakes, Brazil. Mar Pollut Bull 2018; 137:723-727. [PMID: 30503490 DOI: 10.1016/j.marpolbul.2018.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/13/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
The ingestion of detritus by sea turtles results in high mortality and morbidity. The objective of this study was to describe the characteristics of free-living sea turtles that ingested anthropogenic inorganic detritus in comparison to those that did not. A total of 186 necropsy files were analyzed in marine turtles from the beaches of the Microregion dos Lagos, Rio de Janeiro. Among the turtles that ingested detritus, the mean turtle was female and cachectic, with a carapace length of 36,6 cm, detritus accumulated in the large intestine, and fecal compaction. It seems most likely that's low food transit, combined with the multiplicity of ingestion, favored the accumulation of detritus. This ingestion resulted in cachexia associated with fecal compaction, since the greatest accumulation was in the large intestine. The intake of detritus by turtles was not punctual but continuous. These studies demonstrated the vulnerability of these animals to environmental pollution.
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Affiliation(s)
- Samara Rosolem Lima
- Postgraduate Program in Veterinary Medicine (Clinics and Animal Reproduction), Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil.
| | - João Marcos da Silva Barbosa
- Postgraduate Program in Veterinary Medicine (Clinics and Animal Reproduction), Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | - Felipe Gomes Ferreira Padilha
- Postgraduate Program in Veterinary Medicine (Clinics and Animal Reproduction), Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | - Paula Gabrielle Veiga Saracchini
- Postgraduate Program in Veterinary Medicine (Clinics and Animal Reproduction), Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | | | - Juliana da Silva Leite
- Department of Pathology and Veterinary Clinics, Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil
| | - Ana Maria Reis Ferreira
- Postgraduate Program in Veterinary Medicine (Clinics and Animal Reproduction), Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil; Department of Pathology and Veterinary Clinics, Faculty of Veterinary Medicine, Universidade Federal Fluminense, Niteroi, RJ, Brazil
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Larkin PJ, Cherny NI, La Carpia D, Guglielmo M, Ostgathe C, Scotté F, Ripamonti CI. Diagnosis, assessment and management of constipation in advanced cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2018; 29:iv111-iv125. [PMID: 30016389 DOI: 10.1093/annonc/mdy148] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- P J Larkin
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - N I Cherny
- Cancer Pain and Palliative Medicine Service, Department of Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - D La Carpia
- Centro Medicina Dell'Invecchiamento (Ce.M.I.), Fondazione Policlinico Agostino, Gemelli, Roma
| | - M Guglielmo
- Oncology-Supportive Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - C Ostgathe
- Palliative Care Department, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - F Scotté
- Department of Medical Oncology and Supportive Care, Foch Hospital, Suresnes, France
| | - C I Ripamonti
- Oncology-Supportive Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
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4
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Albuquerque A, Macedo G. Anal Sphincters Evaluation by Endoanal Ultrasound in Obstructed Defecation. J Ultrasound Med 2017; 36:2519-2524. [PMID: 28649718 DOI: 10.1002/jum.14300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 12/06/2023]
Abstract
OBJECTIVES To evaluate anal sphincter abnormalities detected by endoanal ultrasound in obstructed defecation due to rectocele and rectal intussusception. METHODS The retrospective analysis includes 45 patients with obstructed defecation syndrome due to rectocele and/or rectal intussusception with or without fecal incontinence, and submitted to endoanal ultrasound. RESULTS Ninety-three percent (n = 42) were women (mean age of 63 ± 12 years), and 47% (n = 21) of the patients had fecal incontinence. In total, 29% (n = 13) had a previous anorectal surgery, and 93% (n = 39) of the women had a previous vaginal delivery. An isolated rectal intussusception was diagnosed in 20% (n = 9) of the patients, an isolated rectocele in 24% (n = 11), and rectal intussusception and rectocele in 56% (n = 25). Thirty-six percent of patients had anal sphincter lacerations (n = 16): 12% (n = 2) had only internal laceration, 69% (n = 11) had only external laceration, and 19% (n = 3) had both. Two patients had a thinner internal anal sphincter with 0.9 and 1.2 mm, respectively. In total, 25% of the patients without fecal incontinence had an occult anal sphincter laceration, and all were women with an external sphincter laceration in the anterior quadrant and a previous vaginal delivery. In patients with obstructed defecation and fecal incontinence, 48% had sphincter lacerations. Previous anorectal surgery was a predictor of anal sphincter laceration (odds ratio [OR] 4.8; 95% confidence interval [CI] = 1.214-18.971; P = .025), but fecal incontinence (OR 2.7; 95% CI = 0.774-9.613; P = .119) and previous vaginal delivery (OR 1.250; 95% CI = 0.104-15.011; P = .860) were not. CONCLUSIONS Endoanal ultrasound should be considered in obstructed defecation with or without fecal incontinence, especially if surgical correction is planned.
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Affiliation(s)
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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5
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Abstract
Fecaloma is common in patients with damage to the autonomic nervous system in the large bowel associated with Chagas disease (inflammatory and neoplastic) or Hirschprung's disease, in psychiatric patients and, more commonly, in elderly patients suffering with chronic constipation. Symptoms of fecaloma are usually nonspecific. Clinical examination can give the appearance of an abdominal tumor. Most cases of fecaloma are treated conservatively with digital evacuation and enemas. In severe and unremitting cases, surgery is required to prevent significant complications. Fecaloma should be considered in the differential diagnosis of any patient with history of chronic constipation and abdominal mass. We present the clinical case of an 85-year-old man with a history of chronic constipation presented to the emergency room with vague abdominal pain of 2 days' duration. An erect abdominal X-ray and computed tomography revealed a supergiant faecaloma extending from the pubis up to the diaphragm associated to a megarectum and megacolon. The patient was treated successfully with digital evacuation and enemas.
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Rabah F, Elnour I, Abdalla E, Abdwani R. Fecaloma, a hard nut to crack? Minerva Pediatr 2016; 68:313-314. [PMID: 27277203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Fatma Rabah
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman -
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Zurabishvili K, Rekhviashvili A, Sakhamberidze M, Tsiklauri K. A case of giant fecaloma in a 24-year-old woman. Georgian Med News 2015:11-14. [PMID: 25879551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Chronic constipation is a very common complaint at outpatient clinics. It can progress to fecal impaction, and rarely to fecalomas if not managed promptly. Fecaloma is characterized by a hardened large mass of feces frequently localized in sigmoid colon and rectum and is difficult to discharge. Fecaliths, stagnating and hardening by time, may cause intestinal obstruction,ulcer development and colonic wall perforation. We present the case of a 24-year-old woman who admitted to our hospital with complaints of severe constipation with 1 bowel movement every third-fifth day with passage of hard stools only with using laxatives and meteorism. This is a rare case of fecalomas and megacolon, when conservative measures were absolutely ineffective and surgical treatment was needed. Therefore, diagnosis of fecaloma must be considered in patients presenting with chronic constipation and abdominal mass.Further investigations are mandatory to delineate guidelines for clinical management of megacolon especially in women of childbearing age.
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Affiliation(s)
- K Zurabishvili
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - A Rekhviashvili
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - M Sakhamberidze
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
| | - K Tsiklauri
- Archangel St. Michael Multiprofile Clinical Hospital, Tbilisi, Georgia
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García-Muñoz-Najar A, Carrión-Álvarez L, Medina-García M, García-González MD, Pereira-Pérez F. [Appendicovesical fistula treated with elective laparoscopic surgery]. CIR CIR 2013; 81:344-347. [PMID: 25063901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND appendicovesical fistula is a rare complication of advanced acute appendicitis and represents a rare type of enterovesical fistula. Its symptoms are vague and imprecise and its diagnosis is difficult, requiring a high level of suspicion. Exploratory laparotomy has been the key for diagnosis and definitive treatment for many years, but recently the laparoscopic approach is standing out among different experienced groups as the method of choice. CLINICAL CASE we report a new case of appendicovesical fistula in a 45 year old female, who was remitted from Urology with symptoms of persistent dysuria and pyuria. She was finally diagnosed by computerized tomography and the appendicovesical fistula was resolved by laparoscopic surgery. This case adds to the one hundred and fifteen cases published so far and to the four treated by the laparoscopic approach. DISCUSSION conventional imaging methods are not reliable for the diagnosis of enterovesical fistula. Since most appendicovesical fistula are found to be secondary to non-diagnosed and advanced acute appendicitis in the majority of the consulted publications laparotomy is the key for the diagnosis of apendicovesical fistula. However laparoscopy is described as a diagnostic and therapeutic tool in few articles. We only found three articles in the literature referring to the laparoscopic approach as a therapeutic option. CONCLUSION computerized tomography is the diagnostic method of choice when communication between the digestive tract and urinary tract is suspected, particularly if the suspected fistula is an appendicovesical one. The laparoscopic approach of an appendicovesical fistula is able to confirm the radiological diagnosis and provide a definitive treatment.
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Affiliation(s)
| | - Lucía Carrión-Álvarez
- Servicio de Cirugía General y del Aparato Digestivo. Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Manuel Medina-García
- Servicio de Cirugía General y del Aparato Digestivo. Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Fernando Pereira-Pérez
- Servicio de Cirugía General y del Aparato Digestivo. Hospital Universitario de Fuenlabrada, Madrid, Spain
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9
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Suárez-Moreno R, Ponce-Pérez LV, Vera-Rodríguez F, Margain-Paredes MA, González-Vargas P. [Appendiceal stump appendicitis]. CIR CIR 2012; 80:385-388. [PMID: 23374389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Stump appendicitis is a rare disease characterized by inflammation of the appendiceal remnant. Although normally this is an early complication, it can present up to 50 years after surgery. CLINICAL CASE Male patient of 66 years old with antecedent of laparoscopic appendectomy, presented with abdominal pain, leucocytosis and peritoneal irritation. It was decided he should have surgical management upon finding stump appendicitis, that is, doing stump appendectomy. His evolution was satisfactory. CONCLUSIONS The diagnosis is a challenge for the surgeon, because imaging studies have not proved very helpful for diagnosis. Resection of the cecal appendix by laparoscopic techniques is now more common, providing the possibility of leaving a long stump, perhaps due to technical difficulties. A history of appendectomy may delay diagnosis thus increasing the morbidity and mortality. The resolution of appendiceal stump appendicitis by surgery is performed either by laparoscopic or open resection of the appendiceal remnant.
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10
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Pelletier JF, Higgins GL, Haydar SA. Obstipation unresponsive to usual therapeutic maneuvers. J Fam Pract 2012; 61:353-355. [PMID: 22670240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Julie F Pelletier
- Department of Emergency Medicine, Maine Medical Center, Tufts University School of Medicine, Portland, ME, USA
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11
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Abstract
Rectal seed bezoars are an uncommon cause of fecal impaction, particularly in the United States. Although the literature has reported several cases of phytobezoars composed of various types of seeds, bezoars formed of pumpkin seeds have rarely been reported. We report a case of a man, aged 62 years, with a rectal bezoar composed of pumpkin seeds with complications necessitating extensive treatment, including manual disimpaction and colonoscopy.
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Affiliation(s)
- Janaki R Manne
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Ave, Marshfield, WI 54449, USA.
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12
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Abstract
INTRODUCTION Faecal concretions or faecalomas ('stone of faeces') are symptomatic of many well-recognised colorectal conditions. Faecalomas are usually located in the colon or rectum and associated with disorders of colorectal transit. We describe an unusual case of 'faecaloma in ano' secondary to a chronic fissure in ano. A 67-year-old woman with a 10-year history of chronic constipation and intermittent anal discomfort presented with a painless perianal lump of similar duration. METHODS The patient's case notes were reviewed and a literature search was carried out. RESULTS Examination under anaesthesia, sigmoidoscopy and anoscopy did not reveal any mucosal abnormality or an internal opening or any connection with the perianal lump. The mass was enucleated after incising the skin, leaving behind a cavity completely separate from the anal canal and sphincters. Histology revealed inspissated faecal material with evidence of calcification. CONCLUSIONS Chronic fissures may be complicated by sepsis and, rarely, a 'fissure fistula' may develop. We suspect that this was the underlying pathogenesis of this 'faecaloma in ano'. The term faecaloma in ano befits the clinical picture.
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Affiliation(s)
- O Jalil
- Royal Gwent Hospital, Newport, UK
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13
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Albert NE, Rudolph DS, Mercogliano G, Dougherty R. Megacolon presenting as anemia. J Am Osteopath Assoc 2012; 112:29. [PMID: 22302744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Nicole E Albert
- Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA 19096-3450, USA.
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Watters AN, Tomashefski JF, Malangoni MA. Colonic obstruction resulting from fecalith in patients with scleroderma. Am Surg 2011; 77:364-366. [PMID: 21375856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Amber N Watters
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
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16
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Dzhavadov EA, Kurbanov FS. [Surgical treatment of chronic coprostasis]. Khirurgiia (Mosk) 2011:46-49. [PMID: 21378707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Surgical treatment of 27 patients with chronic colostasis and dolichocolon was analyzed. Groups of patients with cologenic and proctogenic colostasis were defined, diagnostic criteria were formulated and optimal surgical tactics were described for each group. Short and long-term results were analyzed and proved to be excellent and satisfactory in majority of patients.
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Broeders F, Graat L. [A vomiting man with abdominal pain]. Ned Tijdschr Geneeskd 2011; 155:A2089. [PMID: 21466716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 50-year-old man came to the emergency department because of vomiting, nausea and abdominal pain. It appeared his complaints were caused by a phytobezoar.
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Affiliation(s)
- Fieke Broeders
- St. Elisabeth Ziekenhuis, afd. Chirurgie, Tilburg, the Netherlands.
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18
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de Rycker J, Pauli S, Van Cleemput M. Stenosis of a colorectal anastomosis solved by transanal endoscopic microsurgery combined with laparoscopy. Acta Chir Belg 2010; 110:616-617. [PMID: 21337846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The objective of this case report is to present a minimally invasive technique for solving an anastomotic colorectal stenosis using Transanal Endoscopic Microsurgery (T.E.M.) in combination with laparoscopy. SUMMARY Often a re-intervention is indicated for the resolution of an anastomotic (sub-) obstruction. This re-intervention is associated with the morbidity and mortality of a laparotomy and a prolonged hospital stay. In the case here presented, a 68-year-old man underwent a laparoscopic rectosigmoid resection for a rectal adenocarcinoma. An end-to-end circular stapled colorectal anastomosis was performed. At first without any postoperative problems, the patient presented with a stenosis of the anastomosis 6 months postoperatively. This stenosis did not result in a total obstruction but was sufficiently advanced to cause faecal impaction and discomfort, which was confirmed using a retrograde gastrografine bowel study. Colonoscopic dilatations were insufficient and after several days the patient experienced a recurrence of the original stenosis. A minimally invasive re-intervention with T.E.M. was performed in combination with laparoscopy to solve the stenosis. To our knowledge, this technique has not yet been described. CONCLUSION In this paper we describe a possible minimally invasive technique to avoid laparotomy after colorectal or colo-anal anastomotic stenosis. Both the duration of the hospital stay and patient morbidity can be reduced in this way.
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Affiliation(s)
- J de Rycker
- Department of Abdominal Surgery, Monica-Hospital, Campus Middelares, Deurne, Belgium.
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Serventi A, Rassu PC, Giaminardi E, Vitali GC, Brigli G. Fecaloma in an iatrogenic diverticulum: an unusual complication of the procedure for prolapsed hemorrhoids (PPH). Tech Coloproctol 2010; 14:371-2. [PMID: 20725758 DOI: 10.1007/s10151-010-0636-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 07/19/2010] [Indexed: 11/26/2022]
Affiliation(s)
- A Serventi
- General Surgery Department, San Giacomo Hospital, Novi Ligure, AL, Italy.
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20
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Dzhavadov EA, Kurbanov FS, Tkachenko IN. [Surgical treatment of coprostasis in patients with dolichocolon]. Khirurgiia (Mosk) 2010:50-52. [PMID: 20559212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Data of surgical treatment of 17 patients with proctogenic coprostasis and dolichocolon are summarized and analyzed. In spite of the colon stretching, the main reason of coprostasis in all patients was pelvic floor muscles disfunction. Etiologically aimed treatment provided good and satisfactory immediate and long-term results. An importance of scrupulous preoperative diagnostic and active surgical tactics are stressed.
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Altomare DF, Rinaldi M, Sallustio PL, Armenise N. Giant fecaloma in an adult with severe anal stricture caused by anal imperforation treated by proctocolectomy and ileostomy: report of a case. Dis Colon Rectum 2009; 52:534-7. [PMID: 19333059 DOI: 10.1007/dcr.0b013e318199db36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Although fecalomas are relatively common in patients who are elderly, constipated, or who have spinal injuries, a giant fecaloma formation unresponsive to conservative treatment is a rare condition that sometimes requires surgery for complications. Herein we report a case of a long-lasting (46 years) giant fecaloma associated with severe anal stricture after surgery for anal atresia and resulting in severe malnutrition, bone structural changes, and severe impairment of quality of life. Eight months after treatment by total proctocolectomy and ileostomy, the patient was on a free diet and had gained more than 10 percent of his postoperative body weight; improvements were observed in the tone of the abdominal muscles and in his quality of life.
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Affiliation(s)
- Donato F Altomare
- Department of Emergency and Organ Transplantation, General Surgery and Liver Transplantation Units, University of Bari, Bari, Italy.
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Goldstein MA, Herzog DB, Misra M, Sagar P. Case records of the Massachusetts General Hospital. Case 29-2008. A 19-year-old man with weight loss and abdominal pain. N Engl J Med 2008; 359:1272-83. [PMID: 18799562 DOI: 10.1056/nejmcpc0804641] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mark A Goldstein
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, USA
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Abstract
PURPOSE The use of radiation therapy (RT) together with improvement in the surgical treatment of rectal cancer improves survival and reduces the risk for local recurrences. Despite these benefits, the adverse effects of radiation therapy limit its use. The aim of this review was to present a comprehensive overview of published studies on late adverse effects related to the RT for rectal cancer. METHODS Meta-analyses, reviews, randomised clinical trials, cohort studies and case-control studies on late adverse effects, due to pre- or postoperative radiation therapy and chemo-radiotherapy for rectal cancer, were systematically searched. Most information was obtained from the randomised trials, especially those comparing preoperative short-course 5 x 5 Gy radiation therapy with surgery alone. RESULTS The late adverse effects due to RT were bowel obstructions; bowel dysfunction presented as faecal incontinence to gas, loose or solid stools, evacuation problems or urgency; and sexual dysfunction. However, fewer late adverse effects were reported in recent studies, which generally used smaller irradiated volumes and better irradiation techniques; although, one study revealed an increased risk for secondary cancers in irradiated patients. CONCLUSIONS These results stress the importance of careful patient selection for RT for rectal cancer. Improvements in the radiation technique should further be developed and the long-term follow-up of the randomised trials is the most important source of information on late adverse effects and should therefore be continued.
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Affiliation(s)
- Helgi Birgisson
- Department of Surgery, University Hospital, University of Uppsala, Uppsala, Sweden.
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Ono T, Narikiyo T, Nishida E, Yanagida T, Yasunaga C, Hisaoka M, Sakino I, Osamura S, Nakamoto M. A huge fecalith associated with dialysis-related gastrointestinal amyloidosis. Clin Exp Nephrol 2007; 11:184-187. [PMID: 17593521 DOI: 10.1007/s10157-007-0472-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 03/07/2007] [Indexed: 11/30/2022]
Abstract
A 60-year-old man who had been receiving dialysis for more than 30 years was admitted for treatment of cellulitis in his right thigh on November 7, 2003. He suffered from an ileus on December 14 and was found to have a huge, 7-cm-diameter, well-circumscribed fecalith, incarcerated at the splenic flexure of the colon. It was proving difficult to pass this naturally and surgical removal was thought to be too risky. Using a colonoscope and a water-jet probe, the fecalith was broken up; the ileus then improved and the patient was able to take oral fluids. Unfortunately, he died of cardiac failure on February 13, 2004. We conducted an autopsy, with his family's consent, and found generalized amyloidosis. Deposits of amyloid were seen in all layers of the colon. Because of this, we hypothesized that peristalsis had been poor and this had led to paralytic ileus due to stasis, which, in turn, had led to the formation of the huge fecalith. In Japan it is not rare for a patient to be on dialysis for more than 25 years and it may be that this is a cause of generalized amyloidosis. There have been no such cases of fecalith associated with gastrointestinal amyloidosis described previously, which is why we decided to report this case here.
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Affiliation(s)
- Takashi Ono
- Kidney Center, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Chuou-ku, Fukuoka, 810-0001, Japan.
| | | | - Eiichi Nishida
- Kidney Center, Saiseikai Yahata Hospital, Kitakyushu, Japan
| | | | | | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ikuo Sakino
- Department of Radiology, Saiseikai Yahata Hospital, Kitakyushu, Japan
| | - Shunji Osamura
- Digestive Tract Internal Medicine, Saiseikai Yahata Hospital, Kitakyushu, Japan
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Abstract
BACKGROUND Rectal seed bezoars in children seem to present an uncommon problem that necessitates some operative intervention. PURPOSE Our objective is to determine the occurrence and clinical characteristics of rectal seed bezoars in children with fecal impaction. METHODS A retrospective review of hospital records of children with discharge diagnosis of fecal impaction was conducted from 1996 to 2005 in a university-affiliated general hospital RESULTS The study group is composed 59 children. A total of 53 had rectal seed bezoars: watermelon seeds in 43 children, prickly pear seeds in 6, sunflower seeds in 3, and pumpkinseeds in 1. Six children had seedless fecal impaction. All the children with seed bezoars were of Arab origin. Fifty children were treated under general anesthesia. Of the remaining 9 children, 5 underwent digital disimpaction without general anesthesia: 3 with seedless feces and 2 with rectal seed bezoars. Four children with rectal seed bezoars evacuated spontaneously without digital disimpaction. There was summer seasonal preference for watermelon and prickly pear seed bezoars, whereas sunflower seed bezoars occurred in the spring. CONCLUSIONS Fecal impaction owing to rectal seed bezoars is more common than previously believed. Its occurrence among Arab children alone in this study might indicate a high proportion of fecal seed bezoars throughout the Middle East. We propose that the preferred treatment should include disimpaction and irrigation of the rectal content under anesthesia. Greater awareness by primary care practitioners and parents might be beneficial in its prevention in the future.
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Affiliation(s)
- Arie Eitan
- Department of General Surgery, Western Galilee Hospital, Nahariya, Israel
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26
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Diogo-Filho A, Rocha A, De Conti DO, Ferreira KV. [Ulcerations in Chagas' megacolon operated at urgency and electively]. Arq Gastroenterol 2007; 43:280-3. [PMID: 17406755 DOI: 10.1590/s0004-28032006000400007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Accepted: 07/13/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND [corrected] The megacolon is a frequent disease in our emergencie hospital, and approached in the urgency by your complications as fecal impaction, volvulus and perforations. The ulcerations in the megacolons contribute as probable sites of perforations AIM To compare the frequencies of stercoral ulceration in Chagas' megacolon operated at urgency, by volvulus or fecal impaction, and electively, aiming at a better surgical conduct in the urgency surgery METHODS It was analyzed 356 anatomy-pathological exams from colon resection of operated patients due to Chagas' megacolon at urgency (102 cases; 29%) and electively (254 cases; 71%), from 1980 to 2000. The surgical urgency indications were attributed to volvulus (71 cases; 69,6%), fecal impaction (25 cases; 24,5%), perforated acute abdomen after rectal catheter or sigmoidoscopy (6 cases; 5,9%). The ulceration frequency was compared in both groups of resections, using chi-square RESULTS The pathological anatomy - of surgery resection obtained at urgency surgeries, showed 26 cases of ulceration (25,5%) and in electively resections were verified 21 cases of ulceration (8,25%). The difference observed was statistically significant. The comparison among the groups of volvulus; fecal impaction and volvulus with fecal impaction, separately with electively surgery group evidenced significant differences in relation to volvulus and fecal impaction CONCLUSIONS The higher frequency of ulcerations in the megacolon operated at urgency character emphasizes the needs of immediate resection of sigmoid colon, instead of conservative conduct of simple decompression colostomy, even in exploration laparotomy which the macroscopic examination of sigmoid does not show necrotic signs. This way, should prevent the occurrence of perforation in megacolon at mediate postoperative, with serious results.
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Araujo SEA, Dumarco RB, Bocchini SF, Nahas SC, Kiss DR, Cecconello I. Recurrence of chagasic megacolon after surgical treatment: clinical, radiological, and functional evaluation. Clinics (Sao Paulo) 2007; 62:89-92. [PMID: 17334555 DOI: 10.1590/s1807-59322007000100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kim JY, Goetz L. Image of the month--perforated stercoral ulcer. Arch Surg 2007; 142:97. [PMID: 17224509 DOI: 10.1001/archsurg.142.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Jae Y Kim
- Division of Colorectal Surgery, Department of Surgery, University of California at San Francisco, 2330 Post Street, San Francisco, CA 94143, USA.
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29
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Coria-Avila GA, Menard S, Boulard B, Ryan R, Lemme I, Pfaus JG. Fecal bulking in a frequently mated female rat. Colonic obstruction due to severe vaginal distension. Lab Anim (NY) 2006; 35:20-3. [PMID: 17077830 DOI: 10.1038/laban1106-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Genaro A Coria-Avila
- Center for Studies in Behavioral Neurobiology, Department of Psychology, Concordia University, 7141 Sherbrooke West, Montréal, Quebec H4B 1R6, Canada.
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Abstract
PURPOSE Seed bezoars in the rectum have been considered an uncommon cause of fecal impaction in adults. Although there have been several reports on sunflower seed bezoars, seed bezoars from the fruit of the prickly pear cactus and watermelon have received little notice. This study was designed to determine the frequency of fecal impaction by seed bezoars in the rectum and their clinical characteristics in adults. METHODS A retrospective review of the medical records of patients hospitalized with the diagnosis of fecal impaction during a ten-year period. RESULTS During the study period (January 1996 to December 2005), 55 patients were hospitalized at the Western Galilee Hospital, in northern Israel, with the diagnosis of fecal impaction. Phytobezoars were found in 30 patients (55 percent). The seed bezoars were composed of prickly pear seeds in 12 patients, watermelon seeds in 10 patients, sunflower seeds in 4 patients, popcorn kernels in 1 patient, and pomegranate seeds in 1 patient. The Jew:Arab ratio for seed bezoars was 7:23. Seventy-three patients had seedless fecal masses with a Jew:Arab ratio of 58:15. All 30 patients with bezoar underwent digital disimpaction under general anesthesia. Only 21 of 73 patients with seedless fecal masses were treated under general anesthesia. CONCLUSIONS Seed bezoars found in the rectum were the most common cause of fecal impaction requiring hospitalization, probably to the result of the eating habits in the Middle East. The consumption of seeds with shell fragments or fruits containing many seeds (such as the prickly pear) should be accompanied by the awareness that large quantities may cause fecal impaction.
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Affiliation(s)
- Arie Eitan
- Department of Surgery, Western Galilee Hospital, P.O.B. 21, Naharia 22100, Israel
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Abstract
OBJECTIVE Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an 'iceberg syndrome' characterized by 'underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. METHOD One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1-20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel 'iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. RESULTS Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2-20), the median number of 'occult disorders' was 5 (range 2-8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. CONCLUSION The novel 'iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery.
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Affiliation(s)
- M Pescatori
- Coloproctology Units, Villa Flaminia, Rome, Italy.
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Affiliation(s)
- S Mirpour
- Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Shariati hospital, Northern Kargar St. 14114 Tehran, Iran.
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Araki T, Miki C, Yoshiyama S, Toiyama Y, Sakamoto N, Kusunoki M. Total proctocolectomy and ileal J-pouch anal anastomosis for chagasic megacolon with fecaloma: report of a case. Surg Today 2006; 36:277-9. [PMID: 16493541 DOI: 10.1007/s00595-005-3140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 07/12/2005] [Indexed: 10/25/2022]
Abstract
Megacolon, resulting in severe constipation, is one of the most common manifestations of Chagas' disease. We herein report a case of megacolon with fecaloma in a 39-year-old Brazilian man who presented with severe constipation. He underwent a total proctocolectomy and ileal J-pouch anal anastomosis. Histologically, there was a marked thickening of the proper muscle layer, and a moderate decrease in the myoenteric nerve plexuses and neurons in the megacolon area. A feasible outcome has been achieved after a 1-year follow-up. A total proctocolectomy with ileal J-pouch anal anastomosis may therefore be one of the useful strategies for the surgical treatment of patients with chagasic megacolon.
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Affiliation(s)
- Toshimitsu Araki
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan
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34
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Abstract
Pediatric abdominal complaints are common presentations in emergency departments, and emergency physicians are challenged every day with a vast array of gastrointestinal disorders. Differentiating the child with a benign abdominal process from the child with a more serious condition can be difficult. We report a case of massive dilatation of the colon due to fecal impaction. Means for distinguishing constipation from alternative diagnoses are discussed.
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Affiliation(s)
- Muhammad Waseem
- Department of Emergency Medicine, Lincoln Medica and Mental Health Center, Bronx, NY, USA.
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35
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Abstract
Symptoms of fecal impaction extend from constipation, anorexia, nausea, vomiting and abdominal pain, to full blown sepsis. We present the case of a patient with cerebral palsy and mental retardation, who presented to the Emergency Department with a 3-day history of diffuse abdominal pain and fecal incontinence. Evaluation revealed severe fecal impaction. The patient developed systemic inflammatory response syndrome (SIRS), with negative workup for underlying etiology. He responded well to digital disimpaction and antibiotics. Our case illustrates the serious sequelae of fecal impaction, which should be considered in patients with neurologic disorders and SIRS.
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Affiliation(s)
- Ihab I ElHajj
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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36
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Hirst GR, Arumugam PJ, Watkins AJ, Mackey P, Morgan AR, Carr ND, Beynon J. Antegrade continence enema in the treatment of obstructed defaecation with or without faecal incontinence. Tech Coloproctol 2005; 9:217-21. [PMID: 16328126 DOI: 10.1007/s10151-005-0230-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 05/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Obstructed defaecation and faecal incontinence are complex functional disorders that pose management challenges. In recent times, the antegrade continence enema (ACE) has been tried both as a primary procedure and as a final resort to avoid a colostomy in patients with a variety of functional problems. The purpose of this study was to evaluate the role of the ACE procedure as a treatment option for adult patients suffering from obstructed defaecation with or without faecal incontinence, some of whom also had slow transit constipation. METHODS Twenty female patients underwent ACE as an appendicostomy (65%) or caecostomy (35%). The median age was 44 years (range, 20-65 years). The indications were obstructed defaecation with faecal incontinence (65%) and obstructed defaecation alone (35%). Fifteen of these patients were followed for 3-51 months (median, 6 months). Cleveland continence score, bowel score and quality of life score were recorded pre- and postoperatively along with post-procedure complications. RESULTS Thirteen (65%) patients were satisfied with the outcome and recorded improvement in their scores while two (10%) remained the same and one (5%) was worse. This latter woman and another patient stopped using their ACE, whilst follow-up data was unavailable for three patients. Minor wound infections were noted in nine patients (45%), of whom one needed drainage of an abscess; the rest settled with antibiotics and dressings. Bowel and Cleveland continence scores improved postoperatively (p<0.001 and p=0.001, respectively) but SF36 scores did not. To date, no patient has had a colostomy following an ACE procedure. CONCLUSIONS Colostomies can be avoided in patients with obstructed defaecation. There is, however, a need to minimise wound infections which seem to be the most troublesome complication.
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Affiliation(s)
- G R Hirst
- Colorectal Unit, Singleton Hospital, Swansea, UK.
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37
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Raza M, Meesala M, Panjrath G, Ghanbarinia A, Jain D. Abnormal photopenic area on nuclear perfusion imaging. J Nucl Cardiol 2005; 12:607-9. [PMID: 16171722 DOI: 10.1016/j.nuclcard.2005.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2005] [Accepted: 05/19/2005] [Indexed: 11/19/2022]
Affiliation(s)
- Muhammad Raza
- Department of Internal Medicine, Drexel University College of Medicine, 245 N. 15th Street, Philadelphia, PA 19102, USA
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38
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Salom EM, Diaz JP, Lambrou NC, Pearson J, Penalver MA. Sigmoid impaction secondary to urinary stones: case report and review of literature. Gynecol Oncol 2005; 97:234-7. [PMID: 15790465 DOI: 10.1016/j.ygyno.2004.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND This is the first case report of a Miami pouch sigmoid fistula developing passage of urinary stones resulting in the presentation of constipation secondary to impaction. CASE REPORT A 49-year-old woman who developed a recurrence of invasive squamous cell cervical carcinoma 1 year after pelvis radiation. She then underwent anterior pelvic exenteration and creation of a Miami pouch. Approximately 14 years after the primary radiation therapy and 13 years after the creation of the exenterative procedure, the patient developed a Miami pouch sigmoid fistula. The decision was made at this time to repair the fistula and remove the urinary stones from the sigmoid colon. Postoperatively, the patient remained continent using intermittent catheterization of the pouch and there was no evidence of recurrence of the cancer. CONCLUSION Conservative management of urinary reservoir complications should always be considered before surgical intervention is attempted. When indicated, surgical management should not be delayed.
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Affiliation(s)
- Emery M Salom
- Department of Obstetrics and Gynecology, Sylvester Comprehensive Cancer Center, The University of Miami School of Medicine, 11320 NW 46 Lane, Miami FL 33178, USA
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Affiliation(s)
- Yann Loubières
- Centre Hospitalier de Poissy-Saint Germain-en-Laye, 78105 Saint Germain-en-Laye, France
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40
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Abstract
OBJECTIVE To call attention to constipation as a frequent sign of lichen sclerosus (LS) in girls. METHODS A focused questionnaire was sent to parents of 24 girls with anogenital LS seen in the pediatric dermatology clinic at the Children's Hospital of Wisconsin between January 2001 and May 2004. RESULTS Eighteen of 24 questionnaires were completed and returned. The average age of onset of LS was 4.2 years, but average age at diagnosis was 5.2 years; only 1 patient was diagnosed correctly by her primary care physician. Itching was the most common symptom (78%). Severe constipation was reported in 67% of patients, and 89% had at least 1 gastrointestinal complaint (bleeding with bowel movements, fissuring, soiling, fecal impaction, or constipation). CONCLUSIONS Childhood anogenital LS often presents with recalcitrant constipation or some other gastrointestinal complaint. Primary care physicians need to consider the diagnosis of LS and perform a thorough examination by looking for anogenital lesions when a female pediatric patient presents with unexplained constipation or other severe gastrointestinal complaints.
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Affiliation(s)
- Mandi L Maronn
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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41
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Affiliation(s)
- M A Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.
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42
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Abstract
A donkey developed abdominal discomfort and distension together with cardiovascular collapse and gastric reflux 24 to 36 hours after ingesting a large amount of poultry feed. Rectal findings prompted a laparotomy that identified extensive gastric dilation, an empty, atonic small intestine, dry colonic content and an easily corrected caecal displacement. These findings were not consistent with the severity of the signs, which were attributed to endotoxaemia. The donkey was euthanased during recovery. Necropsy revealed acute necrotising pancreatitis with massive gastric dilation and right dorsal colon impaction. The clinicopathological features of acute equine pancreatitis associated with grain overload are discussed.
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Affiliation(s)
- K Kawaguchi
- University of Melbourne, 250 Princes Highway, Werribee, Victoria 3030
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Thomas S. Bowel care is fundamental to nursing. Nurs Times 2004; 100:18. [PMID: 15360070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
Constipation is extremely common and may affect a variety of patients from different age groups. This article outlines the causes of constipation and describes the nurse's role in the management of patients with constipation, from assessment to intervention. The skills required of the nurse, including taking a detailed history from the patient, the subsequent examination, and the administration of laxatives are discussed in detail. Nurses are best placed to assess, plan, implement and evaluate care for patients presenting with constipation. The article stresses the need for healthcare professionals to aim to prevent constipation and to identify early those patients at risk of developing constipation, to ensure that patients' needs are met fully. Recommendations for good practice are given.
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Affiliation(s)
- Ian Peate
- Department of Adult Nursing and Health Care, Faculty of Health and Human Science, University of Hertfordshire, Hatfield, Hertfordshire
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45
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Abstract
OBJECTIVE Recent evidence suggests that autistic children may have significant gastrointestinal symptoms. Although constipation occurs in 2% to 5% of healthy children, its clinical diagnosis is often difficult in children with behavioral disorders. We thus aimed to assess the prevalence of fecal loading in autistic children with gastrointestinal symptoms and to identify possible predictors of constipation. METHODS We studied abdominal radiographs of 103 autistic children (87 boys) who were referred for gastroenterological assessment, in comparison with 29 control radiographs from children who were referred to the emergency department, most with abdominal pain. Radiographs were scored independently, in blinded manner, by 4 pediatric gastroenterologists and a radiologist. The severity of constipation was determined using a validated index. Details of stool habit, abdominal pain, dietary history, and laxative use were obtained from case notes. RESULTS The incidence of constipation in the control subjects with abdominal pain was higher than reported for normal children. Despite this, moderate or severe constipation was more frequent in the autistic group than in the control subjects (36% vs 10%). Analysis of rectosigmoid loading showed more striking differences (54.4% of autistic children had moderate/severe loading or acquired megarectum compared with 24.1% of control subjects). Multivariate regression analysis showed consumption of milk to be the strongest predictor of constipation in the autistic group, whereas stool frequency, gluten consumption, soiling, and abdominal pain were not predictive of constipation. CONCLUSIONS Constipation is a frequent finding in children with gastrointestinal symptoms and autism, particularly in the rectosigmoid colon, often with acquired megarectum. The absence of any correlation between the clinical history and the degree of fecal impaction in autistic children confirms the importance of an abdominal radiograph in the assessment of their degree of constipation.
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Affiliation(s)
- Nadeem Afzal
- Centre for Pediatric Gastroenterology, Royal Free Hospital, Hampstead, London, United Kingdom
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Colapinto MN, Vowinckel EAM, Colapinto ND. Complete Currarino syndrome in an adult, presenting as a fecalith obstruction: report of a case. Can J Surg 2003; 46:303-6. [PMID: 12930112 PMCID: PMC3211629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
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47
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48
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Abstract
BACKGROUND AND AIMS Prickly pear fruit rectal seed bezoars are an extremely rare entity. Only nine cases of rectal seed bezoar have been reported, only one of which involved the prickly pear fruit seed. Furthermore, to our knowledge, this is also the first reported case presenting as rectal perforation. PATIENTS AND METHODS We report a case of prickly pear fruit bezoar occurring in the elderly whom presented with rectal perforation. Consistent with physical signs, laboratory results, and radiological findings the patient was diagnosed with acute perforation of the rectum. A Hartman procedure was performed, and a colostomy was placed. RESULTS Currently there are very few data regarding seed bezoars reaching the rectum. There are even fewer data concerning this occurrence in the elderly, and the literature contains no report of this phenomenon presenting or even progressing into perforation. We report this rare entity to the existing literature. CONCLUSION We report a rare but important case. A prickly pear fruit phytobezoar presenting as rectal perforation. This case may add to the increasing awareness of the danger associated with ingestion of certain foodstuffs. The previously benign sunflower and psyllium seeds are now known to cause bezoar. We feel that the prickly pear fruit should join this small but important list.
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Affiliation(s)
- Jordan M Steinberg
- Department of Surgery, Western Galilee Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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49
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Lewis NA, Levitt MA, Zallen GS, Zafar MS, Iacono KL, Rossman JE, Caty MG, Glick PL. Diagnosing Hirschsprung's disease: increasing the odds of a positive rectal biopsy result. J Pediatr Surg 2003; 38:412-6; discussion 412-6. [PMID: 12632358 DOI: 10.1053/jpsu.2003.50070] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Rectal biopsies are performed as a definitive means of diagnosing Hirschsprung's Disease (HD) in children presenting with constipation. The authors hypothesized that key features in the history, physical examination, and radiographic evaluation would allow us to avoid unnecessary rectal biopsies. METHODS A retrospective analysis was conducted on patients undergoing rectal biopsy between 1995 and 2001. Patients with HD were identified (n = 50), and a concurrent cohort of patients with idiopathic constipation (IC; n = 50) was selected. Pertinent features in patients with HD versus those with IC were cross tabulated using Pearson Chi2 testing (significance was P <.05). RESULTS Sixty percent of patients with HD and 15% of patients with IC experienced onset of symptoms in the first week of life. HD patients more frequently experienced delayed passage of meconium (P <.05), abdominal distension (P <.05), vomiting (P <.05), and transition zone on contrast enema (P <.05). All patients with HD had one or more of these significant features. In contrast, only 64% of patients with IC had one or more of these features. The classic triad of symptoms (ie, delayed passage of meconium, vomiting, and abdominal distension) was present in 18%, and one or more of these symptoms was present in 98% of HD patients. In contrast, only 60% of patients with IC had a history of delayed passage of meconium, vomiting, or abdominal distension. CONCLUSIONS A history of delayed passage of meconium, abdominal distension, vomiting or the results of a contrast enema identified all patients with HD and excluded HD in approximately 36% of patients with idiopathic constipation. The authors have shown that key features in a patient's history, physical examination, and radiologic evaluation can differentiate between HD and IC. In a child presenting with constipation and none of the above features, it is not necessary to perform a rectal biopsy to exclude HD.
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Affiliation(s)
- Nicola A Lewis
- Department of Pediatric Surgical Services, Children's Hospital of Buffalo, and the State University of New York at Buffalo, Buffalo, New York 14222, USA
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50
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Affiliation(s)
- Anthony G Smith
- Department of Surgery, The Mercy Hospital of Pittsburgh, Pennsylvania 15219-4738, USA
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