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Annals of Medicine and Surgery (2012) Mar 2018Gallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone... (Review)
Review
INTRODUCTION
Gallstone sigmoid ileus is a rare although serious complication of cholelithiasis resulting in large bowel obstruction. The condition accounts for 4% of all gallstone ileus patients. There are no recognized management guidelines currently. Management strategies range from minimally invasive endoscopy and lithotripsy to substantial surgery. We aim to identify trends when managing patients with gallstone sigmoid ileus to help improve outcomes.
METHODS
Literature searches of EMBASE, Medline and by hand were conducted. All English language papers published from 2000 to 2017(Oct) were included. The terms 'gallstone', 'sigmoid', 'colon', 'ileus', 'coleus' and 'large bowel obstruction' were used.
RESULTS
38 papers included, male:female ratio was 8:30. Average age was 81.11 (SD ± 7.59). Average length of preceding symptoms was 5.31days (+/-SD3.16). 20/38 (59%) had diverticulosis. 89% of patients had significant comorbidities documented. 34/38 patients underwent computerized tomography. 31 stones were located within sigmoid colon, 4 at rectosigmoid junction and 2 within descending colon. Average impacted gallstone size was 4.14 cm (2.3-7 cm range). 23/38 (61%) patients' initial management was conservative or with endoscopy ± lithotripsy. Conservative management successfully treated 26% of patients. 28/38 (74%) patients ultimately underwent surgical intervention. 5/38 patients died post-operatively. Patients treated non-operatively had shorter hospital stays (4:12.3days) although not significant (p-value = 0.0056).
CONCLUSIONS
There is no management consensus from the literature. Current evidence highlights endoscopy and lithotripsy as practical firstline strategies. However, surgical intervention should not be delayed if non-operative measures fail or in emergency. Given the complexity of such patients, less invasive timesaving surgery appears practical, avoiding bowel resection and associated complications.
PubMed: 29511540
DOI: 10.1016/j.amsu.2018.01.004 -
The Surgeon : Journal of the Royal... Dec 2021The purpose of this systematic review and meta-analysis was to determine the prevalence of the number of sigmoid arteries (SA) and variations in their origins. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The purpose of this systematic review and meta-analysis was to determine the prevalence of the number of sigmoid arteries (SA) and variations in their origins.
METHODS
A thorough systematic search of literature through February 2020 was conducted on major electronic databases to identify eligible studies. Data were extracted and pooled into a meta-analysis using Metafor package in R. The primary outcome was the variations in the SA origin (according to modified Zebrowski classification), and the secondary outcome was the prevalence of the number of SA.
RESULTS
A total of 22 studies (n = 2653 patients) were included. Type 1 modified Zebrowski (separated origins or common trunk of the SA originating from descending recto-sigmoid trunk (DRST)) was the most common origin type of the SA (pooled prevalence estimate (PPE) = 49.67% (95% CI 32. 67- 66.71)), while type 3 (separated origins or common trunk of 1 or 2 SA originating from DRST or superior rectal artery (SRA) and 1 or 2 SA originating from DRST or SRA) was the least common (PPE = 0.18%; 95% CI 0.00-2.82)). Of the Type 1 variants, the not specified (N.S) variant was by far the most prevalent. The number of SA ranged from one to five, with three being the mode (PPE = 42.3%).
CONCLUSION
This is the most comprehensive analysis of arterial vascular anatomy of the sigmoid colon. In light of the highly variable anatomical pattern displayed by the SA, thorough pre-operative knowledge of their anatomy can be crucial in minimizing incidences of iatrogenic injury.
Topics: Arteries; Humans; Rectum
PubMed: 33414045
DOI: 10.1016/j.surge.2020.11.012 -
Neurogastroenterology and Motility Jan 2018Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between studies, possibly due to a combination of methodological variability, population differences and small sample sizes. We performed a meta-analysis of case-control studies that compared immune cell counts in colonic biopsies of IBS patients and controls.
METHODS
PubMed and Embase were searched in February 2017. Results were pooled using standardized mean difference (SMD) and were considered significant when zero was not within the 95% confidence interval (CI). Heterogeneity was assessed based on I statistics where I ≤ 50% and I > 50% indicated fixed and random effect models, respectively.
KEY RESULTS
Twenty-two studies on 706 IBS patients and 401 controls were included. Mast cells were increased in the rectosigmoid (SMD: 0.38 [95% CI: 0.06-0.71]; P = .02) and descending colon (SMD: 1.69 [95% CI: 0.65-2.73]; P = .001) of IBS patients. Increased mast cells were observed in both constipation (IBS-C) and diarrhea predominant IBS (IBS-D). CD3 T cells were increased in the rectosigmoid (SMD: 0.53 [95% CI: 0.21-0.85]; P = .001) and the descending colon of the IBS patients (SMD: 0.79, 95% CI [0.28-1.30]; P = .002). This was possibly in relation to higher CD4 T cells in IBS (SMD: 0.33 [95% CI: 0.01-0.65]; P = .04) as there were no differences in CD8 T cells.
CONCLUSIONS & INFERENCES
Mast cells and CD3 T cells are increased in colonic biopsies of patients with IBS vs non-inflamed controls. These changes are segmental and sometimes IBS-subtype dependent. The diagnostic value of the quantification of colonic mucosal cells in IBS requires further investigation.
Topics: CD3 Complex; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Colon; Humans; Irritable Bowel Syndrome; Mast Cells
PubMed: 28851005
DOI: 10.1111/nmo.13192 -
Updates in Surgery Aug 2023Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone...
Rare complication of gallstone disease is gallstone ileus. The common location is the small intestine, followed by the stomach. The rarest location is colonic gallstone ileus (CGI). To summarize and define the most appropriate diagnostic methods and therapeutic options for CGI based on the paucity of published data. Literature searches of English-, German-, Spanish-, Italian-, Japanese-, Dutch- and Portuguese language articles included and Italian-language articles using PubMed, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Additional studies were identified from the references of retrieved studies. 113 cases of CGI were recorded with a male to female patient ratio of 1:2.9. The average patient age was 77.7 years (range 45-95 years). The usual location of stone impaction was the sigmoid colon (85.8%), followed by a descending colon (6.6%), transverse colon (4.7%), rectum (1.9%), and lastly, ascending colon (0.9%). Gallstones ranged from 2 to 10 cm. The duration of symptoms was variable (1 day to 2 months), with commonly reported abdominal distension, obstipation, and vomiting; 85.2% of patients had previous biliary symptoms. Diverticular disease was present in 81.8% of patients. During the last 23 years, CT scan was the most common imaging method (91.5%), confirming the ectopic gallstone in 86.7% of cases, pneumobilia in 65.3%, and cholecytocolonic fistula in 68%. The treatment option included laparotomy with cololithotomy and primary closure (24.7%), laparotomy and cololithotomy with diverting stoma (14.2%), colonic resection with anastomosis (7.9%), colonic resection with a colostomy (12.4%), laparoscopy with cololithotomy with primary closure (2.6%), laparoscopy with cololithotomy with a colostomy (0.9%), colostomy without gallstone extraction (5.3%), endoscopic mechanical lithotripsy (success rate 41.1%), extracorporeal shock wave lithotripsy (1.8%). The cholecystectomy rate was 46.7%; during the initial procedure 25%, and as a separate procedure, 21.7%; 53.3% of patients had no cholecystectomy. The survival rate was 87%. CGI is the rarest presentation of gallstone ileus, mainly in women over 70 years of age, with gallstones over 2 cm, and predominantly in the sigmoid colon. Abdominal CT is diagnostic. Nonoperative treatment, particularly in subacute presentations, should be the first-line treatment. Laparotomy with cololithotomy or colonic resection is a standard procedure with favorable outcomes. There are no robust data on whether primary or delayed cholecystectomy is mandatory as a part of CGI management.
Topics: Humans; Female; Male; Aged; Aged, 80 and over; Middle Aged; Gallstones; Ileus; Sigmoid Diseases; Intestinal Obstruction; Algorithms
PubMed: 37209317
DOI: 10.1007/s13304-023-01537-0 -
Digestive and Liver Disease : Official... Oct 2017Microscopic colitis (MC) is a clinical syndrome of severe watery diarrhea with few or no endoscopic abnormalities. The incidence of MC is reported similar to that of... (Review)
Review
INTRODUCTION
Microscopic colitis (MC) is a clinical syndrome of severe watery diarrhea with few or no endoscopic abnormalities. The incidence of MC is reported similar to that of other inflammatory bowel diseases. The need for histological confirmation of MC frequently guides reimbursement health policies. With the advent of high-definition (HD) coloscopes, the incidence of reporting distinct endoscopic findings in MC has risen. This has the potential to improve timely diagnosis and cost-effective MC management and diminish the workload and costs of busy modern endoscopy units.
METHODS
Publications on distinct endoscopic findings in MC available until March 31st, 2017 were searched systematically (electronic and manual) in PubMed database. The following search terms/descriptors were used: collagenous colitis (CC) OR lymphocytic colitis (LC) AND endoscopy, colonoscopy, findings, macroscopic, erythema, mucosa, vasculature, scars, lacerations, fractures. An additional search for MC AND perforation was made.
RESULTS
Eighty (n=80) articles, predominantly single case reports (n=49), were found. Overall, 1582 (1159F; 61.6±14.1 years) patients (pts) with MC and endoscopic findings were reported. The majority of articles (n=62) were on CC (pts 756; 77.5% females). We identified 16 papers comprising 779 pts (69.2% females) with LC and 7 articles describing 47 pts (72.3% females) diagnosed as MC. The youngest patient was 10 and the oldest a 97-year-old. Aside diarrhea, symptoms included abdominal pain, weight loss, bloating, flatulence, edema and others. In the study group we found 615 (38.8%) persons with macroscopic lesions in gut. Isolated linear ulcerations were identified in 7 pts (1.1%) while non-ulcerous lesions i.e. pseudomembranes, a variable degree of vasculature pruning & dwindling, mucosal lacerations and abnormalities such as erythema/edema/nodularity, or surface textural alteration in 608 pts (98.1%). The location of endoscopic findings was not reported in 27 articles. The distinct endoscopic findings were described in the left (descending, sigmoid, rectum - 10/21/11 studies), right (cecum, ascending - 7/7 studies), transverse colon (n=12), as well as duodenum (n=4), and terminal ileum (n=2). In 17 (1.1%) pts colonic perforation occurred.
CONCLUSION
Endoscopic findings are recognized with increased frequency in pts with MC. This could improve MC diagnosis by prompting a more extensive biopsy protocol in such cases and an earlier initiation of treatment. Procedure-related perforation has been reported in this group; therefore, cautious air insufflation is advisable when endoscopic findings are recognised.
Topics: Biopsy; Colitis, Microscopic; Colon; Colonoscopy; Humans; Intestinal Perforation
PubMed: 28847471
DOI: 10.1016/j.dld.2017.07.015 -
Translational Cancer Research Jun 2023The effect of cholecystectomy on the development of colorectal cancer (CRC) has prompted a large number of population-based studies. However, the results of these...
BACKGROUND
The effect of cholecystectomy on the development of colorectal cancer (CRC) has prompted a large number of population-based studies. However, the results of these studies are debatable and inconclusive. Our aim in the present study was to conduct an updated systematic review and meta-analysis to explore the causality between cholecystectomy and CRC.
METHODS
Cohort studies published in the PubMed, Web of Science, Embase, Medline, and Cochrane databases up to May 2022 were retrieved. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were analyzed using a random effects model.
RESULTS
Eighteen studies, involving 1,469,880 cholecystectomy and 2,356,238 non-cholecystectomy cases, were eligible for the final analysis. Cholecystectomy was not associated with the development of CRC (P=0.109), colon cancer (P=0.112), or rectal cancer (P=0.184). Subgroup analysis of sex, lag period, geographic region, and study quality revealed no significant differences in the relationship between cholecystectomy and CRC. Interestingly, cholecystectomy was significantly associated with right-sided colon cancer (RR =1.20, 95% CI: 1.04-1.38; P=0.010), especially in the cecum, the ascending colon and/or the hepatic flexure (RR =1.21, 95% CI: 1.05-1.40; P=0.007) but not in the transverse, descending, or sigmoid colon.
CONCLUSIONS
Cholecystectomy has no effect on the risk of CRC overall, but a harmful effect on the risk of right-sided colon cancer proximally.
PubMed: 37434692
DOI: 10.21037/tcr-22-2049 -
Gastrointestinal Endoscopy Sep 2017Twenty years after the first description of the technique, the debate is still open on the role of self-expandable metallic stent (SEMS) placement as a bridge to... (Comparative Study)
Comparative Study Meta-Analysis Review
Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND AND AIMS
Twenty years after the first description of the technique, the debate is still open on the role of self-expandable metallic stent (SEMS) placement as a bridge to elective surgery for symptomatic left-sided malignant colonic obstruction. The aim was to compare morbidity rates after colonic stenting bridge to surgery (SBTS) versus emergency surgery (ES) for left-sided malignant obstruction.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) on SBTS or ES for acute symptomatic malignant left-sided large bowel obstruction. The primary outcome was overall morbidity within 60 days after surgery.
RESULTS
The meta-analysis included 8 RCTs and 497 patients. Overall mortality within 60 days after surgery was 9.6% in SBTS-treated patients and 9.9% in ES-treated patients (relative risk [RR], 0.99; P = .97). Overall morbidity within 60 days after surgery was 33.9% in SBTS-treated patients and 51.2% in ES-treated patients (RR, 0.59; P = .023). The temporary stoma rate was 33.9% after SBTS and 51.4% after ES (RR, 0.67; P < .001). The permanent stoma rate was 22.2% after SBTS and 35.2% after ES (RR, 0.66; P = .003). Primary anastomosis was successful in 70.0% of SBTS-treated patients and 54.1% of ES-treated patients (RR, 1.29; P = .043).
CONCLUSIONS
SBTS was associated with lower short-term overall morbidity and lower rates of temporary and permanent stoma. Depending on multiple factors such as local expertise, clinical status including level of obstruction, and level of certainty of diagnosis, SBTS does offer some advantages with less risk than ES for left-sided malignant colonic obstruction in the short term.
Topics: Colectomy; Colon, Descending; Colonic Neoplasms; Colostomy; Elective Surgical Procedures; Emergencies; Humans; Intestinal Obstruction; Postoperative Complications; Randomized Controlled Trials as Topic; Self Expandable Metallic Stents; Surgical Stomas
PubMed: 28392363
DOI: 10.1016/j.gie.2017.03.1542 -
Danish Medical Journal Feb 2017Surgery is the most important factor for radical treatment of colon cancer, and the long-term prognosis can be improved by improving the surgical treatment without... (Review)
Review
Surgery is the most important factor for radical treatment of colon cancer, and the long-term prognosis can be improved by improving the surgical treatment without increased risk of perioperative mortality. Complete mesocolic excision (CME), in which more extensive lymph node (LN) dissection is performed, has been shown in single-centre studies with historical controls to be associated with better oncological outcome. However, better evidence is needed. The main purpose of this PhD thesis was to investigate whether CME could be implemented in a colorectal surgical department in Denmark, whether more extensive dissection could demonstrate LN metastases outside the mesocolon, and to demonstrate a possible association between CME and improved oncological results without increased risk of perioperative mortality. This thesis includes five articles. Two articles (IV and V) are based on the population of patients undergoing elective resection for colon cancer in the Capital Region from June 2008 to December 2013. Two articles (II and III) are based on data from the local colon database in Hillerød, and the last article (I) is a systematic review concerning the risk of metastases from colon cancer to the central LNs in the mesocolon. Article I found a risk of metastases in central LNs to be reported in 1-22% of the cases of right-sided colon cancers, and in up to 12% of the cases with sigmoid tumours. The populations included and methods used in the studies were very heterogeneous and no definitive conclusions can be drawn. It was shown in article II that the surgical quality, i.e. quality of the specimens assessed by the pathologists, improved with implementation of CME in Hillerød. The vascular tie was higher, and the implementation was not associated with an increased risk of perioperative mortality. Article III demonstrated a risk of LN metastases in the gastrocolic ligament along the stomach for tumours located in the transverse colon, in the ascending or descending colon close to or in the flexures. It occurred in 4% of all patients and 13% of the patients with LN metastases in mesocolon. Resection of these LNs seems advisable for these tumour locations. Article IV showed no association between increased perioperative mortality and CME (n = 529) when compared with non-CME (n = 1,701). The 30-day mortality was 4.2% after CME compared with 3.7% after non-CME (p = 0.605), and the 90-day mortalities were 6.2% and 4.9% (p = 0.219) respectively. Odds ratios for 30-day and 90-day mortalities after CME were respectively 1.07 (95% confidence interval: 0.62-1.80) and 1.25 (0.77-1.94) in the multi-variable logistic regression analyses. Postoperative respiratory failure and need for vasopressors were significantly more frequent in the CME group and, besides CME itself, could be associated with the fewer laparoscopic resections and more severe preoperative comorbidity in the CME Group. Article V demonstrated an association between higher four-year disease-free survival for stage I-III tumours and CME (n = 364) when compared with non-CME (n = 1,031). Most notable was the difference for stage I and II cancers. The four-year disease-free survival for stage I was 100% in the CME group compared with 89.8% (83.1-96.6) in the non-CME group (p = 0.046). For stage II the disease-free survivals were 91.9% (87.2-96.6%) in the CME group and 77.9% (71.6-84.1%) in the non-CME group (p = 0.0033), and for stage III 73.5% (63.6-83.5) and 67.5% (61.8-73.2) (p = 0.13) respectively. In the multivariable Cox regression models, CME was a significant predictive factor for higher dis-ease-free four-year survival for stage I-III patients with hazard ratios (HR) for CME of 0.59 (0.42-0.83, p = 0.0025). For stage II the HR was 0.44 (0.23-0.86, p = 0.018) and for stage III 0.64 (0.42-1.00, p = 0.048).
Topics: Adenocarcinoma; Colon; Colonic Neoplasms; Digestive System Surgical Procedures; Disease-Free Survival; Feasibility Studies; Humans; Lymph Node Excision; Lymphatic Metastasis; Mesocolon; Survival Rate; Treatment Outcome
PubMed: 28157065
DOI: No ID Found -
European Journal of Gastroenterology &... Jul 2022Microscopic colitis (MC) is an inflammatory disease of the colon characterized by persistent watery, nonbloody diarrhea. Subtypes of MC include collagenous and...
Microscopic colitis (MC) is an inflammatory disease of the colon characterized by persistent watery, nonbloody diarrhea. Subtypes of MC include collagenous and lymphocytic MC. Microscopic examination of colon tissue is crucial to confirming the diagnosis because the colonic mucosa often appears normal during flexible sigmoidoscopy or colonoscopy. We aim to determine the optimal sites and minimum number of colon biopsies required to diagnose MC from published studies. We systematically searched PubMed, Web of Science, Scopus, and Cochrane databases from inception until October 2020 using the following keywords: microscopic, lymphocytic, collagenous, colitis, biopsy, and biopsies. We screened the search results for eligibility and extracted data from the included studies. We pooled the numbers of biopsies provided by each study to calculate the mean number of biopsies, SD, and SEM. We included three retrospective cohort studies with 356 patients (148 collagenous, 192 lymphocytic, and 16 mixed), and the total number of biopsies were 1854. The mean number of biopsies that were recommended by the included studies are 4, 4, and 9, respectively. The pooled mean ± SD is 5.67 ± 2.89. The included studies reported that biopsies from the ascending colon (AC) and descending colon (DC) had the highest diagnostic rates. To ensure a high level of certainty in diagnosing MC, a total of six biopsies should be taken from the AC and DC (3 AC and 3 DC). However, special care should be directed toward differentiating MC from other forms of colitis. In addition, detailed and comparative studies are needed to provide stronger recommendations to diagnose MC.
Topics: Biopsy; Colitis, Collagenous; Colitis, Lymphocytic; Colitis, Microscopic; Colon; Colonoscopy; Diarrhea; Humans; Retrospective Studies
PubMed: 35170530
DOI: 10.1097/MEG.0000000000002355 -
Frontiers in Immunology 2022is a thermally dimorphic fungus that affects multiple organs and frequently invades immunocompromised individuals. However, only a few studies have reported the...
is a thermally dimorphic fungus that affects multiple organs and frequently invades immunocompromised individuals. However, only a few studies have reported the presence of intestinal infection associated with . Herein, we reported a case of intestinal infection in a man who complained of a 1-month history of intermittent fever, abdominal pain, and diarrhea. The result of the human immunodeficiency virus antibody test was positive. Periodic acid-Schiff and Gomorrah's methylamine silver staining of the intestinal biopsy tissue revealed infection. Fortunately, the patient's symptoms rapidly resolved with prompt antifungal treatment. In addition, we summarized and described the clinical characteristics, management, and outcomes of patients with intestinal infection. A total of 29 patients were identified, the majority of whom (65.52%) were comorbid with acquired immunodeficiency syndrome. The main clinical features included anemia, fever, abdominal pain, diarrhea, weight loss, and lymphadenopathy. The transverse and descending colon, ileocecum, and ascending colon were the most common sites of lesions. A considerable number of patients (31.03%) developed intestinal obstruction, intestinal perforation, and gastrointestinal bleeding. Of the 29 patients, six underwent surgery, 23 survived successfully with antifungal treatment, five died of infection, and one died of unknown causes. intestinal infection should be considered when immunodeficient patients in endemic areas present with non-specific symptoms, such as fever, abdominal pain, and diarrhea. Appropriate and timely endoscopy avoids delays in diagnosis. Early aggressive antifungal therapy improves the clinical outcomes of patients.
Topics: AIDS-Related Opportunistic Infections; Abdominal Pain; Acquired Immunodeficiency Syndrome; Antifungal Agents; Diarrhea; Fever; Humans; Male; Methylamines; Mycoses; Periodic Acid
PubMed: 36248856
DOI: 10.3389/fimmu.2022.980242