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Cureus Oct 2023Diverticulitis is a very common cause of hospitalization in the United States with fistula formation being a common complication. However, a fistula formation between...
Diverticulitis is a very common cause of hospitalization in the United States with fistula formation being a common complication. However, a fistula formation between the sigmoid colon and an ovary is an exceptional rarity. We present a case of a 22-year-old female with a colo-ovarian fistula misdiagnosed as a tubo-ovarian abscess after a recent episode of diverticulitis. Initial workup, imaging studies, and treatment ending with Hartmann's procedure with eventual colostomy reversal are described. A review of similar cases within the literature and fistulas is also presented.
PubMed: 37965414
DOI: 10.7759/cureus.47017 -
Journal of Surgical Case Reports Aug 2023Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with...
Although Meckel's diverticulum is the most common congenital anomaly of the small bowel (2% prevalence worldwide), it rarely causes symptoms, with only 4% of those with the anomaly developing any complications, including Meckel's diverticulitis. In contrast to this, appendicitis is the most common general surgical emergency, with a lifetime incidence of 6.7-8.6%. Therefore, the case of a man presenting with right-sided abdominal pain to an Emergency Department with both Meckel's diverticulitis and appendicitis is rare. This case study illustrates the importance of careful assessment of the entire abdomen when operating on patients with right-sided abdominal pain, so as not to miss Meckel's diverticulitis even when appendicitis has already been found.
PubMed: 37593191
DOI: 10.1093/jscr/rjad465 -
Cureus Dec 2023Background Natural orifice specimen extraction (NOSE) involves the removal of specimens through a naturally occurring orifice, such as the anus, rather than...
Background Natural orifice specimen extraction (NOSE) involves the removal of specimens through a naturally occurring orifice, such as the anus, rather than trans-abdominal extraction. NOSE procedures have been shown to significantly reduce postoperative complications and improve healing. Objective The purpose of this case series is to report the outcomes of 27 patients undergoing sigmoidectomies through natural orifice specimen extraction. Materials and methods We carefully recorded demographic data on age and BMI, as well as operative data on surgical indication, and length of stay. We also collected data on postoperative complications, including infection, hernia, wound dehiscence, urinary tract infections (UTIs), or anastomotic leaks. Results Our patients were majority female ( = 21, 77.8%) with a median age of 53.5 (range: 25-79) and median BMI of 33.2 kg/m (range: 16.7 - 48.3 kg/m). Thirteen patients (48.1%) were obese (BMI > 30.0 kg/m). The majority of these patients underwent sigmoidectomies for benign conditions such as recurrent diverticulitis ( = 9, 33.3%), rectal prolapse ( = 8, 29.6%), perforated diverticulitis ( = 3, 11.1%), colovesical fistula ( = 3, 11.1%), and abdominal abscess ( = 3, 11.1%) (Table 1). One patient was receiving treatment for sigmoid cancer. The average estimated blood loss was 63.26 mL. The average hospital stay was 3.61 days. Three patients (11.1%) developed a fever postoperatively (temperature >= 100.4 F), which resolved the day after. One patient completed a post-operative hospital stay of 19 days for dialysis and rehab placement. No patients (0.0%) experienced any postoperative complications, including wound infection, hernia, dehiscence, UTIs, or anastomotic leakages. There was no postoperative mortality. Conclusions Our study demonstrates the practicality and safety of NOSE procedures for sigmoidectomies as an alternative to transabdominal approaches to treat benign colon diseases.
PubMed: 38174165
DOI: 10.7759/cureus.49902 -
Cureus Aug 2023Diverticulitis is a common colorectal disease present in Western countries that develops as infected protrusions (diverticula) along weak points in the colon due to...
Diverticulitis is a common colorectal disease present in Western countries that develops as infected protrusions (diverticula) along weak points in the colon due to increased intraluminal pressure. Most patients with diverticular disease can be asymptomatic; however, several complications can arise from the development of diverticulitis. Here, we discuss the diagnosis and management of a patient presenting with recurrent () vaginal infections due to sigmoid colon diverticulitis resulting in a colo-fallopian fistula that was unremarkable on diagnostic imaging. The patient was managed with minimally invasive surgery. A 65-year-old female with a medical history of hyperlipidemia and recurrent diverticulitis presented with over a year history of recurrent vaginal infections. She underwent a robotic anterior resection with extracorporeal colorectal anastomosis via a Pfannenstiel incision. Less than 48 hours following the surgery, she was discharged without complications and has remained symptom-free nine months postoperatively. Significant improvement was noted following the procedure. The patient was able to advance her diet and was discharged the next day. The patient was seen postoperatively, with no evidence of any recurrent vaginal infections. The case highlights the diagnosis and management of a rare case of colo-fallopian fistula in a situation where the patient had recurrent vaginal infections. It is quite difficult to identify the fistula radiologically. This patient was managed with a minimally invasive surgical technique that proved to be safe and beneficial to the outcome of this patient.
PubMed: 37700951
DOI: 10.7759/cureus.43331 -
Langenbeck's Archives of Surgery Jul 2023The literature reports a varying occurrence (3-33%) of blowout of the rectal remnant after Hartmann's procedure, and there is a lack of multivariate analyses on...
PURPOSE
The literature reports a varying occurrence (3-33%) of blowout of the rectal remnant after Hartmann's procedure, and there is a lack of multivariate analyses on potential risk factors for blowout following Hartmann's procedure. We aimed to estimate the incidence of blowout within 90 days after a primary Hartmann's procedure and to identify potential risk factors for blowout through multivariate analysis.
METHODS
A retrospective cohort study was conducted at the Department of Surgery, Aarhus University Hospital, a Danish primary and tertiary hospital. Patients who underwent primary surgery with Hartmann's procedure irrespective of surgical setting and indications between September 2016 and August 2021 were included. Blowout was defined as a defective closure line of the rectal stump or a pelvic abscess.
RESULTS
A total of 178 patients were included, and blowout occurred in 30 patients (16.9%) within 90 days after a primary Hartmann's procedure. Multivariate analysis showed increased risk of blowout among patients with Hinchey IV diverticulitis (relative risk 6.32 (95% CI 4.09-9.75)), previous radiotherapy (relative risk 3.35 (95% CI 1.67-6.74)), and alcohol overconsumption (relative risk 1.69 (95% CI 1.05-2.72)). Intraoperative insertion of a Foley catheter in the rectal remnant significantly reduced the risk of blowout within 90 days after a primary Hartmann's procedure (relative risk 0.18 (95% CI 0.05-0.65)).
CONCLUSION
Blowout remains a severe and common complication within 90 days after a primary Hartmann's procedure. Hinchey IV diverticulitis, pelvic radiotherapy, and alcohol overconsumption are risk factors. An intraoperatively inserted rectal Foley catheter is a protective factor and can be considered used in all patients undergoing Hartmann's procedure.
Topics: Humans; Incidence; Retrospective Studies; Rectum; Diverticulitis; Colostomy; Risk Factors; Anastomosis, Surgical; Postoperative Complications; Treatment Outcome
PubMed: 37442862
DOI: 10.1007/s00423-023-02967-5 -
Cureus Dec 2023Ventral hernia and acute diverticulitis may present with similar symptoms posing difficulty in clinical diagnosis. Rarely, complicated sigmoid diverticulitis is found...
Ventral hernia and acute diverticulitis may present with similar symptoms posing difficulty in clinical diagnosis. Rarely, complicated sigmoid diverticulitis is found within an irreducible ventral hernia sac in the emergency setting. Intraoperative decision on the appropriate surgical option depends on the surgeon's experience and the patient's clinical state. We present a case of a middle-aged female who came in with infraumbilical hernia containing necrotic sigmoid diverticulitis. Her surgical history was cesarean section and total abdominal hysterectomy with a re-look laparotomy. She had an emergency exploration of the hernia through a midline incision, excision of the necrotic diverticulum, and the formation of loop colostomy at the site of the hernia. Post-operative recovery was uneventful and she has been scheduled for an elective sigmoid colectomy and reversal of the stoma. This study highlights that complicated sigmoid diverticulitis can rarely present as an irreducible ventral hernia and that less is often more in safely getting patients out of trouble in an emergency.
PubMed: 38249178
DOI: 10.7759/cureus.50875 -
Journal of Medical Case Reports Apr 2024Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and...
BACKGROUND
Gas extravasation complications arising from perforated diverticulitis are common but manifestations such as pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum happening at the same time are exceedingly rare. This case report explores the unique presentation of these 3 complications occurring simultaneously, their diagnosis and their management, emphasizing the importance of interdisciplinary collaboration for accurate diagnosis and effective management.
CASE PRESENTATION
A 74-year-old North African female, with a medical history including hypertension, dyslipidemia, type 2 diabetes, goiter, prior cholecystectomy, and bilateral total knee replacement, presented with sudden-onset pelvic pain, chronic constipation, and rectal bleeding. Clinical examination revealed hemodynamic instability, hypoxemia, and diffuse tenderness. After appropriate fluid resuscitation with norepinephrine and saline serum, the patient was stable enough to undergo computed tomography scan. Emergency computed tomography scan confirmed perforated diverticulitis at the rectosigmoid junction, accompanied by the unprecedented presence of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum. The patient underwent prompt surgical intervention with colo-rectal resection and a Hartmann colostomy. The postoperative course was favorable, leading to discharge one week after admission.
CONCLUSIONS
This case report highlights the clinical novelty of gas extravasation complications in perforated diverticulitis. The unique triad of pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum in a 74-year-old female underscores the diagnostic challenges and the importance of advanced imaging techniques. The successful collaboration between radiologists and surgeons facilitated a timely and accurate diagnosis, enabling a minimally invasive surgical approach. This case contributes to the understanding of atypical presentations of diverticulitis and emphasizes the significance of interdisciplinary teamwork in managing such rare manifestations.
Topics: Humans; Female; Aged; Retropneumoperitoneum; Mediastinal Emphysema; Pneumoperitoneum; Diabetes Mellitus, Type 2; Peritonitis; Diverticulitis; Intestinal Perforation
PubMed: 38627832
DOI: 10.1186/s13256-024-04488-1 -
World Journal of Emergency Surgery :... Jun 2024Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position... (Observational Study)
Observational Study
The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery.
BACKGROUND
Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety.
METHODS
The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres.
DISCUSSION
Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs.
Topics: Humans; Robotic Surgical Procedures; Prospective Studies; Emergencies; Observational Studies as Topic; Cholecystitis; Diverticulitis
PubMed: 38835071
DOI: 10.1186/s13017-024-00542-x -
Cureus Apr 2024Ovarian carcinosarcoma, also known as malignant mixed müllerian tumor, is a rare and highly aggressive form of ovarian cancer. This report discusses a case where...
Ovarian carcinosarcoma, also known as malignant mixed müllerian tumor, is a rare and highly aggressive form of ovarian cancer. This report discusses a case where initial misdiagnosis underscored the complexity of diagnosing this condition. The findings highlight the critical nature of considering ovarian malignancies in the differential diagnosis for postmenopausal women presenting with abdominal pain and altered bowel habits. The significance of utilizing advanced imaging techniques and tumor markers in the early detection of ovarian carcinosarcoma is emphasized, demonstrating how such strategies can substantially affect patient management and outcomes. This case also illustrates the effectiveness of a multidisciplinary approach in treating this challenging malignancy, contributing to our understanding and management of ovarian carcinosarcoma.
PubMed: 38738152
DOI: 10.7759/cureus.57948 -
The American Surgeon Apr 2024ChatGPT has substantial potential to revolutionize medical education. We aim to assess how medical students and laypeople evaluate information produced by ChatGPT...
BACKGROUND
ChatGPT has substantial potential to revolutionize medical education. We aim to assess how medical students and laypeople evaluate information produced by ChatGPT compared to an evidence-based resource on the diagnosis and management of 5 common surgical conditions.
METHODS
A 60-question anonymous online survey was distributed to third- and fourth-year U.S. medical students and laypeople to evaluate articles produced by ChatGPT and an evidence-based source on clarity, relevance, reliability, validity, organization, and comprehensiveness. Participants received 2 blinded articles, 1 from each source, for each surgical condition. Paired-sample t-tests were used to compare ratings between the 2 sources.
RESULTS
Of 56 survey participants, 50.9% (n = 28) were U.S. medical students and 49.1% (n = 27) were from the general population. Medical students reported that ChatGPT articles displayed significantly more clarity (appendicitis: 4.39 vs 3.89, = .020; diverticulitis: 4.54 vs 3.68, < .001; SBO 4.43 vs 3.79, = .003; GI bleed: 4.36 vs 3.93, = .020) and better organization (diverticulitis: 4.36 vs 3.68, = .021; SBO: 4.39 vs 3.82, = .033) than the evidence-based source. However, for all 5 conditions, medical students found evidence-based passages to be more comprehensive than ChatGPT articles (cholecystitis: 4.04 vs 3.36, = .009; appendicitis: 4.07 vs 3.36, = .015; diverticulitis: 4.07 vs 3.36, = .015; small bowel obstruction: 4.11 vs 3.54, = .030; upper GI bleed: 4.11 vs 3.29, = .003).
CONCLUSION
Medical students perceived ChatGPT articles to be clearer and better organized than evidence-based sources on the pathogenesis, diagnosis, and management of 5 common surgical pathologies. However, evidence-based articles were rated as significantly more comprehensive.
Topics: Humans; Appendicitis; Reproducibility of Results; Cholecystitis; Diverticulitis; Education, Medical
PubMed: 37309705
DOI: 10.1177/00031348231180950