-
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 -
Techniques in Coloproctology Dec 2017Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular... (Review)
Review
BACKGROUND
Complete mesocolic excision for right-sided colon cancer may offer an oncologically superior excision compared to traditional right hemicolectomy through high vascular tie and adherence to embryonic planes during dissection, supported by preoperative scanning to accurately define the tumour lymphovascular supply and drainage. The authors support and recommend precision oncosurgery based on these principles, with an emphasis on the importance of understanding the vascular anatomy. However, the anatomical variability of the right colic artery (RCA) has resulted in significant discord in the literature regarding its precise arrangement.
METHODS
We systematically reviewed the literature on the incidence of the different origins of the RCA in cadaveric studies. An electronic search was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations up to October 2016 using the MESH terms 'right colic artery' and 'anatomy' (PROSPERO registration number CRD42016041578).
RESULTS
Ten studies involving 1073 cadavers were identified as suitable for analysis from 211 articles retrieved. The weighted mean incidence with which the right colic artery arose from other parent vessels was calculated at 36.8% for the superior mesenteric artery, 31.9% for the ileocolic artery, 27.7% for the root of the middle colic artery and 2.5% for the right branch of the middle colic artery. In 1.1% of individuals the RCA shared a trunk with the middle colic and ileocolic arteries. The weighted mean incidence of 2 RCAs was 7.0%, and in 8.9% of cadavers the RCA was absent.
CONCLUSIONS
This anatomical information will add to the technical nuances of precision oncosurgery in right-sided colon resections.
Topics: Arteries; Cadaver; Colon, Ascending; Colon, Transverse; Colonic Neoplasms; Humans
PubMed: 29196959
DOI: 10.1007/s10151-017-1717-6 -
Surgical and Radiologic Anatomy : SRA Apr 2020During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding...
PURPOSE
During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the mesocolic structures of the ascending colon, the hepatic flexure and the right transverse colon.
METHODS
A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed.
RESULTS
This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon.
CONCLUSIONS
Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies.
Topics: Colon; Humans; Mesenteric Artery, Superior
PubMed: 31637473
DOI: 10.1007/s00276-019-02359-9 -
Journal of Laparoendoscopic & Advanced... Apr 2017To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative... (Comparative Study)
Comparative Study Meta-Analysis Review
AIM
To compare intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right colectomy (LRC) in terms of intraoperative and postoperative outcomes.
METHODS
A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on April 9, 2016. The outcomes of interests included intraoperative outcomes (operative time, blood loss, length of incision, conversion, lymph nodes harvested, and intraoperative complications) and postoperative outcomes (time to first flatus, time to first defecation, time to liquid diet, length of hospital stay, postoperative complications, mortality, ileus, anastomotic leakage, anastomotic bleeding, wound infection, hernia, and intra-abdominal abscess).
RESULTS
Fifteen articles and four conference abstracts published between 2004 and 2016 with a total of 1957 patients were enrolled in this meta-analysis. IA was associated with significant less blood loss, smaller length of incision, shorter time to first defecation, shorter time to liquid diet, and shorter length of hospital stay. No differences were found for operative time, conversion, lymph nodes harvested, intraoperative complications, time to first flatus, postoperative complications, mortality, anastomotic leakage, anastomotic bleeding, ileus, wound infection, intra-abdominal abscess, or hernia between IA and EA.
CONCLUSION
Our meta-analysis suggests that the IA for LRC improves cosmesis and results in better postoperative recovery outcomes without increasing intraoperative and postoperative complications. Furthermore, a large randomized control study is warranted to compare the short-term and long-term outcomes of those two anastomosis techniques.
Topics: Abdominal Abscess; Anastomosis, Surgical; Anastomotic Leak; Colectomy; Colon, Ascending; Humans; Ileus; Intraoperative Complications; Laparoscopy; Length of Stay; Lymph Node Excision; Lymph Nodes; Operative Time; Postoperative Complications; Postoperative Hemorrhage; Postoperative Period; Surgical Wound Infection; Treatment Outcome
PubMed: 27768552
DOI: 10.1089/lap.2016.0485 -
Pediatric Surgery International Nov 2010Hirschsprung's disease is characterised by the congenital absence of ganglion cells beginning in the distal rectum and extending proximally for varying distances. 'Zonal... (Review)
Review
PURPOSE
Hirschsprung's disease is characterised by the congenital absence of ganglion cells beginning in the distal rectum and extending proximally for varying distances. 'Zonal aganglionosis' is a phenomenon involving a zone of aganglionosis occurring within normally innervated intestine. 'Skip segment' Hirschsprung's disease (SSHD) involves a 'skip area' of normally ganglionated intestine, surrounded proximally and distally by aganglionosis. While Hirschsprung's disease is believed to be the result of incomplete craniocaudal migration of neural crest-derived cells, the occurrence of SSHD has no clear embryological explanation. The aim of this study was to perform a systematic review of SSHD, reported in the literature between 1954 and 2009, in order to determine the clinical characteristics of this rare entity and its significance.
METHODS
The first reported case of SSHD was published in 1954. A systematic review of SSHD cases in the literature, from 1954 to 2009, was carried out using the electronic database 'Pubmed'. Detailed information was recorded regarding the age, gender, presenting symptoms and location of the skip segment in each patient.
RESULTS
24 cases of SSHD have been reported in the literature to date. 18/24 (75%) of these cases were males and 6/24 (25%) were females. Of these, 22/24 (92%) were cases of total colonic aganglionosis (TCA), and 2/24 (8%) were rectosigmoid Hirschsprung's disease. Of the 22 TCA cases, 9 (41%) had a skip segment in the transverse colon, 6 (27%) in the ascending colon, 2 (9%) in the caecum and 5 (23%) had multiple skip segments. In both rectosigmoid Hirschsprung's disease cases, the skip segment was in the sigmoid colon. Overall, the length of the skip segment was variable, with the entire transverse colon ganglionated in some cases.
CONCLUSION
SSHD occurs predominantly in patients with TCA. The existence of a skip area of normally innervated colon in TCA may influence surgical management, enabling surgeons to preserve and use the ganglionated skip area during pull-through operations.
Topics: Colon; Enteric Nervous System; Female; Hirschsprung Disease; Humans; Male
PubMed: 20714729
DOI: 10.1007/s00383-010-2692-4 -
International Journal of Colorectal... Oct 2017Delayed post-polypectomy bleeding (PPB) is an infrequent but serious adverse event after colonoscopic polypectomy. Several studies have tried to identify risk factors... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Delayed post-polypectomy bleeding (PPB) is an infrequent but serious adverse event after colonoscopic polypectomy. Several studies have tried to identify risk factors for delayed PPB, with inconsistent results. This meta-analysis aims to identify significant risk factors for delayed PPB.
METHODS
MEDLINE and EMBASE databases were searched through January 2016 for studies that investigated the risk factors for delayed PPB. Pooled odds ratio (OR) for categorical variables and mean differences (MD) for continuous variables and 95% confidence interval (CI) were calculated using a random-effect model, generic inverse variance method. The between-study heterogeneity of effect size was quantified using the Q statistic and I .
RESULTS
Twelve articles involving 14,313 patients were included. The pooled delayed PPB rate was 1.5% (95%CI, 0.7-3.4%), I = 96%. Cardiovascular disease (OR = 1.55), hypertension (OR = 1.53), polyp size > 10 mm (OR = 3.41), and polyps located in the right colon (OR = 1.60) were identified as significant risk factors for delayed PPB, whereas age, sex, alcohol use, smoking, diabetes, cerebrovascular disease, pedunculated morphology, and carcinoma histology were not.
CONCLUSIONS
Cardiovascular disease, hypertension, polyp size, and polyp location were associated with delayed PPB. More caution is needed when removing polyps in patients with these risk factors. Future studies are warranted to determine appropriate preventive hemostatic measures in these patients.
Topics: Cardiovascular Diseases; Cecum; Colon, Ascending; Colonic Polyps; Humans; Postoperative Hemorrhage; Risk Factors; Time Factors
PubMed: 28779355
DOI: 10.1007/s00384-017-2870-0 -
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 -
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 -
Medicina (Kaunas, Lithuania) Nov 2020Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied...
Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied clinical presentations. The current literature focuses on case reports which describe the embryological etiology and anatomical spectrum of the condition giving little attention to the surgical preparation, the need for a well-structured follow-up program, or the transition into adult healthcare of these complex patients. No reviews have been published regarding this complex pathology. : A review of caudal duplication syndrome cases was done to assess the range of the clinical malformations, timing, and types of surgical interventions. Inconsistencies in multidisciplinary care, follow-up, and risk events were described. Hindgut duplication always involved the anorectal region. Anorectal malformations were evenly distributed as unilateral and bilateral. Colon duplication extended from the anal region to the transverse colon or ascending colon in most of the cases and less to terminal. In females, genital duplication was present in all cases. The follow-up period varied between 3 months and 12 years. In all adult females, the motive of presentation was related to pregnancy (complications after successful delivery, fertility evaluation) or late complications (fecalith obstruction of the end-to-side colon anastomosis, repeated UTIs with renal scarring). : Complex malformations affecting multiple caudal organs may have a strong impact in many aspects of the long-term quality of life; therefore, patients with caudal duplication syndrome need increased awareness and joined multidisciplinary treatment.
Topics: Adult; Anorectal Malformations; Colon; Female; Follow-Up Studies; Humans; Quality of Life; Rectum
PubMed: 33260808
DOI: 10.3390/medicina56120650 -
Journal of Clinical Gastroenterology Sep 2014By systematic review, we assessed the impact of fecal microbiota transplantation (FMT) for the treatment of Clostridium difficile (CD)-associated diarrhea. (Review)
Review
GOAL
By systematic review, we assessed the impact of fecal microbiota transplantation (FMT) for the treatment of Clostridium difficile (CD)-associated diarrhea.
BACKGROUND
Fecal microbiota microbiota transplantation from a healthy donor into an individual with CD infection (CDI) can resolve symptoms.
STUDY
We conducted systematic searches in PubMed, SCOPUS, Web of Science, and Cochrane Library. The last search was run on February 8, 2013. The following Medical Subject Headings terms and keywords were used alone or in combination: Clostridium difficile; Clostridium infection; pseudomembranous colitis; feces; stools; fecal suspension; fecal transplantation; fecal transfer; fecal infusion; microbiota; bacteriotherapy; enema; nasogastric tube; colonoscopy; gastroscopy; fecal donation; donor. A critical appraisal of the clinical research evidence on the effectiveness and safety of FMT for the treatment of patients with CD-associated diarrhea was made.
RESULTS
Twenty full-text case series, 15 case reports, and 1 randomized controlled study were included for the final analysis. Almost all patients treated with donors' fecal infusion experienced recurrent episodes of CD-associated diarrhea despite standard antibiotic treatment. Of a total of 536 patients treated, 467 (87%) experienced resolution of diarrhea. Diarrhea resolution rates varied according to the site of infusion: 81% in the stomach; 86% in the duodenum/jejunum; 93% in the cecum/ascending colon; and 84% in the distal colon. No severe adverse events were reported with the procedure.
CONCLUSIONS
FMT seems efficacious and safe for the treatment of recurrent CDI. Hospitals should encourage the development of fecal transplantation programs to improve therapy of local patients.
Topics: Anti-Bacterial Agents; Clostridioides difficile; Clostridium Infections; Diarrhea; Feces; Humans; Microbiota; Recurrence; Treatment Outcome
PubMed: 24440934
DOI: 10.1097/MCG.0000000000000046