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Pediatric Nephrology (Berlin, Germany) Jun 2024The gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to... (Observational Study)
Observational Study
BACKGROUND
The gastrointestinal (GI) tract represents one of the main targets of typical hemolytic uremic syndrome (HUS) in children. In this observational study, we tried to establish (1) the main features of GI complications during STEC-HUS and (2) the relationship between Escherichia coli serotypes and Shiga toxin (Stx) variants with hepatopancreatic involvement.
METHODS
A total of 79 STEC-HUS patients were admitted to our pediatric nephrology department between January 2012 and June 2021. Evidence of intestinal, hepatobiliary, and pancreatic involvements was reported for each patient, alongside demographic, clinical, and laboratory features. Frequency of gastrointestinal complications across groups of patients infected by specific E. coli serotypes and Stx gene variants was evaluated.
RESULTS
Six patients developed a bowel complication: two developed rectal prolapse, and four developed bowel perforation which resulted in death for three of them and in bowel stenosis in one patient. Acute pancreatitis was diagnosed in 13 patients. An isolated increase in pancreatic enzymes and/or liver transaminases was observed in 41 and 15 patients, respectively. Biliary sludge was detected in three, cholelithiasis in one. Forty-seven patients developed direct hyperbilirubinemia. Neither E. coli serotypes nor Shiga toxin variants correlated with hepatic or pancreatic involvement.
CONCLUSIONS
During STEC-HUS, GI complications are common, ranging from self-limited elevation of laboratory markers to bowel perforation, a severe complication with a relevant impact on morbidity and mortality. Hepatopancreatic involvement is frequent, but usually short-lasting and self-limiting.
Topics: Child; Humans; Escherichia coli Infections; Acute Disease; Intestinal Perforation; Pancreatitis; Hemolytic-Uremic Syndrome; Shiga Toxin; Shiga-Toxigenic Escherichia coli
PubMed: 38189960
DOI: 10.1007/s00467-023-06258-5 -
Cureus Dec 2023Colorectal polyps, frequently adenomas, are common in older adults, with villous adenomas being a notable subset due to their potential for significant malignancy risk....
Colorectal polyps, frequently adenomas, are common in older adults, with villous adenomas being a notable subset due to their potential for significant malignancy risk. This case report highlights a rare instance of a giant villous adenoma in a 79-year-old female patient, challenging in both diagnosis and treatment. The patient, with a history of untreated essential arterial hypertension, was hospitalized for severe anemia following a massive rectal hemorrhage. An irreducible, prolapsed rectal mass was evident upon examination, and further investigations, including rectoscopy and abdominopelvic computed tomography scan, confirmed a villous adenoma with severe dysplasia. Given the tumor's substantial size, circumferential nature, and proximity to the dentate line, an abdominoperineal resection using the Miles technique was performed. The histopathological examination post-surgery confirmed the presence of a villous adenoma with high-grade epithelial neoplasia and localized areas of well-differentiated tubular adenocarcinoma. This case underscores the diagnostic and management complexities of large villous adenomas, emphasizing the need for meticulous surgical decision-making to ensure oncological safety and patient welfare, particularly when conservative resection may be inadequate.
PubMed: 38186509
DOI: 10.7759/cureus.50079 -
International Journal of Surgery Case... Feb 2024Transanal small bowel evisceration remains a rarely recorded emergent situation in the scientific literature. This article describes the rather seldom complication of a...
INTRODUCTION
Transanal small bowel evisceration remains a rarely recorded emergent situation in the scientific literature. This article describes the rather seldom complication of a non-treated long standing rectal prolapse presenting in the form of transanal prolapse of the small bowel due to rectal perforation.
PRESENTATION OF CASE
We present the case of an 84 year old female, who presented to our emergency department with transanal evisceration of the small bowel.
DISCUSSION
This rare case presentation led us to perform an accompanying review of the literature, using Pubmed® searching for the words "transanal evisceration", "rectal prolapse", and "rectal perforation". We discuss the outcomes of our literature review, possible pathogenesis and the available treatment options.
CONCLUSION
Although transanal evisceration of small bowel presents a rare emergency, having the knowledge of this condition would help early recognition of this incidence and hopefully lead to early treatment, which would avoid drastic consequences as a result of small bowel strangulation.
PubMed: 38181656
DOI: 10.1016/j.ijscr.2023.109198 -
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 -
International Journal of Surgery Case... Jan 2024Strangled rectal prolapse (RP), also known as incarcerated rectal prolapse, is a condition where the RP cannot be manually reduced.
INTRODUCTION AND IMPORTANCE
Strangled rectal prolapse (RP), also known as incarcerated rectal prolapse, is a condition where the RP cannot be manually reduced.
CASE PRESENTATION
This case report describes a 48-year-old man presenting with a painful and irreducible rectal prolapse. Following failed attempts at manual reduction and the development of necrosis, emergency surgery was performed using the Altemeier procedure. This surgical technique involves resection of the rectum and colon, followed by colo-anal anastomosis and a protective ileostomy.
CLINICAL DISCUSSION
The discussion highlights the rarity of RP in young adults and the associated risk factors. It emphasizes the importance of timely intervention in irreducible cases to prevent complications such as strangulation, ulceration, infection, and pain. Various surgical options exist, but in cases of strangulation requiring emergency surgery, the Altemeier procedure is the preferred approach due to its effectiveness and low morbidity. The decision to perform laparoscopic surgery depends on patient factors and surgeon expertise.
CONCLUSION
This case illustrates the successful management of a challenging and uncommon presentation of rectal prolapse, highlighting the value of surgical intervention in cases of strangulation.
PubMed: 38171272
DOI: 10.1016/j.ijscr.2023.109216 -
Asian Journal of Surgery Mar 2024
Topics: Humans; Hemorrhoids; Prolapse; Postoperative Complications; Rectum; Cysts; Surgical Stapling
PubMed: 38143167
DOI: 10.1016/j.asjsur.2023.12.047 -
Innovative Surgical Sciences Jun 2023Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal...
OBJECTIVES
Rectal prolapse is defined as prolapse of all layers of rectal wallout of the anal sphincter. The aim was to (i) describe the extremely rare combination of a rectal prolapse with colon cancer in an older female patient, (ii) comment on management-specific aspects and (iii) derive some generalizing recommendations by means of a scientific case report and based on the case-specific experiences related to the clinical management and current references from the medical literature.
CASE PRESENTATION
A 69-year old female patient with cancer of the sigmoid colon at a manifest rectal prolapse was diagnosed. Literature search (using the data bank of "PubMed") resulted in only six patients (the majority of them were females) with the coincidence of rectal prolapse and rectal or colon cancer have been reported so far.
CONCLUSIONS
A patient with a manifest rectal prolapse needs always to undergo colonoscopy and - in case of an ulcer - histological investigation of representative biopsies.
PubMed: 38058771
DOI: 10.1515/iss-2023-0014 -
JPGN Reports Nov 2023
PubMed: 38034467
DOI: 10.1097/PG9.0000000000000380 -
JPGN Reports Nov 2023Lynch syndrome (LS) is the most common cause of inherited colorectal cancer and the increases risk of developing extracolonic cancers. We present the first case of...
Lynch syndrome (LS) is the most common cause of inherited colorectal cancer and the increases risk of developing extracolonic cancers. We present the first case of pediatric-onset LS with recurrent adenomatous colonic polyps presenting with rectal prolapse. This case highlights the importance of considering polyposis syndromes such as LS as possible diagnoses for pediatric patients who present with colorectal adenomatous polyps, as well as the need to consider immunohistochemical staining of polyps for mismatch repair protein expression in pediatric populations to rule out LS as a diagnosis. We demonstrate the need to consider pediatric patients in LS guidelines.
PubMed: 38034465
DOI: 10.1097/PG9.0000000000000354 -
BMJ Surgery, Interventions, & Health... 2023There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the...
OBJECTIVE
There is a lack of consensus regarding the optimal approach for patients with full-thickness rectal prolapse. The aim of this international survey was to assess the patterns in treatment of rectal prolapse.
DESIGN
A 23-question survey was distributed to the Pelvic Floor Consortium of the American Society of Colorectal Surgeons, the Colorectal Surgical Society of Australia and New Zealand, and the Pelvic Floor Society. Questions pertained to surgeon and practice demographics, preoperative evaluation, procedural preferences, and educational needs.
SETTING
Electronic survey distributed to colorectal surgeons of diverse practice settings.
PARTICIPANTS
249 colorectal surgeons responded to the survey, 65% of which were male. There was wide variability in age, years in practice, and practice setting.
MAIN OUTCOME MEASURES
Responses to questions regarding preoperative workup preferences and clinical scenarios.
RESULTS
In preoperative evaluation, 19% would perform anorectal physiology testing and 70% would evaluate for concomitant pelvic organ prolapse. In a healthy patient, 90% would perform a minimally invasive abdominal approach, including ventral rectopexy (56%), suture rectopexy (31%), mesh rectopexy (6%) and resection rectopexy (5%). In terms of ventral rectopexy, surgeons in the Americas preferred a synthetic mesh (61.9% vs 38.1%, p=0.59) whereas surgeons from Australasia preferred biologic grafts (75% vs 25%, p<0.01). In an older patient with comorbidities 81% would perform a perineal approach. Procedure preference (Delormes vs Altmeier) varied according to location (Australasia, 85.9% vs 14.1%; Europe, 75.3% vs 24.7%; Americas, 14.1% vs 85.9%). Most participants were interested in education regarding surgical approaches, however there is wide variability in preferred methods.
CONCLUSION
There is significant variability in the preoperative evaluation and surgery performed for rectal prolapse. Given the lack of consensus, it is not surprising that most surgeons desire further education on the topic.
PubMed: 38020494
DOI: 10.1136/bmjsit-2023-000198