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Annals of the Royal College of Surgeons... May 2014Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to... (Review)
Review
INTRODUCTION
Presacral venous bleeding is an uncommon but potentially life threatening complication of rectal surgery. During the posterior rectal dissection, it is recommended to proceed into the plane between the fascia propria of the rectum and the presacral fascia. Incorrect mobilisation of the rectum outside the Waldeyer's fascia can tear out the lower presacral venous plexus or the sacral basivertebral veins, causing what may prove to be uncontrollable bleeding.
METHODS
A systematic search of the MEDLINE(®) and Embase™ databases was performed to obtain primary data published in the period between 1 January 1960 and 31 July 2013. Each article describing variables such as incidence of presacral venous bleeding, surgical approach, number of cases treated and success rate was included in the analysis.
RESULTS
A number of creative solutions have been described that attempt to provide good tamponade of the presacral haemorrhage, eliminating the need for second operation. However, few cases are reported in the literature.
CONCLUSIONS
As conventional haemostatic measures often fail to control this type of haemorrhage, several alternative methods to control bleeding definitively have been described. We propose a practical comprehensive classification of the available techniques for the management of presacral bleeding.
Topics: Administration, Topical; Blood Loss, Surgical; Electrocoagulation; Hemostasis, Surgical; Hemostatics; Humans; Intraoperative Complications; Lumbosacral Plexus; Rectum; Surgical Stapling; Suture Techniques; Veins
PubMed: 24780015
DOI: 10.1308/003588414X13814021679951 -
International Journal of Surgery... Oct 2014Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream. (Review)
Review
INTRODUCTION
Diversion colitis is a non-specific inflammation of a de-functioned segment of intestine after diversion of the faecal stream.
AIM
The aim of this study was to review the current level of knowledge about diversion colitis.
METHODS
A literature search of relevant literature in the English language was carried out on PUBMED, MEDLINE and EMBASE. The following keywords were used: diversion colitis; disuse colitis; proctitis; colonic bacterial flora; stoma; de-functioned colon; faecal diversion; short chain fatty acids and lymphoid follicular hyperplasia.
RESULTS
In total 35 articles met the inclusion criteria. 22 were case series, 9 were case reports, 2 were retrospective analysis and 2 were prospective randomized controlled studies. Diversion colitis is invariably present in all diverted segments of the colon. It is usually asymptomatic but can present with tenesmus, rectal discharge, bleeding per rectum and abdominal pain. Major macroscopic changes include mucosal nodularity, erythema and friability. Microscopic features are predominantly those of lymphoid follicular hyperplasia, apthous ulceration and chronic inflammatory changes, mostly limited to sub mucosa. Treatment modalities include surveillance for asymptomatic patients, restoration of bowel continuity for severely symptomatic cases and the use of short chain fatty acid (SCFA) enemas in selected cases.
CONCLUSION
The clinical presentation of diversion colitis varies significantly. In symptomatic patients short chain fatty acid enema may help. Further prospective studies are required for evaluation.
Topics: Abdominal Pain; Castleman Disease; Colitis; Enema; Erythema; Fatty Acids, Volatile; Gastrointestinal Hemorrhage; Humans; Inflammation; Intestinal Mucosa; Postoperative Complications; Rectum
PubMed: 25150021
DOI: 10.1016/j.ijsu.2014.08.350 -
Arquivos de Gastroenterologia May 2019There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative...
BACKGROUND
There are several therapeutic options for symptomatic hemorrhoids, from hygienic and dietary measures to conventional surgery. The best technique adopted for alternative and non-surgical treatment for intermediate grade (II and III) hemorrhoidal disease is rubber band ligation. More recently, the technique has been used with the aid of a gastroscope and a kit of elastic rubber bands for esophageal varices. This technique was called Endoscopic Rubber Band Ligation of hemorrhoids (ERBL).
OBJECTIVE
The objective is Compare the results and the incidence of the immediate and late complications in patients undergoing ERBL. The satisfaction with the treatment of patients undergoing different number of rubber band ligatures were also analyzed.
METHODS
This is a cohort study included patients undergoing ERBL from 2007 to 2014 at the hospital. The incidence of early and late complications and the satisfaction with the treatment of patients undergoing until two ligatures and patients undergoing three or more ligatures in the same procedure were compared.
RESULTS
The study included 116 patients. The most frequently reported symptom was anal bleeding (n=72; 62.1%). The number of rubber band ligatures performed during the ERBL procedure varied from one to six; 84 (72,4%) patients had three or more rubber band ligatures performed during the procedure. No significant associations were observed between the incidence of early or late complications and satisfaction with ERBL among the group subjected until two rubber band ligatures or three or more rubber band ligatures.
CONCLUSION
The endoscopic elastic ligation method proved to be a feasible, safe and efficient for the treatment of symptomatic hemorrhoidal disease grades II and III. The technique had moderate rates of immediate and late complications, but most of the complications are considered of low magnitude, easily resolved and without clinical repercussions, no matter how much ligations were performed in the same procedure.
Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Endoscopy; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Severity of Illness Index; Treatment Outcome
PubMed: 31141063
DOI: 10.1590/S0004-2803.201900000-15 -
Asian Pacific Journal of Cancer... 2014This study aimed at summarizing published study findings on the diagnostic value of rectal bleeding (RB) and informing clinical practice, preventive interventions and... (Review)
Review
This study aimed at summarizing published study findings on the diagnostic value of rectal bleeding (RB) and informing clinical practice, preventive interventions and future research areas. We searched Medline and Embase for studies published by September 13, 2013 examining the risk of colorectal cancer in patients with RB using highly inclusive algorithms. Data for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive predictive value (PPV) of RB were extracted by two researchers and analyzed applying Meta-Disc (version 1.4) and Stata (version 11.0). Methodological quality of studies was assessed according to QUADAS. A total of 38 studies containing 5,626 colorectal cancer patients and 73,174 participants with RB were included. The pooled sensitivity and specificity were 0.47 (95% CI: 0.45-0.48) and 0.96 (95% CI: 0.96-0.96) respectively. The overall PPVs ranged from 0.01 to 0.21 with a pooled value of 0.06 (95% CI: 0.05-0.08). Being over the age of 60 years, change in bowel habit, weight loss, anaemia, colorectal cancer among first-degree relatives and feeling of incomplete evacuation of rectum appeared to increase the predictive value of RB. Although RB greatly increases the probability of diagnosing colorectal cancer, it alone may not be sufficient for proposing further sophisticated investigations. However, given the high specificity, subjects without RB may be ruled out of further investigations. Future studies should focus on strategies using RB as an "alarm" symptom and finding additional indications to justify whether there is a need for further investigations.
Topics: Colorectal Neoplasms; Gastrointestinal Hemorrhage; Humans; Prognosis; Rectum
PubMed: 24568444
DOI: 10.7314/apjcp.2014.15.2.1015 -
American Family Physician Apr 2005The clinical evaluation of gastrointestinal bleeding depends on the hemodynamic status of the patient and the suspected source of the bleeding. Patients presenting with... (Review)
Review
The clinical evaluation of gastrointestinal bleeding depends on the hemodynamic status of the patient and the suspected source of the bleeding. Patients presenting with upper gastrointestinal or massive lower gastrointestinal bleeding, postural hypotension, or hemodynamic instability require inpatient stabilization and evaluation. The diagnostic tool of choice for all cases of upper gastrointestinal bleeding is esophagogastroduodenoscopy; for acute lower gastrointestinal bleeding, it is colonoscopy, or arteriography if the bleeding is too brisk. When bleeding cannot be identified and controlled, intraoperative enteroscopy or arteriography may help localize the bleeding source, facilitating segmental resection of the bowel. If no upper gastrointestinal or large bowel source of bleeding is identified, the small bowel can be investigated using a barium-contrast upper gastrointestinal series with small bowel follow-through, enteroclysis, push enteroscopy, technetium-99m-tagged red blood cell scan, arteriography, or a Meckel's scan. These tests may be used alone or in combination.
Topics: Acute Disease; Adult; Chronic Disease; Endoscopy, Digestive System; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Rectum; Risk Factors
PubMed: 15832537
DOI: No ID Found -
International Journal of Legal Medicine Jan 2022A 46-year-old man was admitted to the hospital by ambulance due to syncope. A standard blood screening showed a normal Hb value. The man had known hemorrhoids and a...
A 46-year-old man was admitted to the hospital by ambulance due to syncope. A standard blood screening showed a normal Hb value. The man had known hemorrhoids and a single fresh rectal bleeding earlier at home. On the following morning, the patient suddenly required resuscitation within a few minutes and subsequently died. Autopsy revealed a fatal hemorrhage with blood loss in the stomach and small and large intestines and a mucosal defect of the duodenum. After autopsy, the question arose whether the cause of death might have been a rare Dieulafoy's lesion-aim of this case report was to clarify the diagnosis.
Topics: Duodenal Ulcer; Duodenum; Gastrointestinal Hemorrhage; Humans; Middle Aged; Rectum
PubMed: 34668070
DOI: 10.1007/s00414-021-02721-w -
Medicina (Kaunas, Lithuania) May 2020: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. : A systematic...
: The present study aims to assess the effectiveness and current evidence of the treatment of perirectal bleeding after stapled haemorrhoidopexy. : A systematic literature review was performed that combined the published and the obtained original data after a search of PubMed, Web of Science, and SCOPUS. : The present systematic review includes 16 articles with 37 patients. Twelve papers report perirectal and six report intra-abdominal bleeding. Stapled hemorrhoidopexy (SH) was performed in 57% of cases (3 PPH 01 and 15 PPH 03), stapled transanal rectal resection (STARR) in 13%, and for 30% information was not available. The median age was 49 years (±11.43). The sign and symptoms of perirectal bleeding were abdominal pain (43%), pelvic discomfort without rectal bleeding (36%), urinary retention (14%), and external rectal bleeding (21%). The median time to bleeding was 1 day (±1.53 postoperative days), with median hemoglobin at diagnosis 8.8 ± 1.04 g/dL. Unstable hemodynamic was reported in 19%. Computed tomography scan (CT) was the first examination in 77%. Only two cases underwent the abdominal US, but subsequently, a CT scan was also conducted. Non-operative management was performed in 38% (n = 14) with selective arteriography and percutaneous angioembolization in two cases. A surgical treatment was performed in 23 cases - transabdominal surgery (3 colostomies, 1 Hartmann' procedure, 1 low anterior resection of the rectum, 1 bilateral ligation of internal iliac artery and 1 ligation of vessels located at the rectal wall), transanal surgery (n = 13), a perineal incision in one, and CT-guided paracoccygeal drainage in one. : Because of the rarity and lack of experience, no uniform tactic for the treatment of perirectal hematomas exists in the literature. We propose an algorithm similar to the approach in pelvic trauma, based on two main pillars -hemodynamic stability and the finding of contrast CT.
Topics: Adult; Algorithms; Decision Support Techniques; Female; Gastrointestinal Hemorrhage; Hematoma; Hemorrhoidectomy; Humans; Male; Middle Aged; Postoperative Complications; Rectum
PubMed: 32486112
DOI: 10.3390/medicina56060269 -
International Journal of Surgery... 2014The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However... (Meta-Analysis)
Meta-Analysis Review
AIM
The use of robotic technology has proved to be safe and effective, arising as a helpful alternative to standard laparoscopy in a variety of surgical procedures. However the role of robotic assistance in laparoscopic rectopexy is still not demonstrated.
METHODS
A systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library, and Google Scholar up to 30th June 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the data currently available regarding the incidence of recurrence rate of rectal prolapse, conversion rate, operative time, intra-operative blood loss, post-operative complications, re-operation rate and hospital stay in robot-assisted rectopexy (RC) compared to conventional laparoscopic rectopexy (LR).
RESULTS
Six studies were included resulting in 340 patients. The meta-analysis showed that the RR does not influence the recurrence rate of rectal prolapse, the conversion rate and the re-operation rate, whereas it decreases the intra-operative blood loss, the post-operative complications and the hospital stay. Yet, the RR resulted to be longer than the LR. Post-operative ano-rectal and the sexual functionality and procedural costs could not meta-analyzed because the data from included studies about these issues were heterogeneous and incomplete.
CONCLUSION
The meta-analysis showed that the RR may ensure limited improvements in post-operative outcomes if compared to the LR. However, RCTs are needed to compare RR to LR in terms of short-term and long-term outcomes, specially investigating the functional outcomes that may confirm the cost-effectiveness of the robotic assisted rectopexy.
Topics: Blood Loss, Surgical; Digestive System Surgical Procedures; Humans; Laparoscopy; Length of Stay; Operative Time; Postoperative Complications; Rectal Prolapse; Rectum; Recurrence; Robotic Surgical Procedures
PubMed: 25157988
DOI: 10.1016/j.ijsu.2014.08.359 -
European Review For Medical and... Sep 2020Hemorrhoidal disease is a widespread proctologic clinical entity. Even if surgical excision is an effective treatment, it only represents the standard procedure for...
Hemorrhoidal disease is a widespread proctologic clinical entity. Even if surgical excision is an effective treatment, it only represents the standard procedure for patients with high-grade hemorrhoids. Considering that most cases are grade I or II hemorrhoids, oral or topical therapies are widely used despite, currently, there are no satisfactory options for these kinds of treatments. The pathology involves the degeneration of the supporting tissue of the anal cushions, causing venous dilation, blood stagnation, formation of edematous venous plexus covered by mucosa and inflammation. An effective treatment must, therefore, be multi-targeted and capable of acting on all the pathological mechanisms simultaneously. During the 8th National Congress of the Italian Association of Colorectal Surgery (SICCR), some clinical evidence of hemorrhoidal disease has been discussed along with new opportunities in oral and topical treatment options. Among these, the effectiveness and the safety of two innovative products, a sublingual nanoemulsion and a liquid bandage, has been reported.
Topics: Administration, Oral; Administration, Topical; Boswellia; Hemorrhoids; Humans; Plant Extracts
PubMed: 33015808
DOI: 10.26355/eurrev_202009_23053 -
Canadian Association of Radiologists... May 2015Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such... (Review)
Review
Gastrointestinal hollow viscus injury after blunt chest and abdominal trauma is uncommon and complicates 0.6%-1.2% of all cases of trauma. Early recognition of such injuries significantly decreases morbidity and mortality. Since physical examination is not accurate in detecting such injuries, contrast-enhanced computed tomography has been the mainstay for diagnosis in many emergency departments. This pictorial essay aims to review the incidence, mechanisms, and signs of gastrointestinal hollow viscus injuries in the setting of blunt chest and abdominal trauma.
Topics: Abdominal Injuries; Colon; Contrast Media; Esophagus; Gastrointestinal Tract; Hematoma; Hemoperitoneum; Humans; Incidence; Intestine, Small; Pneumoperitoneum; Rectum; Stomach; Thoracic Injuries; Tomography, X-Ray Computed; Wounds, Nonpenetrating
PubMed: 25703545
DOI: 10.1016/j.carj.2014.11.003