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Medicina (Kaunas, Lithuania) Apr 2022This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview... (Review)
Review
This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn's colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis "CC" or "UC". This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.
Topics: COVID-19; Chronic Disease; Colitis; Colitis, Ulcerative; Crohn Disease; Humans; Inflammatory Bowel Diseases; Pandemics
PubMed: 35629984
DOI: 10.3390/medicina58050567 -
Gut Jun 2019Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly...
Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.
Topics: Comorbidity; Constriction, Pathologic; Crohn Disease; Cross-Sectional Studies; Elasticity Imaging Techniques; Female; Fibrosis; Humans; Incidence; Intestinal Obstruction; Intestine, Small; Magnetic Resonance Imaging; Male; Multimodal Imaging; Prognosis; Risk Assessment; Tomography, X-Ray Computed; Ultrasonography, Doppler
PubMed: 30944110
DOI: 10.1136/gutjnl-2018-318081 -
European Journal of Case Reports in... 2018Heyde's syndrome describes an association between aortic stenosis and a predisposition to bleeding from intestinal angiodysplasia resulting from acquired von Willebrand...
UNLABELLED
Heyde's syndrome describes an association between aortic stenosis and a predisposition to bleeding from intestinal angiodysplasia resulting from acquired von Willebrand disease. We present the case of an 82-year-old woman with recurrent intestinal bleeding, severe anaemia and secondary myocardial infarction. Investigation identified ileal angiectasia as the source of haemorrhage. As echocardiography revealed severe aortic stenosis the patient underwent surgical valve replacement. At her 3-month follow-up, the patient reported no new bleeding episodes and her functional status had improved. This case highlights Heyde's syndrome, an entity probably underdiagnosed despite the high prevalence of aortic stenosis and intestinal angiodysplasia in elderly patients.
LEARNING POINTS
In a patient with bleeding intestinal angiectasia, Heyde's syndrome should be considered in the differential diagnosis.Although supportive therapy is crucial for clinical stabilization, aortic valve replacement is the therapeutic gold standard.Appropriate management of these patients requires a multidisciplinary approach.
PubMed: 30756064
DOI: 10.12890/2018_000896 -
Cureus Oct 2020Introduction Ileostomies are life-saving procedures used for temporary fecal diversion in complicated cases of ileal perforation. However, an ileostomy is associated...
Introduction Ileostomies are life-saving procedures used for temporary fecal diversion in complicated cases of ileal perforation. However, an ileostomy is associated with several complications. The goal of this study was to determine the frequency and complications of ileostomy in the Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Methodology We conducted a longitudinal observational study from July 2019 to July 2020. All patients older than age 12 receiving an ileostomy were included. Patient examinations were conducted on the first postoperative day and were assessed for hemorrhage and necrosis. Examinations were conducted on the seventh postoperative day to assess stoma retraction, stenosis, prolapse, and high-output fistula. Patients were monitored via follow-up in the outpatient clinic every 15 days to record any complications for three months until the reversal was performed. All data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp.). Result A total of 84 patients who received ileostomies were included in the study. Most patients were male (n=62; 73.8%), and 22 were female (26.19%). Of the 84 patients in our study, 34 (40.48%) had tuberculous intestine, 23 (27.38%) had typhoid ileal perforation, 23 (27.38%) were trauma patients, and four patients (4.7%) had gangrenous appendicular perforation. 23 patients (27.3%) were discharged with no complications, and 61 patients (72.69%) developed complications. The most common complication was skin excoriation (19.4%), followed by wound infection (13%), nonfunctioning stoma (11.9%), prolapse and stenosis (6%), retraction (4.7%), high-output fistula (3.5%), parastomal hernia and necrosis (2.3% each), and hemorrhage (1.1%). Conclusion Ileostomy is a common and lifesaving surgical diverting procedure. It is still common in our clinic due to late presentation by patients who need the procedure. Complications are common but manageable. Therefore, it is essential to recognize these complications and manage them early to reduce the morbidity of the patients.
PubMed: 33274131
DOI: 10.7759/cureus.11249 -
Journal of Crohn's & Colitis Feb 2018Restorative proctocolectomy with ileal pouch-anal anastomosis removes the diseased tissue in ulcerative colitis but also allows gastrointestinal continuity and... (Review)
Review
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis removes the diseased tissue in ulcerative colitis but also allows gastrointestinal continuity and stoma-free living. Pouch strictures are a complication with a reported incidence of 5-38%. The three areas where pouch strictures occur are in the pouch inlet, mid-pouch and pouch-anal anastomosis.
AIM
To undertake a systematic review of the literature and to identify management strategies available for pouch-anal, mid-pouch and pre-pouch ileal strictures and their outcomes.
METHODS
A computer-assisted search of the online bibliographic databases MEDLINE and EMBASE limited to 1966 to February 2016 was performed. Randomized controlled trials, cohort studies, observational studies and case reports were considered. Those where data could not be extracted were excluded.
RESULTS
Twenty-two articles were considered eligible. Pouch-anal strictures have been initially managed using predominately dilators which include bougie and Hegar dilators with various surgical procedures advocated when initial dilatation fails. Mid-pouch strictures are relatively unstudied with both medical, endoscopic and surgical management reported as successful. Pouch inlet strictures can be safely managed using a combined medical and endoscopic approach.
CONCLUSION
The limited evidence available suggests that pouch-anal strictures are best treated in a stepwise fashion with initial treatment to include digital or instrumental dilatation followed by surgical revision or resection. Management of mid-pouch strictures requires a combination of medical, endoscopic and surgical management. Pouch inlet strictures are best managed using a combined medical and endoscopic approach. Future studies should compare different treatment modalities on separate stricture locations to enable an evidenced-based treatment algorithm.
Topics: Colonic Pouches; Constriction, Pathologic; Digestive System Surgical Procedures; Dilatation; Endoscopy, Gastrointestinal; Humans; Ileum
PubMed: 29155985
DOI: 10.1093/ecco-jcc/jjx151 -
Gastroenterologie Clinique Et Biologique Apr 2007
Comparative Study Review
Topics: Adrenal Cortex Hormones; Anastomosis, Surgical; Anti-Inflammatory Agents; Antibodies, Monoclonal; Budesonide; Colon; Constriction, Pathologic; Crohn Disease; Dilatation; Endoscopy; Gastrointestinal Agents; Glucocorticoids; Humans; Ileal Diseases; Ileum; Infliximab; Intestinal Obstruction; Magnetic Resonance Imaging; Prosthesis Implantation; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Time Factors
PubMed: 17483775
DOI: 10.1016/s0399-8320(07)89397-3 -
Diagnostics (Basel, Switzerland) Dec 2022Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is... (Review)
Review
Eosinophilic gastroenteritis (EoGE) is a rare digestive disorder characterized by eosinophilic infiltration of the stomach and intestines. In the diagnosis of EoE, it is extremely important to recognize distinctive endoscopic findings and accurately detect increased eosinophilia in gastrointestinal tissues. However, endoscopic findings of EoGE in the small intestine remain poorly understood. Therefore, we conducted a literature review of 16 eligible papers. Redness or erythema was the most common endoscopic finding in the small bowel, followed by villous atrophy, erosion, ulceration, and edema. In some cases, stenosis due to circumferential ulceration was observed, which led to retention of the capsule during small bowel capsule endoscopy. Although many aspects of small bowel endoscopic findings in EoGE remain elusive, the findings presented in this review are expected to contribute to the further development of EoGE practice.
PubMed: 36611405
DOI: 10.3390/diagnostics13010113 -
Frontiers in Medicine 2017Crohn's disease is an idiopathic disorder of the gut thought to be caused by a combination of environmental and genetic factors in susceptible individuals. It is... (Review)
Review
Crohn's disease is an idiopathic disorder of the gut thought to be caused by a combination of environmental and genetic factors in susceptible individuals. It is characterized by chronic transmural inflammation of the terminal ileum and colon, with typical transmural lesions. Complications, including fibrosis, mean that between 40 and 70% of patients require surgery in the first 10 years after diagnosis. Presently, there is no evidence that the current therapies which dampen inflammation modulate or reverse intestinal fibrosis. In this review, we focus on cytokines that may lead to fibrosis and stenosis and the contribution of experimental models for understanding and treatment of gut fibrosis.
PubMed: 28824915
DOI: 10.3389/fmed.2017.00126 -
Medical Archives (Sarajevo, Bosnia and... Oct 2017The aim of the study was to determine the most frequent early and late complications in different types of ileal urinary diversions.
INTRODUCTION
The aim of the study was to determine the most frequent early and late complications in different types of ileal urinary diversions.
PATIENTS AND METHODS
The study was conducted in a five-year period, on 106 patients who were diagnosed with invasive urinary bladder cancer and who had indication for radical cystectomy with one of the investigated types of urine derivation. They were divided into 2 groups, based on the type of ileal urinary diversions.
RESULTS
The colonization of bacteria was more prominently present in the ileal conduit urinary diversion group (97%) compared to Ghoneim (25%) and Hautmann (10%) group, Ureteral stenosis was slightly less represented in the conduit group (9.1%). Wound infections were significantly more represented in the conduit (21.2%) than in the Ghoneim group (5%) Nighttime incontinence was present in 20% of patients in both groups or 4 patients in each group. Daytime incontinence in the Ghoneim group was present in 3 patients (15%) and in the Hautmann group 2 patients (10%). Late complications correlate significantly negative with the type of surgery and slightly negative with the grade, and significantly positively with the examined group and T stage, and slightly correlate positively to the N and R stages. Early complications correlate slightly negative with the type of surgery, slightly negative with the grade, and significantly positively with T stage, and slightly positively correlates with the N and R stage.
CONCLUSION
The most commonly reported complications in ileal conduit are: prolonged ileus, stoma infection, wound dehiscence and bacterial colonization, followed by peristomal skin complications and complications related only to the stoma, such as stenosis and stoma retraction, and prolaps of ileostoma and ileointestinal stenosis. The ileus rate in orthotopic derivation was significantly lower than that of the ileal conduit group, which led to the conclusion that the neomybladder position does not disturb the anatomic abdominal structure.
Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Constriction, Pathologic; Cystectomy; Diurnal Enuresis; Humans; Ileum; Middle Aged; Neoplasm Staging; Nocturnal Enuresis; Postoperative Complications; Surgical Wound Dehiscence; Surgical Wound Infection; Ureter; Urinary Bladder Neoplasms; Urinary Diversion
PubMed: 29284898
DOI: 10.5455/medarh.2017.71.320-324 -
Ostomy/wound Management Jan 2010An ileal conduit is the most common urinary diversion following radical cystectomy for invasive bladder cancer. Unlike internal complications commonly described in... (Review)
Review
An ileal conduit is the most common urinary diversion following radical cystectomy for invasive bladder cancer. Unlike internal complications commonly described in urological literature, reports about the incidence of external complications are sparse. A Medline database review (1996-2008) of English-language literature was conducted to: 1) describe and compare external stoma and peristomal complications and complication rates among outpatients with ileal conduit diversion following radical cystectomy, and 2) summarize commonly used prevention and management strategies. Fourteen publications (mostly retrospective, single-center studies) met inclusion criteria. The reported incidence of complications ranged from 15% to 65%. Divided according to pathogenesis, the most commonly reported complications are 1) stoma or abdominal wall-related changes--parastomal hernia, stoma prolapse, stenosis, and retraction; and 2) peristomal skin changes--chemical injury: irritant contact dermatitis, pseudoverrucous lesions, and alkaline crustations; mechanical injury: pressure ulcers, skin stripping injuries, mucocutaneous separation; infection: candidiasis, folliculitis; immunologic disorders: allergic contact dermatitis; and disease-related lesions: varices, pyoderma gangrenosum, malignancy. Peristomal complications also appear to be under-recognized and under-reported. Research to establish the validity and reliability of assessment tools and long-term follow-up studies are needed to improve the evidence-base of prevention and care.
Topics: Cystectomy; Humans; Ileum; Surgical Stomas
PubMed: 20093715
DOI: No ID Found