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Surgery Today Apr 2022Preventing outlet obstruction associated with a diverting stoma is important. Previously, we constructed a diverting loop ileostomy with the proximal limb of the small...
PURPOSE
Preventing outlet obstruction associated with a diverting stoma is important. Previously, we constructed a diverting loop ileostomy with the proximal limb of the small intestine on the caudal side, namely the oral inferior (OI) method. However, to address the issue of twisting and stenosis of the small intestine, we recently constructed a diverting loop ileostomy with the proximal limb on the cranial side, namely the oral superior (OS) method. We compared the incidence of outlet obstruction between the two methods.
METHODS
The subjects of this retrospective study were 133 patients who underwent colorectal resection or total colectomy, with D2 or more lymph node dissection and diverting loop ileostomy construction, between April, 2001 and December, 2018, at our hospital. The OI method was performed in 54 patients and the OS method was performed in 79 patients.
RESULTS
In the OS group, a history of laparotomy, neoadjuvant therapy, clinical stage III, and the use of anti-adhesion materials were more common, whereas blood loss and the incidence of outlet obstruction were significantly lower. Multivariate analysis identified only OS placement as a significant factor for reducing the incidence of outlet obstruction.
CONCLUSION
When constructing a diverting loop ileostomy, placing the proximal limb on the cranial side is important.
Topics: Colectomy; Humans; Ileostomy; Postoperative Complications; Rectal Neoplasms; Retrospective Studies; Surgical Stomas
PubMed: 34689284
DOI: 10.1007/s00595-021-02381-8 -
Journal of the Anus, Rectum and Colon 2021Anastomotic leakage is one of the most severe complications of rectal cancer surgery. A diverting ileostomy was constructed for the purpose of reducing anastomotic...
OBJECTIVES
Anastomotic leakage is one of the most severe complications of rectal cancer surgery. A diverting ileostomy was constructed for the purpose of reducing anastomotic failure risk. Outlet obstruction (OO) is one of the complications of diverting stoma that results in a lack of fecal discharge from the stoma. Detailed etiologies and preventive measures for outlet obstruction have not yet been identified.
METHODS
We studied 125 patients who underwent rectal resection, anastomosis, and elective ileostomy. We evaluated the incidence of outlet obstruction and looked for any relationship between perioperative factors and outlet obstruction.
RESULTS
Outlet obstruction was detected in 20 cases (16.0%). Outlet obstruction occurred 9 days after surgery in most cases. Inserting a decompressing tube improved obstructive symptoms in 4 days. Patients were divided into two cohorts according to the occurrence of outlet obstruction. Postoperative hospital stay was longer in the outlet obstruction group (19 vs. 15 days; p = 0.0003). A multivariate analysis identified that younger patients, a postoperative thicker rectus abdominis muscle at the stoma passage and high output syndrome were independent risk factors for outlet obstruction.
CONCLUSIONS
Younger patients, a postoperative thicker rectus abdominis muscle at stoma passage and high output syndrome were independent risk factors for outlet obstruction.
PubMed: 34395937
DOI: 10.23922/jarc.2021-007 -
Saudi Journal of Gastroenterology :... 2021With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients.
METHODS
We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates.
RESULTS
We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I = 79.3%, P < 0.001).
CONCLUSION
The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.
Topics: Humans; Rectal Neoplasms; Self Expandable Metallic Stents; Stents; Treatment Outcome
PubMed: 33976008
DOI: 10.4103/sjg.sjg_506_20 -
Ultrasound in Obstetrics & Gynecology :... Apr 2011Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this... (Review)
Review
Surgical management of pelvic floor disorders depends on a comprehensive understanding of the structural integrity and function of the pelvic floor. For visualizing this region, ultrasonography has emerged as a procedure that is relatively easy to perform, cost-effective and widely available. In this review, pelvic floor ultrasonography, including two-dimensional (2D), three-dimensional (3D) and 4D imaging as well as transvaginal, endoanal and transperineal techniques, is discussed from a global and multicompartmental perspective, rather than using a compartmentalized approach. The role of the different sonographic modalities in the major disorders of the pelvic floor-urinary and fecal incontinence, pelvic organ prolapse and obstructed defecation syndrome-is evaluated critically.
Topics: Anal Canal; Fecal Incontinence; Female; Humans; Imaging, Three-Dimensional; Pelvic Floor; Rectal Diseases; Ultrasonography; Urinary Incontinence; Uterine Prolapse; Vagina
PubMed: 20814874
DOI: 10.1002/uog.8816 -
Annals of Medicine Dec 1990Defecation may be considered as "the last taboo". The inability to defecate, or to achieve it only by digital evacuation, has never been a popular topic among patients... (Review)
Review
Defecation may be considered as "the last taboo". The inability to defecate, or to achieve it only by digital evacuation, has never been a popular topic among patients and doctors. The extensive development of tests in laboratories studying colorectal disorders during recent years, however, has made it possible to study the different parts of the mechanism for maintaining continence. Since constipation is a disorder of this mechanism, namely a disorder of rectal evacuation, application of these tests on constipated patients is logical. Certainly surgery, either colectomy or sphincter division, is not the solution, nor is the injection of muscle weakening solutions. Biofeedback, however, seems to be a logical treatment. Development of new functional tests and strategies is needed to enable a better understanding of the problem. Collaboration between surgeon and psychologist has proved valuable and is recommended.
Topics: Constipation; Defecation; Humans; Muscles; Rectum
PubMed: 2076272
DOI: 10.3109/07853899009147279 -
Radiology and Oncology Aug 2022Electrochemotherapy (ECT) is a minimally invasive and safe treatment gaining positive and long-lasting antitumoral results that are receiving the attention of the... (Review)
Review
BACKGROUND
Electrochemotherapy (ECT) is a minimally invasive and safe treatment gaining positive and long-lasting antitumoral results that are receiving the attention of the scientific community. It is a local treatment that combines the use of electroporation and the administration of cytotoxic drugs to induce cell death in the target tissue. ECT is largely used for the treatment of cutaneous and subcutaneous lesions, and good results have been reported for the treatment of deep visceral tumors. The latest literature review is provided. Moreover, in line with its development for the treatment of visceral tumors in this article, we describe a novel approach of ECT: endoscopic treatment of colorectal cancer. Endoscopic ECT application was combined with systemic chemotherapy in the treatment of obstructing rectal cancer without prospective surgery. A good response after ECT was described: concentric involvement of the rectum was reduced, and no stenosing lesions were detected.
CONCLUSIONS
Clinical studies have demonstrated that ECT is a very effective treatment for tumors of different histologic types and localizations. Endoscopic treatment for gastrointestinal cancer is an innovative application of ECT. The combination of systemic treatment and ECT was safe and highly effective in the treatment of colorectal cancer, especially when obstructive, giving the patient a significant gain in quality of life.
Topics: Antineoplastic Agents; Bleomycin; Colorectal Neoplasms; Electrochemotherapy; Humans; Quality of Life
PubMed: 35776844
DOI: 10.2478/raon-2022-0022 -
Journal of Medical Case Reports Jul 2011Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it...
INTRODUCTION
Endometriosis is a clinical entity which presents with functioning endometrial tissue at sites outside the uterus. Bowel endometriosis is usually asymptomatic, but it may show non-specific symptoms. The presence and/or association of appendiceal endometriosis, concomitant with rectal endometriosis, is possible.
CASE PRESENTATION
A 36-year-old Greek woman was admitted to the emergency room of our hospital with signs of acute abdomen. On physical examination, our patient had a painful distended abdomen. Digital examination revealed an empty rectum and bowel obstruction was diagnosed. Our patient underwent exploratory laparotomy and rectum stenosis (almost complete obstruction) was observed. The bowel stenosis was resected, and temporary colostomy and appendectomy were performed. The pathology report showed endometriosis of the colon and the appendix, and our patient received medical treatment for endometriosis. Six months after this operation our patient had another surgery for restoration of large bowel continuity. No endometriosis was found. Our patient was doing well at the one-year follow up.
CONCLUSION
Endometriosis of the bowel is a disease that may cause large bowel obstruction. In women of reproductive age, the surgeon should consider endometriosis as a differential diagnosis in case of various gastrointestinal symptoms.
PubMed: 21774792
DOI: 10.1186/1752-1947-5-320 -
Cancer Diagnosis & Prognosis 2021The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic...
BACKGROUND
The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient's quality of life and prolongs hospitalization.
PATIENTS AND METHODS
A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer.
RESULTS
Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO.
CONCLUSION
When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.
PubMed: 35403166
DOI: 10.21873/cdp.10062 -
International Journal of Surgery Case... 2014Colorectal obstructive endometriosis is relatively rare in Japan and its differentiation from malignancy is often difficult. We report a case of rectal obstructive...
INTRODUCTION
Colorectal obstructive endometriosis is relatively rare in Japan and its differentiation from malignancy is often difficult. We report a case of rectal obstructive endometriosis.
PRESENTATION OF CASE
A 37-year-old woman was referred to our hospital with a suspected ileus. Her chief symptoms were left lower abdominal pain and vomiting. Colonoscopy showed an intraluminal mass of redness in the upper rectum. A proctectomy was performed because of the bowel obstruction. The rectum was filled with an intraluminal mass measuring 5cm×4cm, and endometriosis was diagnosed pathologically.
DISCUSSION
A preoperative diagnosis of colorectal obstructive endometriosis is often difficult because of the lack of definite diagnostic, clinical, sonographic, or radiological findings that are characteristic of this disease. Medical treatment is not always effective for colorectal obstructive endometriosis, and surgery is often performed.
CONCLUSION
Colorectal obstructive endometriosis should be considered as a differential diagnosis in cases of various gastrointestinal symptoms in women who are of reproductive age.
PubMed: 25462048
DOI: 10.1016/j.ijscr.2014.04.035 -
Journal of Interventional... Oct 2011A patient with metastatic rectal cancer underwent a diverting transverse loop colostomy due to rectal obstruction. 16 months later, he underwent a low anterior resection...
A patient with metastatic rectal cancer underwent a diverting transverse loop colostomy due to rectal obstruction. 16 months later, he underwent a low anterior resection to resect his rectal cancer along with reversal of his transverse colostomy, and creation of a temporary loop ileostomy. Six months later, he was brought to the operating room for closure of his ileostomy. Post-operatively, the patient developed nausea, vomiting, and abdominal distention and imaging revealed a large bowel obstruction, confirmed by colonoscopy. The patient refused surgical diversion and a cecostomy tube was placed for decompression. After maturation of the cecostomy fistula, a rendezvous colonoscopy was performed, retrograde through the rectum and antegrade through the cecostomy fistula. The obstructing mucosa was traversed and the site of obstruction was balloon dilated, relieving the obstruction endoscopically.
PubMed: 22586533
DOI: 10.4161/jig.1.4.19969