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Journal of Gastrointestinal Surgery :... May 2021Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall...
BACKGROUND
Recent genetic studies identified common mutations between diverticular disease and connective tissue disorders, some of which are associated with abdominal wall hernias. Scarce data exists, however, shedding light on the potential clinical implications of this shared etiology, particularly in the era of laparoscopic surgery.
METHODS
The New York Statewide Planning and Research Cooperative System database was used to identify adult patients undergoing elective sigmoid and left hemicolectomy (open or laparoscopic) from January 1, 2010, to December 31, 2016, for diverticulitis or descending/sigmoid colon cancer. The incidences of incisional hernia diagnosis and repair were compared using competing risks regression models, clustered by surgeon and adjusted for a host of demographic/clinical variables. Subsequent abdominal surgery and death were considered competing risks.
RESULTS
Among 8279 patients included in the study cohort, 6811 (82.2%) underwent colectomy for diverticulitis and 1468 (17.8%) for colon cancer. The overall 5-year risk of incisional hernia was 3.5% among patients with colon cancer, regardless of colectomy route, which was significantly lower than that among diverticulitis patients after both open (10.7%; p < 0.001) and laparoscopic (7.2%; p = 0.007) colectomies. Multivariable analyses demonstrated that patients with diverticulitis experienced a two-fold increase in the risk for hernia diagnosis (aHR 1.8; p < 0.001) and repair (aHR 2.1; p < 0.001), and these findings persisted after stratification by colectomy route.
CONCLUSIONS
Patients undergoing elective colectomy for diverticulitis, including via laparoscopic approach, experience higher rates of incisional hernia compared with patients undergoing similar resections for colon cancer. When performing resections for diverticulitis, surgeons should strongly consider adherence to evidence-based guidelines for fascial closure to prevent this important complication.
Topics: Adult; Colectomy; Colon, Sigmoid; Diverticular Diseases; Humans; Incisional Hernia; Laparoscopy; New York; Retrospective Studies
PubMed: 32748338
DOI: 10.1007/s11605-020-04762-9 -
The Journal of the American Osteopathic... May 1996A 49-year-old man was seen with an unusual complication of diverticulitis--a giant sigmoid diverticulum. This patient had undergone an extensive workup during a 5-year... (Review)
Review
A 49-year-old man was seen with an unusual complication of diverticulitis--a giant sigmoid diverticulum. This patient had undergone an extensive workup during a 5-year period, ranging from multiple extensive gastroenterology evaluations and procedures to an eventual psychiatric evaluation to rule out the possibility of a functional cause for his chronic, intermittent abdominal pain. Later, an accurate diagnosis of a giant sigmoid diverticulum resulted in an en bloc resection of the sigmoid colon and cyst. The patient had an uncomplicated recovery with no return of his previous symptoms. The authors review the many proposed causes of the giant sigmoid diverticulum and possible differential diagnoses. Initially, the diagnosis is usually missed as plain roentgenograms, upper and lower gastrointestinal x-ray studies, and computed tomography scans generally show no abnormality. Management methods are also discussed.
Topics: Colon, Sigmoid; Diagnosis, Differential; Diverticulitis; Diverticulum, Colon; Humans; Male; Middle Aged; Radiography
PubMed: 8936449
DOI: 10.7556/jaoa.1996.96.5.309 -
World Journal of Surgical Oncology Nov 2018To explore whether single-incision laparoscopic surgery (SILS) has the better short-term clinical and pathological outcomes than conventional multiport laparoscopic...
OBJECTIVES
To explore whether single-incision laparoscopic surgery (SILS) has the better short-term clinical and pathological outcomes than conventional multiport laparoscopic surgery (CLS) for sigmoid colon and rectal cancer.
METHODS
A literature investigation of MEDLINE, PubMed, Ovid, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Biological Medicine (CBM), and Wanfang databases for relevant researches was performed. Fixed effects and random effects models were used to calculate the corresponding outcomes. Standardized mean difference and risk ratio were calculated for continuous and dichotomous variables separately.
RESULTS
Nine clinical controlled trials were composed of two randomized clinical trials and seven non-randomized clinical trials with a total of 829 patients. Two hundred ninety-nine (36.1%) patients underwent SILS, and 530 (63.9%) patients underwent CLS. The meta-analysis showed that SILS had more lymph node resection (SMD - 0.25, 95% CI - 0.50 to - 0.002) and less defecation time (SMD - 0.46, 95% CI - 0.75 to - 0.17), exhaust time (SMD - 0.46, 95% CI - 0.75 to - 0.18), and hospital stay (SMD - 0.30, 95% CI - 0.45 to - 0.15 than CLS. SILS was also accompanied with shorter incision length (SMD - 2.46, 95% CI - 4.02 to - 0.90), less pain score (SMD - 0.56, 95% CI - 0.91 to - 0.21), and lower complication rate (RR 0.66, 95% CI 0.47 to 0.91). Blood loss, operative time, distal margin, conversion rate, anastomotic fistula, readmission, local recurrence, and distant metastasis showed no statistical differences in two groups. In all subgroup analysis, SILS also had advantages of incision length, operative time, defecation time, exhaust time, and hospitalization time than CLS.
CONCLUSION
SILS could be a more safe and reliable surgical technique than CLS for sigmoid colon and rectal cancer. However, further high-quality studies between these two techniques need to be further developed.
Topics: Colon, Sigmoid; Controlled Clinical Trials as Topic; Humans; Laparoscopy; Length of Stay; Neoplasm Recurrence, Local; Operative Time; Postoperative Complications; Rectal Neoplasms; Rectum; Sigmoid Neoplasms; Treatment Outcome
PubMed: 30414613
DOI: 10.1186/s12957-018-1521-4 -
Journal of Medical Case Reports Nov 2020Abdominal compartment syndrome (ACS) is defined as a sustained raised level of intra-abdominal pressure more than 20 mmHg with or without abdominal perfusion pressure... (Review)
Review
Abdominal compartment syndrome due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy: a case report and review of the literature.
BACKGROUND
Abdominal compartment syndrome (ACS) is defined as a sustained raised level of intra-abdominal pressure more than 20 mmHg with or without abdominal perfusion pressure less than 60 mmHg and the development of new end-organ failure. Abdominal surgery, major trauma, volvulus, ileus, distended abdomen, fecal impaction, acute pancreatitis, liver dysfunction, sepsis, shock, obesity, and age have all been reported as risk factors. Herein, we report the severest known case of ACS due to extremely elongated sigmoid colon and rectum plus fecal impaction caused by disuse syndrome and diabetic neuropathy, together with a brief review of the literature.
CASE PRESENTATION
A 48-year-old Asian man suffering from shock was transported by ambulance to our hospital. His medical history included hypoglycemic encephalopathy sequelae, disuse syndrome, type 2 diabetic neuropathy, and constipation. He recovered consciousness in the ambulance, and his physical examination as well as laboratory findings were normal. X-ray and dynamic computed tomography revealed a thickened gut wall, and an extremely dilated sigmoid colon and rectum filled with a massive amount of stool as well as gas, compressing other intra-abdominal organs. We diagnosed the patient with transient vasovagal syncope, together with ACS, due to extremely elongated sigmoid colon and rectum plus fecal impaction, caused by anorectal disturbance derived from disuse syndrome and diabetic neuropathy. We first repeated stool extraction for bowel decompression and he subsequently became symptom-free, after which we performed a colostomy on the 28th hospital day. The postoperative course was uncomplicated, and he was discharged on the 44th hospital day.
CONCLUSIONS
Clinicians need to keep ACS in mind as a differential diagnosis and perform careful and detailed examination when encountering patients presenting with symptoms or risk factors of ACS. In addition, they need to precisely diagnose ACS and perform optimal treatment without delay.
Topics: Acute Disease; Colon, Sigmoid; Diabetes Mellitus; Diabetic Neuropathies; Fecal Impaction; Humans; Intra-Abdominal Hypertension; Male; Middle Aged; Pancreatitis; Rectum
PubMed: 33183343
DOI: 10.1186/s13256-020-02566-8 -
Endoscopy Dec 2022
Topics: Humans; Colon, Sigmoid; Cysts; Sclerotherapy; Liver Diseases
PubMed: 35926528
DOI: 10.1055/a-1887-5737 -
The American Surgeon Dec 2023The ideal management of perforated colorectal cancer in the hernia sac remains a challenge for general surgeons. We report such a case requiring a combined-incision...
The ideal management of perforated colorectal cancer in the hernia sac remains a challenge for general surgeons. We report such a case requiring a combined-incision surgical approach and two-stage operation. A male patient in his 80s presented with fatigue and a bulge in his left groin. Contrast-enhanced CT scan revealed a sigmoid colon perforation within the left inguinal hernia sac. A combination of midline abdominal and inguinal incisions was performed for the iliopubic tract repair and Hartmann procedure. Six months later, the recurrent inguinal hernia was repaired using the Kugel mesh. The treatment strategy for colonic perforation into the inguinal hernia remains nonstandardized, compared to those for nonperforated cases. Combined inguinal and midline abdominal incisions might be necessary for infected lesion removal and colon mesentery resection; using mesh to repair hernia is a rare option. Hernia repair using mesh can be performed in two stages when recurrence occurs.
Topics: Humans; Male; Hernia, Inguinal; Sigmoid Neoplasms; Colon, Sigmoid; Groin; Herniorrhaphy; Intestinal Perforation
PubMed: 36757851
DOI: 10.1177/00031348231156780 -
Pediatrics and Neonatology Jun 2016Gastrointestinal perforation in neonates with anorectal malformation (ARM) is extremely uncommon. Delayed patient presentation is an important causative factor. A 2.5-kg... (Review)
Review
Gastrointestinal perforation in neonates with anorectal malformation (ARM) is extremely uncommon. Delayed patient presentation is an important causative factor. A 2.5-kg neonate presented 72 hours after birth with abdominal distention and absent anal opening with meconium pearls. An abdominal X-ray revealed the presence of free gas. After adequate resuscitation patient underwent surgery. Closure of the sigmoid colon perforation with a proximal diverting loop colostomy with anoplasty was done. The literature reveals only two cases of sigmoid colon perforation with low ARM. Ours is the third case, in whom repair of the perforation and correction of the ARM was managed successfully at the same time.
Topics: Anorectal Malformations; Colon, Sigmoid; Humans; Infant, Newborn; Intestinal Perforation; Male
PubMed: 24231113
DOI: 10.1016/j.pedneo.2013.07.011 -
JAMA Network Open Dec 2019Preoperative TNM stratification of colon cancer on computed tomography (CT) does not identify patients who are at high risk of recurrence that could be selected for...
IMPORTANCE
Preoperative TNM stratification of colon cancer on computed tomography (CT) does not identify patients who are at high risk of recurrence that could be selected for preoperative treatment.
OBJECTIVE
To evaluate the utility of CT findings for prognosis of sigmoid colon cancer.
DESIGN, SETTING, AND PARTICIPANTS
This prognostic study used retrospective data from patients who underwent bowel resection for sigmoid colon cancer between January 1, 2006, and January 1, 2015, at a tertiary care center receiving international and national referrals for colorectal cancer. Statistical analysis was performed in April 2019.
MAIN OUTCOMES AND MEASURES
Cox proportional hazards regression analysis was performed to investigate CT findings associated with disease recurrence. Kaplan-Meier survival plots were calculated for disease-free survival using CT staging systems.
RESULTS
Of the 414 patients who had sigmoid colon cancer (248 [60.0%] men; mean [SD] age, 66.1 [12.7] years), with median follow-up of 61 months (interquartile range, 40-87 months), 122 patients (29.5%) developed disease recurrence. On multivariate analysis, nodal disease was not associated with disease recurrence; only tumor deposits (hazard ratio [HR], 1.90; 95% CI, 1.21-2.98; P = .006) and extramural venous invasion (HR, 1.97; 95% CI, 1.26-3.06; P = .003) on CT were associated with disease recurrence. Significant differences in disease-free survival were found using CT-T3 substage classification (HR, 1.88; 95% CI, 1.32-2.68) but not CT-TNM (HR, 1.55; 95% CI, 0.94-2.55). The presence of tumor deposits or extramural venous invasion on CT (HR, 2.45; 95% CI, 1.68-3.56) had the strongest association with poor outcome.
CONCLUSIONS AND RELEVANCE
In this study, T3 substaging and detection of tumor deposits or extramural venous invasion on preoperative CT scans of sigmoid colon cancer were prognostic factors for disease-free survival, whereas TNM and nodal staging on CT had no prognostic value. T3 substaging and detection of tumor deposits or extramural venous invasion of sigmoid colon cancer was superior to TNM on CT and could be used to preoperatively identify patients at high risk of recurrence.
Topics: Aged; Colon, Sigmoid; Extranodal Extension; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Proportional Hazards Models; Retrospective Studies; Sigmoid Neoplasms; Tomography, X-Ray Computed
PubMed: 31808924
DOI: 10.1001/jamanetworkopen.2019.16987 -
Revista Espanola de Enfermedades... Jan 2004The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus.
BACKGROUND/AIMS
The sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus.
METHODOLOGY
We present our experience of 81 cases of sigmoid volvulus admitted to our department.
RESULTS
Preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60%) was higher than with a rigid rectosigmoidoscope (42%). In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann's pouch. There were 9 deaths (21%) among 42 patients who underwent an emergency operation, and one (5.2%) among the 19 patients who had elective surgery died because of a cerebral embolus.
CONCLUSIONS
Initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.
Topics: Adult; Aged; Aged, 80 and over; Colon, Sigmoid; Colonoscopy; Decompression, Surgical; Emergencies; Female; Humans; Intestinal Volvulus; Male; Middle Aged; Postoperative Complications; Sigmoid Diseases; Treatment Outcome
PubMed: 14971995
DOI: 10.4321/s1130-01082004000100005 -
BMJ Case Reports May 2015Colonic schwannomas are very rare gastrointestinal tumours originating from Schwann cells, which form the neural sheath. Primary schwannomas of the lower...
Colonic schwannomas are very rare gastrointestinal tumours originating from Schwann cells, which form the neural sheath. Primary schwannomas of the lower gastrointestinal tract are very rare and usually benign in nature. However, if they are not surgically removed, malign degeneration can occur. We report a case of a 79-year-old woman who presented to our clinic with rectal bleeding and constipation. She underwent a lower gastrointestinal tract endoscopy. A mass subtotally obstructing the lumen of the sigmoid colon was seen and biopsies were taken. Histopathological examination indicated a suspicion of gastrointestinal tumour and the patient underwent sigmoid colon resection after preoperative evaluation by laboratory analysis, abdominal ultrasonography and CT. Her postoperative course was uneventful and she was discharged on the fifth day for outpatient control. The histopathology report revealed schwannoma of the sigmoid colon. This was a case of schwannoma of the sigmoid colon that was successfully treated with total resection.
Topics: Aged; Colon, Sigmoid; Colonic Neoplasms; Constipation; Early Detection of Cancer; Endoscopy, Gastrointestinal; Female; Gastrointestinal Hemorrhage; Humans; Neurilemmoma; Rectum; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25976197
DOI: 10.1136/bcr-2014-208934