Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.
{"title":"A case of acute intestinal obstruction in an infant during the COVID-19 pandemic","authors":"J. Aihole","doi":"10.4103/wjcs.wjcs_25_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_25_23","url":null,"abstract":"Anomalous congenital bands are rare causes of intestinal obstruction in children, adults, and neonates. They are rarely reported, and their etiopathogenesis is unknown, without malrotation in children. Their presentation and radiographic features are similar to any acute intestinal obstruction. The author found approximately 50 similar cases in the literature; however, during and after COVID-19 pandemic, this is the first case of anomalous congenital obstructing band without mal rotation to be reported to date. This is a rare case of infantile intestinal obstruction managed during COVID-19 pandemic. Acute intestinal obstruction due to a congenital anomalous band is rare in infants and children, and if not treated promptly, can lead to morbidity and mortality. Various reasons, such as congenital, acquired, and extrinsic or intrinsic pathologies in children and adults, may be the cause for acute intestinal obstruction. Congenital anomalous bands account for 3% of the intestinal obstructions in infants and children. These bands may cause ischemia and gangrene of the bowel without timely intervention.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Seow-En, S. Khor, Yun Zhao, Yvonne Ng, Emile Wei Tan
Background: In recent years, new technology has emerged with the potential to considerably influence the future landscape of gastrointestinal endoscopy. One example of this is real-time artificial intelligence-assisted colonoscopy (AIC). Reported improvements in polyp detection rate (PDR) and adenoma detection rate (ADR) over standard colonoscopy (SC) have led to its rapid adoption in several tertiary endoscopy centers worldwide. However, many clinicians have mixed attitudes concerning the use of AIC. Similar to other skill-based procedures, the quality of endoscopy is directly proportional to the technical expertise and proficiency of the endoscopist. Objective: To evaluate the use of real-time AIC versus SC at a tertiary, high-volume referral center. Design: Retrospective cohort study. Settings: Single tertiary referral center. Patient and Methods: Data was retrospectively analyzed from patients who underwent elective colonoscopy at Singapore General Hospital from August 1, 2022 to October 31, 2022. Main Outcome Measures: The primary study outcome was PDR and ADR. Subgroup analysis assessed the differences in polyp detection according to the experience level of the endoscopist. Sample Size: Eight hundred and fifty-nine patients. Results: Over the 3-month study period, 859 patients underwent complete colonoscopies performed by nine accredited endoscopists; 430 patients underwent SC and 429 underwent AIC. Both groups were statistically similar in age, gender, and indication for colonoscopy. The median ADR was 34.2% (range, 24.6%–57.3%) for the entire cohort. Overall detection rates were higher for AIC than SC for diminutive polyps (≤5 mm) (45.7% vs 38.6%, P = 0.045), sessile polyps (48.5% vs 37.4%, P = 0.009), and polyps with adenomatous (42.4% vs. 36.3%, P = 0.043) or serrated histology (1.2% vs. 0%, P = 0.025). Using SC, PDR among junior versus senior endoscopists was comparable at 47.9% vs 45.6% (P = 0.672) and ADR at 36.1% vs 36.8% (P = 0.912). With real-time AI enhancement, PDR and ADR for junior endoscopists considerably increased over their senior counterparts, with PDR at 69.5% vs 44.9% (P = 0.0001) and ADR at 50.0% vs 37.7% (P = 0.016). Among senior endoscopists, AIC did not result in any statistical improvement of PDR (P = 0.999) and ADR (P = 0.854) compared to SC. Conclusions: AIC significantly increases PDR and ADR compared to SC, particularly for detecting diminutive and sessile polyps. This benefit was only observed among less experienced endoscopists. Limitations: This study is limited by its retrospective nature, short study duration, and availability of the AI system, leading to practical constraints. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Real-time artificial intelligence-assisted colonoscopy and the effect of endoscopist experience on polyp detection rates at a tertiary referral center","authors":"I. Seow-En, S. Khor, Yun Zhao, Yvonne Ng, Emile Wei Tan","doi":"10.4103/wjcs.wjcs_27_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_27_23","url":null,"abstract":"Background: In recent years, new technology has emerged with the potential to considerably influence the future landscape of gastrointestinal endoscopy. One example of this is real-time artificial intelligence-assisted colonoscopy (AIC). Reported improvements in polyp detection rate (PDR) and adenoma detection rate (ADR) over standard colonoscopy (SC) have led to its rapid adoption in several tertiary endoscopy centers worldwide. However, many clinicians have mixed attitudes concerning the use of AIC. Similar to other skill-based procedures, the quality of endoscopy is directly proportional to the technical expertise and proficiency of the endoscopist. Objective: To evaluate the use of real-time AIC versus SC at a tertiary, high-volume referral center. Design: Retrospective cohort study. Settings: Single tertiary referral center. Patient and Methods: Data was retrospectively analyzed from patients who underwent elective colonoscopy at Singapore General Hospital from August 1, 2022 to October 31, 2022. Main Outcome Measures: The primary study outcome was PDR and ADR. Subgroup analysis assessed the differences in polyp detection according to the experience level of the endoscopist. Sample Size: Eight hundred and fifty-nine patients. Results: Over the 3-month study period, 859 patients underwent complete colonoscopies performed by nine accredited endoscopists; 430 patients underwent SC and 429 underwent AIC. Both groups were statistically similar in age, gender, and indication for colonoscopy. The median ADR was 34.2% (range, 24.6%–57.3%) for the entire cohort. Overall detection rates were higher for AIC than SC for diminutive polyps (≤5 mm) (45.7% vs 38.6%, P = 0.045), sessile polyps (48.5% vs 37.4%, P = 0.009), and polyps with adenomatous (42.4% vs. 36.3%, P = 0.043) or serrated histology (1.2% vs. 0%, P = 0.025). Using SC, PDR among junior versus senior endoscopists was comparable at 47.9% vs 45.6% (P = 0.672) and ADR at 36.1% vs 36.8% (P = 0.912). With real-time AI enhancement, PDR and ADR for junior endoscopists considerably increased over their senior counterparts, with PDR at 69.5% vs 44.9% (P = 0.0001) and ADR at 50.0% vs 37.7% (P = 0.016). Among senior endoscopists, AIC did not result in any statistical improvement of PDR (P = 0.999) and ADR (P = 0.854) compared to SC. Conclusions: AIC significantly increases PDR and ADR compared to SC, particularly for detecting diminutive and sessile polyps. This benefit was only observed among less experienced endoscopists. Limitations: This study is limited by its retrospective nature, short study duration, and availability of the AI system, leading to practical constraints. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francis Yi Yee, Yvonne Ng, A. Chok, E. Tan, I. Seow-En
Background: Despite the improvements in the incidence rate and mortality of colorectal cancer in Singapore, most cases are still diagnosed at later stages. This suggests limitations in the uptake of cancer screening, relating to suboptimal population awareness, unfamiliarity with tests, or cost concerns. Objective: We report our experience with a charity colonoscopy event to assist patients with endoscopy costs, raise public awareness of endoscopic cancer screening, and demonstrate the safety of colonoscopy. Design and Settings: The Singapore General Hospital (SGH) Preventing Rectal and Colon Cancer through Endoscopy (SPRUCE) fund was established in 2019. A charity endoscopic event was held to kickstart the official launch of the fund with corporate, individual, and industry support. Patients and Methods: The recruitment criteria were first-visit patients who required colonoscopic evaluation following specialist evaluation and those in possession of a Community Health Assist Scheme card, for which only Singapore citizens whose annual household per capita income was less than Singapore dollar (SGD) 24,000 (USD 17,500) were eligible. This enabled meaningful selection of patients who would most benefit from financial assistance. Main Outcome Measures: To determine the feasibility of a charity colonoscopy event while raising colorectal cancer public awareness. Sample Size: Forty-eight patients underwent colonoscopies by accredited endoscopists for the SPRUCE endoscopy event. Results: Of the 48 participants, 19 (39.5%) were men and 29 (60.4%) were women, with a median age of 64 years. Seven patients (14.6%) had a normal colonoscopy, while 42 (85.4%) had at least one abnormality documented. Forty-one benign polyps were detected and removed in 22 patients (45.8%), with an overall adenoma detection rate of 85.4%. One patient (2.1%) was diagnosed with colon cancer. No complications resulted from the procedures performed during the charity event. Conclusion: A charity colonoscopy event conducted in the form of a health fair for needy patients is feasible and may help raise colorectal cancer awareness. This framework may serve as a useful basis for similar future events held in Singapore or elsewhere. Limitations: Lack of longitudinal assessment of colorectal cancer awareness among the public, following the charity colonoscopy event. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Charity colonoscopy event and fund in Singapore: A Novel Method to Raise Awareness of Colorectal Cancer Screening","authors":"Francis Yi Yee, Yvonne Ng, A. Chok, E. Tan, I. Seow-En","doi":"10.4103/wjcs.wjcs_29_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_29_23","url":null,"abstract":"Background: Despite the improvements in the incidence rate and mortality of colorectal cancer in Singapore, most cases are still diagnosed at later stages. This suggests limitations in the uptake of cancer screening, relating to suboptimal population awareness, unfamiliarity with tests, or cost concerns. Objective: We report our experience with a charity colonoscopy event to assist patients with endoscopy costs, raise public awareness of endoscopic cancer screening, and demonstrate the safety of colonoscopy. Design and Settings: The Singapore General Hospital (SGH) Preventing Rectal and Colon Cancer through Endoscopy (SPRUCE) fund was established in 2019. A charity endoscopic event was held to kickstart the official launch of the fund with corporate, individual, and industry support. Patients and Methods: The recruitment criteria were first-visit patients who required colonoscopic evaluation following specialist evaluation and those in possession of a Community Health Assist Scheme card, for which only Singapore citizens whose annual household per capita income was less than Singapore dollar (SGD) 24,000 (USD 17,500) were eligible. This enabled meaningful selection of patients who would most benefit from financial assistance. Main Outcome Measures: To determine the feasibility of a charity colonoscopy event while raising colorectal cancer public awareness. Sample Size: Forty-eight patients underwent colonoscopies by accredited endoscopists for the SPRUCE endoscopy event. Results: Of the 48 participants, 19 (39.5%) were men and 29 (60.4%) were women, with a median age of 64 years. Seven patients (14.6%) had a normal colonoscopy, while 42 (85.4%) had at least one abnormality documented. Forty-one benign polyps were detected and removed in 22 patients (45.8%), with an overall adenoma detection rate of 85.4%. One patient (2.1%) was diagnosed with colon cancer. No complications resulted from the procedures performed during the charity event. Conclusion: A charity colonoscopy event conducted in the form of a health fair for needy patients is feasible and may help raise colorectal cancer awareness. This framework may serve as a useful basis for similar future events held in Singapore or elsewhere. Limitations: Lack of longitudinal assessment of colorectal cancer awareness among the public, following the charity colonoscopy event. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139366236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pruritus ani is a condition that results in itching or burning in the perianal area. It can be due to primary or secondary causes and can be self-limiting or persistent. To date, there is limited quality evidence in the literature, and there are no published guidelines to aid the physician in its diagnosis and management. In this article, an overview of the current literature is discussed and a suggested treatment algorithm is provided. A thorough history and physical examination is essential to rule out secondary causes of pruritus. The underlying etiology of pruritus guides management. Education regarding anal hygiene is important for all cases. For any patient with refractory pruritus or an abnormal exam, biopsy should be strongly considered.
{"title":"Anal pruritus: Diagnosis and management","authors":"Daniel Slagle, William Harb","doi":"10.4103/wjcs.wjcs_32_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_32_23","url":null,"abstract":"Pruritus ani is a condition that results in itching or burning in the perianal area. It can be due to primary or secondary causes and can be self-limiting or persistent. To date, there is limited quality evidence in the literature, and there are no published guidelines to aid the physician in its diagnosis and management. In this article, an overview of the current literature is discussed and a suggested treatment algorithm is provided. A thorough history and physical examination is essential to rule out secondary causes of pruritus. The underlying etiology of pruritus guides management. Education regarding anal hygiene is important for all cases. For any patient with refractory pruritus or an abnormal exam, biopsy should be strongly considered.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139365870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Peristomal wounds have a remarkable negative impact on the quality of life (QOL), including the social activities, of stoma patients. Although the number of stoma patients is increasing, the relationship between peristomal disorders and QOL is not widely understood. Objectives: The aim of this study was to elucidate the relationship between the QOL status of stoma patients and the condition of the peristomal skin through structural equation modeling (SEM), which could help provide a comprehensive overview of the factors affecting the health of such patients. Design: Observational study of prospectively collected data. Setting: This study was conducted in the colorectal unit of two educational hospitals in Sapporo, Japan. Patients and Methods: Outpatient patients with a stoma were recruited between July 11, 2019 and November 30, 2019. The relationship among the clinical variables were identified using SEM analysis. Sample Size: Sixty-seven consecutive stoma patients. Main Outcome Measures: The Ostomy Skin Tool [used to assess the discoloration, erosion, and tissue overgrowth (DET) score], Stoma-QOL, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D-5L questionnaire were employed. Results: The observation period in the low DET score group was longer than that in the high DET score group. An SEM-derived path diagram, which exhibited high goodness-of-fit indices, revealed the relationships among the clinical factors. Patient satisfaction was positively associated with the Stoma-QOL score and negatively associated with the HADS-anxiety score but not the HADS-depression score. Conclusions: Peristomal skin disorders did not affect QOL or mental health status. The QOL scores of the patients with mild peristomal skin disorders markedly varied. Anxiety, but not depression, reduced the satisfaction of stoma patients and was alleviated over time. Limitations: A cross-sectional observational study cannot be used to precisely determine causal relationships. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"The structural relationships between quality of life and mental conditions in stoma patients","authors":"Momoka Narumi, H. Nishimori, Masaru Hasegawa, Yuri Hazawa, Tomohiro Ishinuki, Erika Goda, Fumitake Hata, Chikashi Kihara, Kenji Okita, Toshio Ohyanagi, Thomas Hui, Toru Mizuguchi","doi":"10.4103/wjcs.wjcs_16_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_16_23","url":null,"abstract":"Background: Peristomal wounds have a remarkable negative impact on the quality of life (QOL), including the social activities, of stoma patients. Although the number of stoma patients is increasing, the relationship between peristomal disorders and QOL is not widely understood. Objectives: The aim of this study was to elucidate the relationship between the QOL status of stoma patients and the condition of the peristomal skin through structural equation modeling (SEM), which could help provide a comprehensive overview of the factors affecting the health of such patients. Design: Observational study of prospectively collected data. Setting: This study was conducted in the colorectal unit of two educational hospitals in Sapporo, Japan. Patients and Methods: Outpatient patients with a stoma were recruited between July 11, 2019 and November 30, 2019. The relationship among the clinical variables were identified using SEM analysis. Sample Size: Sixty-seven consecutive stoma patients. Main Outcome Measures: The Ostomy Skin Tool [used to assess the discoloration, erosion, and tissue overgrowth (DET) score], Stoma-QOL, Hospital Anxiety and Depression Scale (HADS), and the EQ-5D-5L questionnaire were employed. Results: The observation period in the low DET score group was longer than that in the high DET score group. An SEM-derived path diagram, which exhibited high goodness-of-fit indices, revealed the relationships among the clinical factors. Patient satisfaction was positively associated with the Stoma-QOL score and negatively associated with the HADS-anxiety score but not the HADS-depression score. Conclusions: Peristomal skin disorders did not affect QOL or mental health status. The QOL scores of the patients with mild peristomal skin disorders markedly varied. Anxiety, but not depression, reduced the satisfaction of stoma patients and was alleviated over time. Limitations: A cross-sectional observational study cannot be used to precisely determine causal relationships. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44451702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Appendicitis, is a common emergency condition in children, which mostly requires surgical intervention. Appendicitis occurring in hemolytic disorders such as Cooley's anemia is more challenging to manage as a result of their underlying medial comorbidities. Early surgical intervention may reduce the risk of perforation, and subsequent, morbidity and mortality. Severe acute appendicitis associated with cecal perforation at its base is challenging to manage and has rarely been described in the literature to date.
{"title":"Cecal perforation in a child with Cooley's anemia","authors":"J. Aihole","doi":"10.4103/wjcs.wjcs_9_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_9_23","url":null,"abstract":"Appendicitis, is a common emergency condition in children, which mostly requires surgical intervention. Appendicitis occurring in hemolytic disorders such as Cooley's anemia is more challenging to manage as a result of their underlying medial comorbidities. Early surgical intervention may reduce the risk of perforation, and subsequent, morbidity and mortality. Severe acute appendicitis associated with cecal perforation at its base is challenging to manage and has rarely been described in the literature to date.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47000999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Colon cancer is one of the most common types of cancer. Oncological surgical resection is the most effective method to achieve a successful outcome, but the prognosis of recurrence is poor. Objectives: The objective of our study was to provide an insight into our management of patients who have experienced recurrences by first assessing the 5-year survival rate of patients who underwent curative surgery for right-sided colon cancer and then reporting on the rate and management of recurrences. Study Design: We conducted a retrospective study using a prospective database of patients with recurrent colon cancer following an initial curative right-sided resection. Setting: In the study, patients diagnosed and treated at King's College Hospital for colorectal cancer between 2011 and 2015 were included. Patients and Methods: The study included patients with right-sided colonic adenocarcinoma (including the cecum, ascending colon, hepatic flexure, and proximal two-thirds of the transverse colon) who had undergone curative surgical resection and had completed follow-up. Main Outcome Measures: Our main outcome measures were survival after curative resection of right-sided colon cancers, recurrence, and survival after recurrence. Sample Size: Our study included 195 patients. Results: In this study, 195 patients with stages I–III right-sided colonic tumors were treated with primary curative surgical resection (R0), of which 173 (86.7%) were treated electively and 22 (11.3%) were treated as an emergency. A total of 104 men (53.3%) and 91 women (46.7%) participated in our study, and the mean age at diagnosis was 69.2 (12.8) years. After a 5-year follow-up period, 145 patients (74.4%) successfully completed the follow-up with no loss of patients. We noted that 88.7% of the patients had no recurrence, but 22 (11.3%) of 195 patients experienced recurrences and 28 (14.4%) died. Following further analysis of the patients with recurrences, we found that 13 (6.6%) had distant metastases, seven (3.5%) had local recurrences, and two (1.2%) had multiple recurrences. The mean time to recurrence was 15.1 (10.8) months. Recurrence was associated with a mean survival rate of 39.64 (19.2) months compared to 53.9 ± 15.1 for patients without recurrence (Log Rank P = 0.000). Among patients with recurrences, the 5-year survival rate was 31.8%; however, it was 80.9% (Log Rank P = 0.000) for those without recurrences. Patients with recurrent cancer who received curative treatment had a 5-year survival rate of 40.0% compared to 14.3% for those who received palliative treatments (Log Rank P = 0.068). Conclusion: In our study, right-sided colorectal cancer after oncological surgical resection was associated with a recurrence rate of 11.3%. The survival rate was inversely proportional to the stage of the disease at the time of diagnosis. Detection of recurrence and surgical intervention in a timely manner are associated with improved survival rates. Limitations: This stud
{"title":"Our experiences of tertiary referral centers in the management of recurrent colonic cancer after an initial curative right-sided colonic resection","authors":"AsadA Toor, Lynne Higgins, Asif Haq, Amyn Haji, JosephW Nunoo-Mensah","doi":"10.4103/wjcs.wjcs_22_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_22_23","url":null,"abstract":"Background: Colon cancer is one of the most common types of cancer. Oncological surgical resection is the most effective method to achieve a successful outcome, but the prognosis of recurrence is poor. Objectives: The objective of our study was to provide an insight into our management of patients who have experienced recurrences by first assessing the 5-year survival rate of patients who underwent curative surgery for right-sided colon cancer and then reporting on the rate and management of recurrences. Study Design: We conducted a retrospective study using a prospective database of patients with recurrent colon cancer following an initial curative right-sided resection. Setting: In the study, patients diagnosed and treated at King's College Hospital for colorectal cancer between 2011 and 2015 were included. Patients and Methods: The study included patients with right-sided colonic adenocarcinoma (including the cecum, ascending colon, hepatic flexure, and proximal two-thirds of the transverse colon) who had undergone curative surgical resection and had completed follow-up. Main Outcome Measures: Our main outcome measures were survival after curative resection of right-sided colon cancers, recurrence, and survival after recurrence. Sample Size: Our study included 195 patients. Results: In this study, 195 patients with stages I–III right-sided colonic tumors were treated with primary curative surgical resection (R0), of which 173 (86.7%) were treated electively and 22 (11.3%) were treated as an emergency. A total of 104 men (53.3%) and 91 women (46.7%) participated in our study, and the mean age at diagnosis was 69.2 (12.8) years. After a 5-year follow-up period, 145 patients (74.4%) successfully completed the follow-up with no loss of patients. We noted that 88.7% of the patients had no recurrence, but 22 (11.3%) of 195 patients experienced recurrences and 28 (14.4%) died. Following further analysis of the patients with recurrences, we found that 13 (6.6%) had distant metastases, seven (3.5%) had local recurrences, and two (1.2%) had multiple recurrences. The mean time to recurrence was 15.1 (10.8) months. Recurrence was associated with a mean survival rate of 39.64 (19.2) months compared to 53.9 ± 15.1 for patients without recurrence (Log Rank P = 0.000). Among patients with recurrences, the 5-year survival rate was 31.8%; however, it was 80.9% (Log Rank P = 0.000) for those without recurrences. Patients with recurrent cancer who received curative treatment had a 5-year survival rate of 40.0% compared to 14.3% for those who received palliative treatments (Log Rank P = 0.068). Conclusion: In our study, right-sided colorectal cancer after oncological surgical resection was associated with a recurrence rate of 11.3%. The survival rate was inversely proportional to the stage of the disease at the time of diagnosis. Detection of recurrence and surgical intervention in a timely manner are associated with improved survival rates. Limitations: This stud","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135913957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastric outlet obstruction due to an incarcerated stomach in a parastomal hernia is extremely rare. Here, we present the management of such a case with a review of the literature. A 79-year-old woman presented with a 3-week history of postprandial vomiting and associated parastomal and epigastric pain. She had a loop colostomy created for severe fecal incontinence secondary to anal stenosis. Imaging revealed a large parastomal hernia with an incarcerated gastric antrum. She was initially managed nonoperatively with a nasogastric tube. She underwent a semi-elective open Sugarbaker mesh repair of the parastomal hernia with good results. Gastric outlet obstruction secondary to incarceration of the stomach in a parastomal hernia is uncommon. A conservative approach with nasogastric tube decompression is a reasonable initial approach in a patient who is not critically unwell, which allows time for consideration of different parastomal hernia repair techniques.
{"title":"Gastric outlet obstruction secondary to incarcerated stomach in parastomal hernia","authors":"Mohammed Abdur Raheem, Zi Ng","doi":"10.4103/wjcs.wjcs_12_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_12_23","url":null,"abstract":"Gastric outlet obstruction due to an incarcerated stomach in a parastomal hernia is extremely rare. Here, we present the management of such a case with a review of the literature. A 79-year-old woman presented with a 3-week history of postprandial vomiting and associated parastomal and epigastric pain. She had a loop colostomy created for severe fecal incontinence secondary to anal stenosis. Imaging revealed a large parastomal hernia with an incarcerated gastric antrum. She was initially managed nonoperatively with a nasogastric tube. She underwent a semi-elective open Sugarbaker mesh repair of the parastomal hernia with good results. Gastric outlet obstruction secondary to incarceration of the stomach in a parastomal hernia is uncommon. A conservative approach with nasogastric tube decompression is a reasonable initial approach in a patient who is not critically unwell, which allows time for consideration of different parastomal hernia repair techniques.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47355927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yara Azzawi, N. Azhar, F. Jörgren, Johannes Schultz, P. Buchwald
Background: Diverticulitis is a common medical condition that usually affects older patients. Antibiotic therapy in patients with acute uncomplicated diverticulitis (AUD) has been questioned. Currently, there is limited data on the quality of life (QoL) of patients after AUD. Objectives: The aim of this study was to investigate the long-term QoL in patients with AUD and to assess if antibiotic therapy or recurrent disease impacts the QoL of patients. Design: Cross-sectional questionnaire study. Setting: Two teaching hospitals in Southern Sweden. Patient and Methods: The records of patients who were treated for AUD from 2015 to 2017 were extracted, and their medical charts were used to gather data. Three questionnaires (EuroQol-5 Dimension-5L, the Gastrointestinal Quality of Life Index, and the short health scale) were sent 3–5 years after hospitalization (year 2020) to evaluate the QoL of the patients. Main Outcome Measure: Long-term QoL measured by the aforementioned questionnaires. Sample Size: The original cohort was reduced to 509 due to death, duplications, and sigmoid colectomy. The final patient cohort consisted of 273 patients after exclusion of non-responders or patients who declined participation. Results: In the EuroQol-5 Dimension scale, 147 (55%) patients reported problems in one or more QoL dimension but only 4% experienced severe problems. The Gastrointestinal Quality of Life Index median score was 105.0 (90.0–113.8), while the median short health scale score was 4.0 (0.9–12.5). Among the patients, 76% were treated with antibiotics, but no differences were observed between the antibiotics and no antibiotics groups in any QoL score. Recurrent disease was associated with lower QoL scores. Conclusion: This study showed that 161 (59%) of the patients with AUD experienced QoL problems, with recurrent disease being a risk factor. Antibiotic therapy did not affect the long-term QoL of the patients. Larger prospective studies are needed to confirm these results, and future efforts should be made to prevent the recurrence of AUD. Limitations: Limited sample size, non-randomized study. Conflict of Interest: The authors have no conflict of interest to declare.
{"title":"Long-term quality of life after acute uncomplicated diverticulitis: A cross-sectional study","authors":"Yara Azzawi, N. Azhar, F. Jörgren, Johannes Schultz, P. Buchwald","doi":"10.4103/wjcs.wjcs_18_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_18_23","url":null,"abstract":"Background: Diverticulitis is a common medical condition that usually affects older patients. Antibiotic therapy in patients with acute uncomplicated diverticulitis (AUD) has been questioned. Currently, there is limited data on the quality of life (QoL) of patients after AUD. Objectives: The aim of this study was to investigate the long-term QoL in patients with AUD and to assess if antibiotic therapy or recurrent disease impacts the QoL of patients. Design: Cross-sectional questionnaire study. Setting: Two teaching hospitals in Southern Sweden. Patient and Methods: The records of patients who were treated for AUD from 2015 to 2017 were extracted, and their medical charts were used to gather data. Three questionnaires (EuroQol-5 Dimension-5L, the Gastrointestinal Quality of Life Index, and the short health scale) were sent 3–5 years after hospitalization (year 2020) to evaluate the QoL of the patients. Main Outcome Measure: Long-term QoL measured by the aforementioned questionnaires. Sample Size: The original cohort was reduced to 509 due to death, duplications, and sigmoid colectomy. The final patient cohort consisted of 273 patients after exclusion of non-responders or patients who declined participation. Results: In the EuroQol-5 Dimension scale, 147 (55%) patients reported problems in one or more QoL dimension but only 4% experienced severe problems. The Gastrointestinal Quality of Life Index median score was 105.0 (90.0–113.8), while the median short health scale score was 4.0 (0.9–12.5). Among the patients, 76% were treated with antibiotics, but no differences were observed between the antibiotics and no antibiotics groups in any QoL score. Recurrent disease was associated with lower QoL scores. Conclusion: This study showed that 161 (59%) of the patients with AUD experienced QoL problems, with recurrent disease being a risk factor. Antibiotic therapy did not affect the long-term QoL of the patients. Larger prospective studies are needed to confirm these results, and future efforts should be made to prevent the recurrence of AUD. Limitations: Limited sample size, non-randomized study. Conflict of Interest: The authors have no conflict of interest to declare.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47492620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krukenberg tumors are a type of rare metastatic ovarian cancer that are primarily derived from the gastrointestinal tract. The literature does not agree on a single classification of Krukenberg tumors and uses several characteristics to describe them including histopathology and cancer origin. This can lead to incorrect or delayed diagnoses, which can affect management, treatment, and overall patient outcome. This review compiles current knowledge of Krukenberg tumors including tumor pathophysiology, diagnostics, and treatment options.
{"title":"A review of krukenberg tumors from a gastrointestinal primary site","authors":"Vitaley Kovalev, Ayesha Tariq","doi":"10.4103/wjcs.wjcs_13_23","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_13_23","url":null,"abstract":"Krukenberg tumors are a type of rare metastatic ovarian cancer that are primarily derived from the gastrointestinal tract. The literature does not agree on a single classification of Krukenberg tumors and uses several characteristics to describe them including histopathology and cancer origin. This can lead to incorrect or delayed diagnoses, which can affect management, treatment, and overall patient outcome. This review compiles current knowledge of Krukenberg tumors including tumor pathophysiology, diagnostics, and treatment options.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135913951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：