Solitary fibrous tumors (SFTs) are defined as fibroblast mesenchymal neoplasms. They occur in 0.35 per 100,000 individuals and most commonly occur in the pleura. Surgical resection is the mainstay of treatment. Our case aims to highlight the presentation, imaging findings, and management of colonic SFTs. We describe the case of a 48-year-old woman presenting with back pain and constipation. Computed tomography of the abdomen/pelvis revealed a large mass encompassing the terminal ileum and right hemi colon, suggesting gastrointestinal stromal tumor. Colonoscopy did not reveal any intraluminal lesion. Intraoperative findings revealed a right abdominal mass adherent to the cecum and terminal ileum without liver or peritoneal disease. The patient underwent a standard oncological right hemicolectomy. Histopathology revealed spindle cell neoplasm with foci of prominent vasculature and a positive signal transducer and activator of transcription 6 stain, supporting a diagnosis of SFT. Colonic SFTs are rare and usually benign in nature. To date, guidance with respect to treatment is dependent on case reports and case series.
{"title":"Solitary fibrous tumor arising from the colonic wall: A case report","authors":"J. Mc Garry, Fintan Ryan, Z. Ng","doi":"10.4103/wjcs.wjcs_26_22","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_26_22","url":null,"abstract":"Solitary fibrous tumors (SFTs) are defined as fibroblast mesenchymal neoplasms. They occur in 0.35 per 100,000 individuals and most commonly occur in the pleura. Surgical resection is the mainstay of treatment. Our case aims to highlight the presentation, imaging findings, and management of colonic SFTs. We describe the case of a 48-year-old woman presenting with back pain and constipation. Computed tomography of the abdomen/pelvis revealed a large mass encompassing the terminal ileum and right hemi colon, suggesting gastrointestinal stromal tumor. Colonoscopy did not reveal any intraluminal lesion. Intraoperative findings revealed a right abdominal mass adherent to the cecum and terminal ileum without liver or peritoneal disease. The patient underwent a standard oncological right hemicolectomy. Histopathology revealed spindle cell neoplasm with foci of prominent vasculature and a positive signal transducer and activator of transcription 6 stain, supporting a diagnosis of SFT. Colonic SFTs are rare and usually benign in nature. To date, guidance with respect to treatment is dependent on case reports and case series.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43380124","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}
J. Wlodarczyk, D. Yoon, Carey J. Wickham, K. Mirza, Johnny Wang, S. Lee, G. Ault, K. Cologne
Background: Over- prescription of opioids after surgery contributes to the national opioid epidemic. Differences may exist with procedure type, but these are understudied. Objective: This study aims to evaluate opioid consumption patterns following hemorrhoidectomy vs. other anorectal operations, as hemorrhoidectomy recovery is reportedly more painful. Design: Retrospective cohort study with prospective telephone survey. Setting: Single safety net hospital. Patients: Group of 27 and 73 patients undergoing outpatient hemorrhoidectomy and anorectal surgery other than hemorrhoidectomy, respectively, between July 2019 and March 2020. Main Outcome Measures: We measured the prescription and consumption quantities of morphine milligram equivalents (MME) after surgery for hemorrhoids vs. other anorectal procedures. Results: MME prescribed at discharge was higher for the hemorrhoid cohort vs. for other anorectal surgery (86.1 ± 17.5 vs. 76.0 ± 6.3, P < 0.001). The hemorrhoid group utilized higher quantities of MME during recovery: 30 (IQR 75 MME) vs. 6.25 (IQR 30 MME), P = 0.017), and also expressed lower satisfaction with their post-operative pain control regimen (33.3% vs. 88.3%, P < 0.001). No differences were seen in patients continuing on opioids on postoperative day seven (p = 0.348), and patients with complete compliance with their non-opioid multimodal pain control regimen (p = 1.0). Return trips to the emergency department for pain and patients requiring additional opioid medication after discharge were higher in the hemorrhoidectomy group (33.3% vs. 1.3%, P < 0.001 and 14.8% vs. 1.3% P = 0.016, respectively). The 50th, 75th, and 90th percentile for total MME consumed by the hemorrhoidectomy (vs. other anorectal surgery) cohort were 75 (vs. 30), 75 (vs. 54), and 97.5 (vs. 75) MME, respectively. Conclusions: Hemorrhoidectomy surgery requires up to five times the amount of opioids for postoperative pain control compared to other anorectal surgeries. Prescribed opioids still exceed the amount used, although dissatisfaction with pain control remains high after hemorrhoid surgery. Further study is required to better understand this unique entity. Limitations: Retrospective single-center design, patient-reported outcomes, male majority in the non-hemorrhoidectomy group. Conflict of Interest: None.
{"title":"Apples to oranges: How hemorrhoidectomy pain control differs from other anorectal procedures","authors":"J. Wlodarczyk, D. Yoon, Carey J. Wickham, K. Mirza, Johnny Wang, S. Lee, G. Ault, K. Cologne","doi":"10.4103/wjcs.wjcs_19_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_19_21","url":null,"abstract":"Background: Over- prescription of opioids after surgery contributes to the national opioid epidemic. Differences may exist with procedure type, but these are understudied. Objective: This study aims to evaluate opioid consumption patterns following hemorrhoidectomy vs. other anorectal operations, as hemorrhoidectomy recovery is reportedly more painful. Design: Retrospective cohort study with prospective telephone survey. Setting: Single safety net hospital. Patients: Group of 27 and 73 patients undergoing outpatient hemorrhoidectomy and anorectal surgery other than hemorrhoidectomy, respectively, between July 2019 and March 2020. Main Outcome Measures: We measured the prescription and consumption quantities of morphine milligram equivalents (MME) after surgery for hemorrhoids vs. other anorectal procedures. Results: MME prescribed at discharge was higher for the hemorrhoid cohort vs. for other anorectal surgery (86.1 ± 17.5 vs. 76.0 ± 6.3, P < 0.001). The hemorrhoid group utilized higher quantities of MME during recovery: 30 (IQR 75 MME) vs. 6.25 (IQR 30 MME), P = 0.017), and also expressed lower satisfaction with their post-operative pain control regimen (33.3% vs. 88.3%, P < 0.001). No differences were seen in patients continuing on opioids on postoperative day seven (p = 0.348), and patients with complete compliance with their non-opioid multimodal pain control regimen (p = 1.0). Return trips to the emergency department for pain and patients requiring additional opioid medication after discharge were higher in the hemorrhoidectomy group (33.3% vs. 1.3%, P < 0.001 and 14.8% vs. 1.3% P = 0.016, respectively). The 50th, 75th, and 90th percentile for total MME consumed by the hemorrhoidectomy (vs. other anorectal surgery) cohort were 75 (vs. 30), 75 (vs. 54), and 97.5 (vs. 75) MME, respectively. Conclusions: Hemorrhoidectomy surgery requires up to five times the amount of opioids for postoperative pain control compared to other anorectal surgeries. Prescribed opioids still exceed the amount used, although dissatisfaction with pain control remains high after hemorrhoid surgery. Further study is required to better understand this unique entity. Limitations: Retrospective single-center design, patient-reported outcomes, male majority in the non-hemorrhoidectomy group. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44465276","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: Enhanced Recovery After Surgery (ERAS) is a 24-item multidisciplinary questionnaire program designed to optimize the patient's perioperative care to reduce postoperative morbidity. However, its adoption remains largely influenced by region and the institution and surgeons' personal judgement. Objectives: This study aims to evaluate the practice of ERAS in elective colorectal surgery in Western Australia through a survey. Design: Prospective survey. Setting: The survey was sent to all surgeons identified to be performing routine elective colorectal surgery in Western Australia. Patients and Methods: A questionnaire was designed based on the latest ERAS guidelines, consisting of questions on the demographics of the surgeons, annual number of major colorectal resections, and on various aspects of pre-, intra- and postoperative practices. The questionnaire was sent through email or handed to the surgeons in August 2020 for a period of 2 months. Sample Size: Twenty-four eligible surgeons participated in the survey. Main Outcome Measures: The main outcome was to investigate the areas of agreement and difference in ERAS practice in elective colorectal surgery in Western Australia. Results: Twenty of the 24 eligible surgeons (83.3%) completed the questionnaire. Among these, 65% surgeons perform >50 major colorectal resections annually. There is a high agreement of the practice in certain areas: 70% surgeons perform >50% of their cases laparoscopically; they do not routinely use nasogastric tubes, majority of the surgeons do not routinely place drains after right (95%) and left (70%) colonic surgeries, 75% surgeons are guided by the Acute Pain Service for postoperative analgesia, and 95% surgeons encourage early mobilization. A few areas of practice remain widely variable: preoperative mechanical bowel preparation, postoperative fluids and electrolytes, and assessment of gut function. Conclusion: This survey provides a snapshot of the practice of ERAS in elective colorectal surgery in Western Australia. While certain aspects are considered as universal practice, there are some gaps and barriers to implementation that need to explored further. Limitations: The survey did not classify questions into open or laparoscopic surgery, and some surgeons worked both in public and private institutions, where practices may differ.
{"title":"A survey on the practice of enhanced recovery after elective colorectal surgery in Western Australia","authors":"Z. Ng, M. Theophilus","doi":"10.4103/wjcs.wjcs_3_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_3_21","url":null,"abstract":"Background: Enhanced Recovery After Surgery (ERAS) is a 24-item multidisciplinary questionnaire program designed to optimize the patient's perioperative care to reduce postoperative morbidity. However, its adoption remains largely influenced by region and the institution and surgeons' personal judgement. Objectives: This study aims to evaluate the practice of ERAS in elective colorectal surgery in Western Australia through a survey. Design: Prospective survey. Setting: The survey was sent to all surgeons identified to be performing routine elective colorectal surgery in Western Australia. Patients and Methods: A questionnaire was designed based on the latest ERAS guidelines, consisting of questions on the demographics of the surgeons, annual number of major colorectal resections, and on various aspects of pre-, intra- and postoperative practices. The questionnaire was sent through email or handed to the surgeons in August 2020 for a period of 2 months. Sample Size: Twenty-four eligible surgeons participated in the survey. Main Outcome Measures: The main outcome was to investigate the areas of agreement and difference in ERAS practice in elective colorectal surgery in Western Australia. Results: Twenty of the 24 eligible surgeons (83.3%) completed the questionnaire. Among these, 65% surgeons perform >50 major colorectal resections annually. There is a high agreement of the practice in certain areas: 70% surgeons perform >50% of their cases laparoscopically; they do not routinely use nasogastric tubes, majority of the surgeons do not routinely place drains after right (95%) and left (70%) colonic surgeries, 75% surgeons are guided by the Acute Pain Service for postoperative analgesia, and 95% surgeons encourage early mobilization. A few areas of practice remain widely variable: preoperative mechanical bowel preparation, postoperative fluids and electrolytes, and assessment of gut function. Conclusion: This survey provides a snapshot of the practice of ERAS in elective colorectal surgery in Western Australia. While certain aspects are considered as universal practice, there are some gaps and barriers to implementation that need to explored further. Limitations: The survey did not classify questions into open or laparoscopic surgery, and some surgeons worked both in public and private institutions, where practices may differ.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46156098","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}
A. Duda, M. Caparelli, Timothy S. Braverman, J. Cullen
Intussusception in adults is a rare occurrence, accounting for approximately 1%–3% of bowel obstruction cases. Here, we present a case of colocolic intussusception of the sigmoid colon caused by adenocarcinoma. A 67-year-old male presented to the emergency department with abdominal pain and rectal bleeding. A computed tomography (CT) scan revealed intussusception involving the sigmoid colon and a potential mass. In the operating room, the patient underwent flexible sigmoidoscopy, followed by sigmoidectomy and end colostomy. Pathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma of the sigmoid colon with negative margins, and two of the 54 lymph nodes were positive for metastasis. A repeat CT scan of the abdomen showed multiple sub-centimeter low-density hepatic lesions, and biopsy confirmed a metastatic lesion. The patient ultimately elected hospice care. In this report, we describe a rare case of sigmoid intussusception in an adult patient, review the relevant literature, and summarize the diagnostic and management approaches suitable for adult intussusception cases.
{"title":"Intussusception secondary to adenocarcinoma of the colon: A case report and literature review","authors":"A. Duda, M. Caparelli, Timothy S. Braverman, J. Cullen","doi":"10.4103/wjcs.wjcs_14_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_14_21","url":null,"abstract":"Intussusception in adults is a rare occurrence, accounting for approximately 1%–3% of bowel obstruction cases. Here, we present a case of colocolic intussusception of the sigmoid colon caused by adenocarcinoma. A 67-year-old male presented to the emergency department with abdominal pain and rectal bleeding. A computed tomography (CT) scan revealed intussusception involving the sigmoid colon and a potential mass. In the operating room, the patient underwent flexible sigmoidoscopy, followed by sigmoidectomy and end colostomy. Pathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma of the sigmoid colon with negative margins, and two of the 54 lymph nodes were positive for metastasis. A repeat CT scan of the abdomen showed multiple sub-centimeter low-density hepatic lesions, and biopsy confirmed a metastatic lesion. The patient ultimately elected hospice care. In this report, we describe a rare case of sigmoid intussusception in an adult patient, review the relevant literature, and summarize the diagnostic and management approaches suitable for adult intussusception cases.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44580726","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}
S. Brockman, Henry R E Drysdale, A. Nunn, S. Robson, Sonal Udayasiri, M. Millard, A. Bui, D. Stupart
Background: Many spinal cord injury (SCI) patients experience lifelong disabilities and impaired quality of life (QoL) related to bowel dysfunction. The most common manifestation of bowel dysfunction is constipation or fecal incontinence. There are many options available for the management of bowel function, one of these is stoma formation (ileostomy of colostomy). Studies assessing QoL after stoma formation in SCI patients have yielded variable results. Objective: To determine the impact of stoma formation on QoL in SCI patients. Design: Retrospective study in which eligible patients were asked to complete a structured questionnaire. Setting: The study was conducted at the Austin Hospital (a tertiary referral hospital in Melbourne, Victoria, Australia). The patients were under the care of the Victorian Spinal Cord Service. Patients (Materials) and Methods: Patients were included if they had undergone a colostomy or an ileostomy after sustaining an SCI. The patients had to have had undergone a stoma at least 1 year prior and had a minimum time interval of 2 years post injury at the time of the study. Only adults (>18 years) were included. Main Outcome Measures: Time spent on bowel function and symptoms of incontinence/constipation post stoma formation. A change in QoL post stoma formation and a retrospective view on the timing of stoma formation. Sample Size: A total of 44 patients were initially included in the study. Of these, 15 died and four were unable to be contacted. Of the remaining 25 patients, 22 (88%) completed the questionnaire. Results: Most patients had sustained complete cervical or thoracic injuries. The median age of the injured patients was 28 years (12–73 years). The median time between SCI and stoma formation was 19 years (1–47 years). The patients reported fecal incontinence as the most common indication for stoma formation (12/22, 55%). Stoma formation was associated with a significant reduction in time spent on bowel function (p < 0.05), reduced symptoms of constipation (p < 0.05), and fecal incontinence (p < 0.05). Stoma formation was associated with a "much better" overall QoL in 20/22 (91%) patients. In addition, majority of the patients observed that stoma formation was associated with "much better" ease of bowel management (21/22, 95% patients) and independence (18/22, 82%). The patients (68%) noted that would have preferred to have had their stoma earlier, and no patient wanted their stoma reversed. Conclusions: Stoma formation in SCI patients with bowel dysfunction is associated with improved QoL. Majority of the patients with a stoma would have preferred to have had their stoma earlier. Limitations: The study was limited by its small sample size and retrospective nature. The data collected relied on the patients' recollection of their prestoma symptoms, which, in many cases, was some years prior and not recent. Alternative treatment options, such as medications, anal plugs, and sacral nerve neuromodulation, were not
{"title":"Quality of life in patients with a stoma post spinal cord injury","authors":"S. Brockman, Henry R E Drysdale, A. Nunn, S. Robson, Sonal Udayasiri, M. Millard, A. Bui, D. Stupart","doi":"10.4103/wjcs.wjcs_41_20","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_41_20","url":null,"abstract":"Background: Many spinal cord injury (SCI) patients experience lifelong disabilities and impaired quality of life (QoL) related to bowel dysfunction. The most common manifestation of bowel dysfunction is constipation or fecal incontinence. There are many options available for the management of bowel function, one of these is stoma formation (ileostomy of colostomy). Studies assessing QoL after stoma formation in SCI patients have yielded variable results. Objective: To determine the impact of stoma formation on QoL in SCI patients. Design: Retrospective study in which eligible patients were asked to complete a structured questionnaire. Setting: The study was conducted at the Austin Hospital (a tertiary referral hospital in Melbourne, Victoria, Australia). The patients were under the care of the Victorian Spinal Cord Service. Patients (Materials) and Methods: Patients were included if they had undergone a colostomy or an ileostomy after sustaining an SCI. The patients had to have had undergone a stoma at least 1 year prior and had a minimum time interval of 2 years post injury at the time of the study. Only adults (>18 years) were included. Main Outcome Measures: Time spent on bowel function and symptoms of incontinence/constipation post stoma formation. A change in QoL post stoma formation and a retrospective view on the timing of stoma formation. Sample Size: A total of 44 patients were initially included in the study. Of these, 15 died and four were unable to be contacted. Of the remaining 25 patients, 22 (88%) completed the questionnaire. Results: Most patients had sustained complete cervical or thoracic injuries. The median age of the injured patients was 28 years (12–73 years). The median time between SCI and stoma formation was 19 years (1–47 years). The patients reported fecal incontinence as the most common indication for stoma formation (12/22, 55%). Stoma formation was associated with a significant reduction in time spent on bowel function (p < 0.05), reduced symptoms of constipation (p < 0.05), and fecal incontinence (p < 0.05). Stoma formation was associated with a \"much better\" overall QoL in 20/22 (91%) patients. In addition, majority of the patients observed that stoma formation was associated with \"much better\" ease of bowel management (21/22, 95% patients) and independence (18/22, 82%). The patients (68%) noted that would have preferred to have had their stoma earlier, and no patient wanted their stoma reversed. Conclusions: Stoma formation in SCI patients with bowel dysfunction is associated with improved QoL. Majority of the patients with a stoma would have preferred to have had their stoma earlier. Limitations: The study was limited by its small sample size and retrospective nature. The data collected relied on the patients' recollection of their prestoma symptoms, which, in many cases, was some years prior and not recent. Alternative treatment options, such as medications, anal plugs, and sacral nerve neuromodulation, were not","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44939466","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}
Hemorrhoidal banding is considered a safe, low-risk technique for the management of grade-I–III internal hemorrhoids. Furthermore, information in the literature regarding serious complications associated with banding is limited. Bleeding post hemorrhoidal banding is often considered minor and is expected to resolve spontaneously. Therefore, major hemorrhage post hemorrhoidal banding is often unexpected, recognized late, poorly managed, and may become life-threatening. In this case series, we present two unusual cases with rare, major, life-threatening hemorrhage post banding. Although it is rare, banding is shown to be associated with a risk of life-threatening bleeding, as this report highlights. Major hemorrhage is unusual because most bleeding after hemorrhoidal banding resolves spontaneously; however, as shown in this series, bleeding is a potential complication of hemorrhoidal banding. Thus, an appropriate index of suspicion is important to prevent serious morbidity and mortality. In this study, we discuss the factors associated with bleeding risk as well as surgical and management strategies to reduce the risk of major bleeding with hemorrhoidal banding.
{"title":"Challenges in the management of major hemorrhage after hemorrhoidal banding","authors":"Kabytto Chen, Michael Su, James T. Toh","doi":"10.4103/wjcs.wjcs_22_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_22_21","url":null,"abstract":"Hemorrhoidal banding is considered a safe, low-risk technique for the management of grade-I–III internal hemorrhoids. Furthermore, information in the literature regarding serious complications associated with banding is limited. Bleeding post hemorrhoidal banding is often considered minor and is expected to resolve spontaneously. Therefore, major hemorrhage post hemorrhoidal banding is often unexpected, recognized late, poorly managed, and may become life-threatening. In this case series, we present two unusual cases with rare, major, life-threatening hemorrhage post banding. Although it is rare, banding is shown to be associated with a risk of life-threatening bleeding, as this report highlights. Major hemorrhage is unusual because most bleeding after hemorrhoidal banding resolves spontaneously; however, as shown in this series, bleeding is a potential complication of hemorrhoidal banding. Thus, an appropriate index of suspicion is important to prevent serious morbidity and mortality. In this study, we discuss the factors associated with bleeding risk as well as surgical and management strategies to reduce the risk of major bleeding with hemorrhoidal banding.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43118405","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}
S. Srivishnu, M. Kazi, Ashwin Souza, R. Engineer, A. Saklani
Pediatric rectal adenocarcinoma is a rare disease with an incidence of 1.3 cases per million children; these numbers have been on the rise in the past two decades. Standard management guidelines are yet to be established because of their rarity and complex range of issues that need to be simultaneously addressed. Here, we demonstrate the treatment approach in a 10-year-old girl who presented with bleeding per rectum and was diagnosed with low rectal cancer; the histopathology was moderately differentiated adenocarcinoma. After discussions by a multidisciplinary team, she underwent laparoscopic bilateral ovarian transposition followed by neoadjuvant concurrent chemoradiation therapy. On follow-up, she achieved a complete clinical response that was evaluated by triple assessment (clinical examination, pelvic magnetic resonance imaging, and colonoscopy). For the past three years, the patient is being followed up using the watch and wait strategy, which is not standard in pediatric patients, and has remained disease-free. We believe that this novel perspective will enable the future development of individualized yet standardized management protocols; thus, it may help in minimizing morbidities. We discuss the complexity involved in treating pediatric rectal cancers by quoting the current case, being the first of its kind, to the best of our knowledge.
{"title":"Pediatric rectal cancer: A success story","authors":"S. Srivishnu, M. Kazi, Ashwin Souza, R. Engineer, A. Saklani","doi":"10.4103/wjcs.wjcs_27_21","DOIUrl":"https://doi.org/10.4103/wjcs.wjcs_27_21","url":null,"abstract":"Pediatric rectal adenocarcinoma is a rare disease with an incidence of 1.3 cases per million children; these numbers have been on the rise in the past two decades. Standard management guidelines are yet to be established because of their rarity and complex range of issues that need to be simultaneously addressed. Here, we demonstrate the treatment approach in a 10-year-old girl who presented with bleeding per rectum and was diagnosed with low rectal cancer; the histopathology was moderately differentiated adenocarcinoma. After discussions by a multidisciplinary team, she underwent laparoscopic bilateral ovarian transposition followed by neoadjuvant concurrent chemoradiation therapy. On follow-up, she achieved a complete clinical response that was evaluated by triple assessment (clinical examination, pelvic magnetic resonance imaging, and colonoscopy). For the past three years, the patient is being followed up using the watch and wait strategy, which is not standard in pediatric patients, and has remained disease-free. We believe that this novel perspective will enable the future development of individualized yet standardized management protocols; thus, it may help in minimizing morbidities. We discuss the complexity involved in treating pediatric rectal cancers by quoting the current case, being the first of its kind, to the best of our knowledge.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70854452","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: Fissure–fistula complex is a poorly described condition involving patients with chronic anal fissure and associated fistula-in-ano. Currently, there are no published guidelines on the surgical management of this problem. Objective: The aim of this study was to help establish guidelines for the surgical management of patients with fissure–fistula complex. Design: The study was designed as a retrospective cohort study. Setting: Data were obtained from the operative reports and medical records of patients from two colorectal surgery practices in southeast Michigan from 2000 to 2019. Patients and Methods: Forty-nine patients (47% female, 53% male) with fissure–fistula complexes were included for data analysis. The average age was 45 years. A total of 45 patients (92%) had no previous anorectal surgery, 45 (92%) had a posterior fissure complex, 26 (53%) had an intersphincteric fistula, and 23 (47%) had a low transsphincteric fistula. Although this was a retrospective study, data were described for outcomes of patients who received only a simple fistulotomy as a treatment for fissure–fistula complex. Main Outcome Measures: The primary outcome was the necessity of a lateral internal sphincterotomy after fistulotomy for resolution of the fissure. Sample Size: Forty-nine patients. Results: Three patients (6%) required repeat fistulotomy or abscess drainage during the follow-up period, and only one patient (2%) required a lateral sphincterotomy to resolve the chronic fissure. Forty-five patients (98%) healed their fissures after fistulotomy without sphincterotomy (95% confidence interval [89.1, 99.9]). Conclusions: Our study demonstrated that there is no likely need for a lateral internal sphincterotomy in addition to a fistulotomy in patients with a fissure–fistula complex for resolution of the chronic fissure. Clinical guidelines for the management of this condition should highlight primary fistulotomy as the standard treatment of fissure–fistula complex. Limitations: This study was limited by its retrospective nature and small sample size. Conflict of Interest: None.
{"title":"Is a lateral internal sphincterotomy necessary after fistulotomy in a fissure–fistula complex?","authors":"Sarah E. Diaz, B. Morgan, A. McClure, J. Hain","doi":"10.4103/WJCS.WJCS_5_21","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_5_21","url":null,"abstract":"Background: Fissure–fistula complex is a poorly described condition involving patients with chronic anal fissure and associated fistula-in-ano. Currently, there are no published guidelines on the surgical management of this problem. Objective: The aim of this study was to help establish guidelines for the surgical management of patients with fissure–fistula complex. Design: The study was designed as a retrospective cohort study. Setting: Data were obtained from the operative reports and medical records of patients from two colorectal surgery practices in southeast Michigan from 2000 to 2019. Patients and Methods: Forty-nine patients (47% female, 53% male) with fissure–fistula complexes were included for data analysis. The average age was 45 years. A total of 45 patients (92%) had no previous anorectal surgery, 45 (92%) had a posterior fissure complex, 26 (53%) had an intersphincteric fistula, and 23 (47%) had a low transsphincteric fistula. Although this was a retrospective study, data were described for outcomes of patients who received only a simple fistulotomy as a treatment for fissure–fistula complex. Main Outcome Measures: The primary outcome was the necessity of a lateral internal sphincterotomy after fistulotomy for resolution of the fissure. Sample Size: Forty-nine patients. Results: Three patients (6%) required repeat fistulotomy or abscess drainage during the follow-up period, and only one patient (2%) required a lateral sphincterotomy to resolve the chronic fissure. Forty-five patients (98%) healed their fissures after fistulotomy without sphincterotomy (95% confidence interval [89.1, 99.9]). Conclusions: Our study demonstrated that there is no likely need for a lateral internal sphincterotomy in addition to a fistulotomy in patients with a fissure–fistula complex for resolution of the chronic fissure. Clinical guidelines for the management of this condition should highlight primary fistulotomy as the standard treatment of fissure–fistula complex. Limitations: This study was limited by its retrospective nature and small sample size. Conflict of Interest: None.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43843157","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. Melo, E. Vargas, Julimar Briceño, Daniel Chiantera, M. Pérez, E. Bonilla, Jenils Coacuto, P. Zarza
Background: Anorectal fistulas are common and difficult to manage. Objective: To create a scale of complexity through the identification, description of medical history, clinical and ultrasonographic findings. To reduce the rate of recurrence and complications in fistulas is the treatment goal. Patient's inherent traits increase the complexity of anorectal fistulas with the risks of incontinence, delayed healing, infections, and requiring difficult surgeries. The aim of this study was to create a scale of complexity through identification, description of medical history, and clinical and ultrasonography (USG) findings. Patients and Methods: Retrospective study of a prospectively maintained database conducted at two Venezuelan hospitals. All patients who underwent anorectal USG examination at our institutions between 2010 and 2017 were investigated and included in the numerical scoring system, which categorizes the risk of fistula into simple, intermediate, and complex. The Chi-square test of the Statistical Program of Social Sciences (SPSS) was used to establish the significance level, P < 0.005. One thousand one hundred and seventy-three patients were evaluated, and perianal fistula was identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate, and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of the fistula may not be obvious in routine thorough clinical evaluation, requiring complementary studies. Using the scale avoids excluding factors that indicate complexity, with a statistically significant difference with the classification based exclusively on tracts. Limitation: The limitation of this study is that it is a retrospective single medical group study.
{"title":"Multiple scale of complexity for anorectal fistulas","authors":"I. Melo, E. Vargas, Julimar Briceño, Daniel Chiantera, M. Pérez, E. Bonilla, Jenils Coacuto, P. Zarza","doi":"10.4103/WJCS.WJCS_19_19","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_19_19","url":null,"abstract":"Background: Anorectal fistulas are common and difficult to manage. Objective: To create a scale of complexity through the identification, description of medical history, clinical and ultrasonographic findings. To reduce the rate of recurrence and complications in fistulas is the treatment goal. Patient's inherent traits increase the complexity of anorectal fistulas with the risks of incontinence, delayed healing, infections, and requiring difficult surgeries. The aim of this study was to create a scale of complexity through identification, description of medical history, and clinical and ultrasonography (USG) findings. Patients and Methods: Retrospective study of a prospectively maintained database conducted at two Venezuelan hospitals. All patients who underwent anorectal USG examination at our institutions between 2010 and 2017 were investigated and included in the numerical scoring system, which categorizes the risk of fistula into simple, intermediate, and complex. The Chi-square test of the Statistical Program of Social Sciences (SPSS) was used to establish the significance level, P < 0.005. One thousand one hundred and seventy-three patients were evaluated, and perianal fistula was identified in 989 patients. Results: Of the 232 intersphincteric fistulas, 75.86% were simple, 22.41% were intermediate, and 1.72% were complex. Of the 295 lower transsphincteric fistulas, 51.19% were simple, 42.71% intermediate, and 6.10% were complex. Of the 327 high transsphincteric fistulas, 17.74% were simple, 59.94% were intermediate, and 22.32% were complex. Of the 48 extrasphincteric fistulas, 66.67% were intermediate, and 33.33% were complex. Finally, of the 18 suprasphincteric fistulas, 50% were intermediate and 50% were complex. Conclusions: The complexity of the fistula may not be obvious in routine thorough clinical evaluation, requiring complementary studies. Using the scale avoids excluding factors that indicate complexity, with a statistically significant difference with the classification based exclusively on tracts. Limitation: The limitation of this study is that it is a retrospective single medical group study.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45659143","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}
Joseph C. H. Kong, D. Low, D. Wardill, D. Stupart, G. Guest, D. Watters
Background and Objectives: There is an increasing demand for colonoscopy which tends to exceed service provision. To ensure appropriate referral for colonoscopy, the National Health and Medical Research Council (NHMRC) have developed comprehensive, evidence-based guidelines addressing screening and colonoscopy surveillance. However, some reports suggest that compliance with the guidelines is variable. This study was conducted to determine the compliance rates in our institution and to drive improved adherence to the national guidelines. Patients and Methods: This is a retrospective, observational study of all colonoscopies performed from July 2007 to June 2011. A decision support tool was specifically designed and made available via the World Wide Web. To assess the impact of the decision support tool, we measured compliance rates prospectively in January 2011 and January 2013. Results: Over the two periods of pre- and post-intervention, there were 103 and 98 patients referred to waiting lists for colonoscopy. Following introduction of the web-based decision support tool, the national colonoscopy guidelines compliance rate increased from 70.5% (103/146) to 87.5% (98/112). Critically, all patients who required colonoscopy surveillance had been appropriately listed excluding four patients (2.4%) who were missed before introducing the web-bed decision guide. Conclusion: Using currently available technology, a web-based colonoscopy decision support tool that can generate recommendations according to the NHMRC colonoscopy guidelines was created. This improved the decision-making regarding the need for and timing of diagnostic, screening, or colonoscopy surveillance.
{"title":"Electronic Web-Based Colonoscopy Guidelines: Ease of use and improved compliance","authors":"Joseph C. H. Kong, D. Low, D. Wardill, D. Stupart, G. Guest, D. Watters","doi":"10.4103/WJCS.WJCS_37_18","DOIUrl":"https://doi.org/10.4103/WJCS.WJCS_37_18","url":null,"abstract":"Background and Objectives: There is an increasing demand for colonoscopy which tends to exceed service provision. To ensure appropriate referral for colonoscopy, the National Health and Medical Research Council (NHMRC) have developed comprehensive, evidence-based guidelines addressing screening and colonoscopy surveillance. However, some reports suggest that compliance with the guidelines is variable. This study was conducted to determine the compliance rates in our institution and to drive improved adherence to the national guidelines. Patients and Methods: This is a retrospective, observational study of all colonoscopies performed from July 2007 to June 2011. A decision support tool was specifically designed and made available via the World Wide Web. To assess the impact of the decision support tool, we measured compliance rates prospectively in January 2011 and January 2013. Results: Over the two periods of pre- and post-intervention, there were 103 and 98 patients referred to waiting lists for colonoscopy. Following introduction of the web-based decision support tool, the national colonoscopy guidelines compliance rate increased from 70.5% (103/146) to 87.5% (98/112). Critically, all patients who required colonoscopy surveillance had been appropriately listed excluding four patients (2.4%) who were missed before introducing the web-bed decision guide. Conclusion: Using currently available technology, a web-based colonoscopy decision support tool that can generate recommendations according to the NHMRC colonoscopy guidelines was created. This improved the decision-making regarding the need for and timing of diagnostic, screening, or colonoscopy surveillance.","PeriodicalId":90396,"journal":{"name":"World journal of colorectal surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43889306","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}
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