فهرست مطالب

Colorectal Research - Volume:6 Issue: 4, Dec 2018

Iranian Journal of Colorectal Research
Volume:6 Issue: 4, Dec 2018

  • تاریخ انتشار: 1397/10/01
  • تعداد عناوین: 8
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  • Mahmoud Aghaei, Afshar , Farzaneh Mahmoudikordi , Mohammad Rezazadehkermani * Page 1
    Preoperative bowel preparation was previously strictly done for all patient undergoing colorectal surgeries. With advances in the surgical techniques and patient care, the role of bowel preparation in surgical complications is questioned. In this study we describe a non-randomized retrospective analysis of 193 patients who underwent left colon and rectal resections in two different hospitals, the preoperative bowel preparation regimens were different in two hospitals. Both regimens contain mechanical preparation with polyethylene glycol, however, one hospital administered erythromycin and neomycin and the other hospital did not. From 74 patients receiving oral antibiotic eight (10.8%) one developed wound infection and from 119 patients who did not receive oral antibiotic three (2.5%) patient developed wound infection. This difference was statistically significant. Regarding literature review, it is suggested to omit oral antibiotic from preoperative bowel preparation regimens elective colorectal resections.
    Keywords: Neomycin, Erythromycin, Colectomy, Infection
  • Ashwin Rammohan * Page 2
    Improved results following liver transplantation (LT) over the past 20 years have led clinicians to push boundaries and expand its indications. LT in non-resectable colorectal liver metastases (NCRLM) is being revisited with an aim to radically improve survival. By utilizing new tools for preoperative patient selection, modern operative techniques for LT and an aggressive attitude against metastases, long-term survival, and even cure could be expected. This paper reviews the current status of liver transplantation for NCRLM with an eye on the future.
    Keywords: Non-Resectable Colorectal Liver Metastases, Liver Transplantation, Review
  • Francesco Ferrara*, Paolo Rigamonti , Giovanni Damiani , Maurizio Cariati , Marco Stella Page 3
    Introduction
    Procedure for prolapsed hemorrhoids (PPH) or hemorrhoidopexy is not free from complications, some of which have been described as serious, such as bleeding. This study describes a case of a female patient with post-operative huge pelvic hematoma, successfully treated with percutaneous angioembolization.
    Case Presentation
    A 76-year-old female underwent PPH, with no intraoperative complications. Few hours later, the patient showed signs of acute abdomen. No external rectal bleeding was identified and vital signs were normal. A computerized tomography (CT)-scan showed a giant peri-rectal and retroperitoneal pelvic hematoma, with signs of active bleeding. A subsequent selective arteriography showed huge bleeding from superior hemorrhoidal artery, treated with super-selective embolization. The procedure was successful and the patient showed a symptomatic improvement. The subsequent hospital stay was uneventful and she was discharged on the ninth post-operative day, with no complications. At the 30-day post-discharge follow-up, the patient was completely pain free with no signs of pelvic discomfort. Control CT scan revealed regression of the pelvic hematoma.
    Conclusions
    Severe complications may occur after PPH and one of the most important is local bleeding. In the current case, no signs of external active bleeding were noted. Prompt diagnosis with CT scan allowed efficacious non-operative treatment with angioembolization, avoiding the need of reoperation for a potential serious complication.
    Keywords: Hemorrhoidopexy, PPH, Bleeding, Hematoma, Angioembolization
  • Halim Bou Daher _Ala I Sharara * Page 4
    Colonoscopy is the preferred method for colorectal cancer screening. However, despite significant advances, the examination remains subject to limitations and variability amongst different practitioners. This calls for the need for objective quality indicators to ensure the optimal use of the modality. Three major priority quality measures have been identified that include adenoma detection rate (ADR), cecal intubation, and adherence to surveillance guidelines. ADR is the best-studied metric correlating with outcomes including post-colonoscopy colon cancer, but has inherent limitations such as the potential for corruptibility. Other important quality indicators include the quality of bowel preparation and colonoscopy withdrawal time. All these quality measures are interrelated and an improvement in any of them would help in increasing the power of colonoscopy as a screening tool, as well as decreasing its economic burden and potentially improving adherence to screening guidelines.
    Keywords: Colonoscopy, Quality Indicator, Quality Metrics, Quality, Screening, Colorectal Cancer, Polyps
  • Nitin Rangrao Gaikwad*, Sudhir Jagdishprasad Gupta , Kirti Jaiswal Page 5
    An osseous metaplasia in colonic tissue is extremely rare. The current report presents a case of osseous metaplasia in a hamartomatous rectal polyp in a four-year-old boy, who presented with intermittent rectal bleeding. Though this condition has minimum adverse effects on the prognosis of the patient, awareness of this rare histological variant is of utmost importance.
    Keywords: Polyp, Metaplasia, Histopathology
  • Evaluation and Management of Intractable Constipation in Children
    Lusine Ambartsumyan, Leonel Rodriguez* Page 6

    Intractable constipation has a negative impact on quality of life and well-being of children. The evaluation includes a thorough history and physical examination with diagnostic testing to rule out metabolic, systemic, anatomic, and neurological etiologies. In children with refractory symptoms who failed aggressive medical management, colonic transit studies help guide need for invasive testing. Manometric testing of the anorectum and the colon are recommended to evaluate for enteric neuromuscular compromise and guide novel medical and surgical therapies. Goals of management are to facilitate colonic emptying, ensure fecal continence, and preserve colonic neuromuscular integrity. Treatments range from aggressive medical therapy with stimulant laxatives that modify transit to antegrade continence enemas that facilitate colonic emptying. Surgery, including diverting ostomy and resection, has a limited role and should only be considered in select patients after medical and manometric evaluation. The aim of this article is to provide an update on the evaluation and management of childhood intractable constipation.

    Keywords: Constipation, Children, Refractory
  • Strangulated Small Bowel Obstruction in Paracecal Hernia and Laparoscopic Approach: A Case Report and Review of Literature
    Stefano Mandalà *, Antonino Mirabella , Massimo Lupo , Massimo Branca , Camillo La Barbera , Carlo Szokoll, Vincenzo Mandalà Page 7

    Internal hernia (IH) is an infrequent cause of small bowel obstruction, and paracecal hernia (PH) is very rare. The etiology is related to congenital or acquired causes. The current report was on the case of a 67-year-old male admitted to surgical emergency department for a small bowel obstruction due to a PH. The patient was taken to theatre and underwent a laparoscopic-assisted procedure of small bowel resection for strangulation. The postoperative course was uneventful. As demonstrated in literature, the most important diagnostic tool is contrast-enhanced computed tomography (CT) (when possible with reformatted images). Early diagnosis and prompt surgical intervention is paramount to achieve a good outcome. Laparoscopic approach seems to have an interesting role in such conditions. A further review of literature was performed to highlight the current “state of art” in diagnostic and therapeutic management, especially with regard to laparoscopic approach, of this rare disease.

    Keywords: Paracecal Hernia, Internal Hernia, Small Bowel Obstruction, Strangulation, Laparoscopy
  • EndoTHeF: Endoluminal Treatment of Hemorrhoids with Foam
    Maurizio Ronconi , Silvia Casiraghi *, Mattia Schieppati Page 8
    Background

    Hemorrhoids are normal anatomical structures, present in individuals from birth and recognisable even in intrauterine life. When we talk about haemorrhoids in actual fact we refer to the symptoms caused by haemorrhoids. Currently surgery is considered the gold standard in the treatment of hemorrhoids.

    Objectives

    In our work we propose the application of an alternative, outpatient and painless treatment of hemorrhoids using intraluminal injection of sclerosing foam (EndoTHeF), demonstrating the safety and feseability of this procedure.

    Methods

    We enrolled 615 patients from may 2008 to september 2018 with proctorragy from second and third degree hemorrhoids. Regular 3-week control examinations for all patients were scheduled. A total of 1427 procedures were carried out, with an average of 2.32 sessions per patient.

    Results

    Four hundred seventy six patients were available for follow-up, which lasted on average 12 months. In 83% of the cases proctorragy disappeared as early as after the first session. The analysis of a validity score concerning bleeding, pain level and sense of discomfort reported by patients showed a statistically significant difference (P < 0.0015) between before and after procedure.

    Conclusions

    Hemorrhoidal endosclerosis with foam seems to be an effective and safe method to cure hemorrhoidal pathologies and seems to offer good results in the short-middle term with acceptable results in terms of patient comfort and overall cost to society.

    Keywords: Hemorrhoids, Foam, Endovascular, Sclerosis, Endoscopy, Mininvasive, Outpatient