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BACKGROUND: Diversion colitis (DC) is a prevalent complication of colostomy characterized by intestinal inflammation. This study aimed to investigate the therapeutic potential of somatostatin (SST) in managing DC. METHODS: After establishing a rat DC model, SST was administered via Mini Osmotic Pumps 2001W at a pumping rate of 1.0 µL/h. Various techniques, including hematoxylin and eosin staining, periodic acid-Schiff staining, immunofluorescence staining, and electron microscopy were employed to assess the effects of SST. Intestinal barrier functions were evaluated using Evans blue, enzyme-linked immunosorbent assay, and MacConkey agar. RESULTS: After SST treatment, the significant weight loss and associated high mortality in the DC group were successfully mitigated. Upregulation of claudin-3 and claudin-4 restored mechanical barriers in colon epithelial tissue, whereas protection of goblet cells and stimulation of mucus secretion enhanced mucus barriers. SST effectively reduced leaky gut and alleviated systemic inflammation. CONCLUSION: This study provides initial evidence supporting the efficacy of SST in the treatment of DC. It offers insights into the role of SST in DC by elucidating its ability to restore damaged intestinal barriers.
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Colite , Colostomia , Animais , Ratos , Colostomia/efeitos adversos , Rios , Colite/tratamento farmacológico , Colite/cirurgia , Somatostatina/uso terapêutico , InflamaçãoRESUMO
INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory bowel disease of a multifactorial pathogenesis. Recently numerous genetic variants linked to an aggressive phenotype were identified, leading to a progress in therapeutic options, resulting in a decreased necessity for surgery. Nevertheless, surgery is often inevitable. The aim of the study was to evaluate possible risk factors for postoperative complications and disease recurrence specifically after colonic resections for CD. PATIENTS AND METHODS: A total of 241 patients who underwent colonic and ileocaecal resections for CD at our instiution between 2008 and 2018 were included. All data was extracted from clinical charts. RESULTS: Major complications occurred in 23.8% of all patients. Patients after colonic resections showed a significantly higher rate of major postoperative complications compared to patients after ICR (p = < 0.0001). The most common complications after colonic resections were postoperative bleeding (22.2%), the need for revision surgery (27.4%) and ICU (17.2%) or hospital readmission (15%). As risk factors for the latter, we identified time interval between admission and surgery (p = 0.015) and the duration of the surgery (p = 0.001). Isolated distal resections had a higher risk for revision surgery and a secondary stoma (p = 0.019). Within the total study population, previous bowel resections (p = 0.037) were identified as independent risk factors for major perioperative complications. CONCLUSION: The results indicate that both a complex surgical site and a complex surgical procedure lead to a higher perioperative morbidity in colonic resections for Crohn's colitis.
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Colite , Doença de Crohn , Humanos , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Doença de Crohn/patologia , Colectomia/efeitos adversos , Colectomia/métodos , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/epidemiologia , Colite/cirurgia , Colite/complicações , MorbidadeRESUMO
OBJECTIVE: We aim to present a novel technique for the treatment of neovaginal diversion colitis (also known as neovaginal colitis). CASE: OT is a 21-year-old cisgender female with a history of VACTERL who underwent a colonic vaginoplasty as an infant. She presented with symptoms indicative of and later diagnosed as neovaginal diversion colitis. The patient underwent a novel regimen of vaginal instillation of mesalamine followed by complete resolution of her symptoms. DISCUSSION: The following case study demonstrates a potentially effective treatment for cases of neovaginal diversion colitis.
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Colite , Procedimentos de Cirurgia Plástica , Humanos , Feminino , Adulto Jovem , Adulto , Mesalamina/uso terapêutico , Administração Intravaginal , Vagina/cirurgia , Colite/cirurgiaRESUMO
BACKGROUND: Despite major advances in the clinical treatment of inflammatory bowel disease, some patients still present with acute colitis and require emergency surgery. AIMS: To evaluate the risk factors for early postoperative complications in patients undergoing surgery for acute colitis in the era of biologic therapy. METHODS: Patients with inflammatory bowel disease admitted for acute colitis who underwent total colectomy at a single tertiary hospital from 2012 to 2022 were evaluated. Postoperative complications were graded according to Clavien-Dindo classification (CDC). Patients with more severe complications (CDC≥2) were compared with those with less severe complications (CDC<2). RESULTS: A total of 46 patients underwent surgery. The indications were: failure of clinical treatment (n=34), patients' or surgeon's preference (n=5), hemorrhage (n=3), toxic megacolon (n=2), and bowel perforation (n=2). There were eight reoperations, 60.9% of postoperative complications classified as CDC≥2, and three deaths. In univariate analyses, preoperative antibiotics use, ulcerative colitis diagnosis, lower albumin levels at admission, and preoperative hospital stay longer than seven days were associated with more severe postoperative complications. CONCLUSIONS: Emergency surgery for acute colitis was associated with a high incidence of postoperative complications. Preoperative use of antibiotics, ulcerative colitis, lower albumin levels at admission, and delaying surgery for more than seven days were associated with more severe early postoperative complications. The use of biologics was not associated with worse outcomes.
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Colite Ulcerativa , Colite , Doenças Inflamatórias Intestinais , Humanos , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Colite Ulcerativa/complicações , Estudos Retrospectivos , Colite/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Colectomia/efeitos adversos , Fatores de Risco , Terapia Biológica/efeitos adversos , Antibacterianos , AlbuminasRESUMO
BACKGROUND: Inflammatory bowel disease (IBD) patients are at increased risk of advanced neoplasia (high-grade dysplasia or colorectal cancer). The authors aimed to (1) assess synchronous and metachronous neoplasia following (sub)total or proctocolectomy, partial colectomy or endoscopic resection for advanced neoplasia in IBD, and (2) identify factors associated with treatment choice. MATERIAL AND METHODS: In this retrospective multicenter cohort study, the authors used the Dutch nationwide pathology databank (PALGA) to identify patients diagnosed with IBD and colonic advanced neoplasia (AN) between 1991 and 2020 in seven hospitals in the Netherlands. Logistic and Fine & Gray's subdistribution hazard models were used to assess adjusted subdistribution hazard ratios for metachronous neoplasia and associations with treatment choice. RESULTS: The authors included 189 patients (high-grade dysplasia n =81; colorectal cancer n =108). Patients were treated with proctocolectomy ( n =33), (sub)total colectomy ( n =45), partial colectomy ( n =56) and endoscopic resection ( n =38). Partial colectomy was more frequently performed in patients with limited disease and older age, with similar patient characteristics between Crohn's disease and ulcerative colitis. Synchronous neoplasia was found in 43 patients (25.0%; (sub)total or proctocolectomy n =22, partial colectomy n =8, endoscopic resection n =13). The authors found a metachronous neoplasia rate of 6.1, 11.5 and 13.7 per 100 patient-years after (sub)total colectomy, partial colectomy and endoscopic resection, respectively. Endoscopic resection, but not partial colectomy, was associated with an increased metachronous neoplasia risk (adjusted subdistribution hazard ratios 4.16, 95% CI 1.64-10.54, P <0.01) compared with (sub)total colectomy. CONCLUSION: After confounder adjustment, partial colectomy yielded a similar metachronous neoplasia risk compared to (sub)total colectomy. High metachronous neoplasia rates after endoscopic resection underline the importance of strict subsequent endoscopic surveillance.
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Colite Ulcerativa , Colite , Neoplasias do Colo , Neoplasias Colorretais , Doenças Inflamatórias Intestinais , Humanos , Estudos de Coortes , Colonoscopia , Neoplasias Colorretais/patologia , Colite/etiologia , Colite/patologia , Colite/cirurgia , Colite Ulcerativa/cirurgia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/patologia , Doenças Inflamatórias Intestinais/cirurgia , Neoplasias do Colo/cirurgia , Colectomia/efeitos adversos , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Background and Objectives: Colitis with Clostridium difficile is an important health problem that occurs with an intensity that varies between mild and severe. Surgical interventions are required only in fulminant forms. There is little evidence regarding the best surgical intervention in these cases. Materials and Methods: Patients with C. difficile infection were identified from the two surgery clinics from the 'Saint Spiridon' Emergency Hospital IaÈi, Romania. Data regarding the presentation, indication for surgery, antibiotic therapy, type of toxins, and post-operative outcomes were collected over a 3-year period. Results: From a total of 12,432 patients admitted for emergency or elective surgery, 140 (1.12%) were diagnosed with C. difficile infection. The mortality rate was 14% (20 cases). Non-survivors had higher rates of lower-limb amputations, bowel resections, hepatectomy, and splenectomy. Additional surgery was necessary in 2.8% of cases because of the complications of C. difficile colitis. In three cases, terminal colostomy was performed and as well as one case with subtotal colectomy with ileostomy. All patients who required the second surgery died within the 30-day mortality period. Conclusions: In our prospective study, the incidence was increased both in cases of patients with interventions on the colon and in those requiring limb amputations. Surgical interventions are rarely required in patients with C. difficile colitis.
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Clostridioides difficile , Infecções por Clostridium , Colite , Enterocolite Pseudomembranosa , Humanos , Estudos Prospectivos , Romênia/epidemiologia , Estudos Retrospectivos , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/cirurgia , Infecções por Clostridium/diagnóstico , Enterocolite Pseudomembranosa/epidemiologia , Enterocolite Pseudomembranosa/cirurgia , Enterocolite Pseudomembranosa/complicações , Colite/complicações , Colite/cirurgiaRESUMO
BACKGROUND: This study aims to review and summarize the current up to date literature that explore the current treatment approaches to immune mediated colitis and the role of surgical specialties in the landscape of management. METHODS: A narrative review of papers was performed following a literature search through Medline, EMBASE and Cochrane Central databases pertaining to immune mediated colitis as an adverse event of cancer immunotherapy. RESULTS: Current guidelines for the diagnosis and treatment of immune mediated colitis mirror the approach to the workup of inflammatory bowel disease and guided by treating oncology and gastroenterology specialties. Immune mediated colitis however relies on surgical specific skills as a consequence of obtaining a diagnosis as well as in the management of complications that may arise. CONCLUSION: Immune mediate colitis management has largely been under the purview of medical specialties. This review explores the current landscape of managing immune mediated colitis from a surgical perspective and highlights key areas in which surgeons can engage in the multidisciplinary care of this condition. To facilitate prompt diagnosis and management of immune-mediated colitis, there is an increasing necessity for surgeons to become familiar with the latest multidisciplinary approaches and recommendations.
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Colite , Doenças Inflamatórias Intestinais , Humanos , Anticorpos Monoclonais/efeitos adversos , Colite/diagnóstico , Colite/etiologia , Colite/cirurgia , Doenças Inflamatórias Intestinais/cirurgiaRESUMO
BACKGROUND: When surgery is indicated for fulminant Clostridioides difficile infection (CDI), total abdominal colectomy (TAC) is the most common approach. Diverting loop ileostomy (DLI) with antegrade colonic lavage has been introduced as a colon-sparing surgical approach. Prior analyses of National Inpatient Sample (NIS) data suggested equivalent postoperative outcomes between groups but did not evaluate healthcare resource utilization. As such, we aimed to analyze a more recent NIS cohort to compare these two approaches in terms of both postoperative outcomes and healthcare resource utilization. METHODS: A retrospective analysis of the NIS from 2016 to 2019 was conducted. The primary outcome was postoperative in-hospital morbidity. Secondary outcomes included postoperative in-hospital mortality, system-specific postoperative complications, total admission cost, and length of stay (LOS). Univariable and multivariable regressions were utilized to compare the two operative approaches. RESULTS: In total, 886 patients underwent TAC and 409 patients underwent DLI with antegrade colonic lavage. Adjusted analyses demonstrated no difference between groups in postoperative in-hospital morbidity (aOR 0.96, 95%CI 0.64-1.44, p = 0.851) or in-hospital mortality (aOR 1.15, 95%CI 0.81-1.64, p = 0.436). Patients undergoing TAC experienced significantly decreased total admission cost (MD $79,715.34, 95%CI 133,841-25,588, p = 0.004) and shorter postoperative LOS (MD 4.06 days, 95%CI 6.96-1.15, p = 0.006). CONCLUSIONS: There are minimal differences between TAC and DLI with antegrade colonic lavage for fulminant CDI in terms of postoperative morbidity and mortality. Healthcare resource utilization, however, is significantly improved when patients undergo TAC as evidenced by clinically important decreases in total admission cost and postoperative LOS.
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Infecções por Clostridium , Colite , Humanos , Clostridioides , Pacientes Internados , Ileostomia , Irrigação Terapêutica , Estudos Retrospectivos , Colectomia , Colite/cirurgia , Infecções por Clostridium/cirurgia , Complicações Pós-Operatórias/cirurgiaRESUMO
BACKGROUND AND AIMS: High-dose glucocorticoid treatment has been identified as a risk factor for anastomotic leakage in patients with inflammatory bowel disease [IBD] undergoing bowel resection surgery. By contrast, active disease during surgery is also associated with elevated morbidity. Perioperative low-dose treatment might be beneficial regarding postoperative outcomes by controlling disease activity. The present study is the first to investigate the dose-dependent effect of perioperative prednisolone therapy in a murine IBD model combining dextran sodium sulphate [DSS] colitis with intestinal anastomosis surgery. METHODS: In 84 10-week-old wild-type mice, a colorectal anastomosis was performed using a microsurgical technique. Half the animals received induction of chemical colitis with 2% DSS via drinking water prior to surgery. In both groups, one-third of the animals received daily oral administration of high-dose [0.533 mg/kg] and one-third low-dose [0.133 mg/kg] prednisolone. Evaluation was performed on postoperative days 3 and 7. RESULTS: While high-dose prednisolone treatment led to an increased anastomotic leakage rate in mice under colitis, low-dose prednisolone treatment limited preoperative disease activity and did not influence the leakage rate. Histological examination showed a beneficial effect of low-dose prednisolone treatment on microscopic abscess formation at the anastomotic site in DSS mice as well as an increased anastomotic healing score. CONCLUSIONS: We demonstrate a beneficial effect of perioperative short-term low-dose prednisolone treatment on intestinal anastomotic healing in the context of colitis. Perioperative use of short-term low-dose prednisolone treatment might be beneficial in IBD patients who need to undergo surgery during active disease.
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Colite , Doenças Inflamatórias Intestinais , Camundongos , Animais , Prednisolona/uso terapêutico , Fístula Anastomótica/tratamento farmacológico , Fístula Anastomótica/etiologia , Anastomose Cirúrgica/efeitos adversos , Colite/induzido quimicamente , Colite/tratamento farmacológico , Colite/cirurgia , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/cirurgia , Doenças Inflamatórias Intestinais/complicaçõesRESUMO
A 20-year-old woman with previous COVID-19 diagnosis presented with abdominal pain and colitis on CT scan. She was admitted in septic shock, with etiology of colitis unclear. After resuscitation, antibiotics, and steroids, she clinically deteriorated. Worsening Clostridioides difficile infection was most likely and she was taken to the operating room. Intraoperatively, only a segment of transverse colon appeared abnormal on gross and endoscopic evaluation. Total colectomy was deferred in favor of segmental resection. Given her unusual disease pattern and recent COVID-19 infection, diagnosis of MIS-C was considered. Steroids were continued and treatment broadened to include heparin and IVIG. The patient returned to the operating room for planned reexploration, endoscopy, and end colostomy. On hospital day three, the patient had an acute mental status change. Computed tomography demonstrated acute cerebral edema with brainstem herniation. The family chose comfort-care measures. Final pathology from the transverse colon demonstrated COVID-19-associated vasculitis.
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COVID-19 , Colite , Colo Transverso , Humanos , Feminino , Adulto Jovem , Adulto , Teste para COVID-19 , Colite/diagnóstico , Colite/cirurgia , ColectomiaRESUMO
Colitis cystica profunda is a rare and benign lesion characterized by mucus-containing cysts under the mucosa of the colon and rectum. We report a patient with localized colitis cystica profunda of the rectum diagnosed by endoscopic submucosal dissection. Although colitis cystica profunda is benign, it is sometimes indistinguishable from other malignant lesions. So early excision and biopsy make sense.
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Colite , Doenças do Colo , Cistos , Ressecção Endoscópica de Mucosa , Humanos , Reto/diagnóstico por imagem , Reto/cirurgia , Reto/patologia , Colite/diagnóstico por imagem , Colite/cirurgia , Cistos/diagnóstico por imagem , Cistos/cirurgia , Doenças do Colo/patologiaRESUMO
We highlight the key diagnostic features of solitary rectal ulcer syndrome coexisting with colitis cysticaprofunda in order to increase awareness of the postoperative recurrence of the diseases.
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Colite , Doenças do Colo , Doenças Retais , Humanos , Úlcera/complicações , Úlcera/cirurgia , Doenças Retais/complicações , Doenças Retais/cirurgia , Colite/complicações , Colite/cirurgia , Reto/cirurgiaRESUMO
A 16-year-old Quarter Horse was examined and observed to have acute signs of colic, pyrexia, and diarrhea. A nephrosplenic entrapment was detected via rectal palpation and confirmed with abdominal ultrasound. The nephrosplenic entrapment was resolved non-surgically with jogging and anti-inflammatory medication. Concurrent colitis, toxic laminitis, and inappetence were managed and the horse made a full recovery.
Correction non chirurgicale d'emprisonnement néphro-splénique et de la colite chez un Quarter Horse. Un Quarter Horse âgé de 16 ans a été examiné et on a observé des signes aigus de coliques, de pyrexie et de diarrhée. Un piégeage néphro-splénique a été détecté par palpation rectale et confirmé par échographie abdominale. L'emprisonnement néphro-splénique a été résolu de manière non chirurgicale avec du jogging et des médicaments anti-inflammatoires. La colite concomitante, la fourbure toxique et l'inappétence ont été gérées et le cheval s'est complètement rétabli.(Traduit par Dr Serge Messier).
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Colite , Dermatite , Doenças dos Cavalos , Cavalos , Animais , Colite/cirurgia , Colite/veterinária , Dermatite/veterinária , Diarreia/veterinária , Febre/veterinária , Doenças dos Cavalos/terapiaRESUMO
This article reviews the latest data concerning the use of advanced therapeutic techniques for endoscopically treating colitis-associated neoplastic lesions and discusses factors associated with improved outcomes.
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Colite , Neoplasias Colorretais , Ressecção Endoscópica de Mucosa , Colite/complicações , Colite/cirurgia , Neoplasias Colorretais/etiologia , Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Endoscopia , HumanosRESUMO
INTRODUCTION: Patients with variants in the GNAO1 gene may present with life-threatening dystonic storm. There is little experience using pallidal deep brain stimulation (DBS) as an emergency treatment in such cases. CASE DESCRIPTION: We report on a 16-year-old girl with a variant in the GNAO1 gene (c.626G > T; p.(Arg209Leu)) who was admitted to the intensive care unit with medically refractory dystonic storm with secondary complications inducing rhabdomyolysis and acute colitis. Emergency pallidal DBS resulted in rapid improvement of dystonic storm and the subsidence of rhabdomyolysis and colitis. There were no further episodes of dystonic storm during follow-up of 2 years. CONCLUSION: Pallidal DBS is a useful treatment option for GNAO1-related dystonic storm with secondary complications which can be performed as an emergency surgery.
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Colite , Estimulação Encefálica Profunda , Distúrbios Distônicos , Rabdomiólise , Adolescente , Colite/complicações , Colite/cirurgia , Estimulação Encefálica Profunda/métodos , Distúrbios Distônicos/terapia , Feminino , Subunidades alfa Gi-Go de Proteínas de Ligação ao GTP/genética , Globo Pálido , Humanos , Rabdomiólise/complicações , Resultado do TratamentoRESUMO
PURPOSE: Obstructive colitis (OC) is a risk factor of anastomotic leakage in colorectal cancer resection. We aimed to clarify the relationship between the severity of OC and clinicopathological findings and to detect predictive factors of OC. METHODS: We retrospectively reviewed 43 cases of colectomy after self-expandable metallic stent placement for left-sided colorectal cancer. Preoperative diagnosis of OC was made by multiple modalities (initial computed tomography (CT), presurgical CT, and colonoscopy). We classified OC macroscopically in resected specimens into five groups (Grade 0: none, 1: mild [mild edema], 2: moderate [severe edema, redness, erosion], 3: severe [ulceration, bleeding], 4: very severe [necrosis, perforation]), and investigated the relationship between the preoperative assessment, surgical findings and the severity of OC. RESULTS: OC of Grade 2 or more (53.5%) was significantly correlated with severe edema in initial CT. There was no significant correlation between OC and anastomosis rate. The creation of covering stoma was significantly higher in the Grade 2 or more OC group. No leakage was observed in either group. CONCLUSIONS: Initial CT may be most useful for prediction of OC. It is important to make a preoperative diagnosis of OC by combining multiple modalities, which enables to determine the appropriate location for resection, anastomosis, and construction of a covering stoma.
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Colite , Neoplasias Colorretais , Obstrução Intestinal , Stents Metálicos Autoexpansíveis , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Estudos Retrospectivos , Neoplasias Colorretais/complicações , Neoplasias Colorretais/cirurgia , Colite/diagnóstico por imagem , Colite/cirurgia , Edema , Resultado do Tratamento , Stents/efeitos adversosRESUMO
BACKGROUND: We aimed to compare outcomes of surgical treatments of toxic colitis (infectious/inflammatory/ischemic) by the extent of colectomy (partial vs total colectomy) and different surgical approaches (minimally invasive surgery (MIS) vs open). METHODS: Multivariate analysis using logistic regression was used to investigate outcomes of patients with toxic colitis who underwent emergent colectomy during 2012-2019 by surgical approach and the extent of resection using NSQIP database. RESULTS: Overall, 2,104 adult patients underwent emergent colectomy for toxic colitis within NSQIP database during 2012-2019. Overall, 1,578 (75.4%) underwent total colectomy with colostomy, 486 (23.2%) underwent partial colectomy with colostomy, and 28 (1.3%) underwent partial colectomy with anastomosis. Overall, 198 (9.4%) of procedures were minimally invasive (MIS) with a 40.1% conversion rate to open. Thirty days mortality and morbidity of the patients were 31 and 86%, respectively. There was no significant difference in mortality of partial colectomy without anastomosis compared to total colectomy (P = .86) and partial colectomy with anastomosis (P = .64). Anastomosis was associated with 32.3% anastomosis leakage and 17.9% reoperation. MIS approach was associated with significant decrease in mortality (8.6 vs 33.3%, AOR: .35, P < .01) and morbidity (62.9 vs 87.8%, AOR: .49, P < .01) of patients. CONCLUSION: Patients with toxic colitis undergoing surgical treatment have high mortality and morbidity. An MIS approach when possible is significantly associated with decreased morbidity and mortality of patients. There was no significant difference in outcomes seen when extending the resection in multivariate analysis. Anastomosis is associated with a high anastomosis leakage and need for reoperation risk.