Surgical features to reduce anastomotic recurrence of Crohn's disease that requires reoperation: a systematic review.

Anastomotic recurrence after intestinal resection is one of the main embarrassing problems encountered during Crohn's disease (CD) management. This complication is often associated with an expected consequence, mainly a multiple intestinal resection. This systematic review evaluates published evidence on surgical features to reduce surgical recurrence after bowel resection and provide surgeons with recommendations based on published evidence. We conducted bibliographic research on September 05, 2020, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis, randomized clinical trials, and controlled clinical trials. The strength of clinical data and subsequent recommendations were graded according to the Oxford Centre for Evidence-Based Medicine. Fourteen articles were retained. Early resection reduces surgical relapse and the need for additional medical treatment. There was no difference between conventional and laparoscopic bowel resection. Mesenteric excision seems to reduce surgical recurrence. Stapled side-to-side anastomosis reduces surgical recurrence. However, no difference was observed between Kono-S anastomosis ensure at least similar anastomotic recurrence rate compared to conventional anastomosis. Surgical recurrence was reduced after bowel resection when compared to stricturoplasty. There was no difference between the one and two steps resection. Several surgical features have been investigated. Some of them were unanimously found to be effective in lengthening the disease-free relapse. However, others are still controversial.

Hydatid peritonitis caused by liver hydatid cyst rupture into the peritoneal cavity: A case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease predominantly affects the liver and poses a global health concern in regions with significant livestock presence. Hydatid peritonitis, a rare complication, arises when a liver hydatid cyst ruptures into the peritoneal cavity, posing a potential threat to the patient's life. CASE PRESENTATION: We present a case of a 45-year-old female with abdominal distension, tenderness, and altered general status following an abdominal contusion. Imaging revealed ruptured hydatid cysts in the liver, causing complicated hydatid peritonitis. Emergency laparotomy and various surgical procedures, including cyst evacuation, cholecystectomy, and drainage placement, were performed. The patient's postoperative recovery was uneventful with albendazole therapy. CLINICAL DISCUSSION: Rupture of liver hydatid cysts into the peritoneal cavity is a rare but serious complication, affecting 1 % to 16 % of cases. Factors contributing to rupture include young age, cyst diameter exceeding 10 cm, and superficial lesion location. Clinical presentation varies, and prompt diagnosis through imaging, such as CT scans, is crucial. Surgical intervention is the primary management, focusing on cyst removal, prevention of anaphylactic shock, and peritoneal lavage with scolicidal solutions. CONCLUSION: The rupture of liver hydatid cysts into the peritoneal cavity is a rare but potentially life-threatening complication. Early diagnosis and emergent surgical intervention are critical for improved outcomes. Postoperative albendazole treatment and close follow-up contribute to reducing recurrence risk. Public health measures, including hygiene practices and canine vaccination, play a crucial role in preventing the spread of hydatid disease. Early detection and intervention can mitigate complications and enhance outcomes in hydatid disease cases.

A case report of idiopathic sclerosing encapsulating peritonitis causing an acute bowel occlusion in adult.

INTRODUCTION: Sclerosing peritonitis (SP), also known as abdominal cocoon, is a and potentially serious condition characterised by the fibrous encapsulation of the small intestine within the peritoneal cavity. CASE PRESENTATION: In this report, we detail the case of a 67-year-old male with SP who initially presented with symptoms of constipation, vomiting, and abdominal pain. Despite a previous computed tomography (CT) scan revealing ileal thickening, the accurate diagnosis remained elusive until exploratory laparotomy. The patient underwent successful excision of the thick fibro-collagenous membrane, and histopathological examination revealed fibro-collagenous tissue with mild chronic inflammation. DISCUSSION: SP can be classified into primary (idiopathic) and secondary forms. Primary SP, also referred to as cocoon abdomen, is more common in young females from tropical regions, while secondary SP is associated with peritoneal dialysis and other causative factors. Diagnosing SP presents challenges, as clinical symptoms may mimic those of other conditions. Imaging studies, especially CT scans, play a crucial role in the diagnostic process, yet the rarity of SP often leads to misdiagnosis. Although there is no consensus on treatment options, surgical intervention is generally recommended for symptomatic cases, involving excision of the cocoon and adhesiolysis. Conservative management may be considered for asymptomatic cases. The mortality rate for SP is high, emphasizing the importance of early diagnosis and intervention. CONCLUSION: Primary sclerosing encapsulating peritonitis is a and complex, primarily affecting young individuals. Maintaining a high index of suspicion is crucial for an accurate diagnosis, and surgical intervention remains the primary treatment for symptomatic cases. The prognosis is generally favourable with timely and appropriate management.

Ileocecal colonic intussusception with adenocarcinoma: A rare case report and management strategy.

INTRODUCTION AND IMPORTANCE: Intussusception, a condition primarily seen in pediatric populations, involves the telescoping of one segment of the bowel into an adjacent section. In adults, intussusception is rare and presents unique diagnostic and management challenges. This case report highlights a 73-year-old female with ileocecal colonic intussusception complicated by an underlying adenocarcinoma, emphasizing the need for early diagnosis and a multidisciplinary approach. CASE PRESENTATION: A 73-year-old female with a history of hypertension and type 2 diabetes presented with right-sided abdominal pain, nausea, and vomiting. Physical examination revealed tenderness in the right upper quadrant, and no palpable mass or rectal bleeding. Lab results, including tumour markers, were normal. Multi-detector computed tomography (MDCT) identified ileocecal colonic intussusception with the "target sign" and low colonic wall enhancement. An emergency laparoscopic right colectomy was performed due to compromised blood supply. Postoperatively, an anastomotic leak was managed with antibiotics, bowel rest, and wound care. Pathological examination revealed cecal adenocarcinoma with one positive lymph node, staged as T3N1aM0, necessitating adjuvant chemotherapy. CLINICAL DISCUSSION: Adult intussusception, a rare condition, often has an identifiable organic cause, with clinical symptoms ranging from acute to chronic or asymptomatic. Diagnostic imaging, such as MDCT, plays a crucial role in diagnosis and evaluation. Surgical management varies based on the nature and location of the lead point. In this case, the chronic symptoms, lymph node as the lead point, and low colonic wall enhancement warranted an urgent laparoscopic right colectomy with complete mesocolic excision. CONCLUSION: This case underscores the complexity of adult ileocecal colonic intussusception, especially when associated with adenocarcinoma. Timely diagnosis, multidisciplinary collaboration, and meticulous surgical intervention are essential. Effective management of postoperative complications, like the anastomotic leak, is crucial.