RESUMO
PURPOSE: Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease. METHODS: We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. RESULTS: After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). CONCLUSION: Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
Assuntos
Doenças do Ânus , Doença de Crohn , Estomas Cirúrgicos , Humanos , Doença de Crohn/cirurgia , Doença de Crohn/complicações , Doenças do Ânus/complicações , Doenças do Ânus/cirurgia , Estudos Retrospectivos , Estomas Cirúrgicos/efeitos adversos , Ileostomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaRESUMO
The clinical course of 104 patients with ulcerative colitis who underwent primary surgery at ≥70 years was retrospectively examined. Pre- and postoperative patient conditions determined the choice of surgical procedure. Approximately half of the patients underwent restorative proctocolectomy, resulting in relatively good defecation function. In addition, the long-term outcomes of patients who underwent permanent ileostomy were favorable. However, the postoperative complication and mortality rates were high in all patients, including those with low preoperative performance status due to long-term hospitalization. In this patient population, surgery should be conducted before decreased performance status due to long-term hospitalization.
Assuntos
Colite Ulcerativa , Proctocolectomia Restauradora , Humanos , Idoso , Idoso de 80 Anos ou mais , Colite Ulcerativa/complicações , Estudos Retrospectivos , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Ileostomia/efeitos adversos , Resultado do TratamentoRESUMO
A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ileoanal canal anastomosis, and ileostomy were performed on the patient. Soon after the surgery, his platelet count and coagulability improved, and he recovered from DIC. Thus, when the cause of DIC is probably UC itself, and medical treatment has limited efficacy in improving the DIC, surgery should be performed as soon as possible to eliminate the cause of DIC, considering the general condition of the patient.
Assuntos
Colite Ulcerativa , Coagulação Intravascular Disseminada , Proctocolectomia Restauradora , Masculino , Humanos , Pessoa de Meia-Idade , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Coagulação Intravascular Disseminada/complicações , Coagulação Intravascular Disseminada/cirurgia , Proctocolectomia Restauradora/efeitos adversos , Anastomose Cirúrgica/efeitos adversosRESUMO
PURPOSE: Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion. METHODS: This was a retrospective study based on medical records of patients diagnosed with Crohn's disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen's Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure. RESULTS: Among 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. CONCLUSION: Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.
Assuntos
Neoplasias do Ânus , Doença de Crohn , Neoplasias Retais , Neoplasias do Ânus/cirurgia , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Humanos , Prognóstico , Neoplasias Retais/cirurgia , Estudos RetrospectivosRESUMO
The patient was a 46-year-old woman with a history of Crohn's disease for several years. At 45 years of age, a colonoscopy was performed, and a protruding lesion in the terminal ileum was detected. Pathological analysis of a biopsy specimen noted high suspicion for a well differentiated adenocarcinoma. The patient underwent ileocecal resection, and histological examination of the specimen revealed that infiltration of the well differentiated adenocarcinoma was limited to the mucosa. To the best of our knowledge, this is the first known case of early small intestinal cancer associated with Crohn's disease in Japan. Both endoscopy and a biopsy of any protruding lesions may be useful for making a preoperative diagnosis of small intestinal cancer associated with Crohn's disease.
Assuntos
Doença de Crohn , Neoplasias Duodenais , Neoplasias do Íleo , Doença de Crohn/complicações , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Feminino , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/cirurgia , Intestino Delgado , Japão , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: A few studies have focused on pregnancy and childbirth in patients with Crohn's disease (CD) who had a history of abdominal surgery. The objective of this study is to analyze the problems of pregnant patients with CD with a history of abdominal surgery. METHODS: The rates of pregnancy-related complications and adverse birth outcomes were retrospectively analyzed in 29 patients with CD (45 pregnancies) with previous intestinal surgery. RESULTS: In this study, the following outcomes were observed:normal births occurred in 55.6% of the pregnancies, preterm births in 13.3%, and spontaneous abortions in 20.0%. The vaginal birth and cesarean section rates were 45.7% and 40.0%, respectively. The rate of low-birth weight infants was 14.3%. CONCLUSION: Overall, patients with CD with previous abdominal surgery can conceive and give birth. However, care needs to be taken to avoid preterm birth, spontaneous abortion, low birth weight, and cesarean delivery.
Assuntos
Doença de Crohn , Complicações na Gravidez , Nascimento Prematuro , Cesárea/efeitos adversos , Doença de Crohn/cirurgia , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/cirurgia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos RetrospectivosRESUMO
We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent abdominoperineal resection for anorectal stenosis, complex anal fistula, and rectovaginal fistula in her early twenties. Seven years later, she got pregnant and gave birth to a healthy boy by vaginal delivery. No recurrence of Crohn's disease was observed during the perinatal period. There is no curative treatment for severe anorectal complications, which may be necessary for young patients to undergo abdominoperineal resection. Further studies are needed to determine the effects of Crohn's disease with anorectal complications on pregnancy and childbirth in affected patients.
Assuntos
Doença de Crohn , Protectomia , Fístula Retal , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Parto Obstétrico , Feminino , Humanos , Masculino , Gravidez , Recidiva , Resultado do TratamentoRESUMO
A case of ulcerative colitis (UC) with an internal fistula was reported;the patient, a 42-year-old male, was admitted to the hospital with a diagnosis of refractory UC. The preoperative examination revealed an internal fistula between the transverse colon and the stomach. UC was diagnosed preoperatively with an internal fistula, but the possibility of Crohn's disease could not be ruled out at that time. The patient underwent subtotal colectomy with end ileostomy, sigmoid colon mucous fistula, and partial gastrectomy. UC was diagnosed histopathologically, and an ileal pouch-anal anastomosis was performed. An internal fistula can complicate UC;a split surgery is recommended with the possibility of Crohn's disease in the patient.
Assuntos
Colite Ulcerativa , Fístula , Proctocolectomia Restauradora , Adulto , Colo Transverso , Humanos , Masculino , Estômago , Resultado do TratamentoRESUMO
The patient is 36-year-old woman who complained of proptosis and was diagnosed as thyroid cancer. The pathologic diagnosis of her resected specimen was papillary thyroid cancer, cribriform morular variant (CMV). Subsequently, she was suspected of having familial adenomatous polyposis (FAP), although she had no family history of it. The diagnosis of FAP was confirmed following colonoscopy, which showed multiple polyps, and the biopsies that revealed multiple adenomas and cancers with APC gene mutation. She underwent restorative proctocolectomy, rectal mucosectomy with ileal pouch anal anastomosis, and ileostomy in our department. Cancer in the adenomas was found in four polyps on histopathological examination. CMV is known to be complicated with FAP. However, the number of reported cases remains few. This case was relatively rare, with an initial diagnosis of FAP because of the coexistence of CMV. In patients with papillary thyroid cancer (CMV type), colonoscopy should be considered because of the possibility of FAP.
Assuntos
Adenoma , Polipose Adenomatosa do Colo/cirurgia , Proctocolectomia Restauradora , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Feminino , HumanosRESUMO
An 86-year-old woman was diagnosed with ulcerative colitis (UC) in the 1970s. A colonoscopy performed 40 years thereafter revealed a 0-Is lesion in the upper rectum, and pathological examination showed well-differentiated adenocarcinoma. The lesion was diagnosed as colitic cancer based on the pathological findings and the 40-year interval since the diagnosis of total colitis type of UC. The patient was in good overall health with good anal function, based on the clinical examination and manometric study;she wished to undergo sphincter-preserving operation. Restorative proctocolectomy with ileal pouch-anal canal anastomosis that preserved the anal canal mucosa was performed. The postoperative course was good, with a defecation frequency of 4-5 times/day without fecal incontinence, and the patient resumed her preoperative lifestyle with very few alterations. Even in elderly patients aged >80 years who have UC, restorative proctocolectomy is feasible for those in good general health and with relatively good anal function, determined based on the daily defecation activity and anal manometry.
Assuntos
Colite Ulcerativa , Bolsas Cólicas , Proctocolectomia Restauradora , Idoso , Idoso de 80 Anos ou mais , Canal Anal , Anastomose Cirúrgica , Feminino , HumanosRESUMO
AIM: For ulcerative colitis (UC), stapled ileal pouch anal anastomosis (IPAA) reportedly results in better bowel function than does IPAA with mucosectomy. However, a potential cancer risk in the remnant mucosa has been observed. The clinical results of IPAA by double stapling technique (DS-IPAA) in which the anastomotic line was on the dentate line at posterior wall and the top of anal canal at anterior wall ("Partially intraanal canal anastomosis": PICA) to reduce the remnant mucosa were evaluated. METHODS: Clinical results of PICA were retrospectively compared with those by DS-IPAA with anastomosis at above the anal canal on 1 year after open surgery. Of 211 UC cases that underwent DS-IPAA, 146 cases (69%) with PICA who were confirmed by the squamous epithelium on the posterior part of the distal donuts were included. Sixty-five cases with anastomosis above the anal canal were evaluated as the control. One stage surgery underwent in 95% of PICA and 93% of control. RESULTS: One year after surgery, each group had six bowel movements daily. Nighttime evacuation was found in 16% of PICA and in 20% of control. Soiling was found in 1% of PICA and 4.8% of control. After one stage operation, anastomotic leakage that needed ileostomy was observed in 0.7% of PICA and 3% of control. CONCLUSION: Partially intraanal canal anastomosis (PICA) can reduce anal canal mucosa with the same postoperative bowel function and complication rate as DS-IPAA above the anal canal. This procedure may be feasible for UC patients who can tolerate this procedure in terms of decreasing postoperative cancer risk.
Assuntos
Canal Anal/cirurgia , Colite Ulcerativa/cirurgia , Bolsas Cólicas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Grampeamento Cirúrgico/efeitos adversos , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Recto-perineal-urethral fistula caused by Crohn's disease is a rare, for which fundamental treatment has not been established yet. We analyzed the clinical characteristics, diagnosis, treatment, and prognosis of six male patients with anorectal lesions caused by Crohn's disease. Three patients were treated with abdominoperineal resection and the other three with rectal excision without anastomosis. Excluding one case, which presented worsening immediately after surgery, symptoms of urethral fistula improved without urethral stenosis, dysuria, or sexual dysfunction. Recto-perineal-urethral fistula is currently treated with various treatment modalities, including colostomy and drug therapy. Although the evaluation of these modalities is required, abdominoperineal resection or rectal excision without anastomosis may be a valuable treatment option because these approaches improve the urethral fistula while sparing the urethra without any significant complications.
Assuntos
Doença de Crohn/diagnóstico , Fístula Retal/diagnóstico , Fístula Urinária/diagnóstico , Colostomia , Doença de Crohn/complicações , Doença de Crohn/terapia , Humanos , Masculino , Fístula Retal/complicações , Fístula Retal/terapia , Doenças Uretrais/complicações , Doenças Uretrais/diagnóstico , Doenças Uretrais/terapia , Fístula Urinária/complicações , Fístula Urinária/terapiaRESUMO
A case of Crohn's disease complicated with simultaneous double cancers of the small bowel is reported. The patient is a 66-year-old man who had suffered from Crohn's disease for 20 years. He underwent surgery to identify the source of repeated episodes of intestinal obstruction. Two short segments of strictures and proximal dilatations were found in the distal ileum. Therefore, we performed an en bloc resection of the two stenotic sections instead of strictureplasty. Histological examination of the resected specimen revealed not only Crohn's disease but also a well-differentiated adenocarcinoma within each of the two strictures. One had invaded to the muscular layer and the other to the subserosal layer. In cases of Crohn's disease with longstanding stenosis, the probability of carcinoma should be considered.
Assuntos
Doença de Crohn/complicações , Neoplasias do Íleo/etiologia , Obstrução Intestinal/etiologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Colitis complicating inflammatory bowel disease is gradually increasing in Japan. Although the postoperative cancer in ulcerative colitis is rare, careful postoperative follow up is nec- essary. Anorectal cancer including cancer of anal fistulae in Crohn's disease is the most common cancer in Japan and our original cancer surveillance program in which biopsy for anorectal lesion is performed for longstanding anal lesion (more than 10 years) is suggested to be effective for the detection of early cancer.
Assuntos
Colite Ulcerativa/epidemiologia , Neoplasias do Colo/complicações , Doença de Crohn , Colite Ulcerativa/etiologia , Neoplasias do Colo/cirurgia , Doença de Crohn/complicações , Detecção Precoce de Câncer , HumanosRESUMO
Recent advances in both medical and surgical treatment of ulcerative colitis have been remarkable. Changes in medical treatment are mainly good results of therapy with the anti-TNF-α antibody, tacrolimus, and those in surgical treatment are an expansion of the surgical indications to include patients with intractable disease, such as treatment refractoriness and chronic corticosteroid dependence, by a better postoperative clinical course after pouch surgery, improred selection of surgical procedures and the timing of surgery in elderly patients. To offer the optimal treatment for patients with ulcerative colitis, new medical therapies should be analyzed from the standpoint of the efficacy and limitations of effect. Long postoperative clinical course of surgical patients including colitic cancer, prevention of postoperative complications should be also analyzed.
Assuntos
Colite Ulcerativa/cirurgia , Colite Ulcerativa/tratamento farmacológico , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Qualidade de VidaRESUMO
The present study investigated the long-term outcomes of restorative proctocolectomy in pediatric patients with ulcerative colitis (UC). We report a series of 25 patients who underwent total proctocolectomy with ileal pouch-anal canal anastomosis (IACA). Surgery was performed for medically intractable colitis and severe colitis in 14 and 11 patients, respectively. Early and late complications were observed in 6 (24%) and 14 (56%) patients, respectively. The long-term quality of life outcomes were satisfactory, including both bowel function and social function. Growth retardation was observed in 6 patients. Five patients exhibited catch-up growth and 3 patients overcame growth retardation. Patients with growth retardation tended to have a younger onset and longer duration of UC, as well as a longer duration and higher total dose of steroid use. In conclusion, the long-term outcomes of pediatric patients with UC undergoing IACA are satisfactory. Furthermore, to minimize the risk of growth retardation, surgery should be performed without delay.
Assuntos
Canal Anal/cirurgia , Colite Ulcerativa/cirurgia , Bolsas Cólicas , Adolescente , Criança , Pré-Escolar , Colite Ulcerativa/complicações , Feminino , Seguimentos , Transtornos do Crescimento/etiologia , Humanos , Masculino , Proctocolectomia Restauradora , Qualidade de Vida , Resultado do TratamentoRESUMO
We report a 60-year-old male who was transferred to our hospital for the operation because of refractory ulcerative colitis (UC). He was diagnosed to be infected with COVID-19 for SARS-CoV-2 PCR test positive at the time of transfer. We determined emergency operation because his general condition was poor such as malnutrition and ADL decline due to exacerbation of UC and air embolization by central venous catheter removal. He underwent subtotal colectomy with a sigmoid mucous fistula and ileostomy. He was well postoperatively. This is a first case report in Japan who underwent an operation for UC with COVID-19 infection.
Assuntos
COVID-19 , Colite Ulcerativa , Colectomia , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
The incidence of postoperative esophageal ulcers has been rarely reported associated with severe ulcerative colitis (UC). We report two cases of esophageal ulcers accompanied by acute necrotizing esophagitis after undergoing surgery for severe UC. Both patients, 47- and 53-year-old, were diagnosed with severe UC and underwent subtotal colectomy with sigmoid mucous fistula and ileostomy. In both cases, they had epigastralgia or digestive track bleeding and upper gastrointestinal endoscopy revealed an esophageal ulcer with acute necrotizing esophagitis accompanied by a black degeneration of mucosa after surgery. Conservative treatments improved the lesions. Esophageal stricture requiring endoscopic dilatation occurred in both cases. An acute UC requiring surgery seems to warrant caution in the merger of esophageal ulcer and acute necrotizing esophagitis.
Assuntos
Colite Ulcerativa , Úlcera , Colectomia , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Colo Sigmoide , Humanos , Ileostomia , Pessoa de Meia-Idade , Úlcera/etiologiaRESUMO
BACKGROUND: Infliximab has played a central role in the treatment of luminal Crohn's disease (CD) due to its great usefulness. Although the seton placement has been widely used for the treatment of anal fistula in patients with CD, we have used infliximab for severe cases in which improvement was not achievable by the seton placement, or for patients in whom improvement of quality of life (QOL) could be expected. PATIENTS AND METHODS: The anal region of 383 patients with CD was examined during the period from July 1985 to December 2005 and the presence of a lesion in the anal region was confirmed in 326 patients. Among them, the number of cases with fistula was highest (245), followed by those with skin tags (115), those with fissures (106), those with anal tumefaction and enlarged papillae (61), and those with anal stenosis (56). The seton placement was used for 93 patients with anal fistula; of these, 86 patients received the treatment for one year or more. During the treatment, infliximab was used for 19 patients and their pathology and progress were evaluated. RESULTS: Infliximab was used for 11 severe cases in which improvement had not been achieved using the seton placement, and for 8 patients for improvement of their QOL. For evaluation, the patients who did not undergo additional treatment after infliximab administration were assigned to the good response group, those who underwent additional treatment other than surgical treatment to the intermediate response group and those who required surgical treatment to the poor response group. The good, intermediate and poor response groups included 8 (42.1%), 5 (26.3%) and 6 (31.6%) patients, respectively. A study of the relationship between the diagnostic indications of magnetic resonance imaging (MRI) and the course of disease showed that most of the patients with a localized inflammation of the anal fistula had better courses and most of the patients with diffuse inflammation had poor courses. CONCLUSION: Approximately 70% of the patients required no surgical treatment. In addition, it was considered important to appropriately select patients for infliximab treatment. MRI was useful as a examination to be performed before infliximab administration because it enabled close examination of the localization of anal fistula and the range of inflammation.