Delayed coloanal anastomosis as a stoma-sparing alternative to immediate coloanal anastomosis: A systematic review and meta-analysis.

BACKGROUND: Recent clinical trials have demonstrated favorable outcomes associated with trans-anal colonic pull-through for rectal resection followed by delayed coloanal anastomoses (DCA), resulting in a resurgence in popularity of the technique. This meta-analysis aims to review existing literature to evaluate the postoperative complications associated with DCA, and to make comparisons with immediate coloanal anastomoses (ICA) after colorectal resection to assess the suitability of DCA as an alternative form of surgical treatment. METHODS: Medline and Embase databases were reviewed from inception until 31 July 2020 in accordance with PRISMA guidelines. Single-arm studies that involved patients undergoing DCA for benign or malignant causes were selected, and meta-analysis of proportions was conducted to determine the prevalence of postoperative complications following DCA. Comparative studies comparing postoperative outcomes between DCA and ICA were also included for comparative meta-analysis. RESULTS: Patients undergoing DCA were significantly less likely to require diverting stoma construction as compared to ICA (odds ratio [OR] = 0.04; confidence interval [CI]: 0.02-0.07; P < 0.001). Overall postoperative morbidity (OR = 0.50; 95% CI: 0.23-1.12; P = 0.09) and mortality (OR = 0.49, 95% CI: 0.12-1.98; P = 0.32) was comparable between DCA and ICA groups. No significant differences in perioperative complications, such as anastomotic leakage (OR = 0.42; 95% CI: 0.11-1.64; P = 0.21), postoperative ileus, pelvic abscesses, or sepsis, were noted between DCA and ICA. CONCLUSION: Our study shows no differences in complications or functional outcomes between DCA and ICA. Pooled analysis expectedly revealed a lower rate of diverting stoma in patients undergoing DCA. DCA is thus a safe alternative to current surgical practices where avoidance of a stoma is desired.

Quantifying the rate of recurrence of postoperative Crohn's disease with biological therapy. A meta-analysis.

OBJECTIVE: Preventing the postoperative recurrence (POR) of Crohn's disease (CD) poses a significant challenge to clinicians. With the advent of biologics, various studies have observed a reduction of recurrence after surgery. Hence, we performed a systematic review and meta-analysis to identify the rate of POR at different time points in the era of biologic use. METHODS: We performed a literature search using Medline and Embase databases for studies investigating biologics in preventing the POR of CD. Data were extracted, and a single-arm meta-analysis with generalized linear mixed model and Clopper-Pearson method for confidence interval (CI) was performed to identify endoscopic, clinical and surgical recurrence rates at 6 months and 1, 2 and 5 years postoperatively. RESULTS: Altogether 24 studies were included in the meta-analysis. The endoscopic, clinical and surgical POR rate with the use of anti-tumor necrosis factor (TNF)-α agents at 1 year was 21.72% (95% CI 16.28%-28.37%), 13.06% (95% CI 8.18%-18.92%) and 3.76% (95% CI 1.37%-9.91%), respectively. The 5-year recurrence rate was 84.21% (95% CI 72.35%-91.57%) and 17.49% (95% CI 9.17%-30.80%) for endoscopic and surgical recurrence, respectively. Subgroup analyses at 1 year for the type of anti-TNF-α agent or the timing of initiation after surgery showed no significant difference in endoscopic, clinical and surgical recurrence rates. CONCLUSIONS: Anti-TNF-α agents are effective at preventing clinical, endoscopic and surgical POR of CD. The timing of initiating biological therapy after surgery has no significant effect on the rate of POR. The efficacy of infliximab and adalimumab for postoperative recurrence prevention is similar.

Solitary fibrous tumor of small bowel mesentery: a case report and review of the literature.

Solitary fibrous tumor is an extremely rare clinical entity, most commonly manifested in the pleura and peritoneum. An increasing number of cases are found to occur at extrapleural sites. We report a case of solitary fibrous tumor arising from the mesentery of the small intestine. A 53-year-old man presented with a large abdominal mass which was initially thought to be a gastrointestinal stromal tumor. The tumor was successfully removed surgically and the diagnosis of solitary fibrous tumor was confirmed on immunohistochemical analysis. To our knowledge this is the first reported case of a solitary fibrous tumor arising from the small bowel mesentery.

Benign multicystic peritoneal mesothelioma associated with hydronephrosis and colovesical fistula formation: report of a case.

Mesotheliomas usually arise from the pleura and are malignant. We report an unusual case of benign peritoneal mesothelioma presenting in a 59-year-old woman. The disease resulted in bilateral hydronephrosis, colovesical fistula formation, recurrent small bowel obstruction and chronic abdominal pain. To date only a handful of cases have been reported and to the best of our knowledge, none has been so aggressive.

Ampullary carcinoma associated with an annular pancreas.

CONTEXT: Annular pancreas is an uncommon congenital abnormality. Co-existence of this condition with a pancreaticobiliary malignancy is an exceptionally rare occurrence. CASE REPORT: We present a case report of a 78-year-old woman with jaundice due to an ampullary carcinoma associated with an annular pancreas treated by pancreaticoduodenectomy. CONCLUSIONS: A collection of previously reported cases is reviewed together with the relevant literature. Obstructive jaundice is an uncommon feature of annular pancreas; hence the possibility of co-existent pancreaticobiliary malignancy should be excluded.

Pancreatic and peripancreatic tuberculosis mimicking malignancy.

CONTEXT: There are a variety of differential diagnoses for an abnormal mass arising from the pancreas of which isolated pancreatic or peripancreatic tuberculosis is an extremely rare diagnosis with a variety of elusive presentations. CASE REPORT: We report such a case which masqueraded as malignancy in 43-year-old man presenting with jaundice, weight loss and new onset diabetes. CONCLUSIONS: Tuberculosis should be considered as a differential diagnosis to an obscure pancreatic mass which may result in local complications amenable to surgery.

Osteomyelitis of the iliac crest: a rare complication following perforated appendicitis.

BACKGROUND: Appendicitis is a common surgical emergency with numerous postoperative infective complications. We report an unusual case of iliac crest osteomyelitis as a late complication following emergency appendectomy for perforated gangrenous appendicitis. METHODS: Review of the pertinent English language literature. RESULTS: To the best of our knowledge, this is the first report in the English literature to describe iliac crest osteomyelitis as an infective complication of perforated gangrenous appendicitis. The diagnosis was made with the aid of magnetic resonance imaging and radioisotope bone scans. The complication was treated successfully with broad-spectrum intravenous antibiotics and physiotherapy. CONCLUSION: Iliac crest osteomyelitis is indeed a rare complication of appendicitis. A heightened awareness and better understanding of this complication would necessitate early diagnosis and treatment.

Ruptured internal iliac artery aneurysm presenting as Cullen's sign.

Cullen's sign or periumbilical ecchymosis, is classically considered as an indicator of acute hemorrhagic pancreatitis or ruptured ectopic pregnancy. Internal iliac artery aneurysms are rare and are usually asymptomatic. We present a case of a contained rupture of the internal iliac artery aneurysm presenting with Cullen's sign.