A 50-year-old male, with a medical history of Lynch syndrome and transurethral-resection (TUR) secondary to multifocal bladder tumour (pT1-high grade) with normal subsequent follow-ups, consulted for anal pain, rectal tenesmus and fever for 3 weeks. On examination, he presented perianal oedema and, on digital rectal examination, a right lateral orifice was palpable at 6cm from the anal margin. CT scan revealed a defect-in-continuity in the right rectal wall which communicated with bilateral perirectal collections extending towards the puborectalis-levator ani. On the right side, it extended towards the ischiorectal fossa and, on the left side it continued with another collection that displaced the corpus cavernosum. Urgent transanal debridement of abscess with biopsy and cultures was performed. Subsequent evolution was torpid. The clinical history was reviewed, as the patient had undergone repeated bladder catheterizations after TUR and BCG therapy one year before. Abdominal tomography with urethral contrast and cystourethrography were performed, which confirmed the presence of a fistula in the bulbomembranous urethra that communicated with the perirectal abscesses. Cultures and biopsies were negative for mycobacteria and malignancy was ruled out. A new surgical exploration was carried out, enlarging the transanal drainage orifice, making a temporary intestinal stoma and bladder catheterization. After eighteen weeks, the healing of the fistula was verified through of a new cystourethrography. Reconstruction of the intestinal transit has now been scheduled, after radiologically and endoscopically verifying the closure of the rectal orifice.
Fistula , Rectal Diseases , Male , Humans , Middle Aged , Abscess/diagnostic imaging , Abscess/etiology , Abscess/therapy , Urethra , Rectal Diseases/etiology , Rectal Diseases/therapy , Rectum , Fistula/complications
BACKGROUND: Despite the efficacy of biological agents, surgery is still required for a large percentage of patients with inflammatory bowel disease (IBD). AIMS: To assess the postoperative mortality rates and associated risk factors in IBD patients in a population-based setting in the era of biological agents. METHODS: This is a population-based longitudinal study including all patients diagnosed with IBD in Catalonia who underwent intestinal resection or colectomy between 2007 and 2016, identified from the Catalan Health Surveillance System database. Logistic regression was used to calculate the adjusted odds ratio for postoperative in-hospital and 30-day mortality. Data for Crohn's disease (CD) and ulcerative colitis (UC) were analysed separately. RESULTS: A total of 1,660 interventions for CD (69%) and 738 for UC (31%) were performed at 55 centres. In-hospital and 30-day postoperative mortality rates were 2.1% and 2.5% for CD, and 5.4% and 6.4% for UC, respectively. In the multivariate logistic regression analysis, comorbidity was associated with in-hospital and 30-day postoperative mortality in CD and UC, whereas age was only associated with mortality in CD and a non-laparoscopic surgical approach with UC. CONCLUSIONS: In the era of biologicals, the postoperative mortality rate for IBD depends mostly on co-morbidities and age.
Colitis, Ulcerative/surgery , Crohn Disease/surgery , Digestive System Surgical Procedures/mortality , Postoperative Complications/mortality , Colitis, Ulcerative/epidemiology , Comorbidity , Crohn Disease/epidemiology , Humans , Spain/epidemiology
BACKGROUND AND AIM: Biological therapies may be changing the natural history of inflammatory bowel diseases (IBDs), reducing the need for surgical intervention. We aimed to assess whether the availability of anti-TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC). METHODS: Retrospective, cohort study of patients diagnosed within a 6-year period before and after the licensing of anti-TNFs (1990-1995 and 2007-2012 for CD; 1995-2000 and 2007-2012 for UC) were identified in the ENEIDA Registry. Surgery-free survival curves were compared between cohorts. RESULTS: A total of 7370 CD patients (2022 in Cohort 1 and 5348 in Cohort 2) and 8069 UC patients (2938 in Cohort 1 and 5131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post-biological cohorts. The cumulative probability of surgery was lower in CD following anti-TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3, and 5 years, respectively P < 0.0001), although not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3, and 5 years, respectively; P = 0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high-volume IBD centers (in both CD and UC) and immunosuppressant use (in CD) were protective factors. CONCLUSIONS: Anti-TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in UC.
Biological Factors/therapeutic use , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/surgery , Crohn Disease/drug therapy , Crohn Disease/surgery , Gastrointestinal Agents/therapeutic use , Immunosuppressive Agents/therapeutic use , Infliximab/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adult , Age Factors , Colitis, Ulcerative/mortality , Crohn Disease/mortality , Disease-Free Survival , Female , Gastrointestinal Agents/pharmacology , Humans , Infliximab/pharmacology , Male , Middle Aged , Retrospective Studies , Risk Factors , Time Factors , Young Adult
No disponible
Humans , Male , Middle Aged , Adenocarcinoma/therapy , Pancreatic Neoplasms/pathology , Sister Mary Joseph's Nodule/pathology , Umbilicus/pathology , Drug Therapy/methods , Neoplasm Invasiveness/diagnostic imaging , Neoplasm Invasiveness/pathology , Palliative Care/methods , Pancreatic Neoplasms/diagnostic imaging , Peritoneal Neoplasms/pathology , Tomography, X-Ray Computed/methods
No disponible
Humans , Male , Middle Aged , Aged , Amyloidosis/surgery , Mediastinoscopy/methods , Pneumonectomy , Lung/pathology , Positron Emission Tomography Computed Tomography , Chest Pain/etiology , Bronchoscopy , Biopsy, Large-Core Needle/methods , Amyloidosis/diagnostic imaging , Amyloidosis/pathology
Amyloidosis/diagnosis , Lung Diseases/diagnosis , Aged , Amyloidosis/diagnostic imaging , Amyloidosis/pathology , Amyloidosis/surgery , Biopsy , Humans , Lung Diseases/diagnostic imaging , Lung Diseases/pathology , Lung Diseases/surgery , Male , Middle Aged , Positron Emission Tomography Computed Tomography
Adenocarcinoma/therapy , Pancreatic Neoplasms/pathology , Sister Mary Joseph's Nodule/pathology , Umbilicus/pathology , Drug Therapy/methods , Humans , Male , Middle Aged , Neoplasm Invasiveness/diagnostic imaging , Neoplasm Invasiveness/pathology , Palliative Care/methods , Pancreatic Neoplasms/diagnostic imaging , Peritoneal Neoplasms/pathology , Tomography, X-Ray Computed/methods
