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Stercoral colitis complicated by ischemic colitis is rare. Current literature has focused on the radiographic characteristics of stercoral colitis and management of bowel perforation resulting from complicated stercoral colitis. This case report describes possible challenges in diagnosing and managing stercoral colitis complicated by ischemic colitis. We present a case of stercoral colitis complicated by ischemic colitis in a 28-year-old woman who presented with lower gastrointestinal bleeding.
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Introduction Inflammatory bowel disease (IBD) is increasingly common among patients with other comorbid chronic conditions, particularly diabetes mellitus (DM). Yet, studies that explored the impact of comorbid diabetes on the outcomes of IBD are scanty. Therefore, this study aims to examine the outcomes of inflammatory bowel disease among hospitalized patients with diabetes mellitus. Methods Using the Nationwide Inpatient Sampling (NIS) database from 2016 to 2018, we identified patients' records with a diagnosis of IBD using the International Classification of Diseases, Tenth Revision codes (ICD-10). The overall study population was further stratified by diabetes mellitus status. We matched patients with IBD and diabetes mellitus (IBD DM) with IBD cohorts using a greedy propensity score matching (PSM) ratio of 1:1 and compared in-hospital outcomes between the two cohorts. Conditional logistic regression was performed to estimate the odds of outcomes. Results Out of the 192,456 hospitalizations for IBD, 34,073 (7.7%) had comorbid IBD DM and 158,383 (92.3%) had no diabetes mellitus (IBD only). Patients with IBD DM are likely to be older. They have higher rates of hypertension, hyperlipidemia, coronary artery disease, obesity, peripheral vascular disease, congestive heart failure, chronic kidney disease, chronic lung disease, chronic liver disease, and stroke than the IBD cohort. After propensity score matching, IBD DM was associated with a lower adverse outcome [odds ratio (OR): 0.96, confidence interval (CI): 0.93 - 0.99, p < 0.01], IBD-related complications (intestinal or rectal fistula, intra-abdominal abscess, toxic colitis, intestinal perforation, intestinal obstruction, toxic megacolon, abscess of the abdomen, and perianal abscess), (OR: 0.76, CI: 0.72 - 0.80, P <0.01), IBD-related surgery (intestinal resections, incision, and excisions of intestine and manipulations of the rectosigmoid, rectal and perianal) (OR: 0.90, CI: 0.85 - 0.95, P <0.01). Furthermore, IBD DM was associated with a higher sepsis complication than the IBD-only cohort (OR: 1.24, CI: 1.19 - 1.30, P <0.01). Conclusion Our results highlight the extent to which diabetes mellitus impacts IBD outcomes and prognosis. Additionally, they emphasize the clinical awareness needed in the management of those with comorbid diseases.
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The prostate is anatomically located anterior to the rectum. Due to this proximity, locally advanced tumors of the prostate can invade the rectal tissue; likewise, colorectal cancers can invade the prostate gland; This presents mainly as an invasive mass with an identifiable primary and is rarely an isolated lesion. Prostate cancer rarely affects the gastrointestinal tract. Few cases of prostate cancer metastatic to the gastrointestinal tract have been reported in patients with a known prostate cancer history. Initial diagnosis of prostate cancer diagnosed from a colonic polyp is rare. We report a case of metastatic prostate cancer first diagnosed from a rectal polyp. Our patient is a 76-year-old man who initially presented with fatigue and 20 pounds weight loss in five months. The patient never had a colonoscopy before the presentation. A colonoscopy was done, which showed multiple colonic polyps and a pathology report of metastatic prostate cancer from a 12 mm rectal polyp.
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BACKGROUND: Abdominal trauma constitutes a significant cause of potentially preventable mortality. Therefore, knowledge of the determinants of outcome facilitates the development of rational treatment protocols for improving outcome. OBJECTIVE: To identify the determinants of outcome in patients with abdominal trauma managed in a tertiary health center. PATIENTS AND METHODS: This is a prospective study of consecutive patients presenting with abdominal trauma to our tertiary health center over a 12-month period. Data regarding patient demographics, injury mechanisms, type of organ injuries, treatment modalities, injury-to-intervention time, and outcomes were documented. The Injury Severity Scores and Revised Trauma Scores were determined. The data were analyzed using the Statistical Package for the Social Sciences version 20. RESULTS: There were 76 patients, 66 males and 10 females, whose ages ranged from 15 to 66 years (mean of 32.9 ± 10 years). Thirty-one (40.2%) patients had blunt abdominal trauma whereas 45 (59.8%) patients had penetrating trauma. There was a mortality rate of 8% predominantly from blunt trauma as compared to penetrating abdominal trauma (12.9% vs. 4.4%). There was a statistically significant difference between survivors and nonsurvivors as regards the means of injury-to-intervention time (25.4 ± 36.4 vs. 67.5 ± 58.2, P = 0.007), the means of Injury Severity Scores (15.1 ± 27.9 vs. 23.7 ± 9.8, P = 0.008), and the presence of brain injury (50.0% vs. 5.6%, P = 0.029). CONCLUSION: This study has shown that delayed intervention, high Injury Severity Score, and associated significant brain injury were determinants of poor outcomes. Prompt intervention and postoperative management in intensive care definitely improve outcome.
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BACKGROUND: The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control. METHODS: A pilot observational study included patients with and without cancer undergoing lumpectomy. The convenience sample consisted of an ERAS group and a control usual care (UC) group who underwent surgery during the same time period. Discharge narcotic prescriptions were compared after converting to oral morphine milligram equivalents (MME's). Postoperative day one and week one pain scores were also compared between the two groups. RESULTS: Ninety ERAS and 67 UC patients were enrolled. Most lumpectomies were wire-localized, and half of the patients in each group had breast cancer. There were more obese patients in the ERAS group. UC lumpectomy patients were discharged with a median of 54.5 MMEs (range 0-120), while the ERAS lumpectomy patients were discharged with none (p < 0.001). Postoperative pain scores were not significantly different between groups, and there were few complications. CONCLUSION: A breast surgery-specific ERAS protocol employing opioid-sparing techniques successfully eliminated postoperative narcotic prescription without sacrificing perioperative pain control or increasing postoperative complications. By promoting the adoption of similar protocols, surgeons can continue to improve patient outcomes while decreasing the quantity of narcotics available for diversion within our patients' communities.
