Sigmoid volvulus and descending colon adenocarcinoma, a double cause of intestinal obstruction: a case report.

Large bowel obstruction is caused by colorectal cancer, diverticular disease or volvulus. The latter is caused by rotation of the intestinal loop on its own mesenteric axis, and occurs in the sigmoid colon (80%) and in the cecum (15-20%) Its management includes devolution by colonoscopy or surgery. Malignant bowel obstruction is the initial presentation in 7-29% of colorectal cancer, and its optimal treatment is controversial. We describe a clinical case of a double obstructive lesion and its surgical approach, an unusual presentation that poses a diagnostic and medical-surgical management challenge.

La obstrucción del intestino grueso es causada por cáncer colorrectal, enfermedad diverticular o vólvulo. Este último, por la rotación del asa intestinal sobre su propio eje mesentérico, y se da en el colon sigmoide (80%) y en el ciego (15-20%). Su manejo incluye devolvulación por colonoscopia o quirúrgica. La obstrucción intestinal maligna es la presentación inicial en el 7-29% del cáncer colorrectal, y su tratamiento óptimo es controvertido. Describimos un caso clínico de una doble lesión obstructiva y su abordaje quirúrgico; una presentación inusual que conlleva un reto diagnóstico y de manejo médico quirúrgico.

Intestinal Nonrotation, Imaging Findings in the Malrotation Spectrum: Case Report

Intestinal nonrotation is a rare embryonic developmental anomaly with a reported incidence of up to 0.5% in autopsies. Given the asymptomatic course, the diagnosis may be late, so it becomes an incidental finding. This study presents the most common imaging characteristics to familiarize readers with this pathology. We describe the case of a 73-year-old patient who consulted for pain in the right inguinal region associated with the sensation of a mass. There were no significant findings on physical examination. An abdominal tomography with contrast was requested as a study method, identifying a reversal of the superior mesenteric artery/superior mesenteric vein relationship with the cecum, appendix, and ileocecal valve in the left flank and mesogastrium. A displacement of thin intestinal loops towards the right hemiabdomen was also noted.

La no rotación intestinal es una anomalía del desarrollo embrionario poco frecuente con una incidencia reportada de hasta el 0,5 % en autopsias. El diagnóstico puede ser tardío dado el curso asintomático, por lo que se convierte en un hallazgo incidental. El objetivo de este estudio es dar a conocer las características por imagen más comunes para familiarizar a los lectores con esta patología. Se presenta el caso de un paciente de 73 años que consultó por dolor en la región inguinal derecha asociado a sensación de masa. En el examen físico no hubo hallazgos significativos. Se solicitó una tomografía abdominal con contraste como método de estudio y se identificó una inversión de la relación entre la arteria y vena mesentérica superior con la presencia de ciego, apéndice y válvula ileocecal en el flanco izquierdo y mesogastrio. Adicionalmente, se observó un desplazamiento de asas intestinales delgadas hacia el hemiabdomen derecho.

Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Cirugía para enfermedad colorrectal vía laparoscópica por el servicio de coloproctología del Hospital Militar Central (2005-2015) / Laparoscopic Surgery for Colorectal Disease by the Coloproctology Service of the Hospital Militar Central (2005-2015)

Resumen Introducción: para el tratamiento quirúrgico de la enfermedad colorrectal se han establecido diferentes abordajes. En los últimos 30 años, la evidencia ha demostrado mayores beneficios en las técnicas laparoscópicas (frente a laparotomía), que dependen directamente del entrenamiento continuo y del criterio práctico de los cirujanos coloproctólogos. Objetivo: caracterizar clínica y quirúrgicamente pacientes sometidos a cirugía laparoscópica colorrectal por el servicio de coloproctología del Hospital Militar Central de la ciudad de Bogotá entre los años 2005 y 2015. Metodología: estudio de corte transversal retrospectivo. Resultados: las características demográficas (clínicas y prequirúrgicas) de los pacientes y sus enfermedades, tiempos, tasas de conversión, complicaciones y perfil de recuperación presentes en los pacientes intervenidos en este lapso por el servicio de coloproctología del Hospital Militar Central de la ciudad de Bogotá fueron similares a los reportados por los servicios coloproctológicos de mayor recorrido a nivel mundial. Conclusiones: aunque el desempeño de nuestro equipo de trabajo solo recoge información relacionada con los últimos 10 años quirúrgicos, los mismos nos ponen al nivel de centros de excelencia en el manejo de la enfermedad colorrectal a nivel mundial.

Abstract Introduction: Various surgical approaches have been established to treat colorectal disease, but in the last 30 years the evidence has shown that laparoscopic techniques produce greater benefits than do laparotomies. This depends directly on continuous training and the practical criteria of colorectal surgeons. Objective: This study clinically and surgically characterized patients undergoing colorectal laparoscopic surgery by the Coloproctology Service of the Hospital Militar Central in Bogotá between 2005 and 2015. Methodology: This is a retrospective, cross-sectional study. Results: Patients' demographic characteristics (clinical and pre-surgery), diseases, times, conversion rates, complications and recovery profiles during the study period were recorded by the Coloproctology service and were similar to those reported elsewhere in the world. Conclusions: Although we only collected information related to the last ten years of surgery, this data puts us at the level of centers of excellence in the management of colorectal disease worldwide.

Enfoque del manejo de cuerpos extraños colorrectales: revisión de la literatura / Literature Review of Management of Colorectal Foreign Bodies

Resumen La presentación de pacientes con cuerpos extraños a nivel rectal no es poco frecuente; sin embargo, hay pocas estadísticas sobre la epidemiología de esta entidad. La mayor parte de la literatura publicada hace mención a reporte de casos o series de casos. Los cuerpos extraños rectales son insertados de forma intencional o no intencional, y constituyen un reto diagnóstico y terapéutico para el médico; por lo que el médico a cargo requiere de la habilidad y conocimiento para extraer objetos de diferentes formas y tamaños. Los cuerpos extraños rectales son generalmente observados en la población adulta; en relación con la estimulación erótica o asalto sexual. Adicionalmente, algunos cuerpos extraños pueden ser ingeridos ocasionalmente, pasando a través del tracto gastrointestinal y alojándose en el recto, aunque esta situación es la menos común; en especial en pacientes con enfermedades mentales, trastornos visuales, alcohólicos o usuarios de prótesis dentales. La finalidad de esta revisión es establecer unas pautas de manejo y dar a conocer un algoritmo para el enfoque de los cuerpos extraños colorrectales.

Abstract Patients with foreign bodies in their rectums are not uncommon, but statistics on the epidemiology of this entity are scarce. Most of the literature published consists of case reports or case series. Foreign rectal bodies, whether inserted intentionally or unintentionally, constitute a diagnostic and therapeutic challenge for physicians who need skill and knowledge to extract objects of different shapes and sizes. Foreign rectal bodies are generally observed in the adult population in relation to erotic stimulation or sexual assault. Occasionally, foreign bodies are ingested and pass through the gastrointestinal tract to lodge in the rectum. Although this situation is the least common, it does occur, especially in patients with mental illnesses, visual disorders, or alcoholism and among users of dental prostheses. The purpose of this review is to establish management guidelines and to present an algorithm for the approach to colorectal foreign bodies.