Necroziting fasciitis in right leg secondary to a presacral abscess related to colorectal anastomosis failure

2021 ◽  
Author(s):  
Alejandro Gil Catalán ◽  
Myriam Fernández Isart ◽  
Margarita Gamundí Cuesta ◽  
Francisco Xavier González Argenté
Keyword(s):  
Colorectal Anastomosis ◽  
Presacral Abscess

scholarly journals Mucosa plication reinforced colorectal anastomosis and trans-anal vacuum drainage: a pilot study with preliminary results

2021 ◽  
Author(s):  
Alexander Ferko ◽  
Juraj Váňa ◽  
Marek Adámik ◽  
Adam Švec ◽  
Michal Žáček ◽  
...  
Keyword(s):  
Pilot Study ◽  
Povidone Iodine ◽  
Anal Verge ◽  
Colorectal Anastomosis ◽  
Stapled Anastomosis ◽  
Neoadjuvant Radiotherapy ◽  
Lower Upper ◽  
Registration Number ◽  
The Mean ◽  
Diversion Rate

AbstractDehiscence of colorectal anastomosis is a serious complication that is associated with increased mortality, impaired functional and oncological outcomes. The hypothesis was that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors, such as mechanically stapled anastomosis instability and local infection. Patients with rectal cancer within 10 cm of the anal verge and low anterior resection with double-stapled technique were included consecutively. A stapler anastomosis was supplemented by trans-anal reinforcement and vacuum drainage using a povidone-iodine-soaked sponge. Modified reinforcement using a circular mucosa plication was developed and used. Patients were followed up by postoperative endoscopy and outcomes were acute leak rate, morbidity, and diversion rate. The procedure was successfully completed in 52 from 54 patients during time period January 2019–October 2020. The mean age of patients was 61 years (lower–upper quartiles 54–69 years). There were 38/52 (73%) males and 14/52 (27%) females; the neoadjuvant radiotherapy was indicated in a group of patients in 24/52 (46%). The mean level of anastomosis was 3.8 cm (lower–upper quartiles 3.00–4.88 cm). The overall morbidity was 32.6% (17/52) and Clavien–Dindo complications ≥ 3 grade appeared in 3/52 (5.7%) patients. No loss of anastomosis was recorded and no patient died postoperatively. The symptomatic anastomotic leak was recorded in 2 (3.8%) patients and asymptomatic blind fistula was recorded in one patient 1/52 (1.9%). Diversion ileostomy was created in 1/52 patient (1.9%). Reinforcement of double-stapled anastomosis using a circular mucosa plication with combination of vacuum povidone-iodine-soaked sponge drainage led to a low acute leak and diversion rate. This pilot study requires further investigation.Registered at ClinicalTrials.gov.: Trial registration number is NCT04735107, date of registration February 2, 2021, registered retrospectively.

scholarly journals Less is more—the best test for anastomotic leaks in rectal cancer patients prior to ileostomy reversal

2021 ◽  
Author(s):  
Simon Lindner ◽  
Steffen Eitelbuss ◽  
Svetlana Hetjens ◽  
Joshua Gawlitza ◽  
Julia Hardt ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Methodological Quality ◽  
Colorectal Anastomosis ◽  
Digital Rectal Examination ◽  
Contrast Enema ◽  
Paired Data ◽  
Endoscopic Procedures ◽  
Rectal Examination ◽  
Ileostomy Reversal

Abstract Purpose No clear consensus exists on how to routinely assess the integrity of the colorectal anastomosis prior to ileostomy reversal. The objective of this study was to evaluate the accuracy of contrast enema, endoscopic procedures, and digital rectal examination in rectal cancer patients in this setting. Methods A systematic literature search was performed. Studies assessing at least one index test for which a 2 × 2 table was calculable were included. Hierarchical summary receiver operating characteristic curves were calculated and used for test comparison. Paired data were used where parameters could not be calculated. Methodological quality was assessed with the QUADAS-2 tool. Results Two prospective and 11 retrospective studies comprising 1903 patients were eligible for inclusion. Paired data analysis showed equal or better results for sensitivity and specificity of both endoscopic procedures and digital rectal examination compared to contrast enema. Subgroup analysis of contrast enema according to methodological quality revealed that studies with higher methodological quality reported poorer sensitivity for equal specificity and vice versa. No case was described where a contrast enema revealed an anastomotic leak that was overseen in digital rectal examination or endoscopic procedures. Conclusions Endoscopy and digital rectal examination appear to be the best diagnostic tests to assess the integrity of the colorectal anastomosis prior to ileostomy reversal. Accuracy measures of contrast enema are overestimated by studies with lower methodological quality. Synopsis of existing evidence and risk–benefit considerations justifies omission of contrast enema in favor of endoscopic and clinical assessment. Trial registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019107771

Effect of epidural anesthesia on colorectal anastomosis

1997 ◽  
Vol 40 (8) ◽  
pp. 958-961 ◽  
Author(s):  
Carlos Sala ◽  
Eduardo García-Granero ◽  
María J. Molina ◽  
Jose V. García ◽  
Salvador Lledo
Keyword(s):  
Epidural Anesthesia ◽  
Colorectal Anastomosis

An instrument for colorectal anastomosis without sutures

1963 ◽  
Vol 6 (2) ◽  
pp. 98-101 ◽  
Author(s):  
George A. Hallenbeck ◽  
Edward S. Judd ◽  
Claude David
Keyword(s):  
Colorectal Anastomosis

Simple technique for the treatment of strictured colorectal anastomosis

1995 ◽  
Vol 38 (4) ◽  
pp. 433-434 ◽  
Author(s):  
Sebastian Pagni ◽  
Christopher M. McLaughlin
Keyword(s):  
Simple Technique ◽  
Colorectal Anastomosis

scholarly journals Intraoperative perfusion assessment of the proximal colon by a visual grading system for safe anastomosis after resection in left-sided colorectal cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyo Seon Ryu ◽  
Seok-Byung Lim ◽  
Eu-Tteum Choi ◽  
Inho Song ◽  
Jong Lyul Lee ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Anastomosis ◽  
Proximal Colon ◽  
Grading System ◽  
Visual Grading ◽  
Old Patients ◽  
Factors Affecting ◽  
Poor Grade ◽  
Perfusion Assessment ◽  
Colorectal Cancer Patients

AbstractWe aimed to evaluate the clinical feasibility of a new visual grading system. We included 50 patients who underwent resection of primary colorectal cancer. Before anastomosis, the marginal vessel was cut and the perfusion status was assessed by a visual grading system. The visual grading system is comprised of five grades according to the bleeding from the marginal vessel and is categorized into 4 groups: good (grade A and B), moderate (grade C), poor (grade D) and none (grade E). Colorectal anastomosis was performed only in the good and moderate groups. We compared postoperative outcomes between the good and moderate groups and analysed the factors affecting the perfusion grade. Among the patients, 48% were grade A, 12% were grade B, and 40% were grade C. There was no anastomotic leakage. Only one patient with grade C showed ischemic colitis and needed reoperation. Age was the only factor correlated with perfusion grade in multivariate analysis (OR 1.080, 95% CI 1.006–1.159, p = 0.034). The perfusion grades were significantly different between > 65 and < 65 year-old patients (> 65, A 29.2% B 12.5% C 58.3% vs. < 65, A 65.4% B 11.5% C 23.1%, p = 0.006). Our intraoperative perfusion assessment that uses a cutting method and a visual grading system is simple and useful for performing a safe anastomosis after colorectal resection. If the perfusion grade is better than grade C, an anastomosis can be performed safely. Age was found to be an important factor affecting the perfusion grade.

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