Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

2018 ◽  
Vol 37 (1) ◽  
pp. 53-62 ◽  
Author(s):  
Taro Iwatsubo ◽  
Yoji Takeuchi ◽  
Yasushi Yamasaki ◽  
Kentaro Nakagawa ◽  
Masamichi Arao ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Retrospective Study ◽  
Endoscopic Submucosal Dissection ◽  
Emergency Surgery ◽  
Clinical Course ◽  
Pain Scale ◽  
Fasting Period ◽  
Hospitalization Period ◽  
Delayed Perforation ◽  
Perforation Group

Background: Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD. Methods: This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups. Results: Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate. Conclusions: While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.

scholarly journals Clinical impact of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection

2017 ◽  
Vol 05 (12) ◽  
pp. E1165-E1171 ◽  
Author(s):  
Hideaki Harada ◽  
Satoshi Suehiro ◽  
Daisuke Murakami ◽  
Ryotaro Nakahara ◽  
Tetsuro Ujihara ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Endoscopic Submucosal Dissection ◽  
Tumor Size ◽  
Resected Specimen ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Delayed Perforation ◽  
Clinical Records ◽  
Submucosal Fibrosis ◽  
Clip Closure

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is useful for en bloc resection of superficial colorectal neoplasms to ensure accurate histologic diagnoses. However, colorectal ESD is associated with a high frequency of adverse events (AEs). We aimed to investigate the effectiveness of prophylactic clip closure (PCC) of mucosal defects for AEs after colorectal ESD. Patients and methods This study included 197 patients with 211 lesions who underwent colorectal ESD between June 2010 and August 2016. Patients who had delayed perforation, delayed bleeding, abdominal pain, or fever were defined as AEs after colorectal ESD. Complete PCC was defined as completely sutured mucosal defect using endoclips following colorectal ESD, whereas incomplete PCC was defined as the mucosal defects that did not enable PCC or were partially sutured. Clinical records were retrospectively reviewed and clinical outcomes evaluated. Results AEs occurred in 29 lesions (13.7 %), including 12 with delayed bleeding, 12 with fever, 2 with abdominal pain, 2 with fever and abdominal pain, and 1 with delayed bleeding and fever. Delayed perforation was not observed in any patient. The frequency of AEs was significantly lower in the group with complete PCC than in the group with incomplete PCC (7.3 % [9/123] vs. 22.7 % [20/88]; P < 0.001). Multivariate analysis revealed that AEs after colorectal ESD were significantly associated with tumor size and submucosal fibrosis. Subgroup analysis among the resected specimen size of < 40 mm revealed that there was no significant difference in AEs between the 2 groups (5.6 % [6/107] vs. 17.8 % [8/45]; P = 0.069). However, the frequency of fever with complete PCC was significantly lower than that with incomplete PCC (2.8 % [3/107] vs. 13.3 % [6/45]; P = 0.020). Conclusions Tumor size and submucosal fibrosis were independent risk factors for AEs after colorectal ESD. PCC may be effective in minimizing AEs after colorectal ESD, especially the frequency of fever.

Presentation of Gall Stone Ileus as Gut Obstruction

JMS SKIMS ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 117-119
Author(s):  
Munir Ahmad Wani ◽  
Mubarak Ahmad Shan ◽  
Syed Muzamil Andrabi ◽  
Ajaz Ahmad Malik
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Ct Scan ◽  
Bowel Obstruction ◽  
Emergency Surgery ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Life Threatening ◽  
Life Threatening Complication ◽  
Gall Stone Ileus

Gallstone ileus is an uncommon and often life-threatening complication of cholelithiasis. In this case report, we discuss a difficult diagnostic case of gallstone ileus presenting as small gut obstruction with ischemia. A 56-year-old female presented with abdominal pain and vomiting. A CT scan was performed and showed an evolving bowel obstruction with features of gut ischemia with pneumobilia although no frank hyper density suggestive of a gallstone was noted. The patient underwent emergency surgery and a 60 mm obstructing calculus was removed from the patient's jejunum, with a formal tube cholecystostomy. JMS 2018: 21 (2):117-119

scholarly journals Parenchymal Guidewire Perforation during ERCP: An Unappreciated Injury

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
M. Ezzedien Rabie ◽  
Saad Al Faris ◽  
Ali Nasser ◽  
Abdul Aziz Shahir ◽  
Yasser Al Mahdi ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Emergency Surgery ◽  
Clinical Course ◽  
The Other ◽  
Clinical Deterioration ◽  
Medical Community ◽  
Successful Outcome ◽  
Hepatic Parenchyma ◽  
Pancreatic Parenchyma ◽  
Intraperitoneal Drainage

ERCP is attended with certain complications, the majority of which are well known to the medical community. Other less-known complications also exist. Guidewire injury to the hepatic or pancreatic parenchyma represents one of the much less appreciated, albeit preventable, complications. In this report, we present the clinical course of three patients who sustained guidewire perforation of the pancreatic or hepatic parenchyma. In one patient, the clinical deterioration was confidently attributed to guidewire perforation of the pancreatic parenchyma. Conservative treatment was successful and unnecessary emergency surgery was thus avoided. In the other two, in whom the cause of the clinical deterioration was unclear, an emergency surgery was performed. Guidewire injury to the hepatic parenchyma was then confirmed which needed only intraperitoneal drainage, with successful outcome.

scholarly journals Clinical Practice of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms by a Colonoscopist with Limited Gastric Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Wen-Hsin Hsu ◽  
Meng-Shun Sun ◽  
Hoi-Wan Lo ◽  
Ching-Yang Tsai ◽  
Yu-Jou Tsai
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
R0 Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Limited Experience ◽  
Mean Size ◽  
Delayed Perforation ◽  
The Mean

Objectives. Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD.Methods. The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled.Results. The mean of age was 64 (±9.204) years with mean size of neoplasm at 33 (±12.63) mm. The mean of procedure time was 70.5 (±48.9) min. The rates ofen blocresection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding.Conclusion. Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection.

scholarly journals Delayed Perforation Occurring after Endoscopic Submucosal Dissection for Early Gastric Cancer

2015 ◽  
Vol 48 (3) ◽  
pp. 251 ◽  
Author(s):  
Soo Hoon Kang ◽  
Kyungho Lee ◽  
Hyun Woo Lee ◽  
Ga Eun Park ◽  
Yun Soo Hong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Delayed Perforation

scholarly journals Delayed perforation occurring after endoscopic submucosal dissection for early gastric cancer

2011 ◽  
Vol 15 (1) ◽  
pp. 111-114 ◽  
Author(s):  
Kenji Ikezawa ◽  
Tomoki Michida ◽  
Kiyoshi Iwahashi ◽  
Kosaku Maeda ◽  
Masafumi Naito ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Delayed Perforation

Incidence of Appendicitis in Adults

2021 ◽  
Vol 15 (11) ◽  
pp. 3172-3173
Author(s):  
Maaz-ul-, Hassan ◽  
Syed Muhammad Shah ◽  
Ali Akbar Shah
Keyword(s):  
Abdominal Pain ◽  
Retrospective Study ◽  
Iliac Fossa ◽  
Perforated Appendicitis ◽  
Clinical Information ◽  
Age Group ◽  
Serious Illness ◽  
Imaging Result ◽  
Diagnostic Symptoms ◽  
Common Infection

Background: Appendicitis is a common infection which can lead to serious illness in children as well as adults. Objective: To assess the incidence of appendicitis in adults. Study Design: Retrospective study. Place and Duration of Study: Department of General Surgery, Shalamar Medical & Dental College, Lahore from 1st January 2020 to 30th June 2021. Methodology: One hundred and eighty cases registered for abdominal pain in right iliac fossa. The appendectomy cases of adults (>45 years) were scrutinized from these cases. Demographic and clinical information was gathered from each appendicitis patient with diagnostic symptoms as well as histopathology and radiology imaging. Result: Eighty seven were confirmed acute appendicitis with 48 males and 39 females within the age group of 45-75 years. Gangrenous appendicitis was presented in 11.5% and perforated appendicitis was noticed in 31.03% of the total patients. Conclusion: The incidence of appendicitis was 48.33% in adults. Keywords: Appendectomy, Perforated, Misdiagnosis

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