Factors Influencing the Outcome of Intestinal Anastomosis

2011 ◽  
Vol 77 (9) ◽  
pp. 1169-1175 ◽  
Author(s):  
Juan J. LujÁN ◽  
ZoltÁN H. NÉMeth ◽  
Patricia A. Barratt-Stopper ◽  
Rami Bustami ◽  
Vadim P. Koshenkov ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Blood Loss ◽  
Surgical Site Infection ◽  
Bowel Disease ◽  
Intestinal Anastomosis ◽  
Significant Risk ◽  
Left Colon ◽  
Site Infection ◽  
Intraoperative Blood Loss ◽  
Inflammatory Bowel

Anastomotic leak (AL) is one of the most serious complications after gastrointestinal surgery. All patients aged 16 years or older who underwent a surgery with single intestinal anastomosis at Morristown Medical Center from January 2006 to June 2008 were entered into a prospective database. To compare the rate of AL, patients were divided into the following surgery-related groups: 1) stapled versus hand-sewn, 2) small bowel versus large bowel, 3) right versus left colon, 4) emergent versus elective, 5) laparoscopic versus converted (laparoscopic to open) versus open, 6) inflammatory bowel disease versus non inflammatory bowel disease, and 7) diverticulitis versus nondiverticulitis. We also looked for surgical site infection, estimated intraoperative blood loss, blood transfusion, comorbidities, preoperative chemotherapy, radiation, and anticoagulation treatment. The overall rate of AL was 3.8 per cent. Mortality rate was higher among patients with ALs (13.3%) versus patients with no AL (1.7%). Open surgery had greater risk of AL than laparoscopic operations. Surgical site infection and intraoperative blood transfusions were also associated with significantly higher rates of AL. Operations involving the left colon had greater risk of AL when compared with those of the right colon, sigmoid, and rectum. Prior chemotherapy, anticoagulation, and intraoperative blood loss all increased the AL rates. In conclusion, we identified several significant risk factors for ALs. This knowledge should help us better understand and prevent this serious complication, which has significant morbidity and mortality rates.

Surgical Site Infection Following Surgery for Inflammatory Bowel Disease in Patients with Clean-Contaminated Wounds

2009 ◽  
Vol 33 (5) ◽  
pp. 1042-1048 ◽  
Author(s):  
Motoi Uchino ◽  
Hiroki Ikeuchi ◽  
Toshie Tsuchida ◽  
Kazuhiko Nakajima ◽  
Naohiro Tomita ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Surgical Site Infection ◽  
Bowel Disease ◽  
Site Infection ◽  
Inflammatory Bowel ◽  
Clean Contaminated

Epithelioid Hemangioendothelioma of the Bowel in Crohn’s Disease: The First Reported Case

2018 ◽  
Vol 27 (4) ◽  
pp. 423-426 ◽  
Author(s):  
Smiljana Spasic ◽  
Iva Brcic ◽  
Rochelle Freire ◽  
Monica T. Garcia-Buitrago ◽  
Andrew E. Rosenberg
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Significant Risk ◽  
Muscularis Propria ◽  
Perianal Fistula ◽  
Epithelioid Hemangioendothelioma ◽  
Unknown Etiology ◽  
Inflammatory Bowel

Background. Epithelioid hemangioendothelioma (EHE) is an uncommon malignant endothelial neoplasm that most commonly arises in soft tissue, bone, lung, and liver. Crohn’s disease (CD) is an inflammatory bowel disease of unknown etiology that is frequently associated with complications including strictures, fistulas/fissures, and neoplasms. Case description. A 43-year-old woman with a 6-year history of severe CD presented with anal pain and bleeding. She had prior partial colectomy for a stricture and a diverting ileostomy for perianal fissures and stricture. Colonoscopy showed severe chronic active colitis, stricture at 30 cm of anal verge, and a perianal fistula. The patient underwent total proctocolectomy. The colonic mucosa exhibited segmental ulceration and irregular thickening of the colon wall. Beneath an ulcer of the anal canal within the muscularis propria was a 1.2-cm poorly circumscribed, firm, white-tan mass. The mass was composed of cords and groups of large epithelioid endothelial cells with intracytoplasmic vacuoles enmeshed in a myxohyaline stroma. Immunohistochemically, the tumor cells were positive for ERG, CD31, and CAMTA1 and focally positive for keratin and SMA. Next-generation sequencing revealed a WWTR1-CMATA1 fusion. The morphology, immunoprofile, and molecular genetics were diagnostic of EHE. Discussion. Long-standing inflammatory bowel disease is associated with significant risk for developing neoplasms, usually carcinomas, which can be indistinguishable radiologically and clinically from nonneoplastic complications. These tumors are often identified as an incidental finding in specimens resected for clinically severe disease. This is the first report of EHE arising in the bowel affected by CD, and it mimicked mural fibrosis and fissures.

Significant Risk of Life Threatening Infections in Elderly Patients With Inflammatory Bowel Disease Receiving Anti-TNF Therapy

2015 ◽  
Vol 13 (7) ◽  
pp. 1385-1386
Author(s):  
Ahmad Najib Azmi ◽  
Way-Seah Lee ◽  
Ruey Terng Ng ◽  
Sik-Yong Ong ◽  
Sanjiv Mahadeva ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Elderly Patients ◽  
Bowel Disease ◽  
Significant Risk ◽  
Life Threatening ◽  
Inflammatory Bowel

scholarly journals P100 CD161 levels are reduced in all subpopulations of T-cell colonic mucosal lymphocytes in inflammatory bowel disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S185-S185
Author(s):  
E Tristan ◽  
A Carrasco ◽  
A Martín-Cardona ◽  
Y Zabana ◽  
M Aceituno ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
T Cells ◽  
Bowel Disease ◽  
Immunosuppressive Treatment ◽  
Left Colon ◽  
Double Positive ◽  
Mait Cells ◽  
Healthy Mucosa ◽  
Inflammatory Bowel ◽  
Regional Specialisation

Abstract Background CD161 is a type C lectin expressed in NKs cells and peripheral T cells (TCRγδ and αβ, NKTs), enriched in intestinal populations. Its expression can be modulated by infections and inflammation. MAIT cells are a subset of innate antimicrobial T-cells abundant in the mucosa but their role in immunological regulation is still unknown. Aim To measure CD161 levels in subtypes of T-lymphocytes of intestinal mucosa: CD4+, CD8+, double positive (DP,CD4+CD8+), double negative (DN,CD4−CD8−), MAIT cells (CD161+TCRVα7.2+) and intraepithelial cells (CD103+) Methods Twenty-six patients with active inflammatory bowel disease (IBD) without immunosuppressive treatment (n = 9 Crohn’s disease -CD- colon, 9 CD ileum, n = 8 ulcerative colitis -UC- and 10 healthy controls (paired biopsies of ileum, right and left colon) were included. Lymphocyte subpopulations were analysed with LSRFortessa cytometer. Non-parametric Kruskal–Wallis test was applied. Results are expressed as % of median (25–75%IQI). Results In healthy mucosa, we did not find differences related to location in any of CD161 subpopulations except for increase of CD3+CD161+CD103+ and decrease of CD3+CD161+CD103− in left colon compared with right colon and ileum. Regarding MAIT cells, a progressive decrease was observed in distal parts of intestine for CD3+MAIT+CD103+ while CD3+MAIT+CD103− subpopulation has a specular behaviour; CD3+CD8+MAIT+ was increased in ileum compared with colon (Table 1). Conclusion There is a regional specialisation for the subset CD103+ of both CD161+CD103+ and MAIT_CD103+ cells in healthy intestine. CD3+CD161+ T cells are reduced in IBD colonic inflammation and could serve as a marker of active IBD but not to sort between CD and UC.

scholarly journals Gut-Brain Interactions in Inflammatory Bowel Disease: A Clinician’s Perspective

1995 ◽  
Vol 9 (5) ◽  
pp. 273-276
Author(s):  
Theodore M Bayless
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Psychosocial Factors ◽  
Bowel Disease ◽  
Physiological Responses ◽  
Time Lag ◽  
Colonic Motility ◽  
Ileoanal Pouch ◽  
Left Colon ◽  
Inflammatory Bowel

While most physicians and some patients consider psychosocial factors important in aggravating already existing inflammatory bowel disease (IBD), most of the information is based on a few recent scientific studies, varied anecdotal observations and a tendency for patients and some physicians to view psychosocial and stress-related issues with speculation, bias and some stigmatization. Patients with proctitis who have experienced recrudescence of mucosal friability and rectal bleeding within a day of a severe life stress provide a dramatic example of such anecdotes. Time-lag studies have indicated that stress, especially major life events, precedes illness aggravation in patients with IBD but that stress is not disease-specific. The symptoms studied, pain and diarrhea, were more likely to be physiological responses to acute stress rather than reflections of increased disease activity. Current scientific research supposes the prospect that environmental factors influence disease susceptibility through the central nervous system. Stress is associated with alterations in both humoral and cellular immune mechanisms in humans and in experimental animals. While psychosocial factors may not initiate inflammation in IBD, it is possible that they lead to alterations in the immune response and thereby alter disease activity. Mind-gut interactions affect salivation, gastric secretion, gastric motility and colonic motility, as well as numerous other gastrointestinal functions. These ‘physiological’ responses are expected in the IBD patient and perhaps will be accentuated by inflammation and its multiple effects on gut function. Because 10 to 13% of the general population have a tendency to suffer from irritable bowel syndrome (IBS), it is expected that the same percentage of IBD patients will have both IBD and IBS. An example of clinically relevant alterations in pathophysiology is the association of acute proctosigmoiditis with an increase in IBS symptoms in the left colon. Pain and diarrhea based on distension of an irritable left colon after ileocolonic resection result from excessive distension of the left colon by the larger stool volume following loss of absorptive surface of the ileum and right colon. Patients with IBS are also more symptomatic with small amounts of unabsorbed carbohydrates, such as fructose, sorbitol and lactose. Patients with severe IBS have an irritable small bowel, especially when it is formed into a closed reservoir, such as an ileoanal pouch; these patients have at least eight to 10 bowel movements per day because of the spasticity and small capacity of the ileoanal pouch. The stomach to pouch transit time may also be quite rapid. Explaining the coexistence of IBD and IBS to the patient is often quite helpful to the patient and to the doctor. One hopes that the scientific explanations of these mind-gut interactions are forthcoming.

Dysplastic Lesions in Inflammatory Bowel Disease: Molecular Pathogenesis to Morphology

2013 ◽  
Vol 137 (3) ◽  
pp. 338-350 ◽  
Author(s):  
Kristina A. Matkowskyj ◽  
Zongming E. Chen ◽  
M. Sambasiva Rao ◽  
Guang-Yu Yang
Keyword(s):  
Colorectal Cancer ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Human Cancer ◽  
Significant Risk ◽  
Molecular Pathogenesis ◽  
Field Cancerization ◽  
Molecular Events ◽  
Increased Risk ◽  
Inflammatory Bowel

Context.—Inflammatory bowel disease (IBD) is a long-standing chronic active inflammatory process in the bowel with increased risk for the development of colorectal carcinoma. Several molecular events involved in chronic active inflammatory processes contribute to multistage progression of human cancer development, including reactive oxygen and nitrogen species, aberrant arachidonic acid metabolites and cytokines/growth factors, and immune dysfunction. These molecular events in IBD lead to genetic abnormality and promote aberrant cell proliferation, which further lead to epithelial changes encompassing a broad spectrum from inflammation-induced hyperplasia to dysplasia. Objective.—To review the (1) epidemiologic and molecular pathogenesis of the risk for colorectal cancer in IBD, (2) morphologic characterization, biomarker(s), and classification of dysplastic lesions, and (3) clinical management of dysplastic lesions arising in IBD. Data Sources.—The different IBD-related dysplastic lesions are illustrated by using morphology in conjunction with molecular pathways, and the “field cancerization” theory and its potential significance are discussed with a review of the literature. Conclusions.—Patients with IBD are at increased risk of developing colorectal cancer. The risk of developing carcinoma is related to the extent/duration/activity of the patient's disease. There is no consensus regarding the extent of carcinoma risk associated with IBD; however, all would agree that patients with IBD represent a group at significant risk for developing carcinoma and as such, warrant adequate surveillance and prevention. With better screening modalities and detection/characterization of dysplastic lesions, IBD-associated serrated lesions, and “field cancerization,” we will improve our understanding of and approach to risk stratification.

scholarly journals Are Steroids Still Useful in Immunosuppressed Patients With Inflammatory Bowel Disease? A Retrospective, Population-Based Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Beatriz Sicilia ◽  
Lara Arias ◽  
Gadea Hontoria ◽  
Nieves García ◽  
Ester Badia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Biological Treatment ◽  
Significant Risk ◽  
Steroid Treatment ◽  
Oral Steroid ◽  
Immunosuppressed Patients ◽  
Inflammatory Bowel

Background: Effectiveness of corticosteroids in immunosuppressed patients with inflammatory bowel disease (IBD) has not been completely elucidated.Aims: To assess the effectiveness and examine the long-term follow-up of systemic or low-bioavailability oral steroid treatment for moderate flare-ups in patients treated with immunosuppressive drugs.Methods: Immunosuppressed patients with inflammatory bowel disease (IBD) from our population-data registry were analyzed. For statistical analysis, the chi-square test, Mann-Whitney U test, and Kaplan-Meier survival analysis were used as appropriate.Results: A total of 392 patients with IBD and a median of 82 (range, 6–271) months of immunosuppressive (IMM) treatment were identified. The mean follow-up was 87 months (range, 6–239 months). A total of 89 patients (23%) needed at least one steroid course during their follow-up. Average time from IMM to steroid treatment was 26 (range, 6–207) months. In patients with CD, fibrostenotic (B2) and fistulizing (B3) behaviors [p = 0.005; odds ratio (OR): 2.284] were risk factors for using steroids after IMM treatment. In patients with UC, no statistically significant variables were identified. Of the 89 patients who received one first steroid course, 49 (55%) stepped up to biological treatment or surgery after a median of 13 months (range, 0–178), 19 (21%) were treated with repeated steroid courses, and 31 (35%) required no further treatment. Patients with CD had a higher risk (p = 0.007; OR: 3.529) of receiving biological treatment or surgery than patients with UC. The longer the patients with UC (more months) spent using steroids, the greater the risk of requiring treatment with biological drugs or surgery (p = 0.009).Conclusion: A total of 23% of the immunosuppressed patients with IBD received at least one course of steroid treatment. In patients under immunosuppression treated with at least a course of steroids, CD patients were more likely stepped up to biologics and/or surgery than UC patients. In patients with CD, B2/B3 behavior pattern were significant risk factors. After one course of steroids only 35% of immunosuppressed IBD patients remained in remission without needing treatment scalation.

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