Virtual Ileostomy as an Option for Complicated Colorectal Resections

2021 ◽  
pp. 000313482110474
Author(s):  
Yahya Alwatari ◽  
McKenzie G. Lee ◽  
Nicole E. Wieghard ◽  
Jaime L. Bohl
Keyword(s):  
Recent Literature ◽  
Colorectal Anastomosis ◽  
Clinical Impact ◽  
Significant Morbidity ◽  
Diverting Ileostomy ◽  
Defunctioning Ileostomy ◽  
Virtual Ileostomy ◽  
Medical Histories ◽  
Diverting Ostomy ◽  
Colorectal Resections

When surgery requires a colorectal anastomosis, a diverting ostomy may be created to decrease the clinical impact of anastomotic failure. Unfortunately, diverting ileostomies are also associated with significant morbidity. Recent literature suggests that diverting ostomies are not necessary for the majority of patients undergoing colorectal anastomosis and that creation of a virtual ileostomy (VI) may spare patients the complications that accompany diverting ileostomy creation. We present 4 patients with complex medical histories who underwent colorectal resections with primary anastomoses and VI creation. None of these patients suffered anastomotic leak or required conversion of VI to defunctioning ileostomy and there were no major complications associated with VI creation. Our results, although limited by sample size, support the creation of a virtual ileostomy as a safe and effective alternative to diverting ileostomy creation at the time of colorectal anastomosis.

scholarly journals Diverting Ostomy: For Whom, When, What, Where, and Why

2019 ◽  
Vol 32 (03) ◽  
pp. 171-175 ◽  
Author(s):  
Alexis Plasencia ◽  
Heidi Bahna
Keyword(s):  
Recent Literature ◽  
Coloanal Anastomosis ◽  
Primary Anastomosis ◽  
Loop Ileostomy ◽  
Diverting Ileostomy ◽  
Clinical Scenarios ◽  
Diverting Stoma ◽  
Diverting Loop Ileostomy ◽  
Inflammatory Bowel ◽  
Diverting Ostomy

AbstractFecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.

scholarly journals Experience with multidisciplinary laparoscopic surgery in patients with deep infiltrating colorectal endometriosis

2014 ◽  
Vol 155 (5) ◽  
pp. 182-186 ◽  
Author(s):  
Attila Bokor ◽  
Réka Brubel ◽  
Péter Lukovich ◽  
János Rigó jr.
Keyword(s):  
Bowel Resection ◽  
Rectal Resection ◽  
Colorectal Anastomosis ◽  
Sigmoid Resection ◽  
Deep Infiltrating Endometriosis ◽  
Colorectal Endometriosis ◽  
Segmental Bowel Resection ◽  
The Mean ◽  
Colorectal Resections ◽  
Infiltrating Endometriosis

Introduction: Deep infiltrating endometriosis is a particular form of endometriosis that penetrates the peritoneal surface or it reaches the subserosal neurovascular plexus. Aim: The aim of the authors was to analyze the results of segmental colorectal resections performed for deep infiltrating endometriosis. Method: Between 2009 and 2012, 50 patients underwent segmental rectum or/and sigmoid resection for endometriosis. Results: 21 patients had ultralow rectal resection and 29 patients had low colorectal anastomosis or anterior resection. Concomitant intervention in other organs was required in all cases, including gynecologic procedures (n = 50), additional gynecologic (n = 47), vesical (n = 9) and ureteral (n = 18) resections. The mean number of endometriosis lesions was 2.4±1.8 per patient. In all patients fertility was preserved. Severe surgical complications (Clavien–Dindo stage III or more severe) occurred in 3 patients (6%). Conclusions: The results confirm that segmental bowel resection is an efficient and safe method for the treatment of deep infiltrating colorectal endometriosis. Orv. Hetil., 2014, 155(5), 182–186.

Clinical impact of diverting ileostomy on the dose intensity of adjuvant chemotherapy for colorectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 867-867
Author(s):  
Shusuke Yagi ◽  
Eiji Shinozaki ◽  
Keisho Chin ◽  
Mitsukuni Suenaga ◽  
Daisuke Takahari ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Dose Intensity ◽  
Clinical Impact ◽  
Stage Ii ◽  
Stage Iii ◽  
Diverting Ileostomy ◽  
Grade 3

867 Background: CAPOX as adjuvant chemotherapy is a standard care option for stage III and high risk stage II colorectal cancer(CRC). And then chemotherapy induced diarrhea (CID) is known as one of the dose-limiting toxicities for CAPOX. Although diverting ileostomy is useful for preventing serious complications of high risk anastomosis, it is well recognized that high ileostomy output is hard to manage. Furthermore, the effect of diverting ileostomy on CID of adjuvant chemotherapy is unclear. In this study, we addressed the clinical impact of diverting ileostomy on the dose intensity of adjuvant chemotherapy for CRC. Methods: Patients who diagnosed with stage III colon cancer and stage II or III rectal cancer after curative surgery and received CAPOX as adjuvant chemotherapy during 2011- 2014 were reviewed retrospectively. We investigated the relationship between diverting ileostomy and dose intensity, toxicities and disease-free survival (DFS). Results: 112 patients (median age 60 years, 52% male, 69% colon cancer, 63% stage III, median follow-up 47 months) were enrolled in this study. Of 112 patients, 100 patients were received chemotherapy without ileostomy (non-ileostomy group: NIG) and 12 patients were received chemotherapy with ileostomy (ileostomy group: IG). 112 Patients received 870 chemotherapy cycles. All treatment related grade 3/4 adverse events were documented in 39% of patients in NIG and 33% of patients in IG (P = 0.77). Grade 3/4 of CID occurred in 8% of patients in NIG and 8% of patients in IG (P = 1). Grade 3/4 of neutropenia were recognized in 21% of patients in NIG and 17% of patients in IG (P = 1). Average relative dose intensity (RDI) in NIG were 75.7% and 85.8% for capecitabine and oxaliplatin, respectively. Average RDI of capecitabine and oxaliplatin in IG were 76.1% and 82.7%, respectively. Significant difference of RDI of capecitabine and oxaliplatin were not shown in comparison between NIG and IG (P = 0.93, P = 0.63). The 3-year DFS rate was 85.0% in NIG and 75.0% in IG. The HR for DFS for NIG compared to IG was 1.709 (95% CI, 0.49 to 5.95; P = 0.40). Conclusions: The presence of diverting ileostomy does not affect RDI of CAPOX as adjuvant chemotherapy.

scholarly journals Human parvovirus 4 ‘PARV4’ remains elusive despite a decade of study

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 82 ◽  
Author(s):  
Philippa C. Matthews ◽  
Colin Sharp ◽  
Peter Simmonds ◽  
Paul Klenerman
Keyword(s):  
Risk Factors ◽  
South America ◽  
Recent Literature ◽  
Clinical Impact ◽  
Hiv Disease ◽  
Ongoing Research ◽  
Animal Pathogens ◽  
Disease Associations ◽  
The Impact ◽  
New Evidence

Human parvovirus 4 (‘PARV4’) is a small DNA tetraparvovirus, first reported in 2005. In some populations, PARV4 infection is uncommon, and evidence of exposure is found only in individuals with risk factors for parenteral infection who are infected with other blood-borne viruses. In other settings, seroprevalence studies suggest an endemic, age-associated transmission pattern, independent of any specific risk factors. The clinical impact of PARV4 infection remains uncertain, but reported disease associations include an influenza-like syndrome, encephalitis, acceleration of HIV disease, and foetal hydrops. In this review, we set out to report progress updates from the recent literature, focusing on the investigation of cohorts in different geographical settings, now including insights from Asia, the Middle East, and South America, and discussing whether attributes of viral or host populations underpin the striking differences in epidemiology. We review progress in understanding viral phylogeny and biology, approaches to diagnostics, and insights that might be gained from studies of closely related animal pathogens. Crucial questions about pathogenicity remain unanswered, but we highlight new evidence supporting a possible link between PARV4 and an encephalitis syndrome. The unequivocal evidence that PARV4 is endemic in certain populations should drive ongoing research efforts to understand risk factors and routes of transmission and to gain new insights into the impact of this virus on human health.

scholarly journals Sigmoid Resection and Primary Anastomosis Without Any Diversion or Exteriorization for Impacted Foreign Body in Sigmoid Colon

KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 214-218
Author(s):  
ABM Moniruddin ◽  
M Fardil Hossain Faisal ◽  
Salma Chowdhury ◽  
Tanvirul Hasan ◽  
Romana Rafique ◽  
...  
Keyword(s):  
Foreign Body ◽  
Sigmoid Colon ◽  
Bowel Preparation ◽  
Primary Anastomosis ◽  
Standard Form ◽  
Colorectal Anastomosis ◽  
Sigmoid Resection ◽  
Defunctioning Ileostomy ◽  
Impacted Foreign Body ◽  
Flatus Tube

Colorectal Resections are very often required as an essential surgical procedure for various diseases. These resections are usually accompanied with various forms of diversions with or without primary colo-colonic or colorectal anastomosis. Classically, these are usually preceded by a standard form of bowel preparation. Here, a different form of colorectal surgery without preceding bowel preparation, colorectal resection and primary anastomosis were done, without any covering or defunctioning ileostomy or any other form of diversion or exteriorization and envisaged no complication. A psychiatric adult patient presented with self-introduction of a large foreign body (bobbin) through his anus. On laparotomy, FB (bobbin) impacted at the apex of the loop of sigmoid colon. It was so intensely impacted that milking towards the rectum without serious injury was totally impossible. Sigmoid resection and primary colorectal anastomosis without any form of ileostomy or similar type of diversion or exteriorization was performed. Just before anastomosis, faecal matters were removed as far as possible all from remaining both proximal and distal segments. Then digital anal stretching was done and put a transanastomotic flatus tube through anus. The flatus tube was removed on the 7th post operative day. The outcome was smooth and uneventful. KYAMC Journal Vol. 10, No.-4, January 2020, Page 214-218

scholarly journals The “impossible” rectal anastomosis: a novel use for endoluminal vacuum-assisted therapy

2020 ◽  
Author(s):  
Nadja C. Lehwald-Tywuschik ◽  
Andrea Alexander ◽  
Nour Alkhanji ◽  
Georg Flügen ◽  
Stephen Fung ◽  
...  
Keyword(s):  
High Risk ◽  
Colorectal Anastomosis ◽  
Rectal Stump ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Sigmoid Diverticulitis ◽  
Rectal Anastomosis ◽  
Low Rectal Anastomosis ◽  
Polyurethane Sponge ◽  
Diverting Ostomy

Abstract Purpose Low rectal anastomoses can safely be performed, usually secured by a diverting ostomy. However, in cases of inflammation, extensive scarring, after extensive radiation, or after severe stapler dysfunction the risk for an anastomotic leak may become prohibitively high. We present a novel use for endoluminal vacuum-assisted therapy (EVAT) for otherwise “impossible” low rectal anastomoses. Methods Our initial series consisted of 14 consecutive patients who underwent prophylactic EVAT treatment due to unsafe low colorectal anastomosis. The vacuum sponge was placed intraoperatively in cases otherwise calling for a Hartmann’s procedure. An open-pored polyurethane sponge was placed prophylactically transanally for a mean duration of 11 days. Patient characteristics, complications, and risk factors were prospectively collected from medical records and analyzed. Results Between March 2017 and September 2019, we performed this novel technique in 14 patients enabling us to perform an anastomosis. Our collective consisted of 4 female (29%) and 10 male (71%) patients with a medium age of 59 years. Underlying disease was colorectal cancer in 10 patients, ovarian cancer, perforated sigmoid diverticulitis, ischemic colitis and sarcoma in one patient each. Dominant factors putting the anastomosis at extremely high risk were acute inflammation (n = 2), frozen pelvis (n = 2), intraoperative local chemotherapy (n = 2), stapler dysfunction (n = 2), non-closable rectal stump (n = 2), empty pelvis (n = 1) and ultra-low anastomosis (n = 3). Prophylactic EVAT was successful in 92% and gastrointestinal continuity was preserved in all patients. Conclusion This is the first description of prophylactic EVAT treatment. It seems to be a simple and safe method to enforce the high-risk low rectal anastomosis.

Paediatric retropharyngeal abscess

2004 ◽  
Vol 118 (12) ◽  
pp. 919-926 ◽  
Author(s):  
C.M. Philpott ◽  
D. Selvadurai ◽  
A.R. Banerjee
Keyword(s):  
Computed Tomography ◽  
Management Strategy ◽  
Recent Literature ◽  
Complete Recovery ◽  
Retropharyngeal Abscess ◽  
Surgical Drainage ◽  
Significant Morbidity ◽  
Best Management ◽  
Uncommon Condition ◽  
The Common

Retropharyngeal abscess (RPA) is an uncommon condition with the potential for significant morbidity and mortality if not detected early. The authors present a case report of a 19-month-old child who presented with the common clinical features of a retropharyngeal abscess and in whom the diagnosis was not established by examination and ultrasonography. This led to a delay in appropriate management until a computed tomography (CT) scan was performed under general anaesthesia. The scan demonstrated the diagnosis and surgical drainage was performed under the same anaesthetic. The child subsequently made a complete recovery. The investigation and treatment of RPAs is a matter of some debate and the authors review the recent literature to determine the best management strategy.

scholarly journals Patients need to know that ileostomy following anterior resection may not be reversed

2018 ◽  
Vol 5 (6) ◽  
pp. 1991
Author(s):  
Jing-Yu Ng ◽  
Frederick H. Koh ◽  
Danson Yeo ◽  
Sheldon Jin-Keat Ng ◽  
Kok-Yang Tan ◽  
...  
Keyword(s):  
Disease Progression ◽  
Anastomotic Leak ◽  
Median Time ◽  
Anterior Resection ◽  
Retrospective Review ◽  
Colorectal Anastomosis ◽  
Anastomotic Leaks ◽  
Diverting Ileostomy ◽  
Ileostomy Reversal ◽  
Clinical Consequences

Background: A diverting ileostomy is often created following a low colorectal anastomosis to reduce the clinical consequences of an anastomotic leak. Whilst many patients are advised that these ileostomies are temporary, not all stomas will eventually be closed. This study aimed to look at the reversal rates of diverting ileostomy following anterior resections, and the reasons for delayed or non-reversal.Methods: A retrospective review of all patients who underwent an anterior resection with a diverting ileostomy from March 2011 to March 2013 was performed.Results: A total of 115 patients had a diverting ileostomy following anterior resection within the study period. Seventy-six (66.1%) patients had a reversal before March 2016. The median time to reversal was 8 months (range, 1-26 months) with only 13% reversed within 12 weeks. Two patients (2.6%) had anastomotic leaks post ileostomy reversal requiring surgery and 1 patient (1.3%) had significant hematochezia requiring hospitalization. In the 39 (33.9%) patients who did not have their ileostomies reversed, deterioration in the fitness of the patient for surgery was the most commonly cited reason (n=12, 30.8%). This was followed by disease progression (n=9, 23.1%) and patient’s choice (n=8, 20.5%).Conclusions: One in 3 diverting ileostomies performed following anterior resection is not reversed. The interval time to its closure is longer than typically expected. Patients should be made aware of the significant possibility of non-reversal.

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