Portal Vein Thrombosis following Total Colectomy due to Colonic Inertia: A Case Report and Evaluation of Risk Factors

The portal vein could be occluded by blood clots partially or completely causing portal vein thrombosis (PVT). The acute episode may be asymptomatic or manifested by abdominal pain, increasing body temperature, and unspecific dyspeptic symptoms. The main causes of PVT are categorized into local, acquired, and genetic thrombophilic factors. To our knowledge, this is the 2nd recognized case of PVT following colectomy for colonic inertia successfully treated with an effective anticoagulation therapy. The patient received unfractionated heparin as soon the diagnosis was implemented. The patient was a 34-year-old lady with chief complaint of severe abdominal pain, nausea, vomiting, and anorexia 10 days after the first hospital admission for subtotal colectomy due to colonic inertia. Spiral abdominal CT scan with intravenous (IV) contrast showed thrombosis in main portal vein with its extension to right and left intrahepatic branches. Our case showed that we should keep in mind PVT in patients who present with upper gastrointestinal symptoms several days after a major surgery (open colectomy) as a risk factor and oral contraceptive pills (OCP) usage, postpregnancy, and immobility as other risk factors, that the protein C, S, and FVL deficiencies were secondary, and that the PVT can be managed by low molecular weight heparin plus oral warfarin therapy in the continue.

Constipation Frequency and Factors Influencing Constipation in First-year Nursing Students

The aim of this study was to determine constipation frequency and the factors that influence constipation among first-year nursing students. Data collection form and the constipation severity instrument were used for data collection. A total of 149 students, with mean average age of 19.11 ± 1.55 participated in the study; 62.4% was female and 24.2% of the students were constipated. Straining (16.1%) and difficulty (15.4%) during defecation was stressed by some of the students. The constipation complaints were pain (41.7%) and abdominal distention (25%). The mean score of the constipation severity instrument was 27.24 ± 8.38 (obstructive defecation 13.83 ± 3.90, colonic inertia 11.00 ± 4.11 and pain 2.40 ± 2.08).Gender, exercising, lifestyle, number of meals and the consumption of liquids influenced the constipation severity. Implementing programmes to prevent constipation may help in reducing the severity of the problem. Keywords: Constipation, influencing factors, nursing students

Massive Submucosal Ganglia in Colonic Inertia

Context.— Colonic inertia is a debilitating form of primary chronic constipation with unknown etiology and diagnostic criteria, often requiring pancolectomy. We have occasionally observed massively enlarged submucosal ganglia containing at least 20 perikarya, in addition to previously described giant ganglia with greater than 8 perikarya, in cases of colonic inertia. These massively enlarged ganglia have yet to be formally recognized. Objective.— To determine whether such “massive submucosal ganglia,” defined as ganglia harboring at least 20 perikarya, characterize colonic inertia. Design.— We retrospectively reviewed specimens from colectomies of patients with colonic inertia and compared the prevalence of massive submucosal ganglia occurring in this setting to the prevalence of massive submucosal ganglia occurring in a set of control specimens from patients lacking chronic constipation. Results.— Seven of 8 specimens affected by colonic inertia harbored 1 to 4 massive ganglia, for a total of 11 massive ganglia. One specimen lacked massive ganglia but had limited sampling and nearly massive ganglia. Massive ganglia occupied both superficial and deep submucosal plexus. The patient with 4 massive ganglia also had 1 mitotically active giant ganglion. Only 1 massive ganglion occupied the entire set of 10 specimens from patients lacking chronic constipation. Conclusions.— We performed the first, albeit distinctly small, study of massive submucosal ganglia and showed that massive ganglia may be linked to colonic inertia. Further, larger studies are necessary to determine whether massive ganglia are pathogenetic or secondary phenomena, and whether massive ganglia or mitotically active ganglia distinguish colonic inertia from other types of chronic constipation.

William Arbuthnot Lane (1856–1943): Surgical Innovator and His Theory of Autointoxication

William Arbuthnot Lane contributed to the advancement of many fields of orthopedics, otolaryngology, and general surgery. He is credited for his “no-touch technique” and the invention of long-handled instruments, some of which are still in use today, to minimize tissue handling. He is most well known for his hypothesis that slowing of gastric contents could cause a variety of ailments and this became known as Lane's disease. Although his surgical treatment of Lane's disease is now defunct, it advanced the surgical technique in colorectal surgery. It seems likely that some of Lane's “autointoxication” patients would be classified today as patients with colonic inertia, diverticulitis, colonic volvulus, and megacolon or, which are all treated with colectomy. Lane was a pioneer in multiple fields and a true general surgeon. He advanced colorectal surgery immensely and propelled the field of surgery into a new era.