Comparison of Endotoxin Activity Assay and Various Biomarkers for Severity Assessment in Colorectal Perforation Patients

Colorectal perforation is a serious disease with high mortality requiring emergency surgery. This study aimed to evaluate the role of the endotoxin activity assay (EAA) to assess the severity in patients admitted to the intensive care unit after emergency surgeries for colorectal perforations. Patients were divided into high (EAA ≥.4) and low (EAA <.4) groups based on the EAA levels, and the correlation between the EAA values and clinical variables related to the severity was evaluated. The SOFA scores were significantly higher in the high group than those in the low group. The high EAA value persisted even after 48 hours and extended the ICU length of stay. These results suggest that EAA may be a potential biomarker to assess severity and useful as one of the instrumental in predicting the outcomes for colorectal perforation patients.

Comparison of Laparoscopic and Open Emergency Surgery for Colorectal Perforation: A Retrospective Study

Background This study aimed to clarify the safety and efficacy of laparoscopic surgery for colorectal perforation by comparing the clinical outcomes between laparoscopic and open emergency surgery for colorectal perforation. Methods We retrospectively reviewed the data of 100 patients who underwent surgery for colorectal perforation. The patients were categorized into two groups: the open group included patients who underwent laparotomy, and the laparoscopic group included those who underwent laparoscopic surgery. Clinical and operative characteristics and postoperative outcomes were evaluated. Results The open and laparoscopic groups included 58 and 42 patients, respectively. More than half of the patients in both groups developed perforation in the sigmoid colon (open, 55.2%; laparoscopic, 59.5%). The most common cause of perforation was diverticulum, followed by colorectal cancer. The mean intraoperative blood loss tended to be lower in the laparoscopic group than in the open group (78.8 mL versus 160.1 mL; P=0.0756). Hospital stay tended to be shorter in the laparoscopic group than in the open group (42.5 versus 55.7 days; P=0.0965). There were no significant differences in either the short- or long-term outcomes between the two groups. Univariate and multivariate analyses showed that the choice of surgical approach (open versus laparoscopic) did not affect overall survival in patients with colorectal perforation. Conclusions The laparoscopic approach for colorectal perforation in an emergency setting is a safe procedure compared with the open approach. The laparoscopic approach was associated with a decrease in intraoperative blood loss and a shorter length of hospital stay.

Combination of dirty mass volume and APACHE II score predicts mortality in patients with colorectal perforation

Background “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear. Methods Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis. Results Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.

Combination of dirty mass volume and APACHE II score predicts mortality in patients with colorectal perforation

Background: “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear.Methods: Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were retrospectively reviewed in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis.Results: Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions: The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.

Combination of Dirty Mass Volume and APACHE II Score Predicts Mortality in Patients with Colorectal perforation

Background: “Dirty mass” is a specific computed tomography (CT) finding that is seen frequently in colorectal perforation. The prognostic significance of this finding for mortality is unclear. Methods: Fifty-eight consecutive patients with colorectal perforation who underwent emergency surgery were included in the study. Dirty mass identified on multi-detector row CT (MDCT) was 3D-reconstructed and its volume was calculated using Ziostation software. Dirty mass volume and other clinical characteristics were compared between survivor (n = 45) and mortality groups (n = 13) to identify predictive factors for mortality. Mann–Whitney U test and Χ2 test were used in univariate analysis and logistic regression analysis was used in multivariate analysis. Results: Dirty mass was identified in 36/58 patients (62.1%) and located next to perforated colorectum in all cases. Receiver-operating characteristic (ROC) curve analysis identified the highest peak at 96.3 cm3, with sensitivity of 0.643 and specificity of 0.864. Univariate analysis revealed dirty mass volume, acute disseminated intravascular coagulation (DIC) score, acute physiology and chronic health evaluation II (APACHE II) score, and sequential organ failure assessment (SOFA) score as prognostic markers for mortality (p<0.01). Multivariate analysis revealed dirty mass volume and APACHE II score as independent prognostic indicators for mortality. Mortality was stratified by dividing patients into four groups according to dirty mass volume and APACHE II score. Conclusions: The combination of dirty mass volume and APACHE II score could stratify the postoperative mortality risk in patients with colorectal perforation. According to the risk stratification, surgeons might be able to decide the surgical procedures and intensity of postoperative management.

Sigmoid colon perforation caused by three living loaches inserted into anus: a case report

BACKGROUND Colorectal perforation are common surgical emergencies. Yet perforation caused by living animals has not been reported with no record found on Medline. CASE PRESENTATION A 47-year-old male arrived at our surgical emergency room for "severe abdominal pain with itchy rash for 5 hours", who explained that "three big living loaches" had been squeezed into the anus 1 hour before the onset of symptoms. Thorough physical and auxiliary examinations suggested lower gastrointestinal perforation. After prompt anti-shock, anti-allergy, analgesia and gastrointestinal decompression, we performed exploratory laparotomy, sigmoid colon repair and double-lacuna ileostomy. The patient underwent uneventful postoperative recovery and was discharged on the 10th day after surgery. CONCLUSIONS CT examination is critical for diagnosing colorectal perforation caused by living animals (3 loaches as reported in our case). Specifically, due attention should be given to the serious allergic reaction induced by exogenous organisms entering the abdominal cavity. Surgery should be performed as soon as possible to fundamentally address the allergic shock. As to colorectal perforation caused by multiple living organisms, considering the restricted condition for thorough exploration during emergency surgery (particularly the exploration of the posterior wall of the colon), colostomy should be selected with caution.