EP.TU.911Analysis of the outcomes following reversal of loop ileostomy

Aims A defunctioning loop ileostomy is constructed to reduce the incidence and the consequences of anastomotic leaks following sphincter-sparing colorectal resection. Its construction and reversal may be associated with complications. The aim of this study is to present a snapshot of the outcome of reversal of loop ileostomy in a teaching general hospital. Methods All patients whose loop ileostomy was reversed in 2018 were studied. Sociodemographic and clinical data were collected. The outcomes measured were length of hospital stay, return of bowel function, morbidity and mortality. Results Nine patients had reversal of ileostomy by experienced colorectal surgeons during this period. The patients, 5 males and 4 females, had a median age of 58 years (range 20 to 77 years). The main indications for construction of a loop ileostomy were low anterior resection for rectal neoplasia (7 patients) and iatrogenic rectal perforation during hysterectomy (1 patient), and total colectomy with ileoanal pouch reservoir for ulcerative colitis (1 patient). The ileostomies were reversed between 5 to 10 months following the main operations. The postoperative stay was between 2 to 12 days. The complications included one anastomotic leak, requiring immediate re-operation, 3 wound infections and 2 incisional hernias. There were no postoperative deaths. Conclusion In this study our overall complication rate was well within the range reported in the literature, with only one patient requiring immediate re-operation. The presence of a senior colorectal surgeon at operation as well as careful attention to detail is key to keeping complications to a minimum.

969 Intra-Abdominal Rectal Perforation Post Haemorrhoidal Artery Ligation Operation (HALO) And Converted Ligasure Open Haemorrhoidectomy

Case Report Symptomatic prolapsing haemorrhoids are usually treated with either haemorrhoidal artery ligation operation (HALO), stapled haemorrhoidopexy or open haemorrhoidectomy. Complications are rare with serious complications like rectal perforation reported scarcely in literature. We report a case of intraperitoneal rectal perforation following transanal haemorrhoidal artery ligation and converted open Ligasure-assisted haemorrhoidectomy in a 74-year-old lady with background portal hypertension secondary to primary biliary cirrhosis. We present this case to highlight the importance of preoperative medical optimisation of portal hypertension prior to surgical intervention and consideration of primary open techniques in grade 4 haemorrhoid surgery.

Rectal perforation caused by a self-inserted foreign body: a case report

Rectal foreign bodies have a storied history as a part of anorectal trauma. Objects encountered are most commonly household objects consisting of bottles and glasses. Other objects include tooth brushes, deodorant bottles, food articles, knives, sports equipment, cell phones, flash lights, wooden rods, broom sticks, sex toys including dildos and vibrators, light bulbs, nails, or other construction tools, christmas ornaments, aerosol canisters, cocaine packets, and many more. The reasons for insertion in decreasing order of frequency are autoeroticism, concealment, attention-seeking behavior, accidental, assault and to alleviate constipation. Here we presented a case of 32 years old presented to the ER with complaints of pain in lower abdomen and anal region for 12 hours. He complained of severe pain when he tried to defecate. He gave history of self-insertion of an empty drug vial into his rectum. Rectal foreign bodies represent a challenging and unique field of colorectal trauma. The important factors in dealing with these patients are careful history and physical examination. Patients are often embarrassed about this condition and may conceal the truth. So, a high index of suspicion is required to accurately diagnose.