The Management of Retained Rectal Foreign Body

Purpose: Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.Methods: We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.Results: All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.Conclusion: Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

THE STOMA REVERSAL AFTER HARTMANN PROCEDURE IN PATIENTS WITH COLORECTAL CANCER OPERATED IN EMERGENCY

The Hartmann procedure still has an important place in the surgical therapy of complicated colorectal cancers. The morbidity rate can be very high and many patients never undergo the stoma reversal. We conducted a retrospective study on 431 patients with colorectal cancer operated in the second clinic of General Surgery of the Clinical Emergency County Hospital Galati between 2008-2017. 42,53 % of the patients with Hartmann operation had a stoma reversal after a medium period of 5,7 months. The 5-years survival rate in patients with stoma reversal was 4,9 %. The reversal rate in our study is similar to those found in the literature in recent studies, that report percentages of 23,3 %-55,17 %. In our study, the medium period between the emergency Hartmann procedure and the reversal of the stoma was 5,7 months, which is also similar to the data in the literature. We found a 5-years survival rate of 4,9 % in patients with Hartmann reversal, much lower than others’ results. Many stomas initially intended to be temporary, may not be reversed. It is important to optimize the timing of stoma closure. A period of approximately 6 months between the initial operation and the reversal seem to be adequate.

SURGICAL TREATMENT OPTIONS IN COMPLICATED COLO-RECTAL CANCERS OPERATED IN EMERGENCY

Globally, the colo-rectal cancer is the 4th in frequency of all neoplasia and in Romania is the 2nd, with a yearly tendency of increasing the number of new cases. The poor symptomatology in the inchoate stages and also the deficiency of effective screening programs lead to frequently late presentation of patients, with tumors in complicated stages, when the surgical operations, very often can no longer have a curative intention. We will present the results of a retrospective study during 10 years (2007-2016) that included 431 patients with complicated colo-rectal cancers, admitted and operated in the 2nd Surgery Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galati, Romania. In 133 cases (30,9%), most of them occlusive, it was practiced in emergency a left iliac anus, leaving the tumor in its place. The Hartmann operation was practiced in 97 cases (22,5%). Anytime it was possible, we practiced operations with radical intentions, like: right hemicolectomy, in 46 cases (10,7%), left hemicolectomy, in 13 cases (3%), segmentary colectomy with anastomosis, in 30 cases (6,9%). Regarding the surgical operations in emergency, many of them don’t have a radical intention, taking into account the local invasion of the tumors and the metastasis. In these situations, a first surgical gesture is required, as an intervention that is meant to save the patient’s life, solving only the complication.

Paraduodenale Hernie: Fallbericht einer intraoperativen Zufallsdiagnose

Wir berichten über den Fall einer 65-jährigen Patientin mit Divertikulitis. Eine Hartmann-Operation wurde durchgeführt. Intraoperativ wurde die Diagnose einer linken paraduodenalen Hernie gestellt. Der Bruchsack wurde inzidiert. Die Hernie wurde auf den präoperativen CT-Bildern erst nachträglich gesehen.