Occurrence Of Bowel Obstruction Research Articles

JOURNAL CLUB: Primary Anorectal Melanoma: MRI Findings and Clinicopathologic Correlations.

The purpose of this study is to evaluate the MRI features of primary anorectal malignant melanoma and to correlate these features with its clinical and pathologic characteristics. The medical records of 12 patients (five men and seven women; mean age [± SD], 60.8 ± 10.0 years) with pathologically proven primary anorectal melanoma were retrospectively reviewed. MRI findings were analyzed to determine the shape, size, distance from the anal verge, presence of perirectal or anal infiltration, signal intensity on T1- and T2-weighted images, presence of diffusion restriction, contrast enhancement pattern of the lesion, presence of lymphadenopathy, and occurrence of bowel obstruction. Subsequent follow-up data for the patients were recorded. The most common presentation was hematochezia (41.7% of patients). Common findings on MRI included a large intraluminal polypoid mass (75.0% of lesions) with little perirectal or anal infiltration (100.0%), T1 hyperintensity (66.7%), high T2 signal intensity (54.5%) or mixed T2 signal intensity (45.5%), restricted diffusion (100.0%), and hyper-enhancement (100.0%). The mean length, width, and depth of these masses were 3.5, 2.9, and 2.3 cm, respectively. The mean distance from the anal verge was 1.8 cm. Lymphadenopathy was frequently identified (75.0% of cases), with lymph nodes larger than 2 cm noted in 28.5% of cases and most commonly involving the perirectal area (77.8% of cases). No colonic obstructions were observed. The mean patient follow-up was 32.7 months. A total of 25.0% of patients died as a result of disease progression. The possibility of the presence of anorectal melanoma should be considered for patients with a bulky intraluminal polypoid mass in the anorectum without colonic obstruction, with the mass showing T1 hyperintensity, high or mixed signal T2 intensity, hyperenhancement, minimal perirectal or anal infiltration, and lymphadenopathy.

Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study

BackgroundTissue adhesives (TA) may be useful to strengthen colorectal anastomoses, thereby preventing anastomotic leakage (AL). Previous studies have identified cyanoacrylate (CA) TAs as the most promising colonic anastomotic sealants. This study investigates the protective effects of sealing colonic anastomoses with various CAs.Materials and methodsFifty-five Wistar rats underwent laparotomy and transection of the proximal colon. An anastomosis was created with 4 interrupted sutures followed by either application of Histoacryl Flexible, Omnex, Glubran 2, or no TA seal. An additional control group was included with a 12-suture anastomosis and no TA seal. After 7 days, the rats were sacrificed and scored for the presence of AL as the main outcome. Secondary outcomes were the occurrence of bowel obstruction, adhesions, and anastomotic bursting pressure. Histological evaluation was performed.ResultsThe highest AL rate was found in the Glubran 2 group (7/11), followed by the 4-sutures group without TA (5/11), and the Omnex group (5/11). Histoacryl Flexible showed the lowest AL rate (2/11). In the control group, only one rat showed signs of AL. Histologically, the highest influx of inflammatory cells was found in the 4-suture group without TA and for Omnex and Glubran 2. Histoacryl Flexible caused more mature collagen deposition when compared to the other TA groups.ConclusionsHistoacryl Flexible showed the lowest leakage rate compared to the other TA groups and to the 4-suture control group. Glubran 2 showed the highest AL rate and a high inflammatory response. Histoacryl Flexible was associated with the presence of more mature collagen and seems to promote anastomotic healing.

Adhesion-Related Bowel Obstruction After Hysterectomy for Benign Conditions

To evaluate the occurrence of small bowel obstruction after hysterectomy. Analysis of 326 cases of women who were admitted with a diagnosis of small bowel obstruction during the period 1998-2005. Among cases with small bowel obstruction after hysterectomy for benign conditions, we evaluated the type and technique of hysterectomy and whether the parietal peritoneum was sutured at the completion of the procedure. The main causes of bowel obstruction were intra-abdominal adhesions (41.9%) and abdominal malignancy (40.1%). After excluding oncologic cases, we found that, of 135 cases of adhesion-related small bowel obstruction, gynecologic operations played the largest role in the occurrence of bowel obstruction (n=68, 50.4%). Among all gynecologic operations for benign conditions, total abdominal hysterectomy (TAH) was the most common cause of small bowel obstruction (13.6 per 1,000 TAHs). We did not encounter small bowel obstruction after laparoscopic supracervical hysterectomy. The reduction in absolute risk of small bowel obstruction from TAH to laparoscopic supracervical hysterectomy is 13.6 per 1,000 cases; 73 patients would undergo laparoscopic supracervical hysterectomy to prevent one small bowel obstruction. The median interval between TAH and small bowel obstruction was 4 years. The adhesions were adherent to the previous laparotomy incision in 27 cases (75%) and to the vaginal vault in nine cases (25%). Peritoneal closure was not associated with small bowel obstruction. Hysterectomy plays a major role in the occurrence of adhesion-related small bowel obstruction. Closure of the parietal peritoneum does not contribute to the occurrence of adhesion-related small bowel obstruction, and small bowel obstruction rarely occurs after laparoscopic supracervical hysterectomy. II-3.