Perforation Of Sigmoid Colon Research Articles

Complete Colonic Diaphragm-Like Stricture After Ileostomy and Sigmoidectomy for Sigmoid Colon Perforation With Diverticulitis.

CASE REPORT Anastomotic strictures occur in up to 22% of patients after colorectal resection, and up to 70% of them will eventually require surgical intervention.1,2 Traditionally, the approach taken in such cases has included endoscopic balloon dilation, self-expandable metal stent insertion, or surgical intervention; however, balloon dilation remains the primary modality because of its efficacy and safety profile.1–3 A 61-year-old Japanese woman underwent loop ileostomy creation and then sigmoidectomy for refractory sigmoidovesical fistula because of sigmoid colon perforation with diverticulitis (Figures 1 and 2). We performed a colonoscopy from both the anal and oral stoma sides before ileostomy closure surgery. We identified a complete diaphragm-like stricture in the sigmoid colon that was similar to the end of a blind loop during colonoscopy, and the region of complete construction was whitish and surrounded by a few xanthomas (Figure 3). Therefore, we performed an endoscopic intervention to treat the complete colonic stricture.Figure 1.: Abdominal computed tomography showing (A and B) sigmoidovesical fistula (A; arrow) with an inflammatory fibrous tissue (B; arrowhead) because of sigmoid colon perforation with diverticulitis.Figure 2.: The schema of operation site of this patient. Red circle is loop ileostomy as first operation, and blue slashes are sigmoidectomy as secondary operation.Figure 3.: (A) Colonoscopy from both the anal and oral sides revealing a complete diaphragm-like stricture in the sigmoid colon. (B) An endoscopic injection needle was used to penetrate the contralateral oral side of the colon. (C) An endoscopic catheter was used to investigate the opposite site with a 0.025-inch guidewire. (D and E) A through-the-scope sequential balloon dilator (8 mm) was used to dilate the stricture, and (F) Amidotrizoic acid was advanced into the opposite anal side.First, a 23-G endoscopic injection needle was used to penetrate the center of the blind lumen from the oral side, and then, a pinhole was made in the stricture (Figure 3). The contrast medium was then injected through the needle. After the position of the proximal lumen was confirmed, an endoscopic catheter was inserted into the pinhole that had been made in the stricture, with a 0.025-inch guidewire (Figure 3). Finally, a through-the-scope sequential balloon dilator (8 mm) was used to dilate the stricture, and Amidotrizoic acid was advanced into the opposite site (Figure 3). This intervention led to positive outcomes. Eight days later, the colonic stricture improved. However, the endoscope could not pass through; therefore, we performed balloon dilatation (12.5 mm) again (Figure 4). After 2 sessions, the patient showed improvement and underwent ileostomy closure (Figure 4).Figure 4.: Endoscopy showing (A) the colonic stricture had improved but did the endoscope could not pass through the site of the stricture. (B) A balloon dilator (12.5 mm) is used to dilate the stricture. (C) After 2 sessions, the patient improved.We encountered a colonic diaphragm-like stricture after performing a sigmoidectomy because of perforated colonic diverticulitis. Although anastomotic strictures of the colon are common complications after colorectal surgery, such a complete diagram-like membrane stenosis is rarely seen.4 In this case, we considered that because the loop ileostomy did not allow the passage of stool to the anastomotic site, a complete membrane stenosis had formed. Despite improvements in technology and surgical techniques, the incidence of colorectal anastomotic complications remains stable and substantial, and the detection and treatment of anastomotic complications remain a challenge.5 Our endoscopic intervention was effective in treating a diaphragm-like stricture characterized by complete circular stenosis. DISCLOSURES Author contributions: K. Soga wrote the manuscript and is the article guarantor. H. Mukai and N. Akamatsu edited the manuscript. Financial disclosure: None to report. Informed consent was obtained for this case report.

Successful endoscopic closure with an over-the-scope clip for sigmoid colon perforation due to bile duct stent migration

An 86-year-old woman presented with a history of endoscopic papillary sphincterotomy for bile duct stones and diverticulitis. The patient was admitted as an emergency case of acute cholangitis due to choledocholithiasis, underwent endoscopic bile duct stenting, and was discharged with a plan for endoscopic lithotripsy. One month later, the patient was readmitted owing to abdominal pain. Abdominal computed tomography at admission showed that the bile duct stent had migrated to the sigmoid colon and the presence of a small amount of extraintestinal gas, suggesting a colonic perforation. Lower gastrointestinal endoscopy showed adhesions and intestinal stenosis in the sigmoid colon, probably after diverticulitis, and the bile duct stent that had perforated the same site. The stent was removed and endoscopic closure of the perforation was performed using an over-the-scope clip. Abdominal computed tomography 8 days after the closure showed no extraintestinal gas. The patient resumed eating and was discharged on the 14th day of admission. There was no recurrence of abdominal pain. Endoscopic closure of sigmoid colon perforation due to bile duct stent migration using an over-the-scope clip has not been reported thus far, and it may be a new treatment option in the future.

Acute coronary syndrome associated with diverticular perforation of sigmoid colon

Acute coronary syndrome associated with diverticular perforation of sigmoid colon

Laparoscopic posterior rectopexy for complete rectal prolapse: Is it the ideal procedure for males?

Background:Rectal prolapse is more common in elderly women worldwide, but in India, it predominantly occurs in young- and middle-aged males. While ventral mesh rectopexy is proposed as the preferred procedure in females, the debate on the best procedure in men is still wide open.Methods:A retrospective review of all adult male patients operated for external rectal prolapse (ERP) between January 2005 and December 2019 was performed. Patients either underwent modified laparoscopic posterior mesh rectopexy (LPMR) or laparoscopic resection rectopexy (LRR). The outcome was analysed in terms of recurrence, post-operative constipation, sexual dysfunction and other complications.Results:A total of 118 male patients were included (LPMR: 106, LRR: 12). The mean age was 46.2 years (standard deviation [SD] 11.8, range: 21–88). The mean operating time was 108 min (SD: 24). The mean length of hospital stay was 4.8 days (SD: 1.4, range: 3–11 days). There was no anastomotic leak in the LRR group. Other complications included wound infection (n = 2), mesh infection with sigmoid colon perforation (n = 1), constipation (n = 4), sexual dysfunction (n = 2), urinary urgency (n = 3) and retention of urine (n = 4). There was no mortality in both the groups. During a mean follow-up of 5.2 years, recurrent ERP was noted in one patient and partial mucosal prolapse was seen in three patients.Conclusion:LPMR/LRR is a safe and effective treatment for ERP in men with very low recurrence rates. Randomised trials comparing modified LPMR with LVMR are needed to establish the better procedure in males.

Mimicker of Fitz-Hugh-Curtis syndrome: A case report of perihepatitis secondary to sigmoid colonic perforation

Perihepatitis is an uncommon condition defined as the inflammation of the peritoneal liver capsule. It is more commonly known as Fitz-Hugh-Curtis syndrome, a rare condition characterized by the inflammation of the peritoneum and tissue around the liver. This syndrome is usually associated with pelvic inflammatory disease (PID). However, PID is not always the cause of perihepatitis. We reported a rare case of perihepatitis which occurs secondarily to sigmoid colonic perforation.

Hybrid endo-laparoscopic management of sigmoid colon perforation due to an accidentally ingested denture

The journal is the official publication of the College of Surgeons of Sri Lanka. Its mission is to reach the highest standard of scientific surgical practice by dissemination of high quality scientific information and to foster and promote the growth of scientific surgery in Sri Lanka and in the region. The Sri Lanka Journal of Surgery publishes peer-reviewed leading articles, review articles, scientific articles, perspectives and case reports in the field of surgery and broadly related surgical sciences The journal adheres to the publication ethics as portrayed by the Committee on Publication Ethics (COPE) and is a member of this organisation. It is listed as an ICMJE journal which follow its recommendations (ICMJE recommendations) on Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals.

Sigmoid Colon Perforation Caused by a Foreign Body with Extensive Retroperitoneal and Mediastinal Emphysema—A Case Report and Literature Review—

Sigmoid Colon Perforation Caused by a Foreign Body with Extensive Retroperitoneal and Mediastinal Emphysema—A Case Report and Literature Review—

Two Chronic Kidney Disease Patients Under Maintenance Dialysis with Calcium Polystyrene Sulfonate-induced Sigmoid Colon Perforation.

Two Chronic Kidney Disease Patients Under Maintenance Dialysis with Calcium Polystyrene Sulfonate-induced Sigmoid Colon Perforation.

A Case of Sigmoid Colon Perforation by Ingested Fish Bone

A Case of Sigmoid Colon Perforation by Ingested Fish Bone

A Case of Sigmoid Colon Perforation by a Toothpick Treated by Laparoscopic-Assisted Surgery

A Case of Sigmoid Colon Perforation by a Toothpick Treated by Laparoscopic-Assisted Surgery

Comparative Study of Role of Laparoscopic Vs Conventional Management in Peritonitis

Background : A very commonly encountered case in the field of general surgery is peritonitis. In our study, we analyse 100 cases of acute peritonitis due to various causes, being managed conventionally and laparoscopicaly. Subjects and Methods: The observational, continuous, prospective, single centre study was carried out at Gujarat Adani Institute of Medical Science at GK General Hospital Bhuj. The study was conducted for a total duration of 27 months from October 2017- December 2019 (Patients were enrolled in the study and followed up till the day of admission to the day of the discharge). Total 100 patients are enrolled in the study but there were no intervention done. We compare the outcomes in terms of postoperative pain, removal of ryles tube, urinary catheter, drains, early ambulation and duration of hospital stay. Results: Maximum patients were diagnosed as having pre pyloric peptic (pyloric with antral perforation) perforation (45%) followed by jejunal perforation (17%). successful laparoscopic surgery without conversion was done in 92%. study total 4 cases of laparoscopic managed group needed to convert in open including 2 duodenal perforation cases, 1 sigmoid colon perforation case and 1 ascending colon perforation. Conclusion: Laparascopic intervention to be better of the two provided availability of skill and setup.

Identification of Leptotrichia goodfellowii infective endocarditis by next-generation sequencing of 16S rDNA amplicons.

The oral aerotolerant anaerobe Leptotrichia goodfellowii is an unusual cause of endocarditis and is amenable to treatment with β-lactam antibiotics. Because this organism is difficult to identify by conventional methods, molecular detection is a key diagnostic modality. Broad-range 16S rDNA PCR followed by Sanger sequencing constitute the first-line molecular approach, yet poor DNA quality, contaminating DNA, or low template quantity make identification challenging. Here we report a case of culture-negative, aortic and mitral valve endocarditis in a 66-yr-old woman with a history of cardiomyopathy, atrial fibrillation with intracardiac pacer, poor dentition, and recent tooth infection. In this case, 16S rDNA amplicon Sanger sequencing was not sufficient for pathogen identification because of interfering DNA, but deconvolution of the clinical sample using reflexive next-generation amplicon sequencing enabled confident identification of a single pathogenic organism, L. goodfellowii. The patient developed a sigmoid colon perforation and died despite additional surgical treatment. Most Leptotrichia endocarditis cases have been subacute and have been successfully treated with antibiotics, with or without valve replacement. This case highlights both an unusual etiologic agent of endocarditis, as well as the rational utilization of advanced molecular diagnostics tools for characterizing serious infections.

Ingested Fishbone Results in Sigmoid Colon Perforation

The unwitting swallowing of a foreign body is not uncommon and rarely causes perforation of any part of the gastrointestinal tract. We have reported in this case of a 46-year-old man who presented with a clinical picture similar to a perforated peptic ulcer. At the laparotomy exploration, the case was a perforation of the sigmoid colon by a fishbone (6 cm in length). The foreign object was removed and the perforated site was closed by the primary suturing. There were no postoperative complications. Although intestinal perforation due to an ingested foreign object is seldom to be seen, the surgeon must be aware of its occurrence and put it as one of the differential diagnosis in a case of an acute abdomen. A detailed history and computerized tomography (CT) scan are essential tools to detect intestinal foreign bodies in subjects with acute abdomen.

A Rare Case of Isolated Sigmoid Colon Perforation in Patient with Blunt Trauma Abdomen

A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.

Drain site enterocutaneous fistula after hyperthermic intraperitoneal chemotherapy

Spontaneous sigmoid colon perforation after cytoreduction surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is a rare complication. It is more commonly seen with mitomycin‐based HIPEC. This case study's patient presented with pus discharge at the drain site after 4 weeks of surgery. The symptoms persisted after conservative treatment. High suspicion after the feculent smell of the discharge fluidled to the prompt diagnosis of enterocutaneous fistula. There was limitedperforation with abscess formation, followed by fistula formation. The patient was treated successfully with surgery.

S1817 Rare and Unexpected Finding on Colonoscopy for Abdominal Pain

INTRODUCTION: Incisional hernias are a common complication of abdominal surgeries with an incidence of approximately 10 to 15%. Polypropylene mesh is commonly used to repair these hernias and is effective in decreasing their recurrence. Infection, pain, and adhesions are common complications associated with hernia repair that occur early in the post-operative period. Mesh migration and erosion into adjacent organs have been rarely reported and can present with symptoms at any time after hernia repair. We present a case of migration and erosion of a hernia mesh into the colon approximately nine years after incisional hernia repair. CASE DESCRIPTION/METHODS: The patient was a 70-year-old male who underwent colonoscopy for abdominal pain. Nine years prior to this, patient had recurrent sigmoid colon diverticulitis and perforation, for which he had undergone sigmoid colon resection and Hartman's pouch with a subsequent takedown of colostomy. At the time of colostomy reversal, patient also underwent repair of an incisional hernia with placement of a polypropylene mesh. A few weeks prior to the current colonoscopy, he had developed acute left lower quadrant abdominal pain and CT scan showed thickening of the descending colon (Image 1) which was initially treated conservatively. At colonoscopy, a metal mesh was seen embedded eccentrically in the colon wall about 25 cm from the anal verge with thickening of surrounding colonic mucosa (Image 2) for which he was referred to surgery. At subsequent exploratory laparotomy, the mesh had migrated and was adherent to the pelvic side wall, extending and eroding into the adjacent colon wall. The mesh was removed, and a left hemicolectomy with an end colostomy was performed. Patient has been doing well six months following surgery with plans for abdominal wall reconstruction. DISCUSSION: Hernia repair with mesh is an effective procedure that decreases the risk of recurrence significantly and is generally tolerated well. Very rarely mesh can migrate and erode into adjacent organs. Its clinical presentation is variable and is generally related to the organ involved. Pain in the area of migration is the most common presenting symptom. Migration occurs gradually over several years. Given the frequency with which these surgical procedures are performed, this complication is extremely rare and can be missed easily. Gastroenterologists should thus be aware of this potential complication and appropriately refer these patients to our surgical colleagues.Figure 1.: Thickening of the descending colon seen on CT Scan.Figure 2.: Mesh eroding into the colon wall eccentrically seen on colonoscopy.

Transmurally migrated gossypiboma rarely posing as surgical site infection: a case report and review of literature

The term gossypiboma is used to describe a retained surgical sponge or gauge after surgery. The clinical features range from being asymptomatic to frank bowel obstruction, perforation and peritonitis. Radiological modalities also do not provide a definite diagnosis. We report a case of a 30-year-old lady who presented to the emergency room with recurrent surgical site infection. She had a history of caesarean section 5 months ago. Following the caesarean section, she developed superficial wound dehiscence which was re-sutured. At the present facility, the lady underwent Computed tomography (CT) scan and was suspected to have a foreign body around the gut. She was planned for an exploratory laparotomy. Upon laparotomy, a large thick-walled ileal loop with some unusual intra luminal mass was found. Dense adhesions were present between the ileal loop and sigmoid colon. Adhesiolysis led to an iatrogenic sigmoid colon perforation, around 2 cm length. On incision over the ileal loop, surgical sponge was retrieved. Ileal loop was resected along with perforated site with end-to-end ileo-ileal anastomosis was done. Primary repair of sigmoid colon perforation was done. Patient was stable in postoperative period. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting with recurrent surgical site infection.

A STORY OF EXTRAORDİNARY ABDOMİNALLY PERFORATİTON

Pneumoperitoneum is the result of a gastrointestinal (GI) tract perforation in more than 90% of cases. Perforation of the stomach or duodenum caused by peptic ulcer is considered the most common cause of pneumoperitoneum. In this article, we present a case of pneumoperitoneum associated with sigmoid colon perforation, which is the result of the patient trying to create a laxative effect by inserting the hose attached to the wash basin into his rectum and opening the water afterwards. An 89 years old male patient was brought to the emergency department with complaints of abdominal pain starting about 2 hours ago. The patient's abdominal ultrasonography showed free fluid up to 10 cm in the lower abdomen. Posterior anterior chest X-ray and direct standing abdominal X-ray of the patient had subdiaphragmatic free air and images with free fluid, pneumoperitoneum and perforation were obtained in contrast enhanced abdominal tomography. As a result of surgery performed by general surgery it was seen approximately 30 cm proximal from the rectumthat there was a 4 cm perforation in the sigmoid colon. We must consider pneumoperitoneum, which is the result of colon perforation especially in elderly patients with acute abdominal pain, to be definitely among our differential diagnoses.

Pseudomembranous Colitis at Colostomy Site

An 86-year-old bedridden woman with a history of hypertension and diabetes mellitus visited our hospital. She was on oral steroids for chronic obstructive pulmonary disease and had undergone a colostomy for sigmoid colon perforation 8 months prior. She had recurrent pneumonia and urinary tract infections requiring frequent admissions for antibiotic treatment in the past year. In July 2020, she was admitted for pneumonia and had undergone intravenous antibiotic (ampicillin/sulbactam) treatment. On the 10th day of hospitalization, she developed abdominal pain and watery diarrhea.

Sigmoid colon perforation caused by migrated plastic biliary stents: a case report

Endoscopic migration of plastic biliary stents is performed by endoscopic retrograde cholangiopancreatography (ERCP) for biliary and pancreatic diseases. This plays an increasingly important role. Intestinal perforation caused by stent migration is one of the complications. Although sigmoid colon perforation caused by stent migration is rare, it can be life-threatening. This case shows us that we should increase awareness of sudden abdominal pain after ERCP. We provide a review of the clinical manifestations, imaging data of this case, and the literature related to the perforation caused by stent migration. A male patient had a history of choledocholithiasis, cholecystolithiasis, and biliary pancreatitis treated with ERCP and a pancreatic stent. After the operation, the patient developed cholangitis and was treated with ERCP and a plastic biliary stent. This patient was admitted to the emergency department with sudden lower abdominal pain. A CT scan showed sigmoid colon perforation by a foreign body and infra-diaphragmatic free air. An emergency surgery confirmed that the stent had caused the perforation. The patient was then treated with sigmoid colectomy and sigmoidostomy. Biliary stent migration after ERCP is rare, but intestinal perforation caused by migration should be considered in cases of abdominal pain of unknown cause.