Primary Ileocolic Anastomosis Research Articles

Ileostomies for severely ill children with ileo-colic intussusception: our experience at the University of Uyo Teaching Hospital

Context: Complicated intussusception is associated with life-threatening intestinal gangrene and peritonitis. In critically ill children, a primary ileocolic anastomosis may increase their morbidity and mortality and, thus, a temporary ileostomy may be a safer option. Objective: The purpose of this study is to report the indications, outcomes, and complications after temporary ileostomies for infants with ileocolic intussusception in our institution. Materials and methods: This was a retrospective study of infants who had ileostomies created in our institution following complicated ileocolic intussusceptions between January 2014 and December 2022. The indications, postoperative complications, duration of hospital stay, and recovery were noted and compared. Results: Thirty-four infants had ileostomies created for complicated ileocolic intussusception during this period. There were 13 girls and 21 boys aged 3-10 months (median = 6 months). The indications for ileostomy were intestinal gangrene, colonic perforation, peritonitis, and haemodynamic instability. Ileostomies were created in the primary surgery in 24 patients while 10 had stomas created as a secondary procedure following an anastomotic dehiscence. Postoperative complications occurred in 25 patients (73.5%). Four children died shortly after surgery from the primary disease, while one child died from re-feeding syndrome. Children who required stoma creation following dehiscence of a primary anastomosis had more complications, a longer hospital stay, and a longer delay in commencing feeds. However, there was no difference in mortality rates or time of stoma closure. Conclusion: Temporary ileostomies could potentially reduce intussusception-related mortality and morbidity, ultimately improving the outcome of very ill infants.

Ileocolic Anastomosis Dehiscence in Colorectal Cancer Surgery

Background: Anastomotic leakage (AL) is one of the most feared complications in colorectal cancer (CRC) surgery. Although many series have reported the general risk factors for AL, published studies focusing on ileocolic anastomosis are scarce. The main aim of this study was to identify potential risk factors associated with ileocolic anastomosis dehiscence in surgery for CRC. Methods: A total of 188 patients who underwent primary ileocolic anastomosis after elective CRC surgery in Braga’s Hospital from November of 2018 to February of 2022 were included. A multivariate logistic regression analysis was carried out to identify independent risk factors for AL. Results: AL occurred in 13 patients (6.9%), and about three-fourths of these patients required surgical re-intervention. The mortality rate was 5.3%. Diabetes mellitus, ASA score of ≥3, laparotomy or conversion to laparotomy approach, postoperative blood transfusion, and postoperative hypoalbuminemia were associated with an increased risk of AL. In the multivariable analysis, postoperative hypoalbuminemia (p = 0.018; OR: 0.281; CI: 0.098; 0.806) and shorter operating time (p = 0.038; OR: 0.985; CI: 0.972; 0.999) were independent risk factors for AL. Conclusions: Postoperative hypoalbuminemia and shorter operating time are independent risk factors for AL after ileocolic anastomosis.

Perioperative use of NSAIDs and the risk of short-term endoscopic recurrence in Crohn's disease patients: A retrospective cohort study

BackgroundMore evidence is needed on the use of NSAID based postoperative pain regimens for Crohn's disease (CD) and its association with recurrence. Our goal is to assess the impact of perioperative use of NSAIDs on endoscopic disease recurrence in patients with CD. MethodsA retrospective cohort study was conducted. The primary outcome measured was endoscopic disease recurrence within 24 months of surgery, defined as a Rutgeerts score ≥ i2. ResultsWe identified 107 patients with CD that underwent index ileocolectomy with primary anastomosis between January 2009 and July 2019. Endoscopic disease recurrence was identified in 28 (26.2%) and clinical recurrence in 18 (16.8%) patients. Exposure to NSAIDs did not increase 24-month endoscopic recurrence risk (22.2% vs. 38.5% patients, p = 0.12). ConclusionIn patients with CD undergoing elective ileocolic resection and primary ileocolic anastomosis, NSAID use in the perioperative period did not impact endoscopic or clinical disease recurrence rate.

Endometriosis Affecting the Base of Appendix and the Middle Rectal Artery: A Case Report

Study Objective To demonstrate the rare case of deep endometriosis affecting the base of appendix and the middle rectal artery. Also, highlight the robotic approach assisting for a precise dissection and landmark identification. Design Case report for anatomical study and description of the procedure using video. Setting Tertiary Hospital. Patients or Participants A 38-year-old nulliparous woman presents with acyclic pelvic pain for one year, worse during sexual intercourse. She also had diarrhea during menstrual cycles and constipation the rest of the month. She underwent two failed in vitro fertilizations (IVF) and still had one frozen embryo. In the physical examination her uterus was partially fixed, and she felt pain in the posterior vaginal fornix touch. The MRI evidenced an 83.5 cc uterus, bilateral uterosacral thickening, bilateral round ligament nodules measuring 0.9 cm in the right and 1.7cm in the left. There were also an irregular fibrous tissue and adhesions on the anterior and lateral uterine aspects measuring 3.3 × 1.3 × 1.8 cm in proximity with the posterior vesical wall and right adnexa. Interventions We performed a robotic-assisted laparoscopic resection of superficial and deep lesions of endometriosis including peritoneum, uterosacral ligaments, retrocervix, round ligaments, uterus and bladder, rectum, a rare lesion in proximity with de middle rectal artery on the right and a large lesion in the base of appendix, affecting the cecum and the ileum, treated with ileocecal resection (typhlectomy) with primary ileocolic anastomosis. Measurements and Main Results Patient was discharged in the sixth postoperative day, with mild abdominal pain. The histological diagnosis confirmed endometriosis of all specimens. Conclusion We had a favorable outcome regarding the surgical approach in resecting an extensive disease with atypical lesions, including proximity to an arterial vessel and a large intestinal nodule that compromised the base of appendix. To demonstrate the rare case of deep endometriosis affecting the base of appendix and the middle rectal artery. Also, highlight the robotic approach assisting for a precise dissection and landmark identification. Case report for anatomical study and description of the procedure using video. Tertiary Hospital. A 38-year-old nulliparous woman presents with acyclic pelvic pain for one year, worse during sexual intercourse. She also had diarrhea during menstrual cycles and constipation the rest of the month. She underwent two failed in vitro fertilizations (IVF) and still had one frozen embryo. In the physical examination her uterus was partially fixed, and she felt pain in the posterior vaginal fornix touch. The MRI evidenced an 83.5 cc uterus, bilateral uterosacral thickening, bilateral round ligament nodules measuring 0.9 cm in the right and 1.7cm in the left. There were also an irregular fibrous tissue and adhesions on the anterior and lateral uterine aspects measuring 3.3 × 1.3 × 1.8 cm in proximity with the posterior vesical wall and right adnexa. We performed a robotic-assisted laparoscopic resection of superficial and deep lesions of endometriosis including peritoneum, uterosacral ligaments, retrocervix, round ligaments, uterus and bladder, rectum, a rare lesion in proximity with de middle rectal artery on the right and a large lesion in the base of appendix, affecting the cecum and the ileum, treated with ileocecal resection (typhlectomy) with primary ileocolic anastomosis. Patient was discharged in the sixth postoperative day, with mild abdominal pain. The histological diagnosis confirmed endometriosis of all specimens. We had a favorable outcome regarding the surgical approach in resecting an extensive disease with atypical lesions, including proximity to an arterial vessel and a large intestinal nodule that compromised the base of appendix.

Secondary renocolic fistula caused by pyonephrosis

Introduction. Renoalimentary fistulas represent infrequent pathology with 27 literature reports. The oldest report is from the year 1953. Nowadays, they usually arise after the cryoablation of renal tumors. In this case, we reported secondary renocolic fistula as an unusual complication of pyonephrosis, as well as the treatment modality, providing a literature review that favors a conservative or minimally invasive approach in most cases of renocolic fistula. Case report. In our case, the patient was a young female with a long course of kidney disease, which eventually led to pyonephrosis with renocolic fistula. Initially, the patient was hospitalized due to life-threatening urosepsis, successfully treated with a conservative approach. Afterward, we decided to proceed with surgical treatment. Regarding the poor right kidney function of the patient and the presence of concurrent sepsis, the right hemicolectomy with primary ileocolic anastomosis and the right nephrectomy were performed. The postoperative course was without complications, and the patient was discharged from the hospital on the 10th day. Follow-up did not reveal any complications. Conclusion. Regarding the available literature, a conservative and minimally invasive approach is most frequently employed in such cases. However, in cases of haemorrhage, sepsis, and impaired kidney function, surgery offers the only chance for cure. In patients with concurrent gastrointestinal pathology, surgery is usually the only option. Kidney preservation should be imperative in all cases, except in the case of impaired kidney function. The laparoscopic approach can be utilized in selected cases.

Clinico-pathological Evaluation and Outcomes of Emergency Right Hemicolectomies in the HIV Era

Emergency right hemicolectomies (RH) are attended by high morbidity and mortality. A primary ileocolic anastomosis (PA) or stoma may be performed, depending upon clinical risk factors. In HIV/AIDS patients, multiple pathologies involve the ileo-caecal area, and may necessitate a RH. To provide a clinico-pathological evaluation and outcome analysis of emergency RH. A retrospective chart analysis of 55 patients undergoing an emergency RH in two regional referral centres in KwaZulu-Natal, from January 2013 to December 2018, was undertaken. A total of 55 patients, median age 35 (range 12–83 years), underwent emergency RH. Seventeen patients were HIV-positive (30.9%) and 36 HIV-negative (65.5%), while 2 were not tested. A RH with PA was more commonly performed (61.8%). There was a higher rate of metabolic acidosis (p = 0.0046) and inotropic support (p = 0.001) in the RH and ileostomy cohort. The mortality rate was significantly higher in the RH and ileostomy cohort (42.9% vs 14.7%), p = 0.0275. There was a significantly higher rate of RH and ileostomy done in the HIV-positive cohort than in the HIV-negative cohort (58.8% vs 27.7%), p = 0.03. Ileo-caecal tuberculosis was more common in HIV-positive patients (35.3% vs 2.8%), p = 0.003. Overall, complicated appendicitis was the most common indication for RH (38.2%). Emergency RH with ileostomy is performed more often in the physiologically unstable patient and, hence, has a high mortality rate. Ileo-caecal TB is more common in HIV-positive patients leading to a higher ileostomy rate. Complicated appendicitis was the most common indication for emergency RH.

Caecal bascule: a case series and literature review.

Caecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon, potentially causing obstruction. An unusual variant of volvulus, diagnosis is challenging due to its obscurity. We present the experience of an Australian tertiary-referral hospital with the diagnosis/management of caecal bascule, and review cases reported in the literature to raise awareness of this uncommon diagnosis. Medical records of patients diagnosed with caecal bascule during 2001-2016 were reviewed. Data relating to their presentation, investigations, management and outcomes were obtained. A literature search was conducted through PubMed and Medline databases. Caecal bascule was diagnosed in four patients (median age: 60.5 (range: 48-75) years, two females). Patients presented with abdominal pain (4/4), distension (3/4), vomiting (3/4) and confusion (1/4) over a 1- to 4-day period. Computed tomography identified caecal displacement in three cases, and bascule was diagnosed at laparotomy in all cases. All patients underwent right hemicolectomy, with primary ileo-colic anastomosis in three cases and formation of Abcarian stoma in one case. Median length of stay was 15.5 days (range: 10-24), with no mortality. Fifteen cases of caecal bascule have been reported in the literature to date, with authors suggesting resection as definitive treatment. Correct diagnosis of caecal bascule requires a high index of suspicion and avoids delay of appropriate management. Recent operation, particularly laparoscopic cholecystectomy, may be contributing factors. Resection is recommended, a sentiment echoed by reported cases in the literature.

Traumatic Diaphragmatic Hernia as a Rare Cause of Colonic Obstruction

Travmatik diafragma hernileri nadirdir, tanı ve tedavisinde bir takım güçlükler vardır. Bu yazıda künt travmadan üç yıl sonra tanı konulan ve splenik fleksuranın herniasyonu edeniyle kolon obstruksiyonu gelișen sol diafragma hernili 43 yașındaki hastamızı sunduk. Hastamıza subtotal kolektomi ve primer iliokolik anastomoz yapıldı ve diafragmatik defekt tamir edildi. Akut kolon obstrüksiyonu gelișen hastalarda travma öyküsü varsa diafragma hernisinden șüphelenilmelidir.

Cecal Volvulus

A twisted loop of the bowel and its mesentery on a fixed point is known as volvulus and it may arise more frequently in the sigmoid colon and cecum. Cecal volvulus as an uncommon cause of acute intestinal obstruction is axial twist of the cecum, ascending colon and terminal ileum around their mesenteric pedicles. Although there are many different etiologic and predisposing factors for cecal volvulus, exact etiology is most likely multifactorial in presence of mobile cecum. Its clinical presentation is highly variable, ranging from intermittent episodes of abdominal pain to abdominal catastrophe depending on pattern, severity and duration of cecal volvulus causing intestinal obstruction. Due to its rarity and nonspecific presentation, preoperative diagnosis is rarely achieved in most cases. Abdominal radiographs as an initial diagnostic test are usually abnormal and can detect cecal volvulus in half of cases. Nowadays, computerized tomography is used for more accurate diagnosis and differentiation from other acute emergent conditions. Resection with right hemicolectomy and primary ileocolic anastomosis has been recommended for surgical treatment of cecal volvulus.

Adult large bowel obstruction: A review of clinical experience

Adult large bowel obstruction is an infrequent cause of acute obstruction in Africa and India. The cause of obstruction varies between regions of the world. Current controversy concerns the surgical management of the acutely obstructed left colon. This is a prospective study of adult patients with acute large bowel obstruction over a 6-year period. The diagnosis of adult obstruction was made from a history of constipation, abdominal distension, abdominal pain, nausea, and radiographic features of large bowel obstruction. Laparotomy was performed on all patients after resuscitation. If the obstruction involved the right colon resection and primary ileo-colic anastomosis was performed, while for a lesion in the left colon a resection and primary colocolic anastomosis was performed after intraoperative antegrade colonic irrigation. If the obstructing lesions were thought to be malignant and too advanced to merit any excisional or the patient's general condition was too poor to withstand resection, a biopsy was taken and a decompressive bypass procedure given pending the confirmation of the diagnosis. The clinical course and postoperative outcome were carefully documented. A total of 50 patients aged 20-80 years, with a median age of 49 years, presented with features consistent with large bowel obstruction. Of these, 32 had simple sigmoid volvulus and were offered sigmoid colectomy and primary colorectal anastomosis, while 3 further patients with compound sigmoid volvulus had double resection with primary ileo-ileal and colorectal anastomosis. A patient with sigmoid volvulus had a Hartmann's procedure. Twelve patients had colon cancer, four had left hemicolectomy and primary colocolic anastomosis; three, sigmoid colectomy and primary colorectal anastomosis; three, low anterior resection and primary colorectal anastomosis; one decompressive colostomy and one, a right hemicolectomy and primary ileocolic anastomosis. The two patients with functional obstruction (Ogilvie syndrome) had tube caecostomy. All resections and primary anastomosis involving the right colon were preceded by antegrade on-table colonic lavage. One clinical anastomotic leak occurred in a low rectal anastomosis and minor wound infection in 10 patients. Operative mortality occurred in three patients with sigmoid volvulus. Adult large bowel obstruction is infrequent in our community and is caused commonly by sigmoid volvulus. Resection and primary anastomosis of the acute left-sided large bowel obstruction seems safe after antegrade on-table colonic lavage, provided bowel gangrene with peritonitis or any additional risk factor for anastomotic breakdown is not present.

Volvo de ceco complicado por icterícia séptica

Cecal volvulus is an uncommon cause of acute bowel obstruction in adults. The mechanism is torsion of the enlarged, poorly-fixed or hypermobile cecum. Patients with this condition may display highly variable clinical presentations, ranging from intermittent, self-limiting abdominal discomfort to acute abdominal pain associated with intestinal strangulation and sepsis. The treatment needs to be individualized for each case, but surgical management is required in almost every case. In the presence of gangrene or perforation of the cecum, resection and primary ileocolic anastomosis is recommended. However, in non-complicated cases detorsion and cecopexy are adequate. The authors report one case of cecal volvulus in a 55-year-old women treated with cecopexy that complicated with septic jaundice.

Infectious mononucleosis manifested as a cecal mass

An 11-year-old boy presented with symptoms of periappendiceal abscess. At laparotomy, a tumor-like mass involving the ileocecal mesentery and adjacent part of the cecum and covered by the omentum was found. A right hemicolectomy was performed, followed by primary ileocolic anastomosis. On histologic examination, the tumor-like mass proved to be a lymph node block pushing the adjacent wall of the cecum. The overall histologic and immunophenotypic findings were consistent with ( a) abnormal immune lesion mimicking lymphomatous process because of infection by Epstein-Barr virus and ( b) extensive acute inflammatory infiltration of the cecum and adjacent tissues.

Is preoperative parenteral nutrition necessary for patients with predominantly ileal Crohn's disease?

We reviewed 46 consecutive patients with Crohn's disease predominantly affecting the ileum who specifically underwent right-sided ileocolectomy with primary anastomosis. All had a primary ileocolic anastomosis done by suture in a single-layer closed fashion. Of these 46 patients, 19.6% had overt intra-abdominal sepsis, 30.4% had prior surgery, and 95.7% were taking corticosteroid drugs just before their operation. The mean (+/- SE) age was 31.5 +/- 2.0 years. The serum albumin level was less than 35 g/L in 93.5% of patients; all had a hematocrit value less than 0.36, and 80.4% lost more than 15% of their normal body weight. No patient received parenteral nutrition either preoperatively or postoperatively. No change in the preoperative, intraoperative, or postoperative approach to treating patients with predominantly ileal Crohn's disease occurred during the 10-year period of review. There was a 2.2% incidence of perioperative complications (one superficial wound infection) and a 6.5% incidence of late (>1.49 months) complications (two suture sinuses and one wound abscess unassociated with a fistula). Our findings suggest that preoperative parenteral nutrition is unnecessary in the majority of patients with predominantly ileal Crohn's disease specifically undergoing right-sided ileocolectomy and primary ileocolic anastomosis.

Surgery for Crohn's disease in 28 children with the presence of acid-fast bacilli

Obstruction, abscesses, fistulae, treatment failure, and growth retardation are not always absolute indications for surgery in Crohn's disease. At the Children's Hospital of Eastern Ontario we have advocated earlier surgery since 1974. Forty-eight cases are reviewed, 28 surgical (17 ileocecocolic, 2 ileocolic with normal rectum, 3 colorectal, 1 jejunal, 5 perineal). Ileocecocolic resection with primary anastomosis produced remission for at least 3.2 years. Remission in colectomy with primary ileocolic anastomosis was at least 1 year. Ileostomy and colorectal resection produced remissions for at least 1.66 years. After jejunal resection remission was 1.58 years. Significant height and weight gains in over 80% of cases encourage earlier surgery. Adequate medical treatment has not often influenced the disease process. Surgery does not remove useful, medically restorable to normal bowel. Most postoperative cases required no medications and none jave required steroids. Permanent cure of anorectal disease alone was not achieved. Surgical mortality was 0%. The average hospital stay was 11.6 days. Postoperative fistulae occurred in 1 case and closed spontaneously. Mycobacterium tuberculosis was found in 2 resected specimens and in 1 human tubercle bacilli were cultured after 5 months. Both cases healed spontaneously, and both were otherwise undistinguishable from the other cases of Crohn's disease. Both were white, native-born Canadians. On examination of all the other resected specimens in our series, no acid-fast bacilli were seen.