Gastrointestinal duplications are extremely rare congenital abnormalities having definite difficulties to be diagnosed preoperatively. Most of them are presented at the oesophagus and ileum and only involve colon from 4% to 18%. We illustrate a case report of an 18-year-old female patient with transverse colon duplication. There were symptom manifestations such as chronic constipation with flatulence accompanied with abdominal pain. We demonstrate this case report due to non-specific clinical presentation and some difficulties to form preoperative diagnosis. The patient underwent surgery. Tubular transverse colon duplication communicated with normal bowel in the proximal part was revealed. We performed transverse colon resection with duplication. The postoperative period was uneventful.
Aim:The Enhanced Recovery After Surgery (ERAS®) Society guidelines aim to standardize perioperative care in colorectal surgery via 25 principles. We aimed to assess the variation in uptake of these principles across an international network of colorectal units.Method: An online survey was circulated amongst European Society of Coloproctology members in 2019-2020. For each ERAS principle, respondents were asked to score how frequently the principle was implemented in their hospital, from 1 ('rarely') to 4 ('always'). Respondents were also asked to recall whether practice had changed since 2017.Subgroup analyses based on hospital characteristics were conducted.Results: Of hospitals approached, 58% responded to the survey (195/335), with 296 individual responses (multiple responses were received from some hospitals). The majority were European (163/195, 83.6%). Overall, respondents indicated they 'most often' or 'always' adhered to most individual ERAS principles (18/25, 72%). Variability in the uptake of principles was reported, with universal uptake of some principles (e.g., prophylactic antibiotics; early mobilization) and inconsistency from 'rarely' to 'always' in others (e.g., no nasogastric intubation; no preoperative fasting and carbohydrate drinks). In alignment with 2018 ERAS guideline updates, adherence to principles for prehabilitation, managing anaemia and postoperative nutrition appears to have increased since 2017.Conclusions: Uptake of ERAS principles varied across hospitals, and not all 25 principles were equally adhered to. Whilst some principles exhibited a high level of acceptance, others had a wide variability in uptake indicative of controversy or barriers to uptake. Further research into specific principles is required to improve ERAS implementation.
Colonic intussusception caused by benign tumour in adults is uncommon condition. Lipoma as benign tumour arises from submucosal layer of gastrointestinal tract and derives from mature adypocytes. It is usually small asymptomatic lesion and reveals during colonoscopy, CT, surgery or autopsy accidentally. However, in cases with large size it may cause abdominal pain, constipation, diarrhoea, anaemia, bleeding or intussusceptions. We present a 52-year-old female patient with colonic intussusception caused by lipoma of the transverse colon and with congenital dolichocolon. The patient had several episodes of bowel obstructions which were treated conservatively. We performed elective open extended right hemicolectomy, ileotransversostomy end-to-end.
Представлен клинический случай хирургического лечения пациента с рубцовой стриктурой пищево-да. Первоначально была выполнена гастростомия, затем загрудинная эзофогопластика правым флангом обо-дочной кишки. Послеоперационный период осложнился некрозом трансплантата. Последний был удален, наложена питательная еюностома. В связи с недостаточным кровоснабжением левого фланга ободочной кишки через год пациенту выполнили перевязку сигмовидной артерии с целью гиперваскуляризации левой половины толстой кишки по аналогии с технологией Shumacker H. и Battersby J. (1951) и Шалимова А.А. (1951), предложенной ими для развития сосудистых коллатералей в тощей кишке перед эзофагоеюно-пластикой. После достижения адекватного кровоснабжения колотрансплантата произведена реконструк-тивно-восстановительная операция: лапаротомия, пластика пищевода левым флангом ободочной кишки. Особенностью вмешательства было чресплевральное проведение трансплантата из брюшной полости на шею с помощью эндоскопа, что позволило отказаться от торакотомии. Клинический случай интересен внедрением идеи реваскуляризации кишки для усиления кровоснабжения сегмента толстой кишки, что позволило успешно подготовить для эзофагопластики левый фланг ободочной кишки после некроза эзо-фаготрансплантата из ее правой половины. Ключевые слова: ожог пищевода, абдоминальная полость, рубцовая стриктура пищевода, загрудинная и внутриплевральная эзофагоколопластика, лапаротомия, некроз колотрансплантата, мезентерикография, ре-васкуляризацияThe clinical case of the patient's surgical treatment with the cicatricial esophageal stricture is presented. Gastrostomy was done as the initial procedure and later the retrosternal esophagoplasty with the right colon interposition was performed. Postoperative period was complicated by necrosis of the colon transplant, which was removed and the nourishing jejunostomy was applied. Due to the insufficient blood supply of the left colon flank, the patient was carried out the ligation of sigmoid artery for the left side colon revascularization by analogy with the technique of Shumacker H. and Battersby J. (1951) and Shalimov A.A. (1951), proposed by them to develop the vascular collaterals in the jejunum before esophagojejunoplasty. After restoration of an adequate blood supply in colonic transplant, the reconstructive-restorative procedures had been performed (laparotomy and esophagocoloplasty by using of left colon flank). Transpleural movement of transplant from the abdominal cavity to the neck using endoscope was considered the peculiarity of this case. It permitted to avoid thoracotomy. A clinical case is interesting by implementation of idea of revascularization of intestine to enhance blood supply to the colonic segment, allowing successfully to prepare left colon flank for esophagoplasty after right-sided esophageal graft necrosis.
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