Late perforation after ventriculoperitoneal (VP) shunting is extremely rare. Colonic perforation is uncommon and represents 0.1%-0.7% of abdominal complications. Colonic perforation can challenge diagnostic and therapeutic decisions, and there are no clear guidelines on the management of this problem. We present a 34-year-old woman who was admitted for a 1-week history of sensation of a foreign body through the anus at the time of bowel movements. She had previously undergone a VP derivation for hydrocephalus secondary to neurocysticercosis. Plain abdominal radiographs demonstrated the shunt within the colonic lumen and through the descendening and sigmoid colon. The shunt was exteriorized in the cervical area and a laparotomy was performed with a primary two-layer colonic close. The patient received antibiotic therapy for 2 weeks with good outcome. Percutaneous and endoscopic approaches have been reported in patients with no abdominal signs. Prompt recognition of this complication is critical to avoid high mortality rates.
We present a case of the rare occurrence of a mucus-secreting adenocarcinoma originating in an anal gland. A 37-year-old diabetic man had an anal fistulotomy 16 years before. He had four ischiorectal abscesses in a 6-month period. A seton was inserted in a complex fistula tract in the left anterior lateral aspect. Due to delayed healing, a new surgical exploration was carried out; pathological analysis of the curetted mucinous tissue revealed a mucoid adenocarcinoma. Surgical resection is the first choice of curative treatment, and additional treatments include chemotherapy, radiotherapy and brachytherapy.
Endoanal sonography is an accurate method for assessing sphincter anatomy, delineating both internal and external anal sphincters. Surgical treatment of sphincter defects is associated with good outcome.
Tubercle bacillus was discovered in 1882 by Robert Koch. With the introduction of chemotherapy for tuberculosis in the 1940s the incidence of this entity decreased. The incidence of the tuberculosis of the colon began to increase at the 1980s with the rise in numbers of patients considered as high risk for this entity, such as HIV-infected individuals, patients with chronic renal disease, and immunosuppressed patients with prolonged steroid therapy. We report on two patients with history of chronic abdominal pain and weight loss with a palpable mass in the right lower quadrant. In one patient chest radiography revealed a miliary reticulonodular pattern. In both, abdominal CT scan showed retroperitoneal lymphadenopathy and colonic wall thickness. Colonoscopic examination showed ulcerative lesions and ileocecal valve disruption. Microscopic examination of intestinal content showed evidenced M. tuberculosis. Tuberculosis of the colon should be suspected in patients suffering from chronic abdominal pain and weight loss.
Endoanal sonography can be used in the assessment of benign and malignant anal conditions and to evaluate the anatomy of the anal sphincters. We used endoanal sonography with a 10-MHz rotating endocavitary probe to evaluate a 45-year-old woman with a perianal mass, fecal incontinence, and menses-associated perianal pain. She had had 2 vaginal deliveries requiring episiotomies. Biopsy of the mass showed endometrial tissue. The ultrasound examination showed a perianal mass and an external anal sphincter injury. A wide excision and sphincteroplasty were performed, with improvement of fecal continence and pain. Histopathologic examination of the mass confirmed perianal endometrioma in an episiotomy scar.
Background Human bone marrow transplantation (BMT) becomes an accepted treatment of leukemia, aplastic anemia, immunodeficiency syndromes, and hematologic malignancies. Colorectal surgeons must know how to determine and manage the main colonic complications. Objective To review the clinical features, clinical and pathological staging of graft vs host disease (GVHD), and treatment of patients suffering with colonic complications of human bone marrow transplantation. Patients and methods We have reviewed the records of all patients that received an allogeneic bone marrow transplant and were evaluated at our Colon and Rectal Surgery department due to gastrointestinal symptoms, between January 2007 and January 2012. The study was carried out in patients who developed colonic complications, all of them with clinical, histopathological or laboratory diagnosis. Results The study group was constituted by 77 patients, 43 male and 34 female patients. We identified colonic complications in 30 patients (38.9%); five patients developed intestinal toxicity due to pretransplant chemotherapy (6.4%); graft vs. host disease was present in 16 patients (20%); 13 patients (16.8%) developed acute colonic GVHD, and 3 (3.8%) chronic GVHD. Infection was identified in 9 patients (11.6%). Conclusions The three principal colonic complications are the chemotherapy toxicity, GVHD, and superinfection; the onset of symptoms could help to suspect the type of complication (0–20 day chemotherapy toxicity, 20 and more GVHD), and infection could appear in any time of transplantation.
Diabetes is a strong predictor of worse outcomes in nonalcoholic fatty liver disease (NAFLD), such as cirrhosis, CVD, and overall mortality. However, its true prevalence in clinical practice, and the role of obesity contributing to fibrosis, remain unclear. To this end, we recruited 759 patients without known NAFLD (35% with T2DM; age: 56 ± 11 years; BMI: 30.8 ± 6.5 kg/m2; female 59 %; ethnicity: Caucasian 75%, AA 14%, other 11%) attending outpatient endocrine/primary care clinics. We measured: 1) Routine laboratories; 2) Liver fat (CAP score ≥ 274 dB/m) and fibrosis (liver stiffness measurement or LSM) by elastography. The prevalence of NAFLD in T2DM was 68% vs. 44% in those without T2DM (p<0.05). Comparing patients with vs. without T2DM, the presence of any liver fibrosis (LSM ≥7 kPa or F≥1) was 20% vs. 6%, of clinically significant fibrosis (LSM ≥8 kPa [moderate-to-severe] = F≥2) was 12% vs. 4%, and advanced fibrosis (LSM ≥ 9.7 kPa = F3/F4) was 7% vs. 1%, respectively (all p<0.05). Obesity in T2DM promoted a much higher prevalence of steatosis (80% vs. 47% in T2DM without obesity) and of moderate-to-severe fibrosis (17% vs. 3%, respectively, both p<0.05). In people without T2DM, obesity also played a major role regarding steatosis (obese: 66 % vs. non-obese: 28%) and moderate-to-severe fibrosis (F≥2: 8% vs. 1%, respectively; both p<0.05). Worse glycemic control in people with T2DM (A1c ≥7.0% vs. <7.0%) led to a higher prevalence of steatosis (75% vs. 62%) and of fibrosis (24% vs 18%; both p<0.05). In multiple regression analysis, with a 95% CI, obesity in T2DM was the most significant risk factor for steatosis (OR 2.8, 1.9-4.2) and fibrosis (OR 3.4, 2.1-5.3). Conclusion: People with T2DM are at a very high risk of hepatic steatosis and severe fibrosis. Obesity is a major risk factor for worse disease, even in the absence of diabetes. These findings strongly support recent ADA recommendations to screen people with T2DM and obesity and cardiometabolic risk factors for moderate-to-severe fibrosis. Disclosure E.Valdez saenz: None. D.Barb: None. A.Sharma: None. K.Cusi: Consultant; Poxel SA, Altimmune, Arrowhead Pharmaceuticals, Inc., AstraZeneca, 89bio, Inc., Bristol-Myers Squibb Company, Lilly, Madrigal Pharmaceuticals, Inc., Merck & Co., Inc., Medscape, Myovant, Novo Nordisk, ProSciento, Quest Diagnostics, Sagimet, Sonic Incytes, Terns, Research Support; Echosens, Inventiva, LabCorp, Zydus. E.Godinez leiva: None. R.Lomonaco: None. S.Kalavalapalli: None. S.A.Marangi: None. M.A.Gonzalez: None. A.Ortiz rocha: None. X.Chi: None. M.J.Gurka: None. Funding National Institutes of Health (R01120331-01A1)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.