Introduction
Surgical exploration is still considered mandatory in the setting of small bowel obstruction (SBO) in patients without prior intra‐abdominal surgery. However, recent studies have challenged this ‘classic’ approach describing success with conservative non‐surgical treatment. The aim of this study is to identify clinical, radiological and biochemical variables that may be associated with the absence of intra‐abdominal pathology in patients with SBO who have not undergone previous surgery.
Methods
This is a retrospective cohort study of prospectively recorded data. Patients with SBO without prior abdominal surgery who presented to a single tertiary referral medical center between 2009 and 2019 were included.
Results
Eighty‐seven patients were included of whom 61(70.0%) were allocated to the ‘therapeutic exploration’ group and 26 (30.0%) to the ‘non‐therapeutic exploration’ group. Forty‐eight patients (55.0%) had adhesions, 17.2% had closed‐loop obstruction, 10.0% had an internal hernia, 27.6% had bowel ischemia and 5.7% had bowel necrosis. Although multiple clinical, laboratory, radiological and preoperative factors were examined, none were significantly associated with pathological findings during surgical exploration. There was no statistically significant difference in the incidence of complications when comparing between those groups.
Conclusions
In this series, no variables were associated with intra‐abdominal pathology in patients who underwent surgery for SBO with no history of prior abdominal surgery. However, the fact that 27.0% had ischemic bowel upon surgical exploration suggests that this approach is still mandatory for this specific group of patients. Furthermore, clinicians and patients should be aware that negative exploration may be expected in up to 30.0%.
Background Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer. Methods We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient. Results Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn’s disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms. Conclusions A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn’s disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.
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