Ovarian metastases from colorectal cancer (CRC), also known as Krukenberg Tumors (KT), occur in about 3 per cent of all colorectal cancer patients and make up between 5 to 10 per cent of all colorectal metastases. We sought to determine the effects of presentation of KT on treatment patterns and outcomes of patients diagnosed with KT. Under institutional approval, 26 patients diagnosed with KT were identified from an institutional CRC database from 1994 to 2010. Twenty-two patients presented at the same time of their CRC diagnosis and four patients presented after diagnosis and treatment of their primary CRC. Demographic presentation and treatment patterns were similar between the two groups. There was no overall survival difference between the two groups. The median overall survival in the entire cohort was 27 months. Factors affecting survival may include the extent of metastases and age at time of presentation. Patients who present with metastasis to the ovary alone may trend towards a better overall survival than patients who present with metastases to additional other sites.
Case Description/Methods: A 62-year-old male presented to hospital with right lower quadrant abdominal pain that started twelve hours after outpatient screening colonoscopy. Patient was asymptomatic prior to the procedure. During colonoscopy, bowel prep was noted to be excellent, cecum was reached and appendicial orifice was visualized which didn't show any signs of inflammation. No polypectomy or any other intervention was performed. On admission vital signs were stable. Rebound tenderness to palpation at McBurney's point was noted. WBC count was 13x10^3/uL, lipase level of 126unit/L and normal CMP. CT scan of abdomen showed proximally dilated appendix measuring up to 1.3cm with thickened walls, air in the distal tip, mild fat stranding but no appendicolith was identified nor was any intestinal perforation reported (Figure). General surgery was consulted and patient underwent appendectomy. No fecal material was found within appendiceal lumen. Histological examination revealed marked neutrophilic infiltration and confirmed acute appendicitis. Discussion: Up to one-third of the patients experience pain, bloating and nausea after colonoscopy which is mostly due to air insufflation during the procedure or colonic spasm, and can last for few hours to several days. Pain can also occur after removal of the polyp or if biopsy is taken during the procedure. Although rare, bleeding (0.21%) and perforation (0.1%) are by far the most common complications of colonoscopy. Appendicitis after colonoscopy is an extremely rare complication with an incidence rate of 0.038%. If there is onset of abdominal pain after polypectomy, clinicians are usually concerned about intestinal perforation which should be ruled out by contrast imaging studies. Possible mechanisms of appendicitis after colonoscopy include introduction of fecal content into appendix causing obstruction and later inflammation, barotrauma from over-inflation or direct trauma to appendix lumen. In this case, surprisingly there were no other cause but pneumo-appendix contributing to appendicitis as seen on imaging studies. Clinicians should be aware of this rare complication while evaluating a patient with post-colonoscopy abdominal pain so that it is promptly recognized and early intervention can prevent devastating results.[1985] Figure 1. Pneumo-appendix and fat stranding.
Methods: We conducted a retrospective review of patients undergoing upper esophagogastroduodenoscopy (EGD) at the time of colonoscopy by a single operator from December 12, 2021, to May 3, 2022. We compared the incidence of erosive gastritis in patients receiving OST-D versus oral sulfate solution (OSS) and PEG. We revised EGD images and classified erosive gastritis into mild (focal superficial erosions), moderate (diffuse superficial erosions), and severe (deep, cratered erosions, with scab). We reviewed EGD images from our prior OST study (OST-P) and classified lesions in the same manner. Exclusion criteria included NSAID use and H. pylori infection. Results: 135 patients underwent EGD at the time of colonoscopy. 11 excluded due to NSAID use or H. pylori infection and 1 due to unavailable prep data. Of the remaining 123 patients, 41 received OST-D, 82 OSS and PEG. Among 41 OST-D patients reviewed, 24 (58%) had inflammatory changes characterized by erosions and adherent blood compared to 27/33 (82%) with OST-P (p50.04). Severity in this study was lower with OST-D; severe erosive gastritis was seen in 1/41 (2.4%) moderate in 11/41 (27%) and mild in 12/41 (29%) compared to 4/33 (12%), 14/33 (42%) and 9/33 (27%) respectively with OST-P. Erosive changes were also found in 24/82 (30%) of patients who received OSS and PEG, which is significantly lower than OST-D group 24/41(58%, p , .01). Conclusion: While these findings are consistent with our prior study which suggested an increased incidence of erosive gastritis with OST prep, this study suggests that increasing time interval between Tablets leads to a decrease in incidence and severity of erosive gastritis suggesting that erosive changes are related to retention of OST Tablets. Endoscopists need to be made aware of these findings to decrease incidence and severity of erosive gastritis in patients using OST.
A 56-year-old man with a history of alcohol-related cirrhosis for 15 years with recurrent ascites presented to our emergency department with extensive abdominal swelling and pain for the past 2 months (Figures 1 and 2). His last paracentesis was 2 months ago, but he was unable to follow-up because of COVID restrictions. His abdominal pain was in a band-like distribution and was associated with anorexia and lower extremity edema despite being on diuretics. He has remained sober for the past year, continues to follow in the hepatology clinic, and has been placed on the transplant list.
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