Caecal pneumatosis is not an absolute contraindication for endoluminal stenting in patients with acute malignant large bowel obstruction

Ngu, James Chi‐Yong; Lieske, Bettina; Chan, Dedrick Kok Hong; Lim, Tian-Zhi; Cheong, Wai-Kit; Tan, Ker‐Kan

doi:10.1111/ans.12539

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Interestingly, Ozogul et al reported that of a total of 223 patients who had colon cancer, 26 patients presented with a colonic perforation proximal to the tumor (11.66%), representing the largest reported proportion of patients to be admitted with diastatic colonic perforation [1]. In a study of Ngu et al, 10 out of 60 (16.7%) patients admitted with acute malignant left colon obstruction were reported with CT evidence of cecal wall pneumatosis, a sign of possible imminent perforation, while only one was recognized with perforation through the tumor site [11]. In conclusion, diastatic colonic perforation occurs in approximately 0.7-1% of CRC patients, regarding the study by Ozogul et al as an outlier.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Paramythiotis

Karakatsanis

Moysidis

et al. 2020

Case Reports in Surgery

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Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Paramythiotis

Karakatsanis

Moysidis

et al. 2020

Case Reports in Surgery

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“…The authors of the study analysed the correlation between caecal diameter in the axial plane and the risk of impending caecal perforation on abdominal X‐ray in 19 patients with distal large bowel obstruction and a control group of 100 patients with an artificial dilatation of the caecum and found that all patients with impending caecal perforation had a caecal diameter greater than 9 cm. This 9‐cm rule is often used in combination with other signs such as pericaecal fluid or caecal pneumatosis to raise the suspicion of impending caecal perforation .…”

Section: Discussionmentioning

confidence: 99%

What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer?

et al. 2018

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“…Certain radiological features, such as poor enhancement of the bowel wall in the clinical context of metabolic acidosis with high lactate, should still alert the clinician to the possibility of an ischemic bowel, which can occur in cases of obstructive ileocolitis. However, the authors urge caution in interpreting all cases of pneumatosis intestinalis as definite evidence of an ischemic bowel as our earlier publication disputed this relationship [ 6 ]. To our knowledge, no prior study has conclusively proven that obstructive ileocolitis can be treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Ileocolitis in Patients With Obstructed Colorectal Cancer – A Matched Case Control Study

et al. 2018

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PurposeObstructive ileocolitis is an ulcero-inflammatory condition which typically occurs in the ileum or colon proximal to an obstructing colorectal lesion. If left unresolved, it often leads to intestinal perforation. We present a matched case control study of patients with obstructive ileocolitis caused by colorectal cancer to determine if any factors can predict this condition.MethodsThis is a retrospective review of 21 patients with obstructive colorectal cancer and histologically proven obstructive ileocolitis from 2005 to 2015 matched for age and sex with 21 controls with obstructing colorectal cancer without obstructive ileocolitis.ResultsThe 21 patients with obstructive ileocolitis had a median age of 71 years (range, 52–86 years). The most common presenting symptom was abdominal pain (n = 16, 76.2%), followed by vomiting/nausea (n = 14, 66.7%) and abdominal distension (n = 12, 57.1%). Interestingly, the radiological feature of pneumatosis intestinalis was noted in only 1 case. No significant differences were observed in baseline comorbidities, clinical presentations, or tumor characteristics between the 2 groups. Patients with obstructive ileocolitis were found to have a significantly higher total leucocyte count (17.1 ± 9.4×109/L vs. 12.0 ± 6.8×109/L, P = 0.016), lower pCO2 (32.3 ± 8.2 mmHg vs. 34.8 ± 4.9 mmHg, P = 0.013), lower HCO3 (18.8 ± 4.5 mmol/L vs. 23.6 ± 2.7 mmol/L, P < 0.001), lower base excess (-6.53 ± 5.32 mmol/L vs. -0.57 ± 2.99 mmol/L, P < 0.001) and higher serum lactate levels (3.14 ± 2.19 mmol/L vs. 1.19 ± 0.91 mmol/L, P = 0.007) compared to controls. No radiological features were predictive of obstructive ileocolitis.ConclusionPatients with obstructive ileocolitis tend to present with metabolic acidosis with respiratory compensation, raised lactate, and worse leucocytosis. Radiological features are not useful for predicting this condition.

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Caecal pneumatosis is not an absolute contraindication for endoluminal stenting in patients with acute malignant large bowel obstruction

Abstract: Caecal pneumatosis alone is not a reliable predictor of caecal viability in patients with acute malignant large bowel obstruction. Such a finding on CT scan should be correlated clinically before excluding the role of endoluminal stenting.

Cited by 10 publications

References 18 publications

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer?

Obstructive Ileocolitis in Patients With Obstructed Colorectal Cancer – A Matched Case Control Study

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