LaPlace's law revisited: Cecal perforation as an unusual presentation of pancreatic carcinoma

Slam, Kristine; Calkins, Sarah; Cason, Frederick D

doi:10.1186/1477-7819-5-14

Cited by 25 publications

(25 citation statements)

References 14 publications

(16 reference statements)

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“…In the revised literaturedated from 1979, we found 3 case reports of adjacent colonic involvement of pancreatic adenocarcinoma causing mechanical obstruction (table 1) (3,4,5). We also found 3 other case reports of metastatic pancreatic cancer causing mechanical obstruction (6,7,8). Overall outcomes were poor, with one patient alive at three-months follow-up, since advanced disease was present at the time symptoms were developed.…”

Section: Discussion Discussionsupporting

confidence: 67%

Pancreatic Adenocarcinoma Presenting as Acute Large Bowel Obstruction: Case Report

Gil¹,

Parente²,

Rama³

et al. 2018

SGO

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Introduction: Acute large bowel obstruction is a rare presentation of pancreatic cancer, with only six cases described in the revised literature. In all those cases, diagnosis was made either intraoperatively or post-mortem. Case presentation: A 63-year-old man presented in the emergency room with 4 days of bowel constipation associated with abominal pain and distention. Abdominal CT revealed a narrowing at the colonic splenic flexure and the colonoscopy revealed extrinsic compression at 40 cm from the anal verge. The patient was submitted to emergent exploratory laparotomy. We identified a mass involving the colonic splenic flexure, splenic hilum and the pancreatic tail. An en bloc subtotal colectomy, splenectomy and distal pancreatectomy was performed. Final pathology revealed a pancreatic ductal adenocarcinoma. The postoperative period was complicated with fecal peritonitis due to bowel perforation (day 3), hemoperitoneum secondary to pancreatic stump bleeding (day 10) and surgical site infection. The patient was discharged home on day 43. Conclusion: A high level of suspicion is necessary to take into account pancreatic carcinoma as a differential diagnosis of bowel acute obstruction.

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Section: Discussion Discussionsupporting

confidence: 67%

Pancreatic Adenocarcinoma Presenting as Acute Large Bowel Obstruction: Case Report

Gil¹,

Parente²,

Rama³

et al. 2018

SGO

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“…The area of the esophagus with the smallest diameter requires the highest amount of pressure to facilitate distention. When a food bolus encounters an obstruction, the wall tension in the esophagus increases …”

Section: Discussionmentioning

confidence: 99%

“…When a food bolus encounters an obstruction, the wall tension in the esophagus increases. 21 The importance of measuring IBP in the field of esophageal manometry is not new. In 1993, Ren et al published a study describing the potential clinical utility of this value.…”

Section: Discussionmentioning

confidence: 99%

Intrabolus pressure on high-resolution manometry distinguishes fibrostenotic and inflammatory phenotypes of eosinophilic esophagitis

2015

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The aim of this investigation was to determine the motility patterns of inflammatory and fibrostenotic phenotypes of eosinophilic esophagitis (EoE) utilizing high-resolution manometry (HRM). Twenty-nine patients with a confirmed diagnosis of EoE according to clinicopathological criteria currently being managed at the Joy McCann Culverhouse Swallowing Center at the University of South Florida were included in the retrospective analysis. Only patients who completed HRM studies were included in the analysis. Patients were classified into inflammatory or fibrostenotic subtypes based on baseline endoscopic evidence. Their baseline HRM studies prior to therapy were analyzed. Manometric data including distal contractile integral, integrated relaxation pressure, and intrabolus pressure (IBP) values were recorded. HRM results were interpreted according to the Chicago Classification system. Statistical analysis was performed with SPSS software (Version 22, IBM Co., Armonk, NY, USA). Data were compared utilizing Student's t-test, χ(2) test, Pearson correlation, and Spearman correlation tests. Statistical significance was set at P < 0.05. A total of 29 patients with EoE were included into the retrospective analysis. The overall average age among patients was 40 years. Male patients comprised 62% of the overall population. Both groups were similar in age, gender, and overall clinical presentation. Seventeen patients (58%) had fibrostenotic disease, and 12 (42%) displayed inflammatory disease. The average IBP for the fibrostenotic and inflammatory groups were 18.6 ± 6.0 mmHg and 12.6 ± 3.5 mmHg, respectively (P < 0.05). Strictures were only seen in the fibrostenotic group. Of the fibrostenotic group, 6 (35%) demonstrated proximal esophageal strictures, 7 (41%) had distal strictures, 3 (18%) had mid-esophageal strictures, and 1 (6%) patient had pan-esophageal strictures. There was no statistically significant correlation between the level of esophageal stricture and degree of IBP. Integrated relaxation pressure, distal contractile integral, and other HRM metrics did not demonstrate statistical significance between the two subtypes. There also appeared no statistically significant correlation between patient demographics and esophageal metrics. Patients with the fibrostenotic phenotype of EoE demonstrated an IBP that was significantly higher than that of the inflammatory group.

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“…Thus, whilst the caecum is the preferential geographic point to decompress, it is also more suited to tube decompression as the caecal contents are less formed than those in the distal colon. 11 Cecostomy insertion is performed in children with chronic neurogenic constipation 2 and a short term solution for acute malignant bowel obstruction. 4 A radiologically inserted venting 'cecostomy' can achieve immediate decompression, minimising the risk of perforation while the patient is being stabilised to become a candidate for a more definitive surgical or endoscopic procedure.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous colonic stent insertion via a radiologically placed distal ‘cecostomy’ tube for the management of acute malignant bowel obstruction

Najran

Kallampallil

Bell

et al. 2016

Int J Gastrointest Interv

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Percutaneous cecostomy is an uncommon procedure but is reported as an effective temporising measure to achieve acute decompression of bowel obstruction. It has been reported as a safe procedure in the setting of bowel obstruction providing relief of symptoms. The insertion of a cecostomy in the distal colon is not routinely advised as it will not allow passage of formed faeces. Cases of antegrade stenting of proximal colonic obstruction via cecostomy have been described; however, antegrade stenting of the distal colon from access in the ascending colon can be technically challenging. We describe a case of a percutaneous colostomy inserted temporally at the splenic flexure, which provided close access to an obstructing descending colonic tumour, allowing definitive management with placement of a colonic stent. This technical feasibility case provides evidence that a temporary cecostomy placed in the distal colon can be performed as a measure to facilitate definitive management.

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LaPlace's law revisited: Cecal perforation as an unusual presentation of pancreatic carcinoma

Abstract: Background: Pancreatic cancer is often locally and distally aggressive, but initial presentation as cecal perforation is uncommon.

Cited by 25 publications

References 14 publications

Pancreatic Adenocarcinoma Presenting as Acute Large Bowel Obstruction: Case Report

Pancreatic Adenocarcinoma Presenting as Acute Large Bowel Obstruction: Case Report

Intrabolus pressure on high-resolution manometry distinguishes fibrostenotic and inflammatory phenotypes of eosinophilic esophagitis

Percutaneous colonic stent insertion via a radiologically placed distal ‘cecostomy’ tube for the management of acute malignant bowel obstruction

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