No abstract

Background Diverting ileostomy (DI) is utilised in rectal cancer surgery to mitigate the effects of anastomotic leak. The aim of this study was to assess the clinical risk factors associated with post‐operative complications of DI reversal. Methods A single‐centre retrospective analysis of patients who underwent surgical resection for rectal cancer and subsequent DI reversal between January 2012 and December 2020 was undertaken. Medical records were reviewed to extract clinical, operative and pathologic details and post‐operative complications according to the Clavien‐Dindo classification. Univariate and multivariable analyses were undertaken to assess risk factors associated with post‐operative complications of DI reversal. Results One hundred and twenty‐six adult patients who underwent DI reversal were included of which 49 had a post‐operative complication (39%). The most common complication was prolonged post‐operative ileus, which occurred in 24 patients (19%). On multivariable analysis smoking was significantly associated with overall complications (odds ratio [OR] = 5.60, 95% confidence interval [CI] 1.90–16.52, p = 0.0018), and high Clavien‐Dindo (2–5) category complications (OR = 4.60, 95% CI 1.81–11.68, p = 0.0013). In addition, patients who received adjuvant chemotherapy were less likely to have a reversal of DI complication (OR = 0.43, 95% CI 0.19–0.94, p = 0.0342) and less likely to have a high Clavien‐Dindo (2–5) category complication (OR = 0.44, 95% CI 0.20–0.93, p = 0.0311). Conclusion Smokers who have undergone surgical resection of rectal cancer have a significantly increased risk of post‐operative complications after DI reversal. In these patients, the importance of smoking cessation must be emphasised. The decreased complication rate observed in patients who received adjuvant chemotherapy was an unexpected finding.

Of the current published cases, six had a normal appendix and 10, including our own, had an inflamed, necrotic or perforated appendix and/or caecum. The incidence of appendicitis within an Amyand's hernia is reported as 0.1%. 1,8 Thus, we postulate that left-sided Amyand's hernia is far more likely to be associated with an acute inflammatory component compared with one in a right-sided hernia. The possible aetiology of left-sided Amyand's hernia include situs inversus, intestinal malrotation, a mobile caecum and a lengthy appendix reaching the left iliac fossa. 3,9 Previous studies have debated whether appendicitis is due to primary pathology or by hernia strangulation of blood supply with consequent necrosis, 7 the latter being the more likely aetiology in our patient. This rare case adds to the current sparse literature on acute leftsided Amyand's hernia and emphasizes the increased likelihood of acute appendicitis with left-sided rather than right-sided disease. It is a rare diagnosis worth considering in patients presenting acutely with large left-sided inguinoscrotal hernias. Informed consent has been obtained from the patient for publication of this manuscript.

No abstract

No abstract