Mandatory Resection of Strangulation Marks in Small Bowel Obstruction?

Käser, Samuel; Willi, Niels; Maurer, Christoph A.

doi:10.1007/s00268-013-2248-6

Cited by 8 publications

(3 citation statements)

References 30 publications

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“…Other entities with bowel infarction to be ruled out are ischemic colitis (rarely requiring surgical therapy, without predilection site) [ 9 ], venous mesenteric infarction [ 10 ], infarction due to strangulation ileus [ 11 ] or bowel ischemia due to local compression [ 12 ]. However, these entities are diagnosed by histological examination of the resected specimen.…”

Section: Introductionmentioning

confidence: 99%

Outcome after surgery for acute right-sided colonic ischemia without feasible vascular intervention: a single center experience of 58 patients over 6 years

et al. 2015

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BackgroundThe predilection site of non-occlusive mesenteric ischemia is the right-sided colon. Surgical exploration followed by segmental bowel resection and primary anastomosis or ileostomy is recommended, if vascular interventions are not feasible and conservative treatment fails. We assessed the outcome of patients in this life-threatening condition.MethodsFrom a prospective database 58 patients with urgent surgery for acute right-sided colonic ischemia without feasible vascular intervention (as a surrogate for non-occlusive mesenteric ischemia) were identified. Retrospectively the patients’ characteristics, reason for ischemia, extent of resection, rate of ileostomy creation, 30 day and one year mortality, and rate of ileostomy-reversal at one year postoperative were assessed.ResultsRadiologically mesenteric arteriosclerotic disease was present in 54% of the patients. Vaso-occlusive mesenteric disease was suspected in 15% of the patients, but not confirmed intra-operatively. Ten patients underwent (extended) right-sided hemicolectomy with primary anastomosis (30-days mortality 20%, 1-year mortality 30%). Sixteen patients had (extended) right-sided hemicolectomy with creation of an ileostomy (30-days mortality 44%, 1-year mortality 86%, ostomy reversal in one patient). Twenty-five patients had (sub-) total colectomy with ileostomy creation (30-days mortality 60%, 1-year mortality 72%, ostomy reversal in two patients). Seven patients had exploration only (30-days mortality 86%, 1-year mortality 86%). Overall, the 30-days mortality-rate was 52% and the 1-year mortality-rate was 70%. Only 7% of the patients requiring an ostomy experienced ostomy-reversal.ConclusionsPatients with urgent surgery for acute right-sided colonic ischemia without feasible vascular intervention have a very high short and long-term mortality. The rate of ostomy-reversal is very low.

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Section: Introductionmentioning

confidence: 99%

Outcome after surgery for acute right-sided colonic ischemia without feasible vascular intervention: a single center experience of 58 patients over 6 years

et al. 2015

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“…Types I-III are also sub-grouped into those with or without perforation [ 7 ]. Type I is the most frequently occurring, with a prevalence of 40-50% [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Diverticulitis and Diverticulosis of the Appendix: A Case Series

Lesi¹,

Probert²,

Iqbal³

et al. 2022

Cureus

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IntroductionDiverticula of the appendix is a rare entity, may be complicated by inflammation/infection, and clinically mimics acute appendicitis. The reported associated risk factors include male gender, Hirschprung's disease, cystic fibrosis and adult age, where some reports claim that they are also associated with an increased risk of appendiceal malignancy. Imaging has a place in pre-operative diagnosis, however, most of the cases were diagnosed during a pathological examination after surgery. They are associated with a higher rate of perforation (more than four times compared with classical acute appendicitis). In this review, we present a case series of five patients diagnosed with diverticulitis and one with diverticulosis of the appendix that were managed at a single centre. Our aim is to explore the common clinical, radiological, and intra-operative findings associated with this disease as well as the outcome of management. Materials and methodsA total number of six cases of diverticular disease of the appendix diagnosed and managed at Basildon University hospital in the period between 2016 and 2020 were studied. The demographic details and clinical data including presenting symptoms, laboratory results, radiological characteristics, intraoperative findings and histopathological features were analysed. ResultsThe study group included four males and two females, with an age range of 20-84 years. The most common presenting clinical symptoms were right iliac fossa abdominal pain, nausea, anorexia, and diarrhoea. Half of the cases showed a thickened appendix in the pre-operative CT scan. An inflamed or perforated appendix was seen in five cases as well as inflammation of the diverticula. ConclusionAppendiceal diverticulitis is an uncommon pathology that imitates acute appendicitis, and appendicectomy is the standard treatment. Prophylactic appendicectomy is recommended for non-inflamed diverticula -this is due to the potential risk of inflammation, perforation, and the risk of developing an appendiceal neoplasm.

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“…To avoid this problem, the standard policy at the Department of Surgery of Ka ¨ser et al [3] as stated in their article in the current issue of the World Journal of Surgery, is to resect all strangulation marks in small bowel obstruction, regardless whether frank gangrene of the bowel wall is present at the site of the strangulation mark. To evaluate whether this policy proved to be justified, they examined retrospectively all the pathology specimens of resected segments of small bowel where the indication for resection was a strangulation mark.…”

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confidence: 99%