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David M Ray, Indu Srinivasan, Shou-Jiang Tang, Andreas S Vilmann, Peter Vilmann, Timothy C McCowan, Akash M Patel
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures...
March 28, 2017: World Journal of Radiology
Joseph T Church, Sidd Simha, Laurie C Wild, Daniel H Teitelbaum, Peter F Ehrlich
PURPOSE: Fecal incontinence is a socially debilitating problem for many children. We hypothesized that in selected patients with medically-refractory encopresis, placement of an appendicostomy or cecostomy tube for administration of antegrade continence enemas (ACE) would improve quality of life (QOL). METHODS: We reviewed all patients with encopresis who underwent appendicostomy or cecostomy placement from 2003 to 2014 at our institution. We contacted subjects' parents by phone and administered 3 surveys: a survey reflecting current stooling habits, a disease-specific QOL survey, and the PedsQL™ QOL survey...
January 30, 2017: Journal of Pediatric Surgery
Hiroshi Tamura, Ayaka Otani, Mizuki Tsukui, Koji Toge, Takahiro Otani, Yuki Hirose, Yuta Morimoto, Kei Yoshino, Tomoki Kido, Kazuhiko Endo, Hitoshi Kameyama, Takashi Kobayashi, Toshifumi Wakai
A 77-year-old woman with rectal cancer and synchronous liver metastasis underwent a Hartmann operation with D3 lymph node dissection in June 2014. mFOLFOX6 plus bevacizumab(bev)was then administered to treat the liver metastasis.In February 2015, multiple liver metastases were detected and the regimen was changed to FOLFIRI plus bev.After 3 courses, peritonitis due to intestinal perforation around the descending colostomy occurred, and an emergency operation(partial resection of the descending colon and transverse colostomy)was performed...
November 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Shifra Koyfman, Kristen Swartz, Allan M Goldstein, Kyle Staller
OBJECTIVE: We evaluated the safety and efficacy of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC) procedure both in children and young adults, along with review of their pre-operative motility profiles, antegrade continence enema (ACE) regimen, and postoperative complications. METHODS: This retrospective review investigated 38 patients (32 children and 6 young adults) that underwent the LAPEC procedure. Primary outcomes evaluated were success versus failure of the procedure and post-operative complications...
April 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Peter L Lu, Lindsey Asti, Daniel L Lodwick, Kristine M Nacion, Katherine J Deans, Peter C Minneci, Steven Teich, Seth A Alpert, Desale Yacob, Carlo Di Lorenzo, Hayat M Mousa
BACKGROUND: Sacral nerve stimulation (SNS) can be beneficial for children with constipation, but no studies have focused on children with constipation severe enough to require antegrade continence enemas (ACEs). Our objective was to evaluate the efficacy of SNS in children with constipation treated with ACE. METHODS: Using a prospective patient registry, we identified patients <21years old who were receiving ACE prior to SNS placement. We compared ACE/laxative usage, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), Fecal Incontinence Severity Index (FISI), and Vancouver Dysfunctional Elimination Syndrome Score (DES) at baseline and progressive follow-up time intervals...
November 10, 2016: Journal of Pediatric Surgery
Meric Emre Bostanci, Mustafa Atabey, Birkan Bozkurt, Ilker Ozel, Kursat Karadayi
Detorsion, cecopexy, cecostomy and tube cecostomy are the treatment options for acute cecal volvulus if there is no intestinal ischemia. Resection required if intestinal viability, necrosis, gangrene or perforation exists. After resection, primary anastomosis or ileostomy can be performed. First colonoscopic decompression testing may be appropriate in terms of saving time for elective surgery. The co-existance of situs inversus totalis with cecal volvulus may cause uncertainty of the definite diagnosis and delay of surgical procedure...
September 2016: Turkish Journal of Emergency Medicine
Joseph T Church, Samir K Gadepalli, Toghrul Talishinsky, Daniel H Teitelbaum, Marcus D Jarboe
PURPOSE: Chronic obstructive defecation can occur in patients with Hirschsprung Disease (HD) and internal anal sphincter (IAS) achalasia. Injection of Botulinum Toxin (BoTox) into the IAS can temporarily relieve obstructive defecation, but can be challenging when performed by tactile sense alone. We compared results of BoTox injections with and without ultrasound (US) guidance. METHODS: We retrospectively reviewed BoTox injections into the IAS for obstructive defecation over 5years...
January 2017: Journal of Pediatric Surgery
Alessandra Gasior, Giulia Brisighelli, Karen Diefenbach, Victoria Alison Lane, Carlos Reck, Richard J Wood, Marc Levitt
Introduction Functional constipation is a common problem in children. It usually can be managed with laxatives but a small subset of patients develop intolerable cramps and need to be temporarily treated with enemas. The senior author has previously reported: 1) open sigmoid resection as a surgical option, but this did not sufficiently reduce the laxative need, then 2) a transanal approach (with resection of rectosigmoid), but this led to a high rate of soiling due to extensive stretching of the anal canal and loss of the rectal reservoir...
October 25, 2016: European Journal of Pediatric Surgery
Xiaodong Ni, Shengxian Fan, Yongliang Zhang, Zhiming Wang, Lan Ding, Yousheng Li, Jieshou Li
Since its introduction as an alternative intestinal microbiota alteration approach, fecal microbiota transplantation (FMT) has been increasingly used as a treatment of choice for patients with ulcerative colitis (UC), but no reports exist regarding FMT via percutaneous endoscopic cecostomy (PEC). This report describes the case of a 24-year-old man with a 7-year history of recurrent, steroid-dependent UC. He received FMT via PEC once per day for 1 month in the hospital. After the remission of gastrointestinal symptoms, he was discharged from the hospital and continued FMT via PEC twice per week for 3 months at home...
November 15, 2016: Gut and Liver
Roberto A Gomez-Suarez, Michelle Gomez-Mendez, John K Petty, John E Fortunato
OBJECTIVE: Determine clinical and manometric parameters associated with success of antegrade continence enemas (ACEs) administered via cecostomy in the treatment of constipation and fecal overflow incontinence. METHODS: We performed a retrospective review of clinical symptoms and manometry (colonic and anorectal) before cecostomy in 40 pediatric patients (20 males, 20 females). The mean age at time of follow-up was 9.5 ± 4.4 years with a mean follow-up time of 12...
October 2016: Journal of Pediatric Gastroenterology and Nutrition
Ronak A Gor, Jenna R Katorski, Sean P Elliott
PURPOSE OF REVIEW: Neurogenic bowel dysfunction (NBoD) commonly affects patients with spina bifida, cerebral palsy, and spinal cord injury among other neurologic insults. NBoD is a significant source of physical and psychosocial morbidity. Treating NBoD requires a diligent relationship between patient, caretaker, and provider in establishing and maintaining a successful bowel program. A well designed bowel program allows for regular, predictable bowel movements and prevents episodes of fecal incontinence...
July 2016: Current Opinion in Urology
Pooja Bhadoria, Shahid Bahksh, Shilpi Agarwal, Babita Pangtey, Smita Kakar
Anatomical variations of colon are mostly developmental and can lead to variety of acute and chronic pathological conditions. So it becomes important to recognize and understand the importance of clinical implications of such anomalies to benefit surgeons, clinical geneticists and research community. We describe two cases of right sided sigmoid colon and long descending colon which had two segments: vertical and horizontal. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Yuichi Ishida, Susan F McLean, Alan H Tyroch
INTRODUCTION: Cecal bascule is a rare cause of intestinal obstruction associated with upward and anterior folding of the ascending colon. We report three patients who presented with spinal cord injury complicated with a cecal bascule. Diagnosis and management of cecal bascule is discussed. PRESENTATION OF CASES: Patient 1: 59-year-old male sustained a traumatic brain injury and cervical spinal cord injury after a motorcycle crash. He had abdominal distension and the diagnosis of cecal bascule was made...
2016: International Journal of Surgery Case Reports
Zambaiti Elisa, Chiaramonte Cinzia, Salerno Sergio, Li Voti Giuseppe, Siracusa Fortunato
Congenital colonic stenosis is a rare pediatric condition. Since 1968, only 16 cases have been reported in the literature. To the authors' knowledge, multiple congenital colonic stenosis has not been previously reported in the literature. We report the case of a 2-month-old male, presented at our Neonatal Intensive Care Unit with a suspicion of intestinal malrotation. Clinical examination revealed persistent abdominal distension. During the enema examination, the contrast medium appeared to fill the lumen of the colon up to three stenotic segments and could not proceed further...
2016: Case Reports in Pediatrics
Shruti Arya, Nancy Gupta, Rahul Gupta, Arun Aggarwal
Constipation, defined as delay or difficulty in defecation, present for 2 or more weeks, is a common problem encountered by both primary and specialty medical providers. There are no randomized controlled trials on the use of antegrade enemas in the pediatric population. Most published papers are based on the experience at a particular center. The aim of this article is to describe the pathophysiology of constipation, review the contribution of colonic manometry to the diagnosis of constipation, summarize the advancements in the management of constipation through the use of antegrade enemas, and study the outcomes of cecostomy at different centers...
November 2016: American Journal of Therapeutics
Georgios Papadimitriou, Maria Koukoulaki, Konstantinos Vardas, Alkis Grigorakis, Vasileios Vougas, Spiros Drakopoulos
Fournier's gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation) requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier's gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified...
November 2015: Saudi Journal of Kidney Diseases and Transplantation
Joseph T Church, Daniel H Teitelbaum, Marcus D Jarboe
Fecal incontinence is a debilitating problem for many children, especially those with anorectal malformations. Historically, surgical options have included the Malone antegrade continence enema, using an appendicostomy for antegrade colonic enemas. Since the development of this procedure, multiple alternatives have been developed, including the Chait cecostomy tube. Here, we present our technique for laparoscopic cecostomy tube placement. We find that this approach has several advantages, including mobilization of the cecum to allow the tube to be placed below the waistline for optimal cosmesis and comfort, increased safety provided by direct vision of needle access to the cecum, and increased security of the cecum to the abdominal wall allowing for safer tube replacement should it become dislodged in the early postoperative period...
December 2015: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Jiri Bem, Taimur Saleem
No abstract text is available yet for this article.
December 2015: Diseases of the Colon and Rectum
Armin Küllmer, Arthur Schmidt, Karel Caca
We report on two patients with recurrent episodes of chronic intestinal pseudo-obstruction (CIPO). A 50-year-old woman with severe multiple sclerosis and an 84-year-old man with Parkinson's disease and dementia had multiple hospital admissions because of pain and distended abdomen. Radiographic and endoscopic findings showed massive dilation of the colon without any evidence of obstruction. Conservative management resolved symptoms only for a short period of time. As these patients were poor candidates for any surgical treatment we carried out percutaneous endoscopic colostomy by placing a 20-Fr tube in the cecum with the introducer method...
March 2016: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
J Keller, P Layer
Acute colonic pseudo-obstruction (ACPO) is characterized by marked colonic dilatation which develops over several days. ACPO is due to a motility disorder and is not caused by colonic obstruction and occurs in patients with severe, often acute underlying diseases or postoperatively. It is associated with a 25-30% mortality overall that increases to up to 50% in patients who develop complications (e.g. colonic ischemia and perforation). The pathogenesis of the disorder has not yet been clarified and clinical symptoms and signs are relatively unspecific...
October 2015: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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