Impact of CT imaging on predicting the surgical management of acute diverticulitis

PURPOSE: The incidence of colonic diverticular disease is increasing, and several grading systems based on CT findings have been developed. The objective of this study was to define the impact of various CT findings of colonic diverticulitis and to demonstrate which factors affect the need for operative treatment. METHODS: Three hundred fifty-seven patients diagnosed with colonic diverticulitis from January 2010 to July 2016 were retrospectively evaluated. Patients were excluded if pure diverticulosis, diverticular bleeding, colon cancer, or relevant data deficiencies, and the remaining patients (n = 178) were reviewed. Patients were categorized into a successful nonoperation group and an operation group. The operation group was then matched 1:2 with the nonoperative group based on age, gender, American Society of Anesthesiologists physical status classification, and body mass index. RESULTS: After propensity score matching, there were no significant differences regarding patients' demographic characteristics between the 2 groups. Left location was more associated with need for operation than the right side (79.2% vs. 31.3%, P < 0.001). CT findings such as distant intraperitoneal air, pericolic air, and free fluid were significantly more apparent in the operation group. When these factors were evaluated in a multivariate analysis, distant intraperitoneal air showed statistical significance (P = 0.046) and pericolic air and left location a significant trend (P = 0.071 and P = 0.067, respectively). CONCLUSION: This study suggests that distant intraperitoneal air is the most important factor in the need for surgery in patients with colonic diverticulitis. Further study will be able to identify more detailed CT findings and verify their significance, and will be helpful in designing practical scoring and classification systems.

Nonsteroidal anti-inflammatory drugs induced diaphragm disease: a report of 3 cases and literature review

Multiple strictures of small bowel induced by nonsteroidal anti-inflammatory drugs (NSAIDs), were known as diaphragm disease. The purpose of these case reports is to present 3 cases of diaphragm disease of small bowel and summarize the clinical features of this disease entity. A 34-year-old man, a 63-year-old man, and a 66-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstructions. Two of these patients had taken heavy NSAIDs use. Capsule endoscopy was performed in all cases and the all capsules were retained by circumferential strictures of the ileum. Segmental resection of the strictures was performed in 2 patients and 1 underwent just enterotomy and capsule removal. In conclusion, clinicians should be aware that diaphragm disease might be a cause of small bowel obstruction especially in patients receiving long term NSAIDs therapy.

Adequate analgesic regimen would be required after minimally invasive colorectal surgery

No abstract available.

Unusual intestinal obstruction due to idiopathic sclerosing encapsulating peritonitis: a report of two cases and a review

Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is characterized by a thick fibrotic membrane encasing the small intestine like a cocoon. Accurate preoperative diagnosis is often difficult. We present 2 cases of SEP that were diagnosed preoperatively by contrast-enhanced computed tomography scan. A 38-year-old man and a 56-year-old woman were admitted to Daegu Catholic University Medical Center because of recurrent intestinal obstruction. We performed exploratory laparotomy with doubt of the preoperative diagnosis of SEP. We confirmed the diagnosis of SEP on laparotomy and performed adhesiolysis. Both patients recovered successfully and had no signs of recurrence. A better awareness of SEP and its radiological features should lead to more correct preoperative diagnosis and result in more appropriate management, including surgery.

Laparoscopic para-aortic lymph node dissection for patients with primary colorectal cancer and clinically suspected para-aortic lymph nodes

PURPOSE: Treatment of patients with para-aortic lymph node metastasis from colorectal cancer is controversial. The goal of this study was to investigate the technical feasibility of laparoscopic intrarenal para-aortic lymph node dissection in patients with colorectal cancer and clinically suspected para-aortic lymph node dissection. METHODS: The inclusion criteria for the laparoscopic approach were patients with infrarenal para-aortic lymph node metastasis from colorectal cancer. Patients who had any other distant metastatic lesion or metachronous para-aortic lymph node metastasis were excluded from this study. Perioperative outcomes and survival outcomes were analyzed. RESULTS: Between November 2004 and October 2013, 40 patients underwent laparoscopic para-aortic lymph node dissection. The mean operating time was 192.3 +/- 68.8 minutes (range, 100-400 minutes) and the mean estimated blood loss was 65.6 +/- 52.6 mL (range, 20-210 mL). No patient required open conversion. The postoperative complication rate was 15.0%. Sixteen patients (40.0%) had pathologically positive lymph nodes. In patients with metastatic para-aortic lymph nodes, the 3-year overall survival rate and disease-free survival rate were 65.7% and 40.2%, respectively. CONCLUSION: The results of our study suggest that a laparoscopic approach for patients with colorectal cancer with metastatic para-aortic lymph nodes can be a reasonable option for selected patients.

Duplex Ultrasound-Guided of Balloon Angioplasty Femoral Artery

PURPOSE: To evaluate initial technical success, procedural complication rate, and early patency of duplex sound guided angioplasty we studied 10 consecutive cases. METHOD: From June to August 2005, 10 patients (all male, mean age 64.8) underwent duplex sound guided femoral balloon angioplasty. The common femoral artery was cannulated under ultrasound guidance. Under continued ultrasound guidance a guide wire was introduced into the proximal superficial femoral artery. After the guide wire crossed the diseased segment, a balloon catheter was introduced and then the balloon catheter was inflated. Completed duplex examinations and ABI (ankle/brachial artery pressure index) were obtained in all cases. RESULT: Critical ischemia was included for the procedure in 60% and disabling claudication in remaining 40%. Anatomical lesions were identified at the superficial femoral artery in 90% of cases and at the deep femoral artery in remaining 10%. The lesion characteristics were critical stenosis in 80% of case and occlusion in 20%. For seven patients it was performed as a single therapeutic procedure; however, for three patients it was performed as an added procedure for bypass surgery. Technical success was noted in 100% of cases with an average increase of ABI of 0.4. CONCLUSION: Duplex ultrasound guided balloon angioplasty appears to be a safe and effective technique for the treatment of infrainguinal arterial occlusive disease. Technical advantages include accurate selection of the proper size balloon and confirmation of the adequacy of the technique by hemodynamic and imaging parameters as well as the avoidance of radiation exposure. But needs long term follow up.

Duplex Ultrasound-Guided of Balloon Angioplasty Femoral Artery

PURPOSE: To evaluate initial technical success, procedural complication rate, and early patency of duplex sound guided angioplasty we studied 10 consecutive cases. METHOD: From June to August 2005, 10 patients (all male, mean age 64.8) underwent duplex sound guided femoral balloon angioplasty. The common femoral artery was cannulated under ultrasound guidance. Under continued ultrasound guidance a guide wire was introduced into the proximal superficial femoral artery. After the guide wire crossed the diseased segment, a balloon catheter was introduced and then the balloon catheter was inflated. Completed duplex examinations and ABI (ankle/brachial artery pressure index) were obtained in all cases. RESULT: Critical ischemia was included for the procedure in 60% and disabling claudication in remaining 40%. Anatomical lesions were identified at the superficial femoral artery in 90% of cases and at the deep femoral artery in remaining 10%. The lesion characteristics were critical stenosis in 80% of case and occlusion in 20%. For seven patients it was performed as a single therapeutic procedure; however, for three patients it was performed as an added procedure for bypass surgery. Technical success was noted in 100% of cases with an average increase of ABI of 0.4. CONCLUSION: Duplex ultrasound guided balloon angioplasty appears to be a safe and effective technique for the treatment of infrainguinal arterial occlusive disease. Technical advantages include accurate selection of the proper size balloon and confirmation of the adequacy of the technique by hemodynamic and imaging parameters as well as the avoidance of radiation exposure. But needs long term follow up.