Influencing factors analysis and management strategies of colonoscopy-associated colorectal perforation / 中华消化外科杂志

Objective:To investigate the influencing factors and management strategies of colonoscopy-associated colorectal perforation.Methods:The retrospective case-control study was conducted. The clinical data of 358 patients who underwent colonoscopy in the Affiliated Hospital of Zunyi Medical University from January 2011 to March 2021 were collected. There were 216 males and 142 females, aged (59±14)years. Patients underwent colonoscopy for diagnosis or treatment. Observation indicators: (1) situations of colonoscopy-associated colorectal perforation; (2) analysis of influencing factors of colonoscopy-associated colorectal perforation; (3) construction of prediction model of colonoscop-associated colorectal perforation; (4) management of colonoscopy-associated colorectal perforation. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Wilcoxom rank sum test. Count data were discribed as absolute numbers, and comparison between groups was analyzed using the chi-square test. Multivariate ana-lysis was conducted using the binary Logistic regression model. The sensitivity and specificity of the prediction model were evaluated by the receiver operating characteristic (ROC) curve. Results:(1) Situations of colonoscopy-associated colorectal perforation. Of the 358 patients, 18 cases developed colorectal perforation, including 6 males and 12 females, with an age of 61(49,69) years. Of the 18 patients, there were 12 cases with colon perforation, including 10 cases of sigmoid colon perfora-tion or rectosigmoid junction perforation, 1 case of transverse colon perforation and 1 case of descending colon perforation, 6 cases with rectal perforation. There were 11 cases with diagnostic perforation and 7 cases with therapeutic perforation. (2) Analysis of influencing factors of colonoscopy-associated colorectal perforation. Results of univariate analysis showed that gender, age, colorectal ulcer, colorectal diverticulum, colorectal tumor, history of abdominal surgery, type of colonoscopy and the experience of operating physician were related factors for colonoscopy-associated colorectal perforation ( χ2=5.77, Z=?3.24, χ2=37.99, 97.34, 37.99, 10.31, 8.07, 6.73, P<0.05). Results of multi-variate analysis showed that colorectal diverticulum and abdominal surgery history were indepen-dent risk factors for colonoscopy-associated colorectal perforation ( odds ratios=287.79, 6.74, 95% confidence intervals as 23.14?3 579.11, 1.19?38.27, P<0.05). Therapeutic colonoscopy was an independent protective factor for colonoscopy-associated colorectal perforation ( odds ratio=0.11, 95% confidence interval as 0.23?0.52, P<0.05). (3) Construction of prediction model of colonoscopy-associated colorectal perforation. With the colonoscopy-associated colorectal perforation as depen-dent variable, colorectal diverticulum, abdominal surgery history and therapeutic colonoscopy as independent variables, a prediction model of colonoscopy-associated colorectal perforation was constructed. The ROC of model showed that the sensitivity was 0.56, the specificity was 1.00, and the area under curve was 0.78 (95% confidence interval as 0.63?0.92, P<0.05). (4) Management of colonoscopy-associated colorectal perforation. Of the 18 cases with colonoscopy-associated colorectal perforation, 15 cases underwent laparoscopic perforation repair surgery immediately, 2 cases under-went endoscopic suture, and 1 case received conservative treatment. All the patients with perfora-tion were cured and discharged from hospital, without death due to colonoscopy-associated colorectal perforation. Conclusions:Colonoscopy-associated colorectal perforation is easy to occur at sigmoid colon or rectosigmoid junction. Colorectal diverticulum and abdominal surgery history are indepen-dent risk factors for colonoscopy-associated colorectal perforation. Therapeutic enteroscopy is an independent protective factor for colonoscopy-associated colorectal perforation. Laparoscopic repair of colon perforation has good effects for patients with colorectal perforation.

Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis / Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis

Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

Factors Associated with the Recurrence of Complicated Diverticular Disease

Colonic diverticula is observed in over 60% of the western population aged over 80 where up to 30% will eventually be symptomatic and may develop complications. The natural history and etiology of colonic diverticula have been well described. However, predictive indicators of complicated diverticular disease are not known thus preventing the prophylactic treatment of this subset of patients,. The aim of this study was to observe patients with complicated diverticular disease in order to identify common factors associated with recurrent complications. All hospital admissions from January 2005 to December 2008 for complications of diverticular disease were recruited. Using logistic regression, demographic data and factors such as clinical presentation, nature of complication, lifestyle, concomitant medical illness and medications that may be associated with recurrent episodes of complications were analyzed. A total of 121 patients were diagnosed with complicated diverticular disease during the study period with 24 patients having recurrent complications. Logistic regression analysis performed after controlling for confounders found active smoking (p=0.006) and alcohol consumption (p=0.036) along with underlying diabetes (p=0.031) and dyslipidemia (p=0.039) significantly associated with an increased risk of recurrent complications. We therefore concluded that smoking, alcohol consumption, diabetes mellitus and dyslipidemia are associated with recurrent complicated colonic diverticular disease. As these are modifiable risk factors, they should be sought for during the presentation of the first attack. Aggressive control of these factors will help in reducing the risk of recurrent complications.

Castleman's Disease in the Sigmoid Mesocolon: A Case Report

Castleman's disease is a rare disorder that's characterized by the proliferation of lymphoid tissue. It is very rare to find this disease arising from the sigmoid mesocolon. We report here on a case of localized Castleman's disease involving the sigmoid mesocolon, and we discuss the findings of the gray-scale ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging.

A Clinical Study of Colon Diseases of Old Age Based on Colonoscopic Finding

BACKGROUND: Recently, geriatric diseases become the matter of concern, and the neoplastic lesion of colon including polyp and cancer by the western-style diet is increasing. The aims of this study were to assess the relations between colon diseases, clinical manifestations and features of colonoscopic finding in elderly. METHODS: We retrospectively evaluated records of 764 patients underwent colonoscopy. Colonoscopic finding, each colon diseases and lower gastrointestinal symptoms were analyzed to compare between two groups, which are 416 elders aged over 65 and control of 348 adults aged from 25 to 65. RESULTS: Both two groups underwent colonoscopy showed lower abdominal pain is the most symptom of lower gastrointestinal symptoms. But, anaemia and bowel habit change were significantly high frequency in the elderly group while diarrhea appeared in the control group(p<0.05). Colon polyp and cancer were significantly increased frequency in the elderly group(p<0.05). Symptoms such as diarrhea and hematochezia were significantly high in case of colon polyp of elderly group(p<0.05). But in case of colon cancer, lower abdominal pain had significantly high in the control group compared with the elderly group who had various lower gastrointestinal symptoms such as constipation, diarrhea, hematochezia, bowel habit change(p<0.05). CONCLUSIONS: As people getting older, the incidence of colon polys and cancer is higher, and non-specific, various clinical manifestations are seen. Therefore, we think that seniors who have change in bowel habit, abdominal pain, hematochezia or constipation need colonoscopy increasingly and should pay attention to find neoplastic lesions.