Body mass index and low CIR in colonoscopy!

Aim: The aim of this study was to determine common factors leading to incomplete colonoscopy with a special interest in patient body mass index [BMI], and also to determine most common second line investigation, its pick up rates for cancer and the success rate of re-scoping

Background: Wide availability of scope guide in all procedures may decrease failure rate

Methods: We retrospectively reviewed 2891 colonoscopies performed at our institution from August 2015 to July 2016. The cohort was composed of all incomplete procedures [148] during this time period and a second cohort [148] of complete examinations which were randomly selected for relation of BMI only. The data in incomplete colonoscopy group included age, gender, BMI, causes of failure, mode of referral, second line investigation. The success of re-scope to pick up a cancer was compared to other modalities i.e. CT Colonography etc

Results: Male to female ratio was 1:4.8. High incomplete colonoscopy rate was noted in females [81%]. Mean age in failure group was 64 +/-15. Average BMI was 28+/- 15.Most common mode of referral was urgent or suspected cancer [74%]. Common cause of failure was patient intolerance [30%]. Most common anatomical site of failure was sigmoid colon [35%]. Completion rate of re-scoping in experienced hands was 95%. A lower BMI is related with higher chances of failure or vice versa

Conclusion: Lower BMI has higher chance of failure, possibly due to less extra colonic fat leading to tortuous colon. Female sex is second most common cause of failure due to low intolerance to pain. Using stronger pain relief and equal distribution of these characteristics on different list will have least implications in busy cancer screening unit

Emergency stomas; should non-colorectal surgeons be doing it?

Aim: The aim of this study was to compare general and stoma specific short term complications in patients having stoma surgery in either an emergency or elective setting during their index hospital stay. It also compares the complications specific to a stoma carried out by surgeons with or without a specialist interest in colorectal surgery

Background: The stoma created in emergency surgery has a high short and long term complication rate. Emergency stomas where the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely affect a patient's quality of life

Methods: We retrospectively analysed data for all non-urological stomas created over the last three years in our institute. This covered the period from January 2014 to January 2017. The stoma care department kept a full database record of all patients. Besides demography we analysed the type of stoma i.e. colostomy or ileostomy, indications for the stoma, most common operation, length of stay [LOS] and short term complications based on the Clavien-Dindo classification. We also analysed the perioperative stoma related complications within the emergency cohort

Results: A total of 199 patients had new ostomies created during the three-year period. Four patients died during the inpatient stay and were excluded from the analysis. The total number of stomas created in the emergency cohort was 60 and 135 stomas were elective procedures. The male to female ratio was 1:1.01. The average age for the emergency cohort was 6 years older than for the elective cohort. There was a statistically significant difference in length of stay between the two cohorts [T Test P Value =.02]. There was a higher number of elective patients discharged in the first week compared to the emergency surgery patients. The rate of grade 3 or 4 complications was higher in the emergency cohort of patients. The rate of grade 3 or 4 complications was also much higher in patients operated by surgeons who did not have a specialist interest in colorectal surgery. The majority of grade 3 complications seen in the emergency surgery cohort and operated on by non-colorectal specialists [NCS] were stoma related, i.e retraction, necrosis and prolapse

Conclusion: Emergency surgery procedures are frequently bowel related. Emergency stoma surgery should not be taken as trivial procedure, non-colorectal surgeons should take advice and assistance from specialist colorectal surgeons for bowel related cases, particularly when a stoma is involved

Bacteremia due to aeromonas hydrophila in acute lymphoblastic leukemia

Aeromonas hydrophila [A. hydrophila] is a low virulent organism but may cause devastating fatal infections in immunocompromised host especially in liver cirrhosis. It is rarely reported to cause septicemia in a patient with Acute Lymphoblastic Leukemia [ALL]. The mortality rate of septicemia due to A. hydrophila is 29% to 73%. We report a case of 59-year-old female patient who was a known case of ALL, presented with the complaints of fever, lethargy and generalized weakness for one month. After taking blood samples for investigations, empirical antimicrobial therapy was started. She did not improve after 48 hours of therapy. Meanwhile blood culture revealed pure growth of A. hydrophila. After sensitivity report was available, ciprofloxacin was started. Patient became afebrile after 48 hours of treatment with ciprofloxacin. It is very vital to correctly identified and treat bacteremia due to A. hydrophila especially in the underlying leukemic patient.

Involvement of bone marrow with intravascular large B-cell lymphoma

Intravascular large B-cell lymphoma [IVLBCL] is a rare subtype of extranodal large B-cell lymphoma characterized by a selective proliferation of lymphoma cells within the lumina of vessels. We report a case of an 86-year-old man who presented with fever, shortness of breath and altered mental status. The diagnosis of IVLBCL was confirmed on a bone trephine biopsy that revealed positivity of CD20 and PAX5 immuno-histochemical staining of lymphoma cells confined within the lumina of vessels. The patient had a rapidly deteriorating clinical course with a fatal outcome even before the specific treatment for the underlying disease was commenced

RhnuII: a rare blood group phenotype

Rh[nuII] phenotype is a rare blood group characterized by the lack of expression of all Rh antigens [D, C, c, E and e] on the red cells. The phenotype is further classified into the regulator and amorph type based on underlying genetic defect. The clinical significance of its recognition is that such patients suffer from Rh[null] syndrome associated with osmotically fragile red cells called stomatocytes with subsequent chronic haemolytic anaemia of varying degree. Another importance is that such subjects readily form alloantibodies on exposure to Rh antigens. We report herein rare Rh[null] phenotype in a young pregnant female which was detected as a part of routine antenatal work-up for red cell antibody screening and identification