ABSTRACT
Jejunal diverticulosis (JD) is a rare clinical entity. The potential complications of this condition are discussed here through a series of cases presented to our centre. A retrospective analysis of four cases, which were diagnosed and treated, was performed. These included two cases of gastrointestinal haemorrhage, one case of perforation and one case of enterolith obstruction. All of these cases were secondary to jejunal diverticulosis and treated surgically. This was accompanied by a literature search to identify the different modalities for diagnosis and treatment of this condition. JD is rare and may lead to a diagnostic delay. Awareness of the wide spectrum of potential complications can prevent this delay.
Subject(s)
Diverticulum/diagnosis , Gastrointestinal Hemorrhage/etiology , Intestinal Obstruction/etiology , Intestinal Perforation/etiology , Jejunal Diseases/diagnosis , Aged , Aged, 80 and over , Digestive System Surgical Procedures , Diverticulum/complications , Diverticulum/surgery , Female , Gastrointestinal Hemorrhage/surgery , Humans , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Jejunal Diseases/complications , Jejunal Diseases/surgery , Male , Middle Aged , Treatment OutcomeABSTRACT
PURPOSE: Microscopic mesorectal soft tissue extranodal deposits discontinuous with the primary tumor are identified in many rectal adenocarcinomas. Current guidelines consider them to be involved lymph nodes. We studied the impact of these deposits on the outcome of patients with rectal cancer. METHODS: This was a retrospective study, in which histology slides were reviewed from 55 patients whose resection specimens for rectal cancer were staged as Dukes C or Dukes B with extranodal deposits. Twenty-nine patients had extranodal deposits (19 males), and 26 control patients had lymph node involvement only (14 males). Patient outcome was analyzed in terms of local and systemic control and survival. RESULTS: Distant metastases were diagnosed earlier in patients with extranodal deposits (mean, 14 months) compared with controls (mean, 37 months; P = 0.001). On follow-up, 31.03 percent (9/29) from the extranodal deposit group developed liver metastases compared with 11.5 percent (3/26) of the control group (P = 0.08). Local recurrence was seen in 17.2 percent of patients from the extranodal deposit group and 3.8 percent of the control group (P = not significant). Cancer-related mortality was higher in the extranodal deposit group (16 vs. 7 patients; P = 0.09). The three-year actuarial survival was 48.27 percent in patients with extranodal deposits and 65.38 percent in those without. A significant association was noted between the number of extranodal deposits and intramural vascular invasion (P = 0.017), extramural vascular invasion (P = 0.039), perineural invasion (P = 0.039), and lymph node involvement (P = 0.008). CONCLUSION: These data suggest that extranodal deposit is a distinct form of metastatic disease in patients with rectal cancer. The association with vascular invasion and earlier development of metastases probably infers that a significant proportion of extranodal deposits may represent blood-borne spread. These tumor foci should be considered as indicators of poor prognosis.
Subject(s)
Adenocarcinoma/secondary , Lymph Nodes/pathology , Neoplasm Recurrence, Local/pathology , Rectal Neoplasms/pathology , Adenocarcinoma/mortality , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/mortality , Neoplasm Staging , Prognosis , Rectal Neoplasms/mortality , Rectal Neoplasms/therapy , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
This review deals with various developments in the field of small-bowel surgery, including the role of ileal pouch-anal anastomosis and ileorectal anastomosis in the treatment of ulcerative colitis and familial adenomatous polyposis. We discuss modern trends in the surgical management of Crohn disease, and the increasing use of laparoscopy in the management of inflammatory bowel disease and small-bowel obstruction. In addition to looking at small-bowel tumors, this review deals with the current status of small-bowel transplantation.
