A Case Report of Refractory Graft-Versus-Host Disease Colitis Managed With Robotic Total Abdominal Colectomy.

Graft-versus-host disease (GvHD) is a common complication following hematopoietic stem cell transplant (HSCT) and has protean manifestations. It results from the activation of transplanted T lymphocytes against the HLA antigens of recipient cells, resulting in tissue destruction. The most commonly involved sites of acute GvHD are the skin and gut, with high mortality reported in the latter. Historically, surgery for gut GvHD has been reserved for those with frank perforations or uncontrolled hemorrhage. Here, we present a case of steroid and ruxolitinib refractory colonic GvHD in a 41-year-old female, which was ultimately managed with robotic-assisted total abdominal colectomy with resolution of enteric symptoms. This case highlights the role of surgical management in gut GvHD in patients who are refractory to the growing arsenal of immunomodulating agents. Given the rarity of surgical intervention in this population, more data are needed to minimize morbidity in this setting.

Meckel's Diverticulum Charading as Crohn's Disease: A Single-Institution Case Series.

Meckel's diverticulum is the most common gastrointestinal congenital anomaly and may present with lower gastrointestinal bleeding, abdominal pain, and nausea. Imaging and endoscopic findings can be similar to those of Crohn's disease, including transmural inflammation, stricturing, and superficial ulceration frequently in the distal ileum. Here, we present a case series of three patients who were initially diagnosed with Crohn's disease and ultimately found to have Meckel's diverticulum alone on final pathology. This single-institution case series, the largest in the literature, highlights the importance of maintaining a high index of suspicion for Meckel's diverticulum, especially in the absence of microscopic evidence of inflammatory bowel disease.

High-Grade Dysplasia in Inflammatory Bowel Disease: Indication for Colectomy.

BACKGROUND: Patients with inflammatory bowel disease have an increased risk of colorectal cancer and are recommended to undergo increased surveillance compared to the general population. Currently, inadequate evidence exists to guide management of colonic dysplasia discovered during screening of inflammatory bowel disease patients. OBJECTIVE: The goal of this study was to determine the risk of colorectal cancer in patients with ulcerative colitis or Crohn's disease with dysplasia on colonoscopy. DESIGN: This was a retrospective study. SETTING: This study was conducted at a high-volume, quaternary referral center with an inflammatory bowel disease program. PATIENTS: Patients with a diagnosis of inflammatory bowel disease with colonoscopy within 6 months of colectomy were included. MAIN OUTCOME MEASURES: The primary outcome measures included finding of colorectal cancer at time of colectomy. RESULTS: There were 621 patients, 233 with ulcerative colitis and 388 with Crohn's disease. Of ulcerative colitis patients, 25 had low-grade dysplasia on colonoscopy with 1 (4%) found to have colorectal cancer at colectomy. High-grade dysplasia was noted preoperatively in 14 and colorectal cancer was found in 4 (29%) after colectomy. Compared to no dysplasia, low-grade dysplasia did not increase the risk of colorectal cancer (OR 1.98, p = 0.47), but high-grade dysplasia had an increased risk (OR 19.0, p < 0.001) of colorectal cancer. For the 7 patients with Crohn's disease and low-grade dysplasia, colorectal cancer was found in 1 patient (14%) at colectomy. High-grade dysplasia was noted preoperatively in 4 patients with Crohn's Disease, and colorectal cancer was found in 3 patients (75%) after colectomy. Compared to no dysplasia, low-grade dysplasia did not increase the risk of colorectal cancer (OR 12.4, p = 0.88), but high-grade dysplasia did increase the risk of colorectal cancer (OR 223.2, p < 0.001). LIMITATIONS: This study was limited by its retrospective review. CONCLUSION: In both ulcerative colitis and Crohn's disease, low-grade dysplasia was not associated with colorectal cancer. High-grade dysplasia was associated with an increased risk of colorectal cancer at time of colectomy. While continued surveillance may be appropriate for low-grade dysplasia, high-grade dysplasia necessitates surgical resection given the high likelihood of colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B887 . DISPLASIA DE ALTO GRADO EN LA ENFERMEDAD INFLAMATORIA INTESTINAL INDICACIN DE COLECTOMA: ANTECEDENTES:Los pacientes con enfermedad inflamatoria intestinal tienen un mayor riesgo de cáncer colorrectal y se recomienda someterse a una mayor vigilancia en comparación con la población general. Actualmente, existe evidencia inadecuada para guiar el manejo de la displasia colónica descubierta durante la valoracion de pacientes con enfermedad inflamatoria intestinal.OBJETIVO:Determinar el riesgo de cáncer colorrectal en pacientes con colitis ulcerosa o enfermedad de Crohn con displasia en la colonoscopia.DISEÑO:Este fue un estudio retrospectivo.AJUSTE:Este estudio se llevó a cabo en un centro de referencia cuaternario de alto volumen con un programa de enfermedad inflamatoria intestinal.PACIENTES:Pacientes con diagnóstico de enfermedad inflamatoria intestinal con colonoscopia dentro de los 6 meses posteriores a la colectomía.PRINCIPALES MEDIDAS DE RESULTADO:Las principales medidas de resultado incluyeron el hallazgo de cáncer colorrectal en el momento de la colectomía.RESULTADOS:Hubo 621 pacientes: 233 con colitis ulcerosa y 388 con enfermedad de Crohn. De los pacientes con colitis ulcerosa, 25 tenían displasia de bajo grado en la colonoscopia y 1 (4%) tenía cáncer colorrectal en la colectomía. Se observó displasia de alto grado antes de la operación en 14 y cáncer colorrectal en 4 (29%) después de la colectomía. En comparación con la ausencia de displasia, la displasia de bajo grado no aumentó el riesgo de cáncer colorrectal (Odds Ratio 1,98, p = 0,47), pero la displasia de alto grado tuvo un mayor riesgo (OR 19,0, p <0,001) de cáncer colorrectal. Para los 7 pacientes con enfermedad de Crohn y displasia de bajo grado, se encontró cáncer colorrectal en 1 (14%) en la colectomía. Se observó displasia de alto grado antes de la operación en 4 pacientes con enfermedad de Crohn y cáncer colorrectal en 3 pacientes (75%) después de la colectomía. En comparación con la ausencia de displasia, la displasia de bajo grado no aumentó el riesgo de cáncer colorrectal (Odds Ratio 12.4, p = 0.88), pero la displasia de alto grado sí aumentó el riesgo de cáncer colorrectal (Odds Ratio 223.2, p <.001).LIMITACIONES:Este estudio estuvo limitado por su revisión retrospectiva. CONCLUSIN: Tanto en la colitis ulcerosa como en la enfermedad de Crohn, la displasia de bajo grado no se asoció con el cáncer colorrectal. La displasia de alto grado se asoció con un mayor riesgo de cáncer colorrectal en el momento de la colectomía. Si bien la vigilancia continua puede ser apropiada para la displasia de bajo grado, la displasia de alto grado requiere resección quirúrgica dada la alta probabilidad de cáncer colorrectal. Consulte Video Resumen en http://links.lww.com/DCR/B887 . (Traducción-Dr Yolanda Colorado ).

Carbon Dioxide Embolism Resulting From Liver Laceration During Peritoneal Optical Trocar Entry.

Venous air emboli have been reported to occur in numerous settings, including trauma, various surgical procedures, both laparoscopic and radiologically, and even idiopathically. In this case study, a liver laceration was made during a robot-assisted left colectomy and colostomy in a 69-year-old female resulting in air embolism during insufflation. A drop in end-tidal CO2 was noted and the patient went into immediate cardiac arrest. Adequate pressure was applied and over-suturing of the liver laceration was made with reverse Trendelenburg positioning during the administration of cardiopulmonary resuscitation (CPR) for approximately one minute. The patient completed an open hemicolectomy the following day and made a complete recovery. Preventative and intraoperative measures to prevent further recurrences of venous air emboli are discussed.

Hidradeonoma Papilliferum of the Anus: A Case Report About the Relationship Between Neoplasms of the Mammary-Like-Glands and Hormones.

Hidradenoma papilliferum (HP) is a benign pathologic finding that has been described primarily in the vulvar region. While thought to arise from ectopic tissue along the mammary line, it is now known to also arise from mammary-like anogenital glands (MLG), which are part of the normal anogenital cellular and glandular milieu. Previous work has demonstrated the relationship between HP and hormone receptors, but this has not been documented in a clinical setting. In this case, we present HP in a patient undergoing infertility treatments, presenting with a painful, enlarging anal mass. Upon histopathologic review, the mass was found to be an HP with no malignant changes. This unique case adds to the existing literature on perianal HP. While this case follows the known clinical and histological patterns of HP, the unique temporal relationship to in vitro fertilization (IVF) treatment supports previous in vitrowork on the relationship between HP and hormone receptors.