Wound irrigation before abdominal computed tomography scanning.

The management of penetrating abdominal trauma has evolved considerably over the last 30 years. The goal of any algorithm for penetrating abdominal trauma should be to identify injuries requiring surgical repair and avoid unnecessary laparotomy with its associated morbidity. We describe a case where the infusion of povidone-iodine (Videne) and air into the wound uncovered the peritoneal breach clinically and guided the radiologist to the site of the internal injury. This case report raises an intriguing possible role for povidone-iodine and air to be used both for wound toilet and to aid identification of occult wound tracks on computed tomography imaging. We advocate the routine use of wound irrigation with a mixture of povidone-iodine and air as described, in a select group of patients, as an adjunct to diagnosis before abdominal computed tomography scanning.

Delayed ileal-ileocystoplasty fistula formation: an unusual complication of augmentation enterocystoplasty.

Augmentation enterocystoplasty is a successful treatment for patients with neurogenic bladder dysfunction. Delayed spontaneous bladder rupture is a serious recognised complication of the procedure; however, to our knowledge, delayed fistula formation between the neobladder and the gastrointestinal tract has not been reported in the literature. We report the case of a 21-year-old male who presented with chronic diarrhoea resulting from an ileal-ileocystoplasty fistula 10 years following a successful augmentation enterocystoplasty. Fistula formation is a possible complication of this procedure, and a high index of suspicion is required for patients presenting with diarrhoea who have previously undergone bladder augmentation surgery.

Colorectal cancer in the young: trends, characteristics and outcome.

BACKGROUND: Colorectal cancer (CRC) in young patients is associated with a poor outcome due to advanced stage at diagnosis and poor differentiation. AIM: The aim of this study is to compare clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) of young (≤40 years) and older patients with CRC. METHODS: A total of 2,538 patients including 59 young patients (age ≤40 years) with CRC were identified over 20 years. The clinicopathological variables of young patients were compared with a group of consecutive older patients (n = 416) spanning both decades. Survival analysis was done using Kaplan-Meier, log-rank and Cox regression models. RESULTS: The frequency in young patients increased from 1.4% to 3.0% from first to second decade (overall -2.3%, p = 0.006). There was a higher frequency of tumours with poor differentiation (43% vs. 16%, p = < 0.001), T4 stage (47% vs. 30%, p = 0.005) and vascular invasion (VI; 38% vs. 29%, p = 0.13) in younger group. There was no significant difference in OS (p = 0.116) and DFS (p = 0.261) between the two groups. Node-negative young patients had a significantly better OS (p = 0.046). Young patients with VI had significantly reduced OS (p = 0.043), whereas young patients without VI had significantly better OS (p = 0.012). Multivariate analysis showed T4 status (p = 0.001) and vascular invasion (p = 0.002) as independent prognostic factors for OS and T4 status (p = 0.004) as independent factor influencing DFS. CONCLUSION: The frequency of CRC in young patients increased significantly. Vascular invasion is the single most important prognostic factor in young CRC. Along with vascular invasion, high proportion of T4 status in young patients increases the chances of recurrence and negates any survival advantage in young patients.

Impact of surgery on immunologic function: comparison between minimally invasive techniques and conventional laparotomy for surgical resection of colorectal tumors.

BACKGROUND: Surgical trauma suppresses host immune function, potentially creating an environment vulnerable to tumor cell growth. This study compared immune function after laparoscopy, minilaparotomy, and conventional colorectal tumor resections. METHODS: Seventy-one patients underwent surgery (20 laparoscopy, 21 minilaparotomy, and 30 conventional). Blood samples were taken before surgery and at 3 hours, 24 hours, and 5 days after surgery. White blood cell constitution was determined using monoclonal antibodies. Levels of TH1 cytokines interferon-gamma, tumor necrosis factor-alpha, and interleukin (IL)-2 and TH2 cytokines IL-10, -4, and -6 were measured in plasma and from supernatants of activated peripheral blood mononuclear cells. RESULTS: At 5 days after surgery, lymphocyte counts remained low in the conventional and minilaparotomy groups (P = .001 and P = .008) but had resolved in laparoscopic patients. Three-hour postoperative serum IL-6 concentrations were lower in laparoscopic than in conventional patients (P = .028). Production of TH1 cytokines 3 hours after surgery were significantly increased in laparoscopic patients (interferon-gamma P = .018, tumor necrosis factor-alpha P = .011, and IL-2 P = .037). CONCLUSIONS: TH1 lymphocyte function is improved transiently and immune homeostasis restored earlier in patients undergoing laparoscopic colorectal cancer resection, which may influence disease recurrence.