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Background: Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the gastrointestinal tract. Treatment involves immunosuppression, and surgical intervention is sometimes necessary for patients who do not respond to medical treatment. However, recurrence of the disease is a common complication after surgery. Aim: This case report focuses on a patient with CD who underwent ileocecal resection with Kono-S anastomosis, a surgical technique aimed at reducing recurrence rates. Case description: A 43-year-old male with a known history of CD for 13 years presented with recurring moderate-to-severe lower abdominal pain associated with belching, nausea, subjective fever, and sweats. The patient was on infliximab and azathioprine. Investigations confirmed irregular skip mural thickening of ileal loops with significant luminal narrowing along with stenotic fibrostrictures of the ileum, and mild bilateral sacroiliitis. The patient was treated surgically with an ileocecal resection and a Kono-S anastomosis operation. This case report highlights the advantages and disadvantages of the Kono-S anastomosis technique in treating patients with recurrent CD. Clinical significance: Kono-S anastomosis demonstrates a relative safety profile and carries several potential benefits. However, its wider adoption is limited due to insufficient familiarity among surgeons and the possibility of complications. Nevertheless, embracing Kono-S as the standard anastomosis method holds the promise of significant advantages for individuals with CD. Conclusion: This case report highlights the potential benefits of Kono-S anastomosis in reducing CD recurrence and provides valuable insights for further research and clinical practice. How to cite this article: Saeed M, Algahiny AT, Elmitwalli OSMMS, et al. An Analysis of the Literature and a Case Study on the Successful Surgical Treatment of a Crohn's Patient Using a Kono-S Anastomosis. Euroasian J Hepato-Gastroenterol 2023;13(1):36-39.
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Introduction: A stoma is an artificial anastomosis of the gastrointestinal tract to the abdominal skin wall to reroute the stream of feces. Fecal diversion, bowel decompression, and anastomosis protection are common indications for stomas. Relative to other surgical operations, stomas have a high morbidity rate, with rates averaging 40% and ranging 14-79%. The most common early complication was peristomal skin irritation. In contrast, parastomal hernias were the most common late complication. Methods: This research was performed at King Hamad University Hospital (KHUH) in the Kingdom of Bahrain. Our study included patients who had undergone ileostomies and colostomies. The inclusion criteria included adult patients who are 15 years and older, both emergency and elective cases, and with ASA score of 1-4. The excluded patients were those who had had their stomas performed outside of KHUH and those who were not following up in the hyperbaric department of our hospital. This study was performed using a retrospective study design. The sample size was 98 which included patients with stomas that were following up with the hyperbaric team between January 2018 and February 2021. Results: We have broken down the indications for stoma formation. The breakdown of all our documented complications are illustrated in the given figure. Conclusion: Within our institutional study, 63.3% of stoma complications consisted of skin problems. This formed the majority of complications. Establishing a stoma care unit would offer continuous support and care to patients and help them in returning to an optimal quality of life. Additionally, this goal can be met through preoperative and postoperative education regarding surgery and stoma formation. This includes preoperative stoma marking and siting, as well as improved recovery through instruction from knowledgeable stoma care specialists regarding hands-on stoma care.Finally, patients can be assisted through specialized stoma clinics. How to cite this article: Qassim T, Saeed MF, Qassim A, et al. Intestinal Stomas-Current Practice and Challenges: An Institutional Review. Euroasian J Hepato-Gastroenterol 2023;13(2):115-119.
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Background: Colorectal cancer (CRC) during pregnancy is rare and presents diagnostic and therapeutic challenges. Aim: This case report focuses on a patient who presented with colorectal cancer during pregnancy. Case description: A 45-year-old female primigravid, pregnant woman, in the 20th week of gestation presented with complaints of multiple episodes of bloody diarrhea and tenesmus for the past 3 weeks. This was accompanied by poor appetite and weight loss (15 kg) since the onset of pregnancy. The patient also complained of lower back and abdominal pain. Investigations confirmed an obstructing rectosigmoid mass (15 cm) that could not be passed. The patient's pregnancy was terminated, and chemotherapeutic treatment was initiated. Clinical significance: With the clinical manifestations of CRC during pregnancy being non-specific, tumors are usually discovered at an advanced stage. This poses a challenge for physicians to treat such cases. This case contributes to the growing literature on pregnancies complicated by CRC and highlights the importance of high clinical suspicion and the need for a multidisciplinary team in tailoring treatment regimens in accordance with patient-centered care. Conclusion: This case report highlights the rarity of colorectal cancer during pregnancy and the challenges faced in the diagnoses and treatment. How to cite this article: Saeed MF, Almubarak T, Khalaf S, et al. A Review of the Literature, the Detection and Treatment of Colorectal Cancer during Pregnancy: A Case Study! Euroasian J Hepato-Gastroenterol 2023;13(2):159-162.
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Heterotopic pancreas (HP) is defined as pancreatic tissue which is an anatomically separate entity from the main pancreas and free from the organ's vascular or ductal continuity. Most cases of HP are asymptomatic and are diagnosed incidentally upon laparotomy or on autopsy. The diagnosis of HP can be extremely difficult. A few imaging modalities which include Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) may show characteristic features of HP. However, definitive diagnosis is made by histopathology. Conversely, these modalities may not differentiate a malignant neoplasm from a benign mass. Surgical excision is thought to be curative for HP. In this case report, we present a 62-year-old female with acute myelocytic leukemia on induction chemotherapy who developed abdominal pain during her hospital admission and was referred to the general surgery department. Abdominal computed tomography (CT) was done and showed signs of small bowel obstruction, perforation, and overlapping jejunoileal segments suggestive of intussusception. Upon surgical exploration two small bowel perforations were repaired, one iatrogenic and one pathological. On bowel run a jejunal mass was found, excised, and upon histopathology confirmed to be a mixed endocrine and exocrine heterotopic pancreatic choristoma. Definitive diagnosis of heterotopic pancreatic tissue is made by histopathology, and surgical excision is potentially curative. In conclusion, we recommend excising HP if found incidentally upon surgery as the diagnosis of HP and exclusion of neoplasm may not be possible without a histological specimen.
