BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy findi...BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy finding of a healed diverticular perforation,mimicking a polyp,6 wk post-diverticulitis-something that has not been reported in literature.We aim to shed light on the likely process that resulted in the trompe l'oeil after diverticulitis.This also introduces the possibility of more targeted colonic resection in the event of a similar recurrence.CASE SUMMARY A middle-aged Chinese female presented with a 3-d history of non-colicky left iliac fossa pain.It was associated with fever(Tmax 37.6℃),non-bloody diarrhoea and non-bloody,non-bilious vomiting.She had a history of Type 2 diabetes mellitus,well controlled on metformin.Tenderness was noted on the left iliac fossa region with no guarding or mass.Total white cell count(11.45×10^(9)/L)and C-reactive protein levels(213.9 mg/L)were elevated.Computed tomography imaging of the abdomen revealed pericolonic fat stranding and extraluminal air pockets fluid density with peritoneal thickening at the sigmoid colon,likely representing a sealed perforation.Six weeks after the episode,she underwent a follow-up colonoscopy.An exophytic polypoid lesion closely associated with a diverticulum was seen in the sigmoid colon.The lesion was easily“pinched”off without much effort using endoscopic forceps and sent for histology which revealed granulation tissue suggesting a healed diverticular perforation.CONCLUSION Granulation tissue associated with healed diverticular perforations resemble polyps.Tattooing around these sites may allow for future targeted colonic resections.展开更多
A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of to...A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.展开更多
文摘BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy finding of a healed diverticular perforation,mimicking a polyp,6 wk post-diverticulitis-something that has not been reported in literature.We aim to shed light on the likely process that resulted in the trompe l'oeil after diverticulitis.This also introduces the possibility of more targeted colonic resection in the event of a similar recurrence.CASE SUMMARY A middle-aged Chinese female presented with a 3-d history of non-colicky left iliac fossa pain.It was associated with fever(Tmax 37.6℃),non-bloody diarrhoea and non-bloody,non-bilious vomiting.She had a history of Type 2 diabetes mellitus,well controlled on metformin.Tenderness was noted on the left iliac fossa region with no guarding or mass.Total white cell count(11.45×10^(9)/L)and C-reactive protein levels(213.9 mg/L)were elevated.Computed tomography imaging of the abdomen revealed pericolonic fat stranding and extraluminal air pockets fluid density with peritoneal thickening at the sigmoid colon,likely representing a sealed perforation.Six weeks after the episode,she underwent a follow-up colonoscopy.An exophytic polypoid lesion closely associated with a diverticulum was seen in the sigmoid colon.The lesion was easily“pinched”off without much effort using endoscopic forceps and sent for histology which revealed granulation tissue suggesting a healed diverticular perforation.CONCLUSION Granulation tissue associated with healed diverticular perforations resemble polyps.Tattooing around these sites may allow for future targeted colonic resections.
文摘A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.
