Blind loop perforation after side-to-side ileocolonic anastomosis

Blind loop syndrome after side-to-side ileocolonic anas-tomosis is a well-recognized entity even though its in-cidence and complication rates are not clearly defined. The inevitable dilation of the ileal cul-de-sac leads to stasis and bacterial overgrowth which eventually leads to mucosal ulceration and even full-thickness perfora-tion. Blind loop syndrome may be an underestimated complication in the setting of digestive surgery. It should always be taken into account in cases of acute abdomen in patients who previously underwent right hemicolectomy. We herein report 3 patients who were diagnosed with perforative blind loop syndrome a few years after standard right hemicolectomy followed by a side-to-side ileocolonic anastomosis.

Short benign ileocolonic anastomotic strictures-management with bi-flanged metal stents:Six case reports and review of literature

BACKGROUND The endoscopic management of benign short post-anastomotic ileocolonic stricture(PAICS) that is refractory to primary and secondary treatment modalities remains challenging.The lumen-apposing metal stent(LAMS) is a novel device recently developed for therapeutic gastrointestinal endoscopy.LAMSs have demonstrated significantly better results with regard to stent migration than fully covered self-expandable metal stents(FCSEMSs).CASE SUMMARY This article presents six cases of symptomatic PAICS successfully treated with a LAMS and a review of the relevant literature.We report a life-saving technique not previously documented and the use of technology to improve patient outcomes.The six patients(median age,75 years) suffered from vomiting,constipation and recurrent abdominal pain,with symptoms starting 23-25 wk post-surgery.The median stricture length was 1.83 cm.All six patients underwent successful and uneventful bi-flanged metal stent(BFMS)-LAMS placement for benign PAICS.All patients remained asymptomatic during the three months of stent indwelling and up to a median of 7 mo after stent removal.According to the literature,the application of LAMS for PAICS is associated with a < 10% risk of migration and a < 5% risk of bleeding.Conversely,FCSEMS has a high migration rate(15%-50%).CONCLUSION The evolving role of interventional endoscopy and the availability of LAMSs provide patients with minimally invasive treatment options,allowing them to avoid more invasive surgical interventions.The BFMS(NAGI stent) is longer and larger than the prototype AXIOS-LAMS,which should be considered in the management of short ileocolonic post-anastomotic strictures longer than 10 mm and shorter than 30 mm.

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease:analysis from the PRACTICROHN study

Background:This study is aimed at describing the prevalence of and risk factors associated with early post-operative complications after Crohn’s disease-related intestinal resection.Methods:This was a retrospective analysis of data from the PRACTICROHN cohort.Adult Crohn’s disease patients who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010 were included.The complications evaluated included death,ileus,anastomotic leak,abscess,wound infection,catheter-related infection,digestive bleeding and other extra-abdominal infections that occurred in the 30 days after surgery.Results:A total of 364 patients(median age at surgery 38 years and 50%men)were included.Indication for surgery was:stricturing disease(46.4%),penetrating disease(31.3%),penetrating and stricturing disease(14.0%)or resistance to medical treatment(5.8%).Early complications were recorded in 100(27.5%)patients,with wound infection,intra-abdominal abscess and anastomotic leakage being the most frequent complications.Median hospitalization duration was 16 days for patients with complications vs.9 days without complications(P<0.001).Complications were more common among patients with penetrating disease(36/114,31.6%)and those refractory to treatment(9/21,42.9%)compared with stricturing disease(45/169,26.6%)or stricturingtpenetrating disease(6/51,11.8%)(P=0.040).The rate of complications was higher among patients with diagnosis made at the time of surgery(15/31,48.4%)compared with the rest(85/331,25.7%)(P=0.013).Medication received at the time of surgery did not affect the rate of complications.Conclusions:Almost a quarter of patients developed early complications after intestinal resection.Penetrating disease and urgent surgery were associated with an increased risk of complications.

Benign esophageal stricture after thermal injury treated with esophagectomy and ileocolon interposition

Thermal injuries of the esophagus are rare causes of benign esophageal stricture, and all published cases were successfully treated with conservative management. A 28-year-old Japanese man with a thermal esophageal injury caused by drinking a cup of hot coffee six months earlier was referred to our hospital. The hot coffee was consumed in a single gulp at a party. Although the patient had been treated conservatively at another hospital, his symptoms of dysphagia gradually worsened after discharge. An upper gastrointestinal endoscopy and computed tomography revealed a pinhole like area of stricture located 19 cm distally from the incisors to the esophagogastric junction, as well as circumferential stenosis with notable wall thickness at the same site. The patient underwent a thoracoscopic esophageal resection with reconstruction using ileocolon interposition. The pathological findings revealed wall thickening along the entire length of the esophagus, with massive fibrosis extending to the muscularis propria and adventitia at almost all levels. Treatment with balloon dilation for long areas of stricture is generally difficult, and stent placement in patients with benign esophageal stricture, particularly young patients, is not yet widely accepted due to the incidence of late adverse events. Considering the curability and qualityof-life associated with a long expected prognosis, we determined that surgery was the best treatment option for this young patient. In this case, we decided to perform an esophagectomy and reconstruction with ileocolon interposition in order to preserve the reservoir function of the stomach and to avoid any problems related to the reflux of gastric contents. In conclusion, resection of the esophagus is a treatment option in patients with benign esophageal injury, especially in cases involving young patients with refractory esophageal stricture. In addition, ileocolon interposition may help to improve the quality-of-life of patients.