Abstract
Background
Sarcopenia is associated with increased morbidity and mortality in oncologic and transplant surgery. It has a high incidence in chronic inflammatory states including inflammatory ...bowel disease (IBD). The validity of existing data in IBD and of sarcopenia's correlation with surgical outcomes is limited.
Methods
We performed a systematic review to assess the correlation of sarcopenia with the requirement for surgery and surgical outcomes in patients with IBD. Observational studies of patients with IBD in whom an assessment of sarcopenic status/skeletal muscle index was undertaken, a proportion of whom proceeded to surgical management, were selected.
Results
A total of 5 studies with a combined 658 IBD patients met the inclusion criteria. The majority (70%) had a diagnosis of Crohn's disease. Median (range) body mass index and skeletal muscle index were reported in 4 studies and were 16.58 (13.66-22.50) kg/m2 and 44.52 (42.90-50.64) cm2/m2, respectively. Forty-two percent of IBD patients had sarcopenia. Notably, none of the studies assessed both the anatomical and functional component required for a correct assessment of sarcopenia. Three studies noted that sarcopenic IBD patients had a higher probability of requiring surgery. The rate of major complications (Clavien-Dindo grade ≥IIIa) was significantly higher in patients with sarcopenia. Improved perioperative nutrition management may mitigate the risk of complications.
Conclusion
Many IBD patients are young, may be malnourished, and commonly require emergent surgery. There is considerable heterogeneity in the assessment of sarcopenia. Sarcopenia is common in the IBD population and can predict the need for surgical intervention. Sarcopenia correlates with an increased rate of major postoperative complications. Improved perioperative intervention may diminish this risk. A formal assessment, screening by a dedicated IBD dietician, and preoperative physical therapy may facilitate early intervention.
Acute pancreatitis is a commonly encountered emergency but accurately predicting that subset of patients who will become systemically unwell has proven difficult. Simple haematological prognostic ...markers, such as red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR), could identify such patients. The aim of this study was to assess the usefulness of RDW and NLR measured on admission as predictors of mortality and intensive care (ICU) or high dependency unit (HDU) admission in patients with acute pancreatitis.
All patient who presented to our institution with acute pancreatitis between August 2013 and August 2016 were retrospectively identified using the prospectively maintained Hospital In-Patient Enquiry (HIPE) discharge audit. Data on survival, admission to HDU or ICU, length of stay and haematological parameters including RDW and NLR on presentation to the emergency department were collected.
A total of 185 patients with acute pancreatitis were included of which 23 (12%) patients had a RDW above the upper limit of normal (ULN), which was associated with a significantly increased likelihood of admission to ICU or HDU (RR3.5; p = 0.01); 117 (63%) patients had a NLR above 5 on presentation, which also increased the risk of ICU or HDU admission (RR 8.1; p = 0.01). Patients who had both a RDW above the ULN and a raised NLR had an increased risk of inpatient mortality (RR 9.9; p = 0.04).
RDW and NLR can identify patients at increased risk of severe acute pancreatitis on presentation to the Emergency Department.
•Elevated RDW and NLR are independent predictors of ICU or HDU admission in patients with acute pancreatitis.•Patients with acute pancreatitis in whom both RDW and NLR are raised have an increased risk of mortality.•Elevated NLR on admission predicts prolonged LOS for patients with acute pancreatitis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Benign cystic mesothelioma or peritoneal inclusion cysts are rare benign abdominal tumors usually occurring in females of reproductive age. These cysts present as abdominopelvic pain or masses but ...are often found on imaging or incidentally at surgery. They are commonly associated with pelvic inflammatory disease, endometriosis, or ovarian cysts. We report what is, to the best of our knowledge, the first case of a benign cystic mesothelioma complicating a presentation of acute appendicitis.
A 19-year-old Irish Caucasian woman presented with abdominal pain. Imaging suggested appendicitis with abscess formation. She was treated with antibiotics and scheduled for interval appendicectomy. At laparoscopy, an unusual cystic mass was found arising from the appendix. Histology revealed benign cystic mesothelioma.
We report what is, to the best of our knowledge, the first case of a benign cystic mesothelioma arising from the appendix and complicating a presentation of acute appendicitis. This is a benign pathology, but recurrences are not uncommon. Benign cystic mesothelioma should be included in the differential when investigating pelvic masses or abscesses associated with either appendicitis or pelvic inflammatory disease in women.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Stricture formation in Crohn’s disease occurs as a result of persistent fibroblast activation. Chronic inflammation seen in patients with Crohn’s disease leads to enhanced adhesion molecule ...expression in fibroblasts. Stress-activated mitogen-activated protein kinases are critical signaling pathways that control expression of intracellular adhesion molecule-1 (ICAM-1) in inflammation. The purpose of this study was to investigate the involvement of stress-activated mitogen-activated protein kinases in the regulation of ICAM-1 expression by tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serosal fibroblasts isolated from patients with Crohn’s disease.
Fibroblasts were isolated from serosal biopsies of strictures in patients with Crohn’s disease and normal colon in patients with colorectal carcinoma. Cell surface and whole cell ICAM-1 expression were evaluated by flow cytometry and Western blot analysis, respectively. Cells were stimulated with TNF-α and IL-1β. To determine the mitogen-activated protein kinase signaling pathway required for ICAM-1 induction, cells were pretreated with inhibitors to Jun N-terminal kinase, p38 kinase, and p42/44 kinase.
Baseline ICAM-1 expression was higher (p < 0.001) in fibroblasts isolated from strictures in patients with Crohn’s disease (3.2 ± 0.3) as compared with nonstrictured Crohn’s fibroblasts (2.1 ± 0.3) and control fibroblasts (1.6 ± 0.1). TNF-α and IL-1β increased ICAM-1 expression in both control and Crohn’s disease. Pretreatment of fibroblasts with the Jun N-terminal kinase inhibitor dimethylaminopurine abolished TNF-α– and IL-1β-stimulated ICAM-1 expression.
Serosal fibroblasts isolated from strictures of patients with Crohn’s disease demonstrate enhanced expression of ICAM-1. TNF-α and IL-1β upregulate ICAM-1 expression in serosal fibroblasts through a Jun N-terminal kinase signaling pathway. Specific inhibition of inflammatory signaling pathways could provide novel therapeutic targets for treatment of Crohn’s disease.
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GEOZS, NUK, OILJ, SBCE, SBJE, UL, UPUK
A giant colonic diverticulum (GCD) is a rare presentation of diverticular disease of the colon that usually necessitates surgery. The case described is of a GCD that became symptomatic due to rapid ...enlargement caused by an intracolonic bleed. GCD usually presents with abdominal pain and a palpable periumbilical or pelvic mass. Radiological imaging shows a large gas-filled cyst associated with the colon. Surgical resection with sigmoid colectomy is usually performed to alleviate symptoms and prevent later perforation.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Venous thromboembolism (VTE) following rectal surgery is a significant and preventable cause of morbidity and mortality, yet the true prevalence is not well established. This systematic ...review and meta-analysis assessed the available literature and determined its prevalence following rectal surgery.
Methods
A systematic review assessed the prevalence of VTE following rectal surgery. In addition, we evaluated whether subgroups (open vs. minimally invasive or benign vs. malignant resections) impacted on its prevalence or rate of deep venous thrombosis (DVT) or pulmonary embolism (PE).
Result
Thirty-eight studies met the predefined inclusion criteria. The aggregate prevalence of VTE following rectal surgery was 1.25% (95% CI 0.86–1.63), with DVT and PE occurring in 0.68% (95% CI 0.48–0.89) and 0.57% (95% CI 0.47–0.68) of patients. VTE following cancer and benign resection was 1.59% (95% CI 0.60–1.23 and 1.5% (95% CI 0.89–2.12) respectively. The prevalence of VTE in patients having minimally invasive resection was lower than those having open surgery 0.58% (16/2770) vs. 2.22% (250/11278); RR 0.54, 95% CI 0.33–0.86.
Conclusion
This review observed that there is sparse evidence on prevalence of VTE following rectal surgery. It provides aggregated data and analysis of available literature, showing overall prevalence is low, especially in those having minimally invasive procedures.
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EMUNI, NUK, SBMB, SBNM, UL, UPUK
Almost 50% of patients with inflammatory bowel disease (IBD) will undergo surgery for their disease at some stage of its clinical course. Complications seen following surgery may occur early or late ...in the postoperative period. Patient factors, including active inflammatory disease, malnutrition, and use of immunosuppressant medications, make these patients a challenging surgical group and at increased risk for surgical complications. The purpose of this review is to characterize the complications that are commonly seen following surgery in patients with IBD and to discuss the surgical and patient factors that may influence their development. (Inflamm Bowel Dis 2010;)
Neoplasms of Anal Canal and Perianal Skin Leonard, Daniel; Beddy, David; Dozois, Eric J
Clinics in Colon and Rectal Surgery,
03/2011, Volume:
24, Issue:
1
Journal Article
Peer reviewed
Open access
ABSTRACT
Tumors of the anus and perianal skin are rare. Their presentation can vary and often mimics common benign anal pathology, thereby delaying diagnosis and appropriate and timely treatment. The ...anatomy of this region is complex because it represents the progressive transition from the digestive system to the skin with many different co-existing types of cells and tissues. Squamous cell carcinoma of the anal canal is the most frequent tumor found in the anal and perianal region. Less-frequent lesions include Bowen's and Paget's disease, basal cell carcinoma, melanoma, and adenocarcinoma. This article aims to review the clinical presentation, diagnostic evaluation, and treatment options for neoplasms of the anal canal and perianal skin.
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