BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for e...BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for early detection of stomal complications is important to improve the outcome.A model including patients and disease related factors,intraoperative surgical techniques and biochemical markers would be a better determinant to anticipate early stomal complications.Incorporation of emerging tools and technology such as artificial intelligence(AI),will further improve the prediction.AIM To identify various risk factors and models for prediction of early post operative stomal complications in colorectal cancer(CRC)surgery.METHODS Published literatures on early postoperative stomal complications in CRC surgery were systematically reviewed between 1995 and 2024 from online search engines PubMed and MEDLINE.RESULTS Twenty-four observational studies focused on identifying various risk factors for early post operative stomal complications in CRC surgery were analyzed.Stomal complications in CRC are influenced by several factors such as disease factors,patient-specific characteristics,and surgical techniques.There are some biomarkers and tools loke AI which may play significant roles in early detection.CONCLUSION Careful analysis of these factors,changes in biochemical parameters,and application of AI,a predictive model for stomal complications can be generated,to help in early detection,prompt action to achieve better outcomes.展开更多
Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progr...Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progressive ileal conduit stomal variceal bleeding which was successfully managed by endovascular embolization via the transjugular transhepatic approach.In conclusion,transjugular transhepatic endovascular embolization is a good choice in patients with ileal conduit stomal variceal bleeding who have failed conservative therapy.展开更多
Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death.A 68-year-old woman who had undergone a palliative colostomy(colorectal carcinoma) presented ...Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death.A 68-year-old woman who had undergone a palliative colostomy(colorectal carcinoma) presented with a massive hemorrhage from the colostomy conduit.Considering her oncological status with medial and right hepatic veins thrombosis due to liver metastasis invasion,an emergency transhepatic coil embolization was successfully performed.Standard treatment modality for these cases has not been established.Percutaneous transhepatic coil embolization of varices is a safe and effective choice in patients who present with life threatening bleeding and exhibit contraindications to transjugular intrahepatic portosystemic shunt.展开更多
Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or co...Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.展开更多
In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of tre...In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.展开更多
文摘BACKGROUND Stomal complications though small in early postoperative period,but poses significant morbidity,therapeutic challenge,delay in adjuvant treatment and sometimes even leads to mortality.Predictive model for early detection of stomal complications is important to improve the outcome.A model including patients and disease related factors,intraoperative surgical techniques and biochemical markers would be a better determinant to anticipate early stomal complications.Incorporation of emerging tools and technology such as artificial intelligence(AI),will further improve the prediction.AIM To identify various risk factors and models for prediction of early post operative stomal complications in colorectal cancer(CRC)surgery.METHODS Published literatures on early postoperative stomal complications in CRC surgery were systematically reviewed between 1995 and 2024 from online search engines PubMed and MEDLINE.RESULTS Twenty-four observational studies focused on identifying various risk factors for early post operative stomal complications in CRC surgery were analyzed.Stomal complications in CRC are influenced by several factors such as disease factors,patient-specific characteristics,and surgical techniques.There are some biomarkers and tools loke AI which may play significant roles in early detection.CONCLUSION Careful analysis of these factors,changes in biochemical parameters,and application of AI,a predictive model for stomal complications can be generated,to help in early detection,prompt action to achieve better outcomes.
基金Supported by The National Natural Science Foundation of China,No.81171444 and No.30770984
文摘Ileal conduit stomal varices are rare,and may result in bleeding.The standard treatment modality for management of this type of hemorrhage has not been established.We present the case of a 70-year-old woman with progressive ileal conduit stomal variceal bleeding which was successfully managed by endovascular embolization via the transjugular transhepatic approach.In conclusion,transjugular transhepatic endovascular embolization is a good choice in patients with ileal conduit stomal variceal bleeding who have failed conservative therapy.
文摘Peristomal variceal bleeding due to portal hypertension is an entity that has rarely been reported with 3%-4% risk of death.A 68-year-old woman who had undergone a palliative colostomy(colorectal carcinoma) presented with a massive hemorrhage from the colostomy conduit.Considering her oncological status with medial and right hepatic veins thrombosis due to liver metastasis invasion,an emergency transhepatic coil embolization was successfully performed.Standard treatment modality for these cases has not been established.Percutaneous transhepatic coil embolization of varices is a safe and effective choice in patients who present with life threatening bleeding and exhibit contraindications to transjugular intrahepatic portosystemic shunt.
文摘Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.
文摘In this letter,a commentary on the article by Xu et al has been provided.Gastrointestinal stomal tumours(GISTs)are rare tumours that originate commonly in stomach(60%-70%)and small intestine(30%-40%).The course of treatment especially oesophageal GIST is very complex and hard to diagnose because of limited availability of pathological and clinical data.Endoscopic resection(ER)is a minimally invasive approach for removing tumours from the oesophagus and digestive system that does not require open surgery and is especially successful for very small and low-risk GIST.A retrospective exami-nation of 32 patients treated with ER between 2012 and 2023 was conducted to analyse clinical and pathological characteristics,effectiveness of therapy,and long-term prognosis.The findings demonstrate en bloc resection was achieved in 96.9%of cases with an R0 resection rate of 75%with a median size of tumour was approximately 2.12 cm.Post-surgery complication like hydrothorax,post-endoscopic submucosal dissection electrocoagulation syndrome occurred in about 25%of cases which later go resolved by conservative treatment.Recurrence of GIST was approximately 9.4%primarily in high-risk cases.ER should be widely adopted in clinical practise preferably for managing low-risk oesophageal GIST because of its high success rate,low recurrence rates and excellent survival results,ensuring better patient prognosis.
