Robot-assisted laparoscopic abdominoperineal resection for anal canal cancer associated with Crohn's disease: A case report

A 37-year-old man with Crohn's disease (CD) and a history of abdominal surgery was diagnosed with anal canal cancer. Robot-assisted laparoscopic abdominoperineal resection was performed and the patient was discharged without any postoperative complications. Recently, minimally invasive surgery for CD patients has grown in popularity. However, there have been few studies of robotic surgery for CD patients with anal canal cancer. To the best of our knowledge, we present the first report of a patient with CD-associated anal canal cancer who underwent robot-assisted laparoscopic abdominoperineal resection.     

Extracorporeal photopheresis for the treatment of severe,refractory steroid dependent pediatric Crohn's Disease

Crohn's disease is a chronic, inflammatory disease of the gastrointestinal tract, affecting both children and adults. Extracorporeal photopheresis (ECP) has been used in steroid dependent adults with moderate to severely active Crohn's disease, with response rates up to 50%, with up to 25% complete responses. A 12‐year‐old male patient had severe unremitting Crohn's disease for one year, despite treatment with anti‐inflammatory, immunosuppressive, and biologic agents. He failed elemental enteral nutrition and required total parenteral nutrition (TPN). A diverting colostomy for perforation was required. He required frequent hospitalizations and required homebound schooling. Endoscopy revealed severe inflammation and ulcerations of the entire colon. ECP was begun twice weekly for 4 weeks, then twice per week every 14 days for a total of 28 weeks. ECP was well tolerated and prednisone was gradually discontinued. He continued daily azathioprine and infliximab at 6 week intervals. TPN was weaned as enteral intake improved. Disease abatement allowed a return to school and normal activities. Endoscopy at completion of ECP course revealed normal upper tract, normal ano‐rectum, and decreased, although significant, colonic disease. This response has continued for at least 16 months since completion of ECP. We conclude that ECP is useful for pediatric patients with steroid dependent Crohn's disease and prospective evaluation is warranted. J. Clin. Apheresis 28:381–386, 2013. © 2013 Wiley Periodicals, Inc.     

Single‐incision laparoscopic surgery for small bowel resection with an intraumbilical arcuate incision in children

Single‐incision laparoscopic surgery (SILS) has been performed on children for various procedures. However, few reports are available about SILS for small bowel resection, particularly involving conventional instruments in the pediatric population. Herein, we report four cases of small bowel resection with single umbilical incision and a three‐trocar approach. From October 2010 to September 2011, we performed small bowel resection with SILS on four cases, including a boy with an intestinal duplication cyst and three children with Meckel's diverticulum. An intraumbilical arcuate incision was made to expose the abdominal wall fascia, and one 5‐mm and two 3.5‐mm trocars were inserted. It was not necessary to extend the initial incision to exteriorize the lesion except in one case in which we applied the so‐called Y‐V closure plasty. All procedures were successful and did not require conversion, and all patients recovered smoothly without any complications. Small bowel resection using the SILS approach is suitable for these diseases.     

Advances in reduced port laparoscopic liver resection

Reduced port surgery has been attracting attention in the field of minimally invasive surgery. Although the use of SILS is becoming widespread, technical difficulty has delayed its adoption for laparoscopic liver resection. Recently, advances in laparoscopic liver resection have been made in tandem with advances in surgical skill and devices. The main driver in conventional laparoscopic liver resection's evolution to become less surgically invasive seems to be single‐incision laparoscopic liver resection (SILLR). To date, most reports on SILLR have been single case reports or case series. Only a few cohort studies on conventional laparoscopic surgery and SILLR have been conducted. Recent reports have described the use of SILLR for well‐localized lesions and solitary tumors located in the anterolateral segments of the liver or left liver lobe, but its application remains limited to partial resection and left lateral sectionectomy. The feasibility and safety of SILLR have been demonstrated, but additional work is needed for standardization of the procedure.     

FOCAL LYMPHOID HYPERPLASIA OF THE TERMINAL ILEUM MIMICKING CROHN'S DISEASE

SUMMARY Focal lymphoid hyperplasia of the terminal ileum is a rare cause of terminal ileitis.¹ We describe the case of a 13-year-old boy with a stricture of the terminal ileum that was diagnosed as Crohn's disease on barium meal and follow through. This failed to resolve on steroid therapy and the boy eventually required resection of his terminal ileum. Pathology of the terminal ileum showed focal lymphoid hyperplasia and not Crohn's disease.     

Single‐incision laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor arising from the duodenum

We report a case involving a minimally invasive single‐incision laparoscopic and endoscopic cooperative local excision of a duodenal gastrointestinal stromal tumor. A 59‐year‐old man presented with a 35‐mm lesion located in the second portion of the duodenum. A local resection was performed via single‐incision laparoscopic and endoscopic cooperative surgery. Intraluminal endoscopic dissection of the duodenal mucosa and submucosa was performed circumferentially around the tumor. The resection was then completed by laparoscopic dissection of the seromuscular layer around the tumor. The tumor was retrieved laparoscopically. After confirming that the resection achieved clear surgical margins, we closed the duodenal wall with a laparoscopic stapling device. There were no postoperative complications, including stenosis. Single‐incision laparoscopic and endoscopic cooperative surgery can be safely and effectively performed for a duodenal submucosal tumor.     

Hydrocortisone‐Induced Convulsions

Abstract

Glucocorticoids may indirectly cause convulsions by the induction of electrolytes abnormalities, severe hypertension, or severe hyperglycemia. These agents may rarely cause convulsions by a direct toxicity to the central nervous system (CNS). We describe a 23‐yr‐old patient with Crohn's disease in whom generalized convulsions developed on two occasions while receiving intravenous hydrocortisone.     

First successful use of leukocyte apheresis as maintenance therapy for Crohn's disease in the United Kingdom

We describe the case of a 24 year old male with severe fistulating Crohn's disease who failed mutliple modalities of medical and surgical therapy. We present objective and subjective evidence of disease remission after induction and maintenance treatment with leukocyte apheresis. This is the first described case of successful maintenance treatment of severe Crohn's disease with leukocyte apheresis in the United Kingdom. J. Clin. Apheresis 29:181–182, 2014. © 2013 Wiley Periodicals, Inc.     

Crohn's pericarditis identified with point‐of‐care ultrasonography: A case report

We report the case of a 71‐year‐old male with Crohn's disease, shortness of breath, and chest pain that highlights cardiac involvement in inflammatory bowel disease and the role of point‐of‐care ultrasonography using an alternate cardiac ultrasound window in making the diagnosis of Crohn's pericarditis. The role of ultrasonography in diagnosis and management of inflammatory bowel disease focuses primarily on intestinal pathology. Cardiac involvement is a rare but clinically impactful extraintestinal manifestation, the diagnosis of which benefits from ultrasonography if the clinician performing and interpreting the exam is aware of the possibility and understands the potential value of whole‐body ultrasonography as part of a physical exam.     

克罗恩病照顾者负担水平现状调查及影响因素分析

目的 调查克罗恩病照顾者负担情况,并探究其影响因素。方法 采用一般资料调查表、照顾者负担量表、社会支持量表对南京某医院的96例克罗恩病患者及其照顾者进行调查。 结果 照顾者的总负担为35.08±13.51分,其中,15.6%无负担,50%轻度负担,32.3%中度负担,2.1%重度负担。单因素分析显示照顾者性别、居住地、文化程度、职业、与患者关系、月收入,社会支持和病人有无造口、营养支持方式均可影响照顾者负担。多元线性回归分析显示照顾者月收入、社会支持情况以及患者营养支持方式对照顾者负担有影响。结论 克罗恩病照顾者普遍存在照顾负担,且影响因素较多,护理人员应及早识别其影响因素,并通过针对性的护理措施以降低照顾者负担。     

Robotic mitral valve plasty for mitral regurgitation after blunt chest trauma in Barlow's disease

We successfully treated a case of mitral regurgitation due to chest trauma in Barlow's disease. A 71‐year‐old man was admitted with severe mitral regurgitation after blunt compression of the chest by a heavy object 5 months earlier. Preoperative examination revealed wide chordae tendineae rupture and myxomatous changes to the bileaflets. Neo‐chordae reconstruction of the anterior mitral leaflet using loop technique, triangular resection of the posterior mitral leaflet, and ring annuloplasty was performed via surgical robot. Robotic mitral valve plasty for severe mitral regurgitation due to chest trauma in Barlow's disease was achieved safely with good clinical and excellent cosmetic results.     

High post surgical opioid requirements in Crohn's disease are not due to a general change in pain sensitivity

Crohn's disease (CD) is a painful inflammatory bowel disease with complex multigenic inheritance. Suggested on the basis of a few isolated reports CD patients require significantly higher post operative opioid doses than patients undergoing comparable severe abdominal surgery. Crohn's disease therefore may be a suitable model for the identification of novel pain susceptibility genes. In order to confirm this observation and to elucidate the underlying molecular mechanisms, we investigated if higher opioid needs of CD patients are due to a general change in pain sensitivity. Quantitative sensory testing (QST) was applied to a subgroup of patients and polymorphisms in the μ‐opioid receptor (OPRM1) and catechol‐O‐methyltransferase (COMT) were investigated. Significantly increased post operative opioid requirements in CD patients were confirmed and QST assessment demonstrates that CD patients do not display increased pain sensitivity in terms of lowered thresholds to thermal and mechanical stimuli. The data also suggest that common variants in OPRM1 and specific ‘high pain sensitivity’ COMT haplotypes may not be the cause of high opioid needs. The results indicate that a more complex pathway is involved in the greater post operative opioid demand in CD. Therefore the presence of other, as yet unknown, genes could modulate opioid requirements in CD patients.     

Laparoscopic colectomy after self‐expanding metallic stent placement through the ileocecal valve for right‐sided malignant colonic obstruction: A case report

A 78‐year‐old man with a history of open sigmoidectomy for sigmoid cancer presented with abdominal pain and vomiting. Abdominal multi‐detector CT revealed an obstructive ileocecal tumor with distended small bowel on the oral side. We performed emergency drainage using a transnasal decompression tube, and 2 days later, we conducted a colonoscopic examination, which lead to a provisional diagnosis of obstruction with a malignant tumor invading the ileocecal valve. We then placed a self‐expanding metallic stent (SEMS) through the ileocecal valve. We confirmed patency of the ileocecal valve and removed the transnasal decompression tube 2 days after SEMS placement. We then performed elective laparoscopic colectomy 8 days after SEMS placement. To the best of our knowledge, there has been only one previous report of laparoscopic colectomy after decompression with SEMS placement through the ileocecal valve for right‐sided malignant colonic obstruction.     

肠道超声检查在克罗恩病及其黏膜愈合的随访监测中的应用

克罗恩病（Crohn''s disease，CD）是炎症性肠病的一种，肠道超声检查（intestinal ultrasound，IUS）在CD患者初诊及随访中具有重要作用。相比于胃肠镜、磁共振肠道成像（magnetic resonance enterography，MRE）以及计算机断层扫描肠道成像（Computed tomography enterography，CTE）等检查方式，IUS具有无辐射、价格低廉、患者耐受好、重复性高等优点。实现和维持CD患者的黏膜愈合（Mucosal healing，MH）对维持临床缓解和无手术生存率有重要的临床意义。本文综述了IUS在CD及其MH中的应用现状     

Spontaneous enterourachocutaneous fistula in Crohn's disease: Sonographic diagnosis

Spontaneous abdominal wall fistulas are rare in Crohn's disease. We report a case of enterourachocutaneous fistula in a woman with Crohn's disease and present the sonographic, computed tomographic, and sinographic findings. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26 : 43–45, 1998.     

Laparoscopic low anterior resection for rectal cancer after Whitehead's hemorrhoidectomy: A case report

A 65‐year‐old man presented with bloody stool. Colonoscopy revealed a raised tumor in the rectum, above the peritoneal reflection. He underwent endoscopic mucosal resection, but the pathological findings suggested the possibility of residual cancer. We performed laparoscopic low anterior resection using a circular stapling instrument for additional curative surgery. However, we could not insert the shaft of the endoscopic circular stapler from the anus because of anal stenosis due to Whitehead's hemorrhoidectomy the patient had undergone 20 years earlier. Therefore, we planned to use a linear stapler to insert an anvil into the rectum. The cartridge‐carrying instrument was inserted from the sigmoidal side, and we performed a side‐to‐end anastomosis. The patient was discharged without anastomotic leakage or defecation disorder. We present this case because laparoscopic low anterior resection for rectal cancer with anal stenosis has not been previously reported.     

Single‐port endo‐laparoscopic surgery in combined abdominal procedures

Single‐port endo‐laparoscopic surgery has gained support in the surgical community because it is perceived to offer a better postoperative outcome as it requires only a single incision. We write this prospective observational study to ascertain the feasibility and safety of this technique in patients otherwise requiring two operations. Five patients who underwent double procedures with a single‐port device were reviewed: Case 1, a transabdominal preperitoneal hernia repair and gastric wedge resection; Case 2, cholecystectomy and diaphragmatic hernia repair; Case 3, oophorectomy and incisional hernia repair; Case 4, anterior resection of the rectum and hepatic segmentectomy; and Case 5, left adrenalectomy and cholecystectomy. Patient demographics, type of port used, operative time, complications and incision length were collected. Mean operative time for the cases ranged from 100 to 315 min. Incision length for the single‐port device was 2 cm. In Case 2, an additional 5‐mm port was used and an intraoperative complication involving a laceration of the liver occurred during the suturing of the gallbladder fundus. An additional 8‐cm lower abdominal incision (Pfannenstiel) was required in Case 4 to complete the colonic anastomosis and for specimen retrieval. Single‐port endo‐laparoscopic surgery is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that a double procedure creates, and if difficulty arises, another port can always be added to ease the operation. It can also potentially reduce the number of admissions and anesthesia that a patient undergoes.     

14例乌司奴单抗治疗克罗恩病的疗效观察与护理体会

目的 总结乌司奴单抗在克罗恩病患者治疗中的护理体会。方法 回顾2020年5月至今我科接收乌司奴单抗治疗的14例克罗恩病患者资料,分析患者的一般资料、用药前后的疾病进展及不良事件的发生情况。结果 14例患者中,8例为首次注射乌司奴单抗,另6例为再次注射；其中,12例患者注射乌司奴单抗后症状明显好转出院。2例患者出现不良事件,均为腹痛、便血等胃肠道症状,最终因效果不理想、不良事件较重,改用其他药物治疗。结论 乌司奴单抗在治疗传统药物或生物制剂效果不佳的活动性克罗恩病患者中有着诸多优势,但在临床使用过程中,护理人员需密切关注可能出现的不良事件,并予以及时的对症处理。     

内镜下切开术治疗原发性克罗恩病肛管直肠狭窄的初步探讨

目的 评价内镜下切开术(ES)治疗原发性克罗恩病肛管直肠狭窄的临床疗效.方法 回顾性分析2018年9月-2019年12月在该院接受ES治疗的原发性克罗恩病肛管直肠狭窄患者的临床资料.结果 13例患者共接受22次ES治疗,人均治疗次数(1.7±0.6)次,狭窄长度0.5～10.0 cm,中位数1.5 cm,狭窄直径0.2...     

两种腹腔镜手术方案在乙状结肠癌患者中的疗效对比

目的对比传统腹腔镜乙状结肠癌根治术与腹部无切口经直肠取出标本腹腔镜手术的近期疗效。方法以2015年1月-2016年12月于该院拟实施腹腔镜辅助乙状结肠癌根治手术的患者中选出34例实施腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术的患者作为腹部无切口组。以1∶2的配对方式选择同期内年龄、性别一致,体质指数(BMI)相近的实施腹腔镜辅助乙状结肠癌根治手术的患者68例作为对照组。对比两种腹腔镜手术方案的手术时间、手术出血量、术后排气时间、术后疼痛评分、手术并发症、术后住院时间、附加镇痛处理情况、肠管切除长度、近远端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期。结果腹部无切口组乙状结肠癌患者的手术时间、手术出血量明显高于对照组,腹部无切口组乙状结肠癌患者的术后排气时间、术后清醒时疼痛评分、术后第1天的疼痛评分明显低于对照组,差异有统计学意义(P0.05);两组乙状结肠癌患者的肠管切除长度、远近端切缘、肿瘤大小、淋巴结清扫数目和p TNM分期差异无统计学意义(P0.05)。腹部无切口组随访5~8个月,平均6个月;对照组随访6~9个月,平均7个月,均未发现肿瘤局部复发及远处转移。结论相比于传统腹腔镜手术,腹部无切口经直肠取出标本腹腔镜乙状结肠癌根治术可以明显降低患者的疼痛程度,缩短术后排气时间,肿瘤根治效果相近。