BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the end...BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the endoscopic closure fails,or the patient's clinical condition deteriorates.In cases of delayed AICP(>4 h),surgical repair or enterostomy is usually performed,but delayed rectal perforation is rare.CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection(ESD)at a local hospital for the treatment of a laterally spreading tumor of the rectum,and the wound was closed by an endoscopist using a purse-string suture.Unfortunately,the patient then presented with delayed rectal perforation(6 h after ESD).The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery(TEM);however,the perforation worsened and became enlarged,multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred,and the internal anal sphincter was damaged.As a result,the perforation became more complicated.Due to the increased bleeding,surgical treatment with suturing could not be performed using TEM.Therefore,the patient was sent to our medical center for follow-up treatment.After a multidisciplinary discussion,we believed that the patient should undergo an enterostomy.However,the patient strongly refused this treatment plan.Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared,we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent(SECMS)in combination with a transanal ileus drainage tube(TIDT).CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation,a SECMS combined with a TIDT can be used and may result in very good outcomes.展开更多
Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with ML...Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.展开更多
基金Supported by the Hangzhou Major Science and Technology Projects,No.202004A14the Hangzhou Medical and Health Science and Technology Plan,No.OO20190610 and No.A20200174+1 种基金the Zhejiang Medical and Health Science and Technology Plan,No.WKJ-ZJ-2136 and No.2019RC068the Natural Science Foundation of Zhejiang Province,No.LGF21H310004.
文摘BACKGROUND Acute iatrogenic colorectal perforation(AICP)is a serious adverse event,and immediate AICP usually requires early endoscopic closure.Immediate surgical repair is required if the perforation is large,the endoscopic closure fails,or the patient's clinical condition deteriorates.In cases of delayed AICP(>4 h),surgical repair or enterostomy is usually performed,but delayed rectal perforation is rare.CASE SUMMARY A 53-year-old male patient underwent endoscopic submucosal dissection(ESD)at a local hospital for the treatment of a laterally spreading tumor of the rectum,and the wound was closed by an endoscopist using a purse-string suture.Unfortunately,the patient then presented with delayed rectal perforation(6 h after ESD).The surgeons at the local hospital attempted to treat the perforation and wound surface using transrectal endoscopic microsurgery(TEM);however,the perforation worsened and became enlarged,multiple injuries to the mucosa around the perforation and partial tearing of the rectal mucosa occurred,and the internal anal sphincter was damaged.As a result,the perforation became more complicated.Due to the increased bleeding,surgical treatment with suturing could not be performed using TEM.Therefore,the patient was sent to our medical center for follow-up treatment.After a multidisciplinary discussion,we believed that the patient should undergo an enterostomy.However,the patient strongly refused this treatment plan.Because the position of the rectal perforation was relatively low and the intestine had been adequately prepared,we attempted to treat the complicated delayed rectal perforation using a self-expanding covered mental stent(SECMS)in combination with a transanal ileus drainage tube(TIDT).CONCLUSION For patients with complicated delayed perforation in the lower rectum and adequate intestinal preparation,a SECMS combined with a TIDT can be used and may result in very good outcomes.
文摘Objective To compare the outcomes after self-expanding metallic stent (SEMS) or transanal drainage tube (TDT) placement in patients with malignant large-bowel obstruction (MLBO). Methods Seventy-three patients with MLBO from the clinical unit underwent SEMS (n = 51) or TDT (n = 22) placement from 2012 to 2017. The success rates of placement, clinical outcomes after decompression, complications, the time to resuming enteral nutrition (EN), Karnofsky performance status (KPS) scoring and the following-up therapeutic options were investigated. Results Technical success were achieved in 100% of patients in both groups. The clinical success rates were 98.0%(50/51) for SEMS and 95.5%(21/22) for TDT. No perforation was found in any group, while 3.9%(2/51) in the SEMS and 18.2%(4/22) in TDT group experienced displacement (P = 0.26). It took 2.1 IQR (0~2) days and 3 IQR (2~5) days to resume EN in the SEMS and TDT groups, respectively (P < 0.001). The KPS scores were significantly higher in patients implanted with SEMS (70, IQR 50~80) than in those with TDT (35, IQR 30~50)(P < 0.001). In the SEMS group, 37.3%(19/51) of patients underwent stenting as a bridge to surgery, 9.8%(5/51) for chemotherapy only and 52.9%(27/51) for palliation, while 40.9%(9/22), 0 and 59.1%(13/22) underwent placement for these reasons in the TDT group, respectively. The majority (6/9) of the patients who underwent TDT placement as a bridge to surgery required stoma creation, while only 31.6%(6/19) of those in the SEMS group needed a stoma (P = 0.080). In addition, anastomotic leakage was only found in the TDT group (2/9)(P = 0.10). Conclusion Both SEMS and TDT placement could provide clinical relief for MLBO. However, SEMS placement is associated with earlier EN, fewer complications, and benefits for the postoperative quality-of-life.
