Annals of Coloproctology

Original Articles

Colorectal cancer

Comparison of colorectal cancer surgery patients in intensive care between rural and metropolitan hospitals in Australia: a national cohort study: Jessica A. Paynter, Zakary Doherty, Chun Hin Angus Lee, Kirby R. Qin, Janelle Brennan, David Pilcher; Ann Coloproctol. 2025;41(1):68-76. Published online January 24, 2025; DOI: https://doi.org/10.3393/ac.2024.00269.0038

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Abstract PDF Supplementary Material: Purpose
A small proportion of colorectal cancer (CRC) surgical patients will require an admission to an intensive care unit (ICU) within the early postoperative period. This study aimed to compare the characteristics and outcomes of patients admitted to an ICU following CRC surgery per hospital type (metropolitan vs. rural) over a decade in Australia.
Methods
A retrospective cohort analysis was undertaken of all adult patients admitted to a participating Australian ICUs following CRC surgery between January 2011 and December 2021. The primary outcome was in-hospital mortality.
Results
Over the 10-year period, 19,611 patients were treated in 122 metropolitan ICUs and 4,108 patients were treated in 42 rural ICUs. Rural ICUs had a lower proportion of annual admissions following CRC surgery (20 vs. 36, P<0.001). Patients admitted to a rural ICU were more likely to have undergone emergency CRC surgery compared to those admitted to a metropolitan cohort (28.5% vs. 13.8%, P<0.001). There was no difference in in-hospital mortality between metropolitan and rural hospitals (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.73–1.35; P=0.500). There was a general trend for lower mortality in later years of the study with the odds of death in the final year of the study (2021) almost half that of the first study year (OR, 0.52; 95% CI, 0.34–0.80; P=0.003).
Conclusion
There was no difference between in-hospital mortality outcomes for CRC surgical patients requiring ICU admission between metropolitan and rural hospitals. These findings may contribute to discussions regarding rural scope of colorectal practice within Australia and globally.

Benign bowel disease

Ileostomy volvulus as an underreported problem causing small bowel obstruction in patients living with ostomy: a case report and literature review: Julianna Seo, Ishith Seth, Dilshad Dooreemeah, Chun Hin Angus Lee; Ann Coloproctol. 2024;40(5):424-430. Published online March 2, 2023; DOI: https://doi.org/10.3393/ac.2022.00976.0139

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Abstract PDF Supplementary Material: Purpose
Ileostomy volvulus is a rare cause of small bowel obstruction. We present an unusual case of ileostomy volvulus without the presence of adhesions. Additionally, a systematic literature review was performed to collate the current literature on the causes, diagnosis, treatment, and preventative measures of ileostomy-related small bowel obstruction.
Methods
PubMed (MEDLINE), Embase, Google Scholar, Scopus, and CENTRAL were searched from their inception up to August 2022. This study adhered to the PRISMA guidelines and was registered on PROSPERO. The primary outcomes included patients’ demographics, imaging modality, indication for initial surgery, type and configuration of stoma, surgical treatment, and recurrence of volvulus. The quality of included studies was assessed using the Murad tool. Written informed consent was obtained from the patient.
Results
Seven studies were included, comprising 967 patients. Stoma outlet obstruction (SOO) was reported in all 159 patients, and 12 had ileostomy volvulus as the cause. A majority of patients had loop ostomies for ileostomy volvulus. No complications or mortality were reported in the included studies, and half of the included studies were deemed to be of good quality.
Conclusion
This case demonstrates the need for high clinical suspicion of SOO in patients with loop ileostomy, and rapid management should be undertaken. Whilst loop ileostomies, increased rectus abdominal muscle thickness, and lower preoperative total glucocorticoid dosage are associated with SOO, large-scale retrospective studies are needed to validate our findings.

Review

Inflammatory bowel diseases

Colorectal surgical management of colitis induced by vasculitis in the absence of inflammatory bowel disease: a case report and literature review: Jessica A. Paynter, Kirby R. Qin, Georgia Seamer, Ruchira Fernando, Janelle Brennan, Chun Hin Angus Lee; Ann Coloproctol. 2023;39(3):193-203. Published online November 16, 2022; DOI: https://doi.org/10.3393/ac.2022.00584.0083

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1 Citations

Abstract PDF

Colitis caused by vasculitis is a rare and poorly understood pathology. Little evidence exists on its clinical presentation, path to diagnosis, and surgical management. In this report, we present a case report and literature review. A healthy 20-year-old male patient presented with hemorrhagic colitis requiring total colectomy with end ileostomy. Pathological examination showed pancolitis with multiple ulcers, transmural inflammation, hemorrhage, and microvascular thrombosis. Extensive serological testing revealed elevated cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and eosinophilia, leading to a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA) and vasculitis-induced colitis. A literature review was subsequently conducted. Nineteen studies were found documenting vasculitis-induced colitis in the absence of inflammatory bowel disease (IBD). Systemic signs of vasculitis, hemorrhagic colitis, and progression to fulminant colitis were present. Of all patients, 40.0% required colorectal surgery and 62.5% of those patients received a stoma; 25% underwent emergency surgery following failed immunosuppression. All cases relied on clinical correlation with serology and/or histopathology to reach a final diagnosis. We report a case of vasculitis-induced colitis caused by c-ANCA−positive EGPA. The review shows that vasculitis-induced colitis without IBD is an important differential that clinicians should be aware of in patients presenting with colitis.

Citations

Citations to this article as recorded by

Systemic Lupus Erythematosus Vasculitis Causing Perforation Peritonitis in Miliary Tuberculosis: A Disease in Disguise
Soumyajit Jana, Monika Gureh, Ankur Cheleng, Ayush Vardhan
Cureus.2025;[Epub] CrossRef

Original Article

Anorectal benign disease

Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report: Jessica A. Paynter, Kirby R. Qin, Dongrong Situ, Chun Hin Angus Lee; Ann Coloproctol. 2023;39(5):421-426. Published online May 26, 2022; DOI: https://doi.org/10.3393/ac.2022.00192.0027

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2 Web of Science
3 Citations

Abstract PDF

Purpose
A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation.
Methods
Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: (“fournier’s gangrene”) AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors.
Results
The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting.
Conclusion
This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature.

Citations

Citations to this article as recorded by

SYNCHRONOUS MULTIFOCAL NECROTIZING FASCIITIS IN AN INFANT: A CASE REPORT
Adrien Walther, Giacomo De Marco, Oscar Vazquez, Christina Steiger, Sana Boudabbous, Romain Dayer, Dimitri Ceroni
Pediatric Infectious Disease Journal.2025;[Epub] CrossRef
FOURNIER'S GANGRENE: A CASE REPORT
Serhiy Morozov, Mariia Matvieienko, Tetiana Kozlova
Eastern Ukrainian Medical Journal.2024; 12(2): 448. CrossRef
Fournier's gangrene complicated by lower limb necrotising fasciitis and pelvic bone osteomyelitis: A case report with literature review
Joshua Chek Hao Foo, Ernest Junrui Lim, Alvin Yuanming Lee, Yadong Lu
International Journal of Surgery Case Reports.2024; 121: 109974. CrossRef

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