Annals of Coloproctology

Original Articles

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.

Stoma

Benefits and risks of diverting stoma creation during rectal cancer surgery: Masaya Kawai, Kazuhiro Sakamoto, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shingo Kawano, Shinya Munakata, Kiichi Sugimoto, Shun Ishiyama, Makoto Takahashi, Yutaka Kojima, Yuichi Tomiki; Ann Coloproctol. 2024;40(5):467-473. Published online December 5, 2022; DOI: https://doi.org/10.3393/ac.2022.00353.0050

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8 Web of Science
8 Citations

Abstract PDF

Purpose
A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.
Methods
We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (–) groups, and the outcomes, including postoperative complications, were compared.
Results
The incidence of ileus was higher in the DS (+) group than in the DS (–) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (–) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group.
Conclusion
Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Citations

Citations to this article as recorded by

Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer
Hirotaka Momose, Makoto Takahashi, Masaya Kawai, Kiichi Sugimoto, Hiromitsu Takahashi, Shunsuke Motegi, Kumpei Honjo, Yu Okazawa, Rina Takahashi, Shun Ishiyama, Yuichi Tomiki, Kazuhiro Sakamoto
Journal of the Anus, Rectum and Colon.2025; 9(1): 88. CrossRef
Prevalence and pooled risk factors of stoma outlet obstruction after colorectal surgery with diverting ileostomy: a systematic review and meta-analysis
Jian-xin Gan, Hai-peng Liu, Kang Chen
International Journal of Colorectal Disease.2025;[Epub] CrossRef
A multicentre prospective study of anal function after laparoscopic ultra‐low rectal cancer surgery using a mixed‐effects model
Makoto Takahashi, Kazuhiro Sakamoto, Yuichiro Tsukada, Shingo Kawano, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Hiroki Hamamoto, Masanori Yoshimitsu, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshi
Colorectal Disease.2025;[Epub] CrossRef
The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats
Georgios Geropoulos, Kyriakos Psarras, Maria Papaioannou, Vasileios Geropoulos, Argyri Niti, Christina Nikolaidou, Georgios Koimtzis, Nikolaos Symeonidis, Efstathios T. Pavlidis, Georgios Koliakos, Theodoros E. Pavlidis, Ioannis Galanis
Journal of Personalized Medicine.2024; 14(1): 121. CrossRef
Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multicentre retrospective study
Scott MacDonald, Li‐Siang Wong, Hwei Jene Ng, Claire Hastings, Immogen Ross, Tara Quasim, Susan Moug
Colorectal Disease.2024; 26(5): 994. CrossRef
Nomogram for predicting the probability of rectal anastomotic re-leakage after stoma closure: a retrospective study
Yuegang Li, Gang Hu, Jinzhu Zhang, Wenlong Qiu, Shiwen Mei, Xishan Wang, Jianqiang Tang
BMC Cancer.2024;[Epub] CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
Effect of intraoperative anastomotic reinforcement suture on the prevention of anastomotic leakage of double-stapling anastomosis for laparoscopic rectal cancer: a systematic review and meta-analysis
Chaoyang Wang, Xiaolong Li, Hao Lin, Jiahua Ju, Haibao Zhang, Yongjiang Yu
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef

Clinical Significance of Perineal Descent in Pelvic Outlet Obstruction Diagnosed by using Defecography: Hyun Nam Baek, Yong Hee Hwang, Yong Hwan Jung; J Korean Soc Coloproctol. 2010;26(6):395-401. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.395

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15 Citations

Abstract PDF

Purpose

The aim of this study was to evaluate the clinical significance of perineal descent (PD) in pelvic outlet obstruction patients diagnosed by using defecography.

Methods

One hundred thirty-six patients with pelvic outlet obstruction (POO; median age 49 years) had more than one biofeedback session after defecography. Demographic finding, clinical bowel symptoms and anorectal physiological studies were compared for PD at rest and PD with dynamic changes.

Results

Age (r = 0.33; P < 0.001), rectocele diameter (r = 0.31; P < 0.01), symptoms of incontinence (P < 0.05) and number of vaginal deliveries (r = 0.46; P < 0.001) were correlated with increased fixed PD. However, the female gender (P < 0.005), rectal intussusceptions (P < 0.05), negative non-relaxing puborectalis syndrome (P < 0.00005) and rectocele (P < 0.0005) were correlated with increased dynamic PD. Duration of symptoms, number of bowel movements, history of pelvic surgery and difficult defecation were not related with PD. There was no significant correlation between fixed and dynamic PD and success of biofeedback therapy.

Conclusion

Age, vaginal delivery and diameter of the rectocele are associated with increased fixed PD. Female gender, rectal intussusceptions and a rectocele are correlated with increased dynamic PD. Biofeedback is an effective option for POO regardless of severity of PD.

Citations

Citations to this article as recorded by

Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging
Isabelle M. A. van Gruting, Kirsten Kluivers, Aleksandra Stankiewicz, Joanna IntHout, Kim W. M. van Delft, Ranee Thakar, Abdul H. Sultan
Journal of Clinical Medicine.2025; 14(2): 548. CrossRef
Association of body composition with the symptoms of pelvic floor disorders in middle-aged women: a longitudinal study
Mari A. Kuutti, Enni-Maria Hietavala, Hanna-Kaarina Juppi, Sarianna Sipilä, Pauliina Aukee, Eija K. Laakkonen
Menopause.2025;[Epub] CrossRef
Rectal prolapse (62.2, 62.3), adults
Yu. A. Shelygin, S. I. Achkasov, D. V. Alyoshin, O. M. Biryukov, V. S. Groshilin, V. N. Kashnikov, I. V. Kostarev, N. V. Kostenko, A. I. Moskalev, A. A. Mudrov, A. V. Muravyov, N. V. Oleinik, V. V. Polovinkin, V. M. Тimerbulatov, A. Yu. Titov, O. Yu. Fome
Koloproktologia.2024; 23(3): 10. CrossRef
Rectal prolapse (62.2, 62.3), adults
Yu. A. Shelygin, S. I. Achkasov, D. V. Alyoshin, O. M. Biryukov, V. S. Groshilin, V. N. Kashnikov, I. V. Kostarev, N. V. Kostenko, A. I. Moskalev, A. A. Mudrov, A. V. Muravyov, N. V. Oleinik, V. V. Polovinkin, V. M. Тimerbulatov, A. Yu. Titov, O. Yu. Fome
Koloproktologia.2024; 23(3): 10. CrossRef
The role of obesity on urinary incontinence and anal incontinence in women: a review
SK Doumouchtsis, J Loganathan, V Pergialiotis
BJOG: An International Journal of Obstetrics & Gynaecology.2022; 129(1): 162. CrossRef
The Digital Rectal Examination
Gregory S. Sayuk
Gastroenterology Clinics of North America.2022; 51(1): 25. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Techniques in Coloproctology.2021; 25(1): 3. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Diseases of the Colon & Rectum.2021; 64(1): 31. CrossRef
Consensus Definitions and Interpretation Templates for Fluoroscopic Imaging of Defecatory Pelvic Floor Disorders Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the Society of Abdom
Ian Paquette, David Rosman, Rania El Sayed, Tracy Hull, Ervin Kocjancic, Lieschen Quiroz, Susan Palmer, Abbas Shobeiri, Milena Weinstein, Gaurav Khatri, Liliana Bordeianou
Female Pelvic Medicine & Reconstructive Surgery.2021; 27(1): e1. CrossRef
European society of neurogastroenterology and motility guidelines on functional constipation in adults
Jordi Serra, Daniel Pohl, Fernando Azpiroz, Giuseppe Chiarioni, Philippe Ducrotté, Guillaume Gourcerol, A. Pali S. Hungin, Peter Layer, Juan‐Manuel Mendive, Johann Pfeifer, Gerhard Rogler, S. Mark Scott, Magnus Simrén, Peter Whorwell
Neurogastroenterology & Motility.2020;[Epub] CrossRef
Pathophysiology of the functional constipation in elderly
Michael D. Levin
Pelviperineology.2019; : 53. CrossRef
Systematic review with meta‐analysis: defecography should be a first‐line diagnostic modality in patients with refractory constipation
Ugo Grossi, Gian Luca Di Tanna, Henriette Heinrich, Stuart A. Taylor, Charles H. Knowles, S. Mark Scott
Alimentary Pharmacology & Therapeutics.2018; 48(11-12): 1186. CrossRef
Defecatory Dysfunction and the Pelvic Floor
Ajay Rane, Sapna Dilgir
Current Obstetrics and Gynecology Reports.2017; 6(3): 237. CrossRef
Defecographic Findings in Patients with Severe Idiopathic Chronic Constipation
Rahmatollah Rafiei, Azadeh Bayat, Masoud Taheri, Zahra Torabi, Lotfollah Fooladi, Saideh Husaini
The Korean Journal of Gastroenterology.2017; 70(1): 39. CrossRef
Descending perineum syndrome: a review of the presentation, diagnosis, and management
Zaid Chaudhry, Christopher Tarnay
International Urogynecology Journal.2016; 27(8): 1149. CrossRef

Prognostic Factors Associated with Poor Outcome of Biofeedback Therapy for Constipated Patients with Pelvic Outlet Obstruction.: Kim, Sung Jin , Hwang, Yong Hee , Jung, Yong Hwan; J Korean Soc Coloproctol. 2008;24(5):313-321.; DOI: https://doi.org/10.3393/jksc.2008.24.5.313

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Abstract PDF: PURPOSE
The aim of this study was to identify the prognostic factors associated with poor outcome of biofeedback therapy.
METHODS
One hundred thirty-seven (137) constipated patients with pelvic outlet obstruction (median age 49 years) had more than one biofeedback session after defecography. Follow-up data (mean follow-up: 14 months; range: 2~37 months) were obtained in 114 patients. Any differences in demographics, clinical symptoms, and parameters of an anorectal physiological study were evaluated between the success group and the failure group.
RESULTS
At follow-up, 80 (70 percent) patients felt improvement in symptoms, but 34 (30 percent) patients did not. Pre-biofeedback presence of symptoms of difficult defecation predict poor outcome (88 vs. 69 percent for failure vs. success, P<0.05). The positive and the negative predictive values of difficult defecation for poor outcome were 35 percent and 86 percent, respectively. A negative mean pressure change on pre-biofeedback anal manometry was related to a poor outcome (65 vs. 26 percent for failure vs. success, P<0.001). The positive and the negative predictive values of negative mean pressure change for poor outcome were 51 percent and 83 percent, respectively. A negative electrical current change on pre-biofeedback anal electromyography was related to a poor outcome (23 vs. 9 percent for failure vs. success, P<0.05). The positive and the negative predictive values of negative electrical-current change for poor outcome were 53 percent and 74 percent, respectively.
CONCLUSIONS
Difficult defecation, negative mean pressure change in pre-biofeedback anal manometry, and negative electrical current change in pre-biofeedback anal electromyography were predictors associated with poor outcome of biofeedback therapy for constipated patients with pelvic outlet obstruction.

Physiologic Characteristics and its Clinical Significances in the Patients with Pelvic Outlet Obstruction.: Park, Ung Chae , Chung, Soon Sup , Park, Seung Hwa; J Korean Soc Coloproctol. 2000;16(4):215-222.

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Abstract PDF: Current study was designed to assess the functional etiology of patients with pelvic outlet obstruction. Moreover, physiologic characteristics and theirs clinical significances were evaluated in the patients with ramified diagnosis.
METHODS
172 patients with pelvic outlet obstruction were performed 328 numbers of physiologic studies. These included cinedefecography (n=172), anal manometry (n=87), colonic transit time study (n=38), and anal EMG/PNTML (n=31). On the basis of physiologic findings, patient groups were categorized as rectocele (group I), nonrelaxing puborectalis syndrome (group II), anal dyschezia (group III), and rectoanal intussusception (group IV). The physiologic findings were compared between subgroup patients.
RESULTS
Incidence of categorized patients was 51.7% (group I, n=89), 22.7% (group II, n=39), 12.2% (group III, n=21), and 8.7% (group IV, n=15), respectively. The mean age of patients with group III were lower (p<0.05) than that of overall patients. The incidence of female patients was higher in group I and the incidence of male patients was higher in group II (p<0.0001). In cinedefecography, patients with group II showed smaller anorectal angle at strain (p<0.001), at dynamic change between rest and strain (p=0.002). In anal manometry, patients with group III showed higher mean resting pressures (p=0.001), higher maximum resting pressures (p<0.001), higher mean squeeze pressures, and higher maximal voluntary contraction (p=0.003) than those of patients with other group. In neurologic study, mean value of PNTML was 2.32 +/- 0.34 (range, 1.60~3.66) msec in overall patients. The size of rectocele was increased in proportion to patient's age (r=0.229, p<0.05), number of delivery (r=0.393, p=0.001), and degree of perineal descent (r=0.231, p<0.05). The degree of perineal descent was increased in proportion to patient's age (r=0.249, p<0.05).
CONCLUSIONS
Present series provided the diagnostic ramification of pelvic outlet obstruction by using the anorectal physiologic investigations. In addition to the function of puborectalis muscle, evacuation dynamics of anorectum should be emphasized. These findings could provide the fundamental information for guideline of future therapy in the patients with obstructed defecation.

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