Annals of Coloproctology

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Original Articles

ERAS

Safety and patient’s satisfaction of preoperative carbohydrate drink until 2 hours before colorectal cancer surgery: a single-center, prospective randomized controlled trial: Yun Min Lee, Kyeong Eui Kim, Sung Uk Bae, Seong Kyu Baek, Woon Kyung Jeong; Ann Coloproctol. 2025;41(6):519-527. Published online December 24, 2025; DOI: https://doi.org/10.3393/ac.2025.00521.0074

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Abstract PDF: Purpose
Traditionally, fasting from midnight has been a standard practice in elective surgery for reduce the risk of aspiration. However, Enhanced Recovery After Surgery (ERAS) programs recommend clear fluid intake until 2 hours before anesthesia. This study aimed to evaluate the safety and patient satisfaction of preoperative carbohydrate drink intake until 2 hours before colorectal cancer surgery.
Methods
Sixty patients who underwent colorectal cancer surgery between April 2021 and February 2023 at Keimyung University Dongsan Medical Center were enrolled. This study included 30 patients who fasted from midnight (nothing by mouth [NPO] group) and 30 patients who consumed a high concentration of complex carbohydrate fluids (New Care NO-NPO) until 2 hours before surgery (No-NPO group). Patient satisfaction was assessed using a visual analog scale. Perioperative and postoperative outcomes were compared.
Results
Basic characteristics of patients were similar for the 2 groups. The No-NPO group had a significantly higher patient satisfaction score than the NPO group (3.7 vs. 2.2, P=0.040). Scores of operative difficulty, operation time, blood loss, postoperative recovery parameters, and postoperative complication rates were similar for the 2 groups. Pathological outcomes were also comparable. No mortality occurred in either group.
Conclusion
High-concentration carbohydrate fluid intake until 2 hours before induction of anesthesia could improve patient satisfaction without increasing postoperative complications, demonstrating its safety and feasibility in colorectal cancer surgery. Trial registration CRIS (cris.nih.go.kr) identifier: KCT0011323.

Complications

Effect of oral antibiotic bowel preparation versus no preparation on surgical site infections in elective colorectal surgery: a randomized trial: Kavyashree Mallesh, Rajendran Theakarajan, Balasubramanian G, Prashant Penumadu, Raja Kalayarasan, Rajkumar Nagarajan; Ann Coloproctol. 2025;41(5):393-399. Published online October 20, 2025; DOI: https://doi.org/10.3393/ac.2025.00633.0090

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Abstract PDF

Purpose
Surgical site infections (SSIs) represent a significant cause of morbidity following colorectal surgery. While mechanical bowel preparation combined with oral antibiotics is known to reduce SSIs, the independent effect of oral antibiotics alone remains unclear. This study compared the efficacy of oral antibiotic bowel preparation (OABP) versus no bowel preparation (NBP) in reducing SSIs among patients undergoing elective colorectal surgery.
Methods
A prospective, randomized, double-blinded trial was performed at a tertiary care center in India. Eighty-six patients scheduled for elective colorectal surgery were randomized to receive either OABP (oral ciprofloxacin and metronidazole) or placebo, in addition to standard intravenous antibiotics. The primary outcome was the rate of SSIs. Secondary outcomes included anastomotic leak, length of hospital stay, overall morbidity, and readmission rates.
Results
Baseline characteristics were comparable between the groups. The incidence of SSI was significantly lower in the OABP group compared to the NBP group (14.0% vs. 41.9%, P<0.01). The severity of infections and postoperative complications was also reduced in the OABP group (P<0.01). Although rates of anastomotic leak, readmission, and reoperation were higher in the NBP group, these differences were not statistically significant. The mean duration of hospital stay was shorter for patients in the OABP group (8.09 days vs. 11.28 days, P<0.01). No adverse effects related to oral antibiotics were observed.
Conclusion
OABP without mechanical cleansing significantly reduces SSIs, postoperative morbidity, and length of hospital stay in elective colorectal surgery. This approach is safe and effective, offering a strategy to improve surgical outcomes.

Citations

Citations to this article as recorded by

Oral antibiotics alone for bowel preparation in colorectal surgery: time to rethink tradition?
Soo Young Lee
Annals of Coloproctology.2025; 41(5): 367. CrossRef

Review

Colorectal cancer

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis: Ricardo Purchio Galletti, Gabriel Andrade Agareno, Lucas de Abreu Sesconetto, Rafael Benjamim Rosa da Silva, Rafael Vaz Pandini, Lucas Soares Gerbasi, Victor Edmond Seid, Sérgio Eduardo Alonso Araujo, Francisco Tustumi; Ann Coloproctol. 2023;39(5):375-384. Published online December 20, 2022; DOI: https://doi.org/10.3393/ac.2022.00605.0086

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Abstract PDF Supplementary Material

Purpose
This study aimed to review the outcomes of redo procedures for failed colorectal or coloanal anastomoses.
Methods
A systematic review was performed using the PubMed, Embase, Cochrane, and LILACS databases. The inclusion criteria were adult patients undergoing colectomy with primary colorectal or coloanal anastomosis and studies that assessed the postoperative results. The protocol is registered in PROSPERO (No. CRD42021267715).
Results
Eleven articles met the eligibility criteria and were selected. The studied population size ranged from 7 to 78 patients. The overall mortality rate was 0% (95% confidence interval [CI], 0%–0.01%). The postoperative complication rate was 40% (95% CI, 40%–50%). The length of hospital stay was 13.68 days (95% CI, 11.3–16.06 days). After redo surgery, 82% of the patients were free of stoma (95% CI, 75%–90%), and 24% of patients (95% CI, 0%–39%) had fecal incontinence. Neoadjuvant chemoradiotherapy (P=0.002) was associated with a lower probability of being free of stoma in meta-regression.
Conclusion
Redo colorectal and coloanal anastomoses are strategies to restore colonic continuity. The decision to perform a redo operation should be based on a proper evaluation of the morbidity and mortality risks, the probability of remaining free of stoma, the quality of life, and a functional assessment.

Citations

Citations to this article as recorded by

Abdominoperineal pull-through with delayed coloanal anastomosis for pelvic anastomotic failure—a systematic review
T. J. K. Tan, S.-M. Ng, T. S. Q. Lee, E. K.-W. Tan, I. Seow-En
Techniques in Coloproctology.2025;[Epub] CrossRef
Laparoscopic redo endorectal pull‐through procedure for complex rectovaginal fistula after rectal resection for endometriosis: A Video Vignette
Sergio Eduardo Alonso Araujo, Francisco Tustumi, Ana Sarah Portilho, Lucas de Araujo Horcel, Victor Edmond Seid
Colorectal Disease.2023; 25(11): 2284. CrossRef

Original Articles

Colorectal cancer

Evaluating prognostic significance of preoperative C-reactive protein to albumin ratio in older patients with pathological stage II or III colorectal cancer: Koji Numata, Yukari Ono, Mihwa Ju, Shizune Onuma, Ayano Tanaka, Taichi Kawabe, Sho Sawazaki, Akio Higuchi, Kazuki Yamanaka, Shinsuke Hatori, Hiroyuki Saeki, Hiroshi Matsukawa, Yasushi Rino, Kazuyuki Tani; Ann Coloproctol. 2024;40(2):161-168. Published online October 11, 2022; DOI: https://doi.org/10.3393/ac.2022.00367.0052

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Abstract PDF

Purpose
This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection.
Methods
We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined.
Results
The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001).
Conclusion
Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.

Citations

Citations to this article as recorded by

C-Reactive Protein/Albumin Ratio Is an Independent Risk Factor for Recurrence and Survival Following Curative Resection of Stage I–III Colorectal Cancer in Older Patients
Tomoaki Bekki, Manabu Shimomura, Minoru Hattori, Saki Sato, Atsuhiro Watanabe, Sho Ishikawa, Kouki Imaoka, Kosuke Ono, Keiso Matsubara, Tetsuya Mochizuki, Shintaro Akabane, Takuya Yano, Hideki Ohdan
Annals of Surgical Oncology.2024; 31(7): 4812. CrossRef
Towards a Gradual Optimization of Oncologic Prognostic Factors in the Era of the Frail Patient: The Potential Role of Preoperative Inflammation and Nutritional Status
Giuseppe Zimmitti
Annals of Surgical Oncology.2024; 31(8): 4853. CrossRef
Prognostic role of C-reactive protein to albumin ratio in cancer patients treated with immune checkpoint inhibitors: a meta-analysis
Menglu Dai, Wei Wu
Frontiers in Oncology.2023;[Epub] CrossRef
The association of blood biomarkers with treatment response and adverse health outcomes in older patients with solid tumors: A systematic review
Yara van Holstein, P. Janne E. van den Berkmortel, Stella Trompet, Diana van Heemst, Frederiek van den Bos, Marieke Roemeling-van Rhijn, Nienke A. de Glas, Marian Beekman, P. Eline Slagboom, Johanneke E.A. Portielje, Simon P. Mooijaart, Barbara C. van Mun
Journal of Geriatric Oncology.2023; 14(7): 101567. CrossRef
Prognostic prediction of colorectal cancer using the C-reactive protein to albumin ratio: the importance of inflammatory biomarkers and their association with long-term outcomes
Chul Seung Lee
Annals of Coloproctology.2023; 39(4): 287. CrossRef

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina: René M. Palacios Huatuco, Diana A. Pantoja Pachajoa, Julian E. Liaño, Héctor A. Picón Molina, Rafael Palencia, Alejandro M. Doniquian, Matías Parodi; Ann Coloproctol. 2023;39(2):123-130. Published online November 24, 2021; DOI: https://doi.org/10.3393/ac.2021.00402.0057

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Abstract PDF

Purpose
In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD).
Methods
In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed.
Results
Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34).
Conclusion
Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.

Citations

Citations to this article as recorded by

Comparison of surgical management and outcomes of acute right colic and sigmoid diverticulitis: a French national retrospective cohort study
E. Karam, C. Sabbagh, L. Beyer-Bergeot, P. Zerbib, V. Bridoux, G. Manceau, Y. Panis, E. Buscail, A. Venara, I. Khaoudy, M. Gaillard, M. Viennet, A. Thobie, B. Menahem, C. Eveno, C. Bonnel, J.-Y. Mabrut, B. Badic, C. Godet, Y. Eid, E. Duchalais, Z. Lakkis,
Techniques in Coloproctology.2024;[Epub] CrossRef

Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries: Dan Assaf, David Hazzan, Almog Ben-Yaacov, Shachar Laks, Douglas Zippel, Lior Segev; Ann Coloproctol. 2023;39(2):168-174. Published online August 6, 2021; DOI: https://doi.org/10.3393/ac.2021.00241.0034

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Abstract PDF

Purpose
One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS.
Methods
We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group.
Results
A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001).
Conclusion
Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

Citations

Citations to this article as recorded by

High output stoma after surgery for rectal cancer - a risk factor for low anterior resection syndrome?
Xuena Zhang, Qingyu Meng, Jianna Du, Zhongtao Tian, Yinju Li, Bin Yu, Wenbo Niu
BMC Gastroenterology.2025;[Epub] CrossRef
Atrial Flutter With Intraventricular Conduction Delay, Hypotension, and Bradycardia in the Setting of High-Output Ileostomy With Renal Failure, Hyperkalemia, and Metabolic Acidosis: A Case Report With Brief Literature Review
Edinen Asuka, Barbara Odac, Andrew Ndakotsu, Anastasia Postoev
Cureus.2025;[Epub] CrossRef
Preoperative High Agatston Score in Aorta Leads to Postoperative High-Output Ileostomy
Yusuke Kono, Manabu Yamamoto, Chiharu Yasui, Ryo Ishiguro, Takuki Yagyu, Kyoichi Kihara, Tomoyuki Matsunaga, Shuichi Takano, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara
Journal of Surgical Research.2025; 314: 139. CrossRef
A review of chyme reinfusion: new tech solutions for age old problems
Chen Liu, Sameer Bhat, Ian Bissett, Gregory O'Grady
Journal of the Royal Society of New Zealand.2024; 54(2): 161. CrossRef
Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study
Qing Zhang, Jianan Sun, Dongxue Wang, Quan Wang, Haiyan Hu
Supportive Care in Cancer.2024;[Epub] CrossRef
Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer
A.I. Maksimkin, Z.A. Bagatelia, V.M. Kulushev, E.N. Gordienko, M.S. Lebedko, S.S. Anikina, E.P. Shin
Pirogov Russian Journal of Surgery.2024; (4): 16. CrossRef
The Frequency of Stoma-Related Readmissions After Emergency and Elective Ileostomy Formation: The Leicester Experience
Ting-Wei Wu, Wen Yuan Chung, Hui En Jewel Ng, Ashley Yap, Konstantinos Baronos, Deepak Paul, Christopher P Neal, David Bowrey
Cureus.2024;[Epub] CrossRef
Predictors of High-output Stoma in Diverting Ileostomy for Rectal Cancer Surgery
Hiroaki Uehara, Hitoshi Kameyama, Toshiyuki Yamazaki, Akira Iwaya, Yuya Enoki
Nippon Daicho Komonbyo Gakkai Zasshi.2023; 76(3): 286. CrossRef
Morpho-functional aspects of various parts of the intestine and risk factors associated with the preventive ileostomy (review)
A. I. Maksimkin, Z. A. Bagatelia, E. N. Gordienko, E. B. Emelyanova, D. M. Sakaeva
Koloproktologia.2023; 22(4): 147. CrossRef
Obstructive and secretory complications of diverting ileostomy
Shingo Tsujinaka, Hideyuki Suzuki, Tomoya Miura, Yoshihiro Sato, Chikashi Shibata
World Journal of Gastroenterology.2022; 28(47): 6732. CrossRef

Case Report

Malignant disease,Rare disease & stoma,Complication

Colonic Perforation After Treatment With Nivolumab in Esophageal Cancer: A Case Report: Hye Jung Cho, Woo Ram Kim, Joo-Hang Kim, Duk Hwan Kim, Dae Jung Kim, Haeyoun Kang; Ann Coloproctol. 2021;37(Suppl 1):S39-S43. Published online June 24, 2021; DOI: https://doi.org/10.3393/ac.2020.00213.0030

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Abstract PDF

With the advent of checkpoint inhibitors, it has opened up opportunities for numerous cancer patients. However, as is the case with every treatment, complications need to be weighed. Gastrointestinal adverse effects, such as diarrhea and colitis are well-known complications for checkpoint inhibitors. In severe cases, colitis-induced colonic perforation may occur with an estimation of 1.0% to 1.5% in anti-CTLA-4 antibodies. However, only a handful of cases of such devastating complications have been reported in anti-PD-1 antibodies such as pembrolizumab and nivolumab. We here report a case of intestinal perforation in a patient treated with nivolumab.

Citations

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Intestinal perforation in recurrent cervical cancer following bevacizumab and pembrolizumab therapy: A case report
Yuanchun Fan, Shihao Liu, Jiangjing Zhao, Yawei Fu, Jiahui Yang, Chunyang Wang, Hui Zhang
Medicine.2025; 104(15): e40473. CrossRef
Iatrogenic effect of immune checkpoint inhibitors and targeted therapies on the lower gastrointestinal tract
Dua Abuquteish, Ahmad Yousef Alazzam, Aws Khalid Abushanab, Omar Amjad Almajdoubah, Sara Aljfout, Mahmoud Taysir Mousa, Mus’ab Theeb Mustafa, Bashar Khater, Maher Sughayer
Frontline Gastroenterology.2025; : flgastro-2025-103094. CrossRef
Chemotherapy-associated pneumoperitoneum in cancer patients: a scoping review
Renee M. Maina, Caroline Rader, Jeevan Kypa, Constantine Asahngwa, Hilary M. Jasmin, Nia N. Zalamea, John S. Nelson, Jonathan L. Altomar, Mary Brinson Owens, Clarisse S. Muenyi, Denis A. Foretia
Annals of Medicine & Surgery.2024; 86(5): 2828. CrossRef
Update on immunotherapy‐mediated colitis: Clinical features, mechanisms, and management
Dandan Wang, Yiwei Zhao, Yiyun Zeng, Lanlin Hu, Chuan Xu
Malignancy Spectrum.2024; 1(4): 225. CrossRef
Gastrointestinal perforation associated with novel antineoplastic agents: A real-world study based on the FDA Adverse Event Reporting System
Zicheng Yu, Haibin Zhu, Hongjun Chen, Lifei Zhu, Xiaolan Liao
Journal of Pharmacy & Pharmaceutical Sciences.2023;[Epub] CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2023; 30(3): 230. CrossRef
An updated review of gastrointestinal toxicity induced by PD-1 inhibitors: from mechanisms to management
Yiyu Cheng, Fangmei Ling, Junrong Li, Yidong Chen, Mingyang Xu, Shuang Li, Liangru Zhu
Frontiers in Immunology.2023;[Epub] CrossRef
Nivolumab

Reactions Weekly.2022; 1892(1): 181. CrossRef
Gastrointestinal and Hepatobiliary Immune-related Adverse Events: A Histopathologic Review
Zainab I. Alruwaii, Elizabeth A. Montgomery
Advances in Anatomic Pathology.2022; 29(4): 183. CrossRef

Original Article

Malignant disease, Rectal cancer,Colorectal cancer,Biomarker & risk factor

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Obstructing Colorectal Cancer Treated by Endoscopic Stenting as a Bridge to Surgery: Jiwei Guo, Aik Yong Chok, Hui Jun Lim, Wei Xuan Tay, Weng Kit Lye, Lasitha Bhagya Samarakoon, Emile John Tan, Ronnie Mathew; Ann Coloproctol. 2021;37(3):159-165. Published online May 28, 2021; DOI: https://doi.org/10.3393/ac.2020.05.25

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Abstract PDF Supplementary Material

Purpose
Neutrophil-to-lymphocyte ratio (NLR) has been reported to predict adverse survival outcomes among patients with colorectal cancer (CRC). This study evaluates the prognostic value of NLR among patients with obstructing CRC who successfully underwent stenting before curative surgery.
Methods
We retrospectively reviewed patients who underwent stenting before surgery. Patient demographics, tumor characteristics, perioperative outcomes, recurrence-free survival (RFS), and overall survival (OS) were analyzed. NLR was calculated from the differential white blood cell counts at least 4 days after successful stenting, before elective surgery. Optimal cutoff to dichotomize NLR was obtained by maximizing log-rank test statistic with recursive partitioning of KaplanMeier RFS and OS curves. The optimal cutoff for high NLR was ≥ 5 at presentation before stenting, and ≥ 4 after stenting.
Results
Fifty-seven patients with localized obstructing CRC underwent successful endoscopic stenting before curative surgery. High NLR was associated with lymphovascular invasion (P = 0.006) and apical lymph node involvement (P = 0.034). Major perioperative complication(s) (hazard ratio [HR], 11.34; 95% confidence interval [CI], 2.49 to 51.56; P < 0.01) and high NLR (HR, 3.69; 95% CI, 1.46 to 9.35; P < 0.01) negatively impacted OS on univariate and multivariate analyses. High NLR negatively impacted RFS on univariate analysis (HR, 2.91; 95% CI, 1.29 to 6.60; P = 0.01).
Conclusion
NLR of ≥ 4 after stenting is an independent prognostic factor among patients with obstructing localized CRC who are successfully decompressed by endoscopic stenting before curative surgery.

Citations

Citations to this article as recorded by

Impact of Postoperative Naples Prognostic Score to Predict Survival in Patients with Stage II–III Colorectal Cancer
Su Hyeong Park, Hye Seung Woo, In Kyung Hong, Eun Jung Park
Cancers.2023; 15(20): 5098. CrossRef
Inflammatory Response Markers as Predictors of Colorectal Cancer Prognosis
Minsung Kim, Il Tae Son, Bo Young Oh
The Ewha Medical Journal.2023;[Epub] CrossRef
Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef

Case Report

Benign GI diease

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review: Kwang-Seop Song, Min Jung Kim, Han-Ki Lim, Yoon Hwa Hong, Sung Sil Park, Chang Won Hong, Sung Chan Park, Dae Kyung Sohn, Kyung Su Han, Jae Hwan Oh; Ann Coloproctol. 2020;36(4):281-284. Published online August 31, 2020; DOI: https://doi.org/10.3393/ac.2018.10.01.1

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Abstract PDF

Gastrointestinal graft-versus-host disease (GVHD) is a common complication after hematopoietic stem cell transplantation. Concomitant cytomegalovirus (CMV) enteritis worsens the prognosis of this condition. We report a case of small bowel perforation associated with gastrointestinal GVHD and CMV enteritis in a patient with leukemia who was successfully treated surgically. A 39-year-old man presented with intestinal perforation necessitating emergency surgical intervention. He was diagnosed with T-cell acute lymphoblastic leukemia and developed severe gastrointestinal GVHD and CMV enteritis after hematopoietic stem cell transplantation. His terminal ileum showed a perforation with diffuse wall thinning, and petechiae were observed over long segments of the distal ileum and the proximal colon. Small bowel segmental resection and a subtotal colectomy with a double-barreled ileocolostomy were performed. The patient recovered uneventfully after the operation. Based on reports described in the literature, surgery plays a minor role in the management of gastrointestinal GVHD; however, timely surgical intervention could be effective in selected patients.

Citations

Citations to this article as recorded by

Cytomegalovirus enteritis resistant to antiviral drugs improved following total colectomy
Sae Kawata, Jumpei Takamatsu, Yuichi Yasue, Aya Fukuhara, Jinkoo Kang
Surgical Case Reports.2023;[Epub] CrossRef

Original Article

Benign GI diease

Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?: Yilseok Joo, Yujin Lee, Taeyoung Yoo, Jungbin Kim, Inseok Park, Geumhee Gwak, Hyunjin Cho, Keunho Yang, Kiwhan Kim, Byung-Noe Bae; Ann Coloproctol. 2020;36(3):178-185. Published online June 30, 2020; DOI: https://doi.org/10.3393/ac.2019.11.14.1

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Abstract PDF

Purpose
To identify factors significantly associated with the mortality of patients with left colonic perforation, and to compare the outcome of Hartmann’s procedure (HP) and primary repair (PR) or primary anastomosis (PA) in patients with left colonic perforation without factors associated with mortality.
Methods
This retrospective study included patients who underwent surgery for left colonic perforation from January 2009 to February 2018. Preoperative factors related to postoperative mortality, including vital signs, laboratory findings, and intraoperative findings, were analyzed by type of operation. The chi-square, Fisher exact, and Mann-Whitney U-tests were used to analyze the data.
Results
Ninety-one patients were included (36 men, 55 women), and 15 (16.5%) died postoperatively. Prognostic factors were age, leukopenia, thrombocytopenia, bleeding tendency, acute kidney injury, hemodynamic instability, and the existence of feculent ascites. Leukopenia and longer operative time were independent risk factors for mortality. Seventy-nine patients did not have leukopenia and 30 of these patients who underwent PR without diversion were excluded from the subanalysis. HP was performed in 30 patients, and PR with diversion and PA with or without diversion were performed in 19. Compared to the other operative methods, HP had no advantage in reducing hospital mortality (P=0.458) and morbidity.
Conclusion
Leukopenia could be an objective prognostic factor for left colonic perforation. Although HP is the gold standard for septic left colonic perforation, it did not improve the hospital mortality of the patients without leukopenia. For such patients, PR or PA may be suggested as an alternative option for left colonic perforation.

Citations

Citations to this article as recorded by

Risk Factors for Postoperative Major Morbidity, Anastomotic Leakage, Re-Surgery and Mortality in Patients with Colonic Perforation
Maximilian Brunner, Lara Gärtner, Andreas Weiß, Klaus Weber, Axel Denz, Christian Krautz, Georg F. Weber, Robert Grützmann
Journal of Clinical Medicine.2024; 13(17): 5220. CrossRef
Evaluation of Morbidity and Mortality in Iatrogenic Colonic Perforation During Colonoscopy: A Comprehensive Systematic Review and Meta-Analysis
Ajibola A Adebisi, Daniel E Onobun, Adeola Adediran, Reginald N Ononye, Ethel O Ojo, Adedayo Oluyi, Ayotunde Ojo, Stephen Oputa
Cureus.2024;[Epub] CrossRef
Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study
Do-bin Lee, Seonhui Shin, Chun-Seok Yang
Journal of Yeungnam Medical Science.2022; 39(2): 133. CrossRef
Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review
Ann-Kathrin Lederer, Fabian Bartsch, Markus Moehler, Peter Gaßmann, Hauke Lang
Cells.2022; 11(20): 3314. CrossRef

Review

Benign GI diease,Epidemiology & etiology

A Review of Bowel Preparation Before Colorectal Surgery: Yeon Uk Ju, Byung Wook Min; Ann Coloproctol. 2021;37(2):75-84. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.04.01

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Abstract PDF

Infectious complications are the biggest problem during bowel surgery, and one of the approaches to minimize them is the bowel cleaning method. It was expected that bowel cleaning could facilitate bowel manipulation as well as prevent infectious complications and further reduce anastomotic leakage. In the past, with the development of antibiotics, bowel cleaning and oral antibiotics (OA) were used together. However, with the success of emergency surgery and Enhanced Recovery After Surgery, bowel cleaning was not routinely performed. Consequently, bowel cleaning using OA was gradually no longer used. Recently, there have been reports that only bowel cleaning is not helpful in reducing infectious complications such as surgical site infection (SSI) compared to OA and bowel cleaning. Accordingly, in order to reduce SSI, guidelines are changing the trend of only intestinal cleaning. However, a consistent regimen has not yet been established, and there is still controversy depending on the location of the lesion and the surgical method. Moreover, complications such as Clostridium difficile infection have not been clearly analyzed. In the present review, we considered the overall bowel preparation trends and identified the areas that require further research.

Citations

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General Principles of Risk Mitigation before Colorectal Surgery
Sarah Atoui, A. Sender Liberman
Clinics in Colon and Rectal Surgery.2026; 39(01): 015. CrossRef
Curiosity and the Cat
Lester Gottesman
Diseases of the Colon & Rectum.2026; 69(1): 1. CrossRef
Advanced Protocols for Preoperative Colon Preparation: Enhancing Outcomes in Colorectal Surgery
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Case Reports

Benign GI diease,Rare disease & stoma,Complication

Intestinal Perforation as a Paradoxical Reaction to Antitubercular Therapy: A Case Report: Sung Hoon Kang, Hee Seok Moon, Jae Ho Park, Ju Seok Kim, Sun Hyung Kang, Eaum Seok Lee, Seok Hyun Kim, Byung Seok Lee, Jae Kyu Sung, Hyun Yong Jeong, Kyung Ha Lee; Ann Coloproctol. 2021;37(Suppl 1):S18-S23. Published online May 15, 2020; DOI: https://doi.org/10.3393/ac.2020.03.16.1

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Abstract PDF

Paradoxical reactions to tuberculosis (TB) treatment are characterized by an initial improvement of the clinical symptoms followed by clinical or radiological deterioration of existing tuberculous lesions, or by development of new lesions. Intestinal perforation in gastrointestinal TB can occur as a paradoxical reaction to antitubercular therapy. A 55-year-old man visited the outpatient department with lower abdominal pain and weight loss. He was diagnosed with intestinal TB and started antitubercular therapy. After 3 months of antitubercular therapy, a colonoscopy revealed improvement of the disease. Three days after the colonoscopy, the patient visited the emergency room complaining of abdominal pain. Abdominal computed tomography revealed extraluminal air-filled spaces in the pelvic cavity. We diagnosed a small bowel perforation and performed an emergency laparotomy and a right hemicolectomy with small bowel resection. This report describes the case of intestinal perforation presenting as a paradoxical reaction to antitubercular and provides a brief literature review.

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International Journal of Surgery Case Reports.2025; 137: 112100. CrossRef
Réaction paradoxale tuberculeuse
L.-D. Azoulay, A.-L. Houist, E. Feredj, W. Vindrios, S. Gallien
La Revue de Médecine Interne.2024; 45(5): 279. CrossRef
Left hand abscess as a paradoxical reaction during treatment of disseminated tuberculosis in immunocompetent patient: case report and review of literature
Aisha Alharbi, Aseel Aljahdali, Mohamed Firoze Ahamed, Hassan Almarhabi
BMC Infectious Diseases.2024;[Epub] CrossRef
Paradoxical Reaction to Antitubercular Treatment Causing Colonic Obstruction
Akira Hokama, Yuiko Oishi, Erika Koga, Sayuri Takehara, Jiro Fujita
Chonnam Medical Journal.2022; 58(1): 52. CrossRef
Multiple drugs

Reactions Weekly.2021; 1881(1): 189. CrossRef

Malignant disease, Benign GI diease,Colorectal cancer,Complication

An Unusual Case of Colon Perforation With Multiple Transmural Ulcers After Use of Polmacoxib and Everolimus in a Metastatic Breast Cancer Patient: In-Gyu Song, Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Ho-Kyung Chun; Ann Coloproctol. 2021;37(2):120-124. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.08.17

6,134 View
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2 Web of Science
3 Citations

Abstract PDF

Everolimus (Afinitor) is an inhibitor of mammalian target of rapamycin. Polmacoxib (Acelex) is a nonsteroidal anti-inflammatory drug that belongs to the cyclooxygenase-2 (COX-2) inhibitor family and is mainly used for treatment of arthritis. Intestinal perforation has not been reported previously as a complication of everolimus, and perforation of the lower intestinal tract caused by a selective COX-2 inhibitor is extremely rare. We present here a case of colon perforation that occurred after use of polmacoxib in a metastatic breast cancer patient who had been treated with everolimus for the preceding six months.

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Review

Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives: Hye Jin Kim, Gyu–Seog Choi; Ann Coloproctol. 2019;35(3):109-117. Published online June 30, 2019; DOI: https://doi.org/10.3393/ac.2019.06.12

24,669 View
384 Download
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63 Citations

Abstract PDF

Lymph node metastasis is regarded as an indubitable prognostic factor for predicting disease recurrence and survival in patients with colorectal cancer. Lymph node status based on examination of a resected specimen is a key element of the current staging system and is also a crucial factor to determine use of adjuvant chemotherapy after surgical resection. However, the current tumor-node-metastasis (TNM) staging system only incorporates the number of metastatic lymph nodes in the N category. Numerous attempts have been made to supplement this simplified N staging including lymph node ratio, distribution of metastatic lymph nodes, tumor deposits, or extracapsular invasion. In addition, several attempts have been made to identify more specific prognostic factors in resected colorectal specimens than lymph node status. In this review, we will discuss controversies in lymph node staging and factors that may influence survival beyond lymph node status.

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Frontiers in Oncology.2020;[Epub] CrossRef

Case Report

Pneumatic Colorectal Injury Caused by High Pressure Compressed Air: Jin Young Lee, Young Hoon Sul, Seung Je Go, Jin Bong Ye, Jung Hee Choi; Ann Coloproctol. 2019;35(6):357-360. Published online May 22, 2019; DOI: https://doi.org/10.3393/ac.2018.08.19

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Abstract PDF

The pneumatic colorectal injury caused by high pressure compressed air are rare and can be fatal. Herein, we present a case of 45-year-old male who developed sudden onset of severe abdominal pain after cleaning the dust on his pants with high pressure compressed air gun dust cleaner. Emergent exploratory laparotomy was done which findings are a huge rectal perforation with multiple serosal and subserosal tear in sigmoid to splenic flexure of colon. Anterior resection with left hemicolectomy, and temporary transverse colostomy was performed. Postoperative course was uneventful. Recently, prognosis is generally favorable because of prompt diagnosis and emergent surgical management.

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Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report
Ibrahim Elnogoomi, Hoorieh Qasemi, Mariam Aylan Alshamsi, Majid Alhammadi, Omar Elnogoomi
Cureus.2024;[Epub] CrossRef
Air Nozzle Injury: Barotrauma Resulted From an Industrial Accident
Ashok N Mhaske, Nishi Gupta, Abhishek Mishra, Shubham Jaiswal, Chirag Dausage, Jyoti Meena, Gourav Goyal
Cureus.2024;[Epub] CrossRef
Emergency laparoscopic resection of the anterior rectum due to rectal trauma secondary to compressed air, case report
Daniel Gómez, Luis F. Cabrera, Mauricio Pedraza, Andres Mendoza-Zuchini, Nicolás Sánchez, Hector W. Cure, Héctor O. Cure Bulicie, Jean A. Pulido
International Journal of Surgery Case Reports.2020; 76(C): 288. CrossRef

Original Article

Neutrophil to Lymphocyte Ratio: A Predictive Marker for Treatment Outcomes in Patients With Rectal Cancer Who Underwent Neoadjuvant Chemoradiation Followed by Surgery: Byong Ho Jeon, Ui Sup Shin, Sun Mi Moon, Jung Il Choi, Mi-Sook Kim, Kie Hwan Kim, Se-Jin Sung; Ann Coloproctol. 2019;35(2):100-106. Published online April 30, 2019; DOI: https://doi.org/10.3393/ac.2018.10.01

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Abstract PDF

Purpose
In this study, we investigated the role of neutrophil to lymphocyte ratio (NLR) as a predictor of tumor response and as a prognostic factor in patients with rectal cancer who had undergone curative surgery after neoadjuvant chemoradiation therapy (nCRT).
Methods
Between January 2009 and July 2016, we collected 140 consecutive patients who had undergone curative intent surgery after nCRT due to rectal adenocarcinoma. We obtained the pre- and post-nCRT NLR by dividing the neutrophil count by the lymphocyte count. The cutoff value was obtained using receiver operating characteristic analysis for tumor response and using maximally selected rank analysis for recurrence-free survival (RFS). The relationship among NLR, tumor response, and RFS was assessed by adjusting the possible clinico-pathological confounding factors.
Results
The possibility of pathologic complete response (pCR) was significantly decreased in high pre- (>2.77) and postnCRT NLR (>3.23) in univariate regression analysis. In multivariate analysis, high post-nCRT NLR was an independent negative predictive factor for pCR (adjusted odds ratio, 0.365; 95% confidence interval [CI], 0.145–0.918). The 5-year RFS of all patients was 74.6% during the median 37 months of follow-up. Patients with higher pre- (>2.66) and post-nCRT NLR (>5.21) showed lower 5-year RFS rates (53.1 vs. 83.3%, P = 0.006) (69.2 vs. 75.7%, P = 0.054). In multivariate Cox analysis, high pre-nCRT NLR was an independent poor prognostic factor for RFS (adjusted hazard ratio, 2.300; 95% CI, 1.061–4.985).
Conclusion
Elevated NLR was a negative predictive marker for pCR and was independently associated with decreased RFS. For confirmation, a large-scale study with appropriate controls is needed.

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Recurrence risk following rectal cancer surgery: a survival analysis of key predictors
Neda Gorjizadeh, Reza Hajebi, Matin Vahedi, Mahsa Mottahedi, Elham Nazar
Japanese Journal of Clinical Oncology.2025; 55(8): 880. CrossRef
Circulating Markers of Systemic Inflammation, Measured After Completion of Neoadjuvant Therapy, Associated With Response in Locally Advanced Rectal Cancer
Ross K. McMahon, Sean M. O’Cathail, Colin W. Steele, Harikrishnan S. Nair, Jonathan J. Platt, Donald C. McMillan, Paul G. Horgan, Campbell S. Roxburgh
Diseases of the Colon & Rectum.2025; 68(6): 713. CrossRef
Response Prediction to Neoadjuvant Chemoradiotherapy in Rectal Cancer Based on Systemic Inflammatory Markers (NLR, PLR, and LMR)
Roger Beltrati Coser, Caio Sergio R. Nahas, Alex Jones Flores Cassenote, Omar S. T. Ghani, Rafaela B. B. Pinheiro, Sergio Carlos Nahas, Carlos Frederico S. Marques
Journal of Gastrointestinal Cancer.2025;[Epub] CrossRef
Prognostic Value of Dynamic Changes in Immune-Inflammatory and Tumor Biomarkers Following Chemoradiotherapy in Locally Advanced Rectal Cancer
Mahmoud Al-Masri, Yasmin Safi, Mohammad Almasri, Ramiz Kardan, Daliana Mustafa, Osama Alayyan, Bilal Kahalah, Rama AlMasri
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Hematological markers as prognostic predictors in patients undergoing colon cancer surgery
Jessica Patricia Gonzales Stuva, Carlos Pérez-López, Marcelo Sebastian Ramírez Romero, Ana Bernabeu García, Pamela Vivas Angeles, Diana Escolà Ripoll, Sandra López Gordo
Scientific Reports.2025;[Epub] CrossRef
Landscape of Biomarkers and Pathologic Response in Rectal Cancer: Where We Stand?
Abrahams Ocanto, Macarena Teja, Francesco Amorelli, Felipe Couñago, Ariel Gomez Palacios, Diego Alcaraz, Ramón Cantero
Cancers.2024; 16(23): 4047. CrossRef
Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis
Giuseppe Portale, Patrizia Bartolotta, Danila Azzolina, Dario Gregori, Valentino Fiscon
Langenbeck's Archives of Surgery.2023;[Epub] CrossRef
NEUTROPHIL-LYMPHOCYTE RATIO (NLR) AND LYMPHOPENIAAS PROGNOSTIC FACTORS OF OVERALL SURVIVAL IN LOCALADVANCED RECTAL CANCER
Ocanto A, Morera R, Rodríguez I, Cantero R
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH.2023; : 11. CrossRef
Neutrophil-to-lymphocyte ratio predicts survival of patients with rectal cancer receiving neo-adjuvant chemoradiation followed by radical resection: a meta-analysis
Giuseppe Colloca, Antonella Venturino, Domenico Guarneri
Expert Review of Anticancer Therapy.2023; 23(4): 421. CrossRef
Efficacy of concurrent radiotherapy in patients with locally advanced rectal cancer and synchronous metastasis receiving systemic therapy
Tzu-Chieh Yin, Po-Jung Chen, Yung-Sung Yeh, Ching-Chun Li, Yen-Cheng Chen, Wei-Chih Su, Tsung-Kun Chang, Ching-Wen Huang, Chun-Ming Huang, Hsiang-Lin Tsai, Jaw-Yuan Wang
Frontiers in Oncology.2023;[Epub] CrossRef
The Crying Need for a Better Response Assessment in Rectal Cancer
Samuel Amintas, Nicolas Giraud, Benjamin Fernandez, Charles Dupin, Quentin Denost, Aurelie Garant, Nora Frulio, Denis Smith, Anne Rullier, Eric Rullier, Te Vuong, Sandrine Dabernat, Véronique Vendrely
Current Treatment Options in Oncology.2023; 24(11): 1507. CrossRef
Prognostic Role of Peripheral Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) in Patients with Rectal Cancer Undergoing Neoadjuvant Chemoradiotherapy
Şefika Arzu Ergen, Ceren Barlas, Cumhur Yıldırım, Didem Çolpan Öksüz
Journal of Gastrointestinal Cancer.2022; 53(1): 151. CrossRef
Deep regional hyperthermia combined with modern concurrent chemoradiotherapy increases T-downstaging rate in locally advanced rectal cancer
Yuxia Wang, Siyi Lu, Yuxia Shao, Ran Peng, Xuemin Li, Junjie Wang, Hao Wang
International Journal of Hyperthermia.2022; 39(1): 431. CrossRef
High Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Low Lymphocyte Levels Are Correlated With Worse Pathological Complete Response Rates
Serdar Karakaya, İbrahim Karadağ, Mehmet Emin Yılmaz, Ömür Berna Çakmak Öksüzoğlu
Cureus.2022;[Epub] CrossRef
Pretreatment inflammatory markers predicting treatment outcomes in colorectal cancer
Sanghyun An, Hongjin Shim, Kwangmin Kim, Bora Kim, Hui-Jae Bang, Hyejin Do, Hyang-Rae Lee, Youngwan Kim
Annals of Coloproctology.2022; 38(2): 97. CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Histopathological and Haemogram Features Correlate with Prognosis in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiation without Pathological Complete Response
Yu-Ming Huang, Hsi-Hsien Hsu, Chien-Kuo Liu, Ching-Kuo Yang, Po-Li Tsai, Tzu-Yin Tang, Shih-Ming Hsu, Yu-Jen Chen
Journal of Clinical Medicine.2022; 11(17): 4947. CrossRef
Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis
Hytham K.S. Hamid, George N. Davis, Mario Trejo-Avila, Patrick O. Igwe, Andrés Garcia-Marín
Surgical Oncology.2021; 37: 101556. CrossRef
The prognostic utility of pre‐treatment neutrophil‐to‐lymphocyte‐ratio (NLR) in colorectal cancer: A systematic review and meta‐analysis
Mate Naszai, Alina Kurjan, Timothy S. Maughan
Cancer Medicine.2021; 10(17): 5983. CrossRef
Predictive Ability of Neutrophil-Lymphocyte Ratio in Determining Tumor Staging in Colorectal Cancer
Chirag Pereira, Jiju Mohan, Shankar Gururaj, Prajwal Chandrashekhara
Cureus.2021;[Epub] CrossRef
An inflammation index-based prediction of treatment response to neoadjuvant chemoradiotherapy for rectal mucinous adenocarcinoma
Yanwu Sun, Zhekun Huang, Pan Chi
International Journal of Clinical Oncology.2020; 25(7): 1299. CrossRef

Case Report

Inflammatory Myofibroblastic Tumor of the Retroperitoneum Including Chronic Granulomatous Inflammation Suggesting Tuberculosis: A Case Report: Younglim Kim, Ji Won Park, Sungwhan Kim, Kil-Yong Lee, Jeongmo Bae, Yoon Kyung Jeon, Ji Min Im, Seung-Bum Ryoo, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2019;35(5):285-288. Published online March 20, 2019; DOI: https://doi.org/10.3393/ac.2018.05.09

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Abstract PDF: An inflammatory myofibroblastic tumor (IMT) is a solid tumor of unknown etiology frequently affecting children and young adults and commonly affecting the lung or orbital region. We present a case involving a 41-year-old man who had an IMT combined with Mycobacterium tuberculosis infection in the retroperitoneum. He presented with only pain in the right lower abdomen without accompanying symptoms; a retroperitoneal mass was found on computed tomography. The tumor had invaded the end of the ileum and was attached to the omentum, so mass excision could not be performed. The tumor was completely excised surgically and had histological features diagnostic of an IMT. Histologic findings of the omentum were positive for Ziehl-Nielsen staining for acid-fast bacilli and for a positive polymerase chain reaction for M. tuberculosis. The patient had no apparent immune disorder. These findings made this case exceptional because IMTs, which are mostly due to atypical mycobacteria, have been found mainly in immunocompromised patients.

Original Article

Efficacy and Safety of Laparoscopic Hartmann Colostomy Reversal: Won Park, Won Cheol Park, Keun Young Kim, Seok Youn Lee; Ann Coloproctol. 2018;34(6):306-311. Published online December 20, 2018; DOI: https://doi.org/10.3393/ac.2018.09.07

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Abstract PDF

Purpose
Hartmann operation is widely recognized as a useful procedure, especially in emergencies involving the rectosigmoid colon. One of the surgeon’s foremost concerns after Hartmann operation is future colostomy reversal, as colostomy reversal after a Hartmann procedure is associated with relatively high morbidity and mortality. Laparoscopic surgical techniques continue to prove useful for an ever-increasing variety of indications. We analyzed the outcomes of laparoscopic Hartmann colostomy reversals at our center.
Methods
We retrospectively analyzed the hospital records of 170 patients who had undergone Hartmann operation between January 2010 and June 2017 at Wonkwang University Hospital. Among 68 Hartmann colostomy reversals, we evaluated and compared the outcomes of 3 groups of patients: 29 patients in the open colostomy reversal group (OG) who had undergone laparotomies for Hartmann reversals, 19 patients in the conversion group (CG) whose laparoscopic procedures had required conversion to a laparotomy, and 20 patients in the laparoscopy group (LG).
Results
The overall reversal rate for Hartmann colostomies was 40.5% during this time period. The duration of hospital stay was significantly shorter among LG patients (10.15 ± 2.94 days) than among OG patients (16 ± 9.5 days). The overall complication rate among OG patients was higher than that among LG patients (adjusted odds ratio, 8.78; P = 0.01). The most common complication was postoperative ileus (19.1%).
Conclusion
If no contraindications to laparoscopy exist, surgeons should favor a laparoscopic reversal of Hartmann operation over an open reversal.

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Surgical Outcomes of Open and Laparoscopic Hartmann Reversal: A Single-Center Comparative Study
Mu-Han Tsai, Ming-Jenn Chen, Khaa-Hoo Ong, Chih-Ying Lu, Chung-Han Ho, Hsuan-Yi Huang, Yu-Feng Tian, I-Ning Yang
Cureus.2024;[Epub] CrossRef
Laparoscopic versus open Hartmann reversal: a propensity score matching analysis
Li Tan, Xiao-Yu Liu, Bin Zhang, Lian-Lian Wang, Zheng-Qiang Wei, Dong Peng
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Comparison of outcomes between laparoscopic and open Hartmann's reversal: A single‐center retrospective study in Japan
Aya Sato, Ken Imaizumi, Hiroyuki Kasajima, Keisuke Obuchi, Kentaro Sato, Daisuke Yamana, Yosuke Tsuruga, Minoru Umehara, Michihiro Kurushima, Kazuaki Nakanishi
Asian Journal of Endoscopic Surgery.2022; 15(1): 137. CrossRef
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Ryo Maemoto, Shingo Tsujinaka, Ryotaro Sakio, Nao Kakizawa, Rei Takahashi, Yuuri Hatsuzawa, Yasuaki Kimura, Erika Machida, Sawako Tamaki, Hideki Ishikawa, Yasuyuki Miyakura, Toshiki Rikiyama
Nippon Daicho Komonbyo Gakkai Zasshi.2022; 75(1): 36. CrossRef
Is laparoscopy a reliable alternative to laparotomy in Hartmann's reversal? An updated meta-analysis
D. Chavrier, A. Alves, B. Menahem
Techniques in Coloproctology.2022; 26(4): 239. CrossRef
Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients
Anwar Medellin Abueta, Nairo Javier Senejoa, Mauricio Pedraza Ciro, Lina Fory, Carlos Perez Rivera, Carlos Edmundo Martinez Jaramillo, Lina Maria Mateus Barbosa, Heinz Orlando Ibañez Varela, Javier A. Carrera, Rafael Garcia Duperly, Luis A Sanchez, Ivan D
Health Science Reports.2022;[Epub] CrossRef
Laparoscopic Hartmann reversal: experiences from a developing country
Dung Anh Nguyen, Tuong-Anh Mai-Phan, Truc Thanh Thai, Hai Van Nguyen
Annals of Coloproctology.2022; 38(4): 297. CrossRef
Open versus laparoscopic Hartmann’s procedure: a systematic review and meta-analysis
Yingjia Zhang, Chunxi Liu, Kameswara Rishi Yeshayahu Nistala, Choon Seng Chong
International Journal of Colorectal Disease.2022; 37(12): 2421. CrossRef
Laparoscopic Versus Open Hartmann Reversal: A Case-Control Study
Paolo Panaccio, Tommaso Grottola, Rossana Percario, Federico Selvaggi, Severino Cericola, Alfonso Lapergola, Maira Farrukh, Giuseppe Di Martino, Marco Ricciardiello, Pierluigi Di Sebastiano, Fabio Francesco Di Mola, Todd Pesavento
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Effects of Laparoscopic Hartmann Reversal on Short-term Operative Outcomes Among Vietnamese Patients
Viet Van Ung, Bang Cong Huynh, Vinh Chi Le, Dang Ngoc Tran, Trung Nguyen Vo, Tan Van Pham, Bac Hoang Nguyen
Journal of Coloproctology.2021; 41(02): 117. CrossRef
A comparative study between open versus laparoscopic Hartmann reversal
Hye Jung Cho, Woo Ram Kim, Jong Woo Kim
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A. N. Igolkin, V. V. Polovinkin
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Emergency Hartmann’s Procedure and its Reversal: A Totally Laparoscopic 2-Step Surgery for the Treatment of Hinchey III and IV Diverticulitis
Diletta Cassini, Michelangelo Miccini, Farshad Manoochehri, Matteo Gregori, Gianandrea Baldazzi
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Case Report

Colonoscopic Removal of an Intrauterine Device That Had Perforated the Rectosigmoid Colon: Jin Myeong Huh, Ki Seok Kim, Yong Seok Cho, Dong Kwon Suh, Jae Uk Lee, Seong Deuk Baek, Sin Kil Moon; Ann Coloproctol. 2018;34(2):106-108. Published online April 30, 2018; DOI: https://doi.org/10.3393/ac.2017.10.30

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Abstract PDF

The intrauterine device (IUD) is a widely used contraceptive method. One of the most serious and rare complications of using an IUD is colon perforation. We report a case of colonoscopic removal of an IUD that had perforated into the rectosigmoid colon in a 42-year-old woman who presented with no symptoms. Colonoscopy showed that the IUD had penetrated into rectosigmoid colon wall and that an arm of the IUD was embedded in the colon wall. We were able to remove the IUD easily by using colonoscopy. The endoscopic approach may be considered the first choice therapy for selected patients.

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Aparimita Das, Tarun S Joseph, Gangireddy Siva Sankar Reddy, Amrit Pipara, Sumit Mukhopadhyay
Cureus.2025;[Epub] CrossRef
Retroperitoneal Displacement of an Intrauterine Device (IUD): A Case Report
Godwin Silas Macheku, Fidelis Clarence Jungulu, Ezekiel Kalibugwe Kiyogoma, Kheri Kagya, Salehe Mrutu, Michael Johnson Mahande
International Journal of Innovative Science and Research Technology.2025; : 713. CrossRef
Rectal Foreign Body Shaped Like an Endoscopic Clip: Migrated Intrauterine Devices to the Rectum
Xinyu Xie, BoYuan, Chunmei Li, Lina Cao
Digestive Diseases and Sciences.2025; 70(9): 2899. CrossRef
Endoscopic Removal of Intrauterine Contraceptive Device From the Descending Colon: A Case Report
Muhammad Shabbir, Mishal A Aljohani, Abdurahman Alfaiz, Msab Aldakheel, Zeeshan Ali
Cureus.2024;[Epub] CrossRef
Colonoscopic removal of an intrauterine device with rectal perforation: A case report
Lingrun Ye, Yuanyuan Zhu, Fanglai Zhu
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Is It a “Colon Perforation”? A Case Report and Review of the Literature
Shuangshuang Lu, Xinyu Yao, Jun Shi, Jian Huang, Shaohua Zhuang, Junfang Ma, Yan Liu, Wei Zhang, Lifei Yu, Ping Zhu, Qiuwei Zhu, Ruxia Shi, Hong Zheng, Dong Shao, Yuyan Pan, Shizhen Bao, Li Qin, Lijie Huang, Wenjia Liu, Jin Huang
Frontiers in Medicine.2022;[Epub] CrossRef
Endoscopic removal of an intrauterine device from the lumen of the sigmoid colon
V. V. Bereshchenko, D. V. Lazarevich, N. N. Goncharov, P. V. Khodanovich
Health and Ecology Issues.2022; 19(1): 145. CrossRef
Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon
Junseak Lee, Jung Hwan Oh, Jinsu Kim, Chul-Hyun Lim, Sung Hoon Jung
The Korean Journal of Gastroenterology.2021; 78(1): 48. CrossRef
Chronic nodules of sigmoid perforation caused by incarcerated intrauterine contraception device
Xiaohui Huang, Rui Zhong, Liqin Zeng, Xuhui He, Qingshan Deng, Xiuhong Peng, Jieming Li, Xiping Luo
Medicine.2019; 98(4): e14117. CrossRef
Endoscopic Removal of Migrated Intrauterine Device: Case Report and Review of Literature and Technique
Yang Lei, Vadim Iablakov, Riaz J. Karmali, Nauzer Forbes
ACG Case Reports Journal.2019; 6(6): e00090. CrossRef

Original Article

Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients: Jae Ho Park, Kyung Jong Kim; Ann Coloproctol. 2018;34(1):16-22. Published online February 28, 2018; DOI: https://doi.org/10.3393/ac.2018.34.1.16

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Abstract PDF

Purpose

The management of a colonoscopic perforation (CP) varies from conservative to surgical. The objective of this study was to evaluate the outcomes between surgical and conservative treatment of patients with a CP.

Methods

From 2003 to 2016, the medical records of patients with CP were retrospectively reviewed. Patients were divided into 2 groups depending on whether they initially received conservative or surgical treatment.

Results

During the study period, a total of 48 patients with a CP were treated. Among them, 5 patients had underlying colorectal cancer and underwent emergency radical cancer surgery; these patients were excluded. The mean age of the remaining 43 patients was 64.5 years old, and the most common perforation site was the sigmoid colon (15 patients). The initial conservative care group included 16 patients, and the surgery group included 27 patients. In the conservative group, 5 patients required conversion to surgery (failure rate: 5 of 16 [31.3%]). Of the surgery group, laparoscopic surgery was performed on 19 patients and open surgery on 8 patients, including 2 conversion cases. Major postoperative complications developed in 11 patients (34.4%), and postoperative mortality developed in 4 patients (12.5%). The only predictor for poor prognosis after surgery was a high American Society of Anesthesiologists physical status classification.

Conclusion

In this study, conservative treatment for patients with a CP had a relatively high failure rate. Furthermore, surgical treatment showed significant rates of complications and mortality, which depended on the general status of the patients.

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Multicenter retrospective evaluation of ileocecocolic perforations associated with diagnostic lower gastrointestinal endoscopy in dogs and cats
Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef

Case Report

Colorectal Perforation After Anorectal Manometry for Low Anterior Resection Syndrome: Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul; Ann Coloproctol. 2017;33(4):146-149. Published online August 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.4.146

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Abstract PDF

We experienced 3 cases of manometry-induced colon perforation. A 75-year-old man (case 1) underwent anorectal manometry (ARM) 3 years after radiotherapy for prostate cancer and a laparoscopic intersphincteric resection for rectal cancer. A 70-year-old man (case 2) underwent ARM 3 months after conventional neoadjuvant chemoradiotherapy and a laparoscopic low anterior resection for rectal cancer. A 78-year-old man (case 3) underwent ARM 2 months after a laparoscopic intersphincteric resection for rectal cancer. In all cases, a colon perforation with fecal peritonitis occurred. All were treated successfully using prompt and active operations and were discharged without any complications. ARM with a balloon, as a measure of rectal compliance, should be performed 2 months or longer after surgery. If a perforation occurs, prompt and active surgical intervention is necessary due to the high possibility of extensive fecal peritonitis.

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Keiji Koda, Toshiki Mimura, Tetsuo Yamana, Mitsuru Ishizuka, Tomoko Takahashi, Shota Takano, Tatsuya Abe, Yuji Nishizawa, Hidetoshi Katsuno, Masami Sato, Kaoru Nishimura, Masahiro Yoshida, Kotaro Maeda
Journal of the Anus, Rectum and Colon.2026; 10(1): 64. CrossRef
Colorectal perforation following anorectal manometry in a patient with anal stenosis post rectal prolapse repair: a rare complication
Leanne Iorio, Monique Couto Matos, Benjamin Linkous, Marco Ferrara, Antonio Caycedo
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Dong-Ai Jin, Fang-Ping Gu, Tao-Li Meng, Xuan-Xuan Zhang
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Functional anorectal studies in patients with low anterior resection syndrome
Ssu‐Chi Chen, Kaori Futaba, Wing Wa Leung, Cherry Wong, Tony Mak, Simon Ng, Hans Gregersen
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Bin Zhang, Ke Zhao, Yu‐Juan Zhao, Shu‐Hui Yin, Guang‐Zuan Zhuo, Yong Zhao, Jian‐Hua Ding
Colorectal Disease.2021; 23(2): 424. CrossRef
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Christian German Ospina-Pérez, Ana Milena Álvarez-Acuña, Lina María López-Álvarez, Rosa María Ospina-Pérez, Ivan David Lozada-Martínez, Sabrina Rahman
International Journal of Surgery Case Reports.2021; 85(C): 106261. CrossRef
Assessment of defecation function after sphincter-saving resection for mid to low rectal cancer: A cross-sectional study
Bao-Jia Luo, Mei-Chun Zheng, Yang Xia, Zhu Ying, Jian-Hong Peng, Li-Ren Li, Zhi-Zhong Pan, Hui-Ying Qin
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Original Article

Correlation Between Bowel Preparation and the Adenoma Detection Rate in Screening Colonoscopy: Jung Hun Park, Sang Jin Kim, Jong Hee Hyun, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Sang-Jeon Lee, Dae Kyung Sohn; Ann Coloproctol. 2017;33(3):93-98. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.93

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Abstract PDF

Purpose

The adenoma detection rate is commonly used as a measure of the quality of colonoscopy. This study assessed both the association between the adenoma detection rate and the quality of bowel preparation and the risk factors associated with the adenoma detection rate in screening colonoscopy.

Methods

This retrospective analysis involved 1,079 individuals who underwent screening colonoscopy at the National Cancer Center between December 2012 and April 2014. Bowel preparation was classified by using the Aronchick scale. Individuals with inadequate bowel preparations (n = 47, 4.4%) were excluded because additional bowel preparation was needed. The results of 1,032 colonoscopies were included in the analysis.

Results

The subjects' mean age was 53.1 years, and 657 subjects (63.7%) were men. The mean cecal intubation time was 6.7 minutes, and the mean withdrawal time was 8.7 minutes. The adenoma and polyp detection rates were 28.1% and 41.8%, respectively. The polyp, adenoma, and advanced adenoma detection rates did not correlate with the quality of bowel preparation. The multivariate analysis showed age ≥ 60 years (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.02–1.97; P = 0.040), body mass index ≥ 25 kg/m² (HR, 1.56; 95% CI, 1.17–2.08; P = 0.002) and current smoking (HR, 1.44; 95% CI, 1.01–2.06; P = 0.014) to be independent risk factors for adenoma detection.

Conclusion

The adenoma detection rate was unrelated to the quality of bowel preparation for screening colonoscopy. Older age, obesity, and smoking were independent risk factors for adenoma detection.

Citations

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Burak Sakar, Osman Zekai Oner, Ali Celik, Omer Celik, Turan Can Yıldız, Ugur Dogan, Onur Ilkay Dincer
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Case Reports

Urinary Bladder Injury During Colonoscopy Without Colon Perforation: Jung Wook Suh, Jun Won Min, Hwan Namgung, Dong-Guk Park; Ann Coloproctol. 2017;33(3):112-114. Published online June 30, 2017; DOI: https://doi.org/10.3393/ac.2017.33.3.112

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Abstract PDF

We report a case of urinary bladder perforation during colonoscopy. A 67-year-old female, who had undergone a transabdominal hysterectomy for uterine myomas 15 years ago, visited the emergency department with complaint of abdominal pain after a screening colonoscopy. Laparoscopic examination revealed severe adhesion between the sigmoid colon and the urinary bladder. The urinary bladder wall was weakened, and several perforation sites were found. The surgery was converted to a laparotomy. After a thorough examination, we performed primary repair for the perforation sites, followed by an omentopexy.

Citations

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Trauma to the solid abdominal organs: The missed dark box of colonoscopy
Mohamed H Emara, Usama Mazid, Yasmine A Elshaer, Mahmoud A Elkerdawy, Dilaver Farooq Malik, Aya M Mahros
World Journal of Gastroenterology.2024; 30(7): 624. CrossRef
Mesenteric laceration of the sigmoid colon after colonoscopy: A rare complication
Min Wu, Yonghua Lin, Zhichao Chen, Jianfeng Wei
Asian Journal of Surgery.2023; 46(11): 5391. CrossRef
Massive retroperitoneal hematoma following colonoscopy
Reo Ohtsuka, Hodaka Amano, Kei Niida, Takeaki Yoshino, Michiyo Owari, Ryotaro Takano, Yuichi Akama, Yohei Watanabe, Toshiyasu Iwao
Medicine.2018; 97(31): e11723. CrossRef

Colonic Perforation Secondary to Idiopathic Intramural Hemorrhage: Takashi Sakamoto, Akira Saito, Alan Kawarai Lefor, Tadao Kubota; Ann Coloproctol. 2016;32(6):239-242. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.239

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Abstract PDF

Intramural colonic hemorrhage is rare and often secondary to trauma or anticoagulation therapy. Idiopathic intramural hemorrhages in the alimentary tract have rarely been reported. While several reports of spontaneous perforation of an intramural rectal hematoma have been published, no reports of spontaneous perforation in the ascending colon due to a hematoma have. We describe a patient with an ascending colonic perforation secondary to spontaneous intramural hemorrhage. The patient is a 35-year-old male, who presented with acute abdominal pain and no history of trauma. An abdominal computed tomography scan showed a high-density area around the ascending colon, and nonoperative management was instituted. On the eighth hospital day, the pain worsened, and abdominal computed tomography scan showed free air. An emergent right hemicolectomy was performed. Intramural hematoma and ischemia with perforation, with no obvious etiology, were found. The patient was discharged on the 14th postoperative day.

Citations

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A case of gastrointestinal perforation following transarterial embolization for an intramural hematoma after cold snare polypectomy of an adenoma in the transverse colon
Yuu Kodama, Yuji Mizokami, Yuzo Toyama, Hiroyasu Kusaka, Gen Maeda, Shingo Asahara, Ryuji Nagahama, Shin‐ichiro Horiguchi, Hiroki Aoyama
DEN Open.2025;[Epub] CrossRef
Giant Proximal Right Colon Submucosal Hematoma Leading to a Large Bowel Obstruction
Arham Siddiqui, Hijab Ahmed, Muhammad H Nazim, Basem Soliman, Izi Obokhare
Cureus.2022;[Epub] CrossRef
Spontaneous colonic perforation in adults: Evaluation of a pooled case series
Ren Chongxi, Ji Jinggang, Shi Yan, Wang Hongqiao, Liu Yan, Yang Fengshuo
Science Progress.2020;[Epub] CrossRef
Idiopathic intramural hematoma of the right colon. A case report and review of the literature
Rosario Vecchio, Emma Cacciola, Michele Figuera, Renato Catalano, Giuseppe Giulla, Emanuele Rosario Distefano, Eva Intagliata
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Intramural Hematoma Causing Hematochezia After Colonoscopy With Polypectomy
Aleksandar Gavrić, Rok Dežman, Sebastian Stefanović, Jan Drnovšek, Borut Štabuc
ACG Case Reports Journal.2019; 6(7): e00129. CrossRef

Pneumoretroperitoneum, Pneumomediastinum, Subcutaneous Emphysema After a Rectal Endoscopic Mucosal Resection: Hee Cheul Jung, Hyun Jin Kim, Sung Bok Ji, Jun Hyeong Cho, Ji Hye Kwak, Chang Min Lee, Wan Soo Kim, Jin Ju Kim, Jae Min Lee, Sang Su Lee; Ann Coloproctol. 2016;32(6):234-238. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.234

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Abstract PDF

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.

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Asymptomatic sigmoid diverticulum perforation-induced subcutaneous, mediastinal, and retroperitoneal emphysema: A case report and literature review
Daichi Setoguchi, Naoki Iwanaga, Kotaro Nema, Tomoya Hagiwara, Kotaro Hayashida, Koki Yamashita, Tatsuro Hirayama, Masataka Yoshida, Kazuaki Takeda, Shotaro Ide, Masato Tashiro, Takahiro Takazono, Masachika Kitajima, Noriho Sakamoto, Koichi Izumikawa, Kat
Respiratory Medicine Case Reports.2025; 56: 102229. CrossRef
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The Close Relationship between Large Bowel and Heart: When a Colonic Perforation Mimics an Acute Myocardial Infarction
Maria Francesca Secchi, Carlo Torre, Giovanni Dui, Francesco Virdis, Mauro Podda
Case Reports in Surgery.2018; 2018: 1. CrossRef
Pneumoretroperitoneum, Pneumomediastinum, Pneumothorax, and Subcutaneous Emphysema after Diagnostic Colonoscopy
Hee Sung Lee, Hwan Hee Park, Ju Seok Kim, Sun Hyung Kang, Hee Seok Moon, Jae Kyu Sung, Byung Seok Lee, Hyun Yong Jeong
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Original Articles

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation: Rumi Shin, Sang Mok Lee, Beonghoon Sohn, Dong Woon Lee, Inho Song, Young Jun Chai, Hae Won Lee, Hye Seong Ahn, In Mok Jung, Jung Kee Chung, Seung Chul Heo; Ann Coloproctol. 2016;32(6):221-227. Published online December 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.6.221

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Purpose

An intestinal perforation is a rare condition, but has a high mortality rate, even after immediate surgical intervention. The clinical predictors of postoperative morbidity and mortality are still not well established, so this study attempted to identify risk factors for postoperative morbidity and mortality after surgery for an intestinal perforation.

Methods

We retrospectively analyzed the cases of 117 patients who underwent surgery for an intestinal perforation at a single institution in Korea from November 2008 to June 2014. Factors related with postoperative mortality at 1 month and other postoperative complications were investigated.

Results

The mean age of enrolled patients was 66.0 ± 15.8 years and 66% of the patients were male. Fifteen patients (13%) died within 1 month after surgical treatment. Univariate analysis indicated that patient-related factors associated with mortality were low systolic and diastolic blood pressure, low serum albumin, low serum protein, low total cholesterol, and high blood urea nitrogen; the surgery-related factor associated with mortality was feculent ascites. Multivariate analysis using a logistic regression indicated that low systolic blood pressure and feculent ascites independently increased the risk for mortality; postoperative complications were more likely in both females and those with low estimated glomerular filtration rates and elevated serum C-reactive protein levels.

Conclusion

Various factors were associated with postoperative clinical outcomes of patients with an intestinal perforation. Morbidity and mortality following an intestinal perforation were greater in patients with unstable initial vital signs, poor nutritional status, and feculent ascites.

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Byung Soh Min
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The Outcomes of Management for Colonoscopic Perforation: A 12-Year Experience at a Single Institute: Jung Yun Park, Pyong Wha Choi, Sung Min Jung, Nam-Hoon Kim; Ann Coloproctol. 2016;32(5):175-183. Published online October 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.5.175

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Abstract PDF

Purpose

Optimal management of colonoscopic perforation (CP) is controversial because early diagnosis and prompt management play critical roles in morbidity and mortality. Herein, we evaluate the outcomes and clinical characteristics of patients with CP according to treatment modality to help establish guidelines for managing CP.

Methods

Our retrospective analysis included 40 CP patients from January 1, 2003, to December 31, 2014. Patients with CP were categorized into 2 groups according to therapeutic modality: operation (surgery) and nonoperation (endo-luminal clip application or conservative treatment) groups.

Results

The postoperative morbidity rate was 40%, and no mortalities were noted. The incidence of abdominal pain and tenderness in patients who received only conservative management was significantly lower than in those who underwent surgery (P < 0.001 and P = 0.004, respectively). Patients tended to undergo surgery more often for diagnosis times longer than 24 hours and for diagnostic CPs. The mean hospital stays for the operation and nonoperation groups were 14.6 ± 7.77 and 5.9 ± 1.62 days, respectively (P < 0.001). Compared to the operation group, the nonoperation group began intake of liquid diets significantly earlier after perforation (3.8 ± 1.32 days vs. 5.6 ± 1.25 days, P < 0.001) and used antibiotics for a shorter duration (4.7 ± 1.29 days vs. 8.7 ± 2.23 days, P < 0.001).

Conclusion

The time of diagnosis and the injury mechanism may be useful indications for conservative management. Nonoperative management, such as endo-luminal clip application, might be beneficial, when feasible, for the treatment of patients with CP.

Citations

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Risk Factors for Perforation in Endoscopic Treatment for Early Colorectal Cancer: A Nationwide ENTER-K Study
Ik Hyun Jo, Hyun Gun Kim, Young-Seok Cho, Hyun Jung Lee, Eun Ran Kim, Yoo Jin Lee, Sung Wook Hwang, Kyeong-Ok Kim, Jun Lee, Hyuk Soon Choi, Yunho Jung, Chang Mo Moon
Gut and Liver.2025; 19(1): 95. CrossRef
Cold Versus Hot Endoscopic Mucosal Resection for ≥15 mm Large Nonpedunculated Colorectal Polyps
Sneh Sonaiya, Dushyant S. Dahiya, Raj Patel, Shahryar Khan, Charmy Parikh, Karan Yagnik, Chun-Han Lo, Kyaw Min Tun, Pranav D. Patel, Bradley Confer, Harshit S. Khara, Sumant Inamdar, Babu P. Mohan
Journal of Clinical Gastroenterology.2025;[Epub] CrossRef
Luminal electrophysiological neuroprofiling system for gastrointestinal neuromuscular diseases
Shriya S. Srinivasan, Sabrina Liu, Ryo Hotta, Sukhada Bhave, Amro Alshareef, Binbin Ying, George Selsing, Johannes Kuosmanen, Keiko Ishida, Joshua Jenkins, Wiam Abdalla Mohammed Madani, Alison Hayward, Niora Fabian, Allan M. Goldstein, Giovanni Traverso
Device.2024; 2(7): 100400. CrossRef
Laparoscopic versus open surgery for colonoscopic perforation: A systematic review and meta-analysis
Wu Zhong, Chuanyuan Liu, Chuanfa Fang, Lei Zhang, Xianping He, Weiquan Zhu, Xueyun Guan
Medicine.2023; 102(24): e34057. CrossRef
Analysis of the Characteristics of Colonoscopy Perforation and Risk Factors for Failure of Endoscopic Treatment
Zhi Jiehua, Ali Kashif , Che YaoSheng , Sun YunYun , Liang Lanyu
Cureus.2022;[Epub] CrossRef
Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
Nihat Gülaydın, Raim İliaz, Atakan Özkan, A Hande Gökçe, Hanifi Önalan, Berrin Önalan, Aziz Arı
Turkish Journal of Surgery.2022; 38(3): 221. CrossRef
The analysis of outcomes of surgical management for colonoscopic perforations: A 16-years experiences at a single institution
Dae Ro Lim, Jung Kul Kuk, Taehyung Kim, Eung Jin Shin
Asian Journal of Surgery.2020; 43(5): 577. CrossRef
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Vanessa L. Woolhead, Jacqueline C. Whittemore, Sarah A. Stewart
Journal of Veterinary Internal Medicine.2020; 34(2): 684. CrossRef
Clinical Characteristics of Colonoscopic Perforation and Risk Factors for Complications After Surgical Treatment
Liang Li, Bing Xue, Chunxia Yang, Zhongbo Han, Hongqiang Xie, Meng Wang
Journal of Laparoendoscopic & Advanced Surgical Techniques.2020; 30(11): 1153. CrossRef
ESTUDO RETROSPECTIVO DA PREVALÊNCIA DE PERFURAÇÕES GASTROINTESTINAIS EM PACIENTES SUBMETIDOS A COLONOSCOPIAS NO HOSPITAL REGIONAL HANS DIETER SCHMIDT
Viviane Helena Raimundo, Paula Fernanda Partika, Haroldo Luiz Jordelino da Luz, Eduardo Manoel Pereira
Arquivos Catarinenses de Medicina.2020; 49(2): 14. CrossRef
Adverse events related to colonoscopy: Global trends and future challenges
Su Young Kim, Hyun-Soo Kim, Hong Jun Park
World Journal of Gastroenterology.2019; 25(2): 190. CrossRef
Iatrogenic Colonic Perforations: Changing the Paradigm
Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): 173. CrossRef
Diagnosis and Management of Colonoscopy-related Perforation
Nam Seok Ham, Jung Ho Bae, Dong-Hoon Yang
The Korean Journal of Gastroenterology.2019; 73(6): 327. CrossRef
Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
Nicola de’Angelis, Salomone Di Saverio, Osvaldo Chiara, Massimo Sartelli, Aleix Martínez-Pérez, Franca Patrizi, Dieter G. Weber, Luca Ansaloni, Walter Biffl, Offir Ben-Ishay, Miklosh Bala, Francesco Brunetti, Federica Gaiani, Solafah Abdalla, Aurelien Ami
World Journal of Emergency Surgery.2018;[Epub] CrossRef

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea: Sang Mok Lee, Eon Chul Han, Seung-Bum Ryoo, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Joo Sung Kim, Hyun Chae Jung, Kyu Joo Park; Ann Coloproctol. 2015;31(4):144-152. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.144

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Abstract PDF

Purpose

Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results.

Methods

We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors.

Results

The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767).

Conclusion

We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

Citations

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Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence
Mafalda Santiago, Fernando Magro, Luís Correia, Francisco Portela, Paula Ministro, Paula Lago, Eunice Trindade, Cláudia Camila Dias
Clinical and Translational Gastroenterology.2020; 11(9): e00227. CrossRef
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study
Hee Man Kim, Jin Woo Kim, Hyun-Soo Kim, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Won Ho Kim, Byong Duk Ye, Won Moon, Sung Hee Jung, Young-Ho Kim, Dong Soo Han
Journal of Clinical Medicine.2020; 10(1): 25. CrossRef
Risk factors for postoperative surgical site infections in patients with Crohn’s disease receiving definitive bowel resection
Song Liu, Ji Miao, Gefei Wang, Meng Wang, Xiuwen Wu, Kun Guo, Min Feng, Wenxian Guan, Jianan Ren
Scientific Reports.2017;[Epub] CrossRef
Advanced age impacts surgical characteristics and postoperative course in patients with Crohn's disease
Stanislaus Argeny, Anton Stift, Martina Mittlböck, Amy C. Lord, Svenja Maschke, Mathias Schneeweiß, Stefan Riss
International Journal of Surgery.2016; 33: 182. CrossRef
Effect of Tripterygium Wilfordii Polyglycoside on Experimental Prostatitis Caused by Ureaplasma Urealyticum in Rats
Pingnan Shan, Zhiyong Lu, Lihong Ye, Yaqin Fang, Suhong Tan, Guohong Xuan, Jincheng Ru, Liming Mao
Medical Science Monitor.2016; 22: 3722. CrossRef
Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease
Anne-Laure Boucher, Bruno Pereira, Stéphanie Decousus, Marion Goutte, Felix Goutorbe, Anne Dubois, Johan Gagniere, Corinne Borderon, Juliette Joubert, Denis Pezet, Michel Dapoigny, Pierre J Déchelotte, Gilles Bommelaer, Anthony Buisson
World Journal of Gastroenterology.2016; 22(21): 5068. CrossRef
Anti-tumor Necrosis Factor Therapy for Crohn Disease: Friend or Foe to the Surgeon?
Hungdai Kim
Annals of Coloproctology.2015; 31(4): 121. CrossRef

Colovesical Fistula: Should It Be Considered a Single Disease?: Qamar Hafeez Kiani, Mark L. George, Emin A. Carapeti, Alexis M. P. Schizas, Andrew B. Williams; Ann Coloproctol. 2015;31(2):57-62. Published online April 30, 2015; DOI: https://doi.org/10.3393/ac.2015.31.2.57

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Abstract PDF

Purpose

This research was conducted to compare the management and the outcome of patients with colovesical fistulae of different aetiologies.

Methods

Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies.

Results

A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48-75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17-70 days vs. 16 days; IQR, 11-25 days; P < 0.001).

Conclusion

Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.

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Maurizio ZIZZO, David TUMIATI, Maria C. BASSI, Magda ZANELLI, Francesca SANGUEDOLCE, Francesco PORPIGLIA, Cristian FIORI, Davide CAMPOBASSO, Carolina CASTRO RUIZ, Franco A. BERGAMASCHI, Umberto V. MAESTRONI, Giuseppe CARRIERI, Luigi CORMIO, Federico BIOLC
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Case Reports

Acute Hyponatremia With Seizure and Mental Change After Oral Sodium Picosulfate/Magnesium Citrate Bowel Preparation: Young Sun Cho, Kyung Min Nam, Jang Ho Park, Sang Hwan Byun, Jin Suck Ryu, Hyun Ju Kim; Ann Coloproctol. 2014;30(6):290-293. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.290

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Abstract PDF

Sodium picosulfate/magnesium citrate (Picolight Powder), which is used as a bowel preparation for the colon and the rectum, can cause a severe electrolyte imbalance like hyponatremia. When hyponatremia gets severe or occurs rapidly, it can lead to death due to associated complications. We have experienced a case of hyponatremia associated with seizure and loss of consciousness in a 76-year-old woman, who took sodium picosulfate/magnesium citrate as a bowel preparation for colonoscopy. She was taking thiazide and synthroid for the treatment of hypertension and hypothyroidism, respectively, and she had other underlying medical conditions such as a history of seizure and dementia. Following the diagnosis of hyponatremia, we used an intravenous injection of 3% NaCl to normalize the sodium level in her serum, and her associated symptoms soon disappeared.

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Hyponatremic Seizure after Ingestion of an Oral Sulfate Tablet for Bowel Preparation for Colonoscopy
Sung Hyun Hong, Dong Seok Lee, Ji Won Kim, Kook Lae Lee, Hyoun Woo Kang, Su Hwan Kim
The Korean Journal of Gastroenterology.2022; 80(3): 154. CrossRef
Seizure from water intoxication following bowel preparation: a case report
Ting-Hsuan Chiang, Jui-Hsiang Tan, Chun-Chao Chang, Kuan-Chieh Fang
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Severe symptomatic hyponatraemia secondary to bowel preparation
Krishan Pratap, Manasi Jiwrajka, Liam Weber, Alan Richardson
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Preparation for colonoscopy: Recommendations by an expert panel in Italy
Cristiano Spada, Renato Cannizzaro, Maria Antonietta Bianco, Rita Conigliaro, Emilio Di Giulio, Cesare Hassan, Riccardo Marmo, Pietro Occhipinti, Franco Radaelli, Alessandro Repici, Enrico Ricci, Guido Costamagna
Digestive and Liver Disease.2018; 50(11): 1124. CrossRef
Severe hyponatremia secondary to preparation for colonoscopy with sodium picosulfate/magnesium citrate
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“Bowel prep hyponatremia“ – a state of acute water intoxication facilitated by low dietary solute intake: case report and literature review
Martin Windpessl, Christoph Schwarz, Manfred Wallner
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Severe Hyponatremia with Mental Change after Ingestion of Picosulfate Sodium/Magnesium Citrate for Bowel Preparation
Woojung Kim, Sang Young Park, Mi Jeoung Kim, Hyang Mo Koo
The Korean Journal of Medicine.2016; 91(2): 206. CrossRef
Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder
Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong
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Jae Seung Soh, Kyung-Jo Kim
World Journal of Gastroenterology.2016; 22(10): 2915. CrossRef
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Miguel Muñoz-Navas, José Luis Calleja, Guillermo Payeras, Antonio José Hervás, Luis Esteban Abreu, Víctor Orive, Pedro L. Menchén, José María Bordas, José Ramón Armengol, Cristina Carretero, Vicente Pons Beltrán, Inmaculada Alonso-Abreu, Román Manteca, Ad
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Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation: Jalal Vahedian-Ardakani, Shahram Nazerani, Amir Saraee, Ali Sarmast, Ehsan Saraee, Mohammad Reza Keramati; Ann Coloproctol. 2014;30(6):285-289. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.285

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Abstract PDF

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

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Yixing Lu, Lixian Mo, Junhong Chen, Wei Peng
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Shoichiro HARA, Junichi HAMADA, Kenichi TAKEMOTO, Kei NAITO, Toshiya OCHIAI, Eigo OTSUJI
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Barium sulfate

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Original Articles

Comparative Study of Postoperative Complications in Patients With and Without an Obstruction Who Had Left-Sided Colorectal Cancer and Underwent a Single-Stage Operation After Mechanical Bowel Preparation: Sang Hun Jung, Jae Hwang Kim; Ann Coloproctol. 2014;30(6):251-258. Published online December 31, 2014; DOI: https://doi.org/10.3393/ac.2014.30.6.251

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Abstract PDF

Purpose

The purpose of this study is to compare postoperative complications for single-stage surgery after mechanical bowel preparation in patients who experienced obstruction and those who did not.

Methods

From 2000 to 2011, 1,224 patients underwent a single-stage operation for left colorectal cancer after bowel preparation. Nonobstruction (NOB) and obstruction (OB) colorectal cancer patients were 1,053 (86.0%) and 171 (14.0%), respectively. Postoperative morbidity and mortality were compared between groups.

Results

The OB group had poor preoperative conditions (age, white blood cell, hemoglobin, albumin level, and advanced tumor stage) compared with the NOB group (P < 0.05). Mean on-table lavage time for the OB group was 17.5 minutes (range, 14-60 minutes). Mean operation time for the OB group was statistically longer than that of the NOB group (OB: 210 minutes; range, 120-480 minutes vs. NOB: 180 minutes; range, 60-420 minutes; P < 0.001). Overall morbidity was similar between groups (NOB: 19.7% vs. OB: 23.4%, P = 0.259). Major morbidity was more common in the OB group than in the NOB group, but the difference was without significance (OB: 11.7% vs. NOB: 7.6%, P = 0.070). Postoperative death occurred in 16 patients (1.3%), and death in the OB group (n = 7) was significantly higher than it was in the NOB group (n = 9) (4.1% vs. 0.9%, P = 0.001). Twelve patients had surgical complications, which were the leading cause of postoperative death: postoperative bleeding in five patients and leakage in seven patients.

Conclusion

Postoperative morbidity for a single-stage operation for obstructive left colorectal cancer is comparable to that for NOB, regardless of poor conditions of the patient.

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Associated factors for postoperative morbidity and mortality following surgery of obstructive colon tumors
Mseddi Mohamed Ali, Siala Rakia, Yakoubi Chaima, Hsairi Mariem, Hssin Hajer, Krifa Nesrine, Trifa Fatma, Boubaker Radhia, Sallemi Karim, Khemakhem Emna, Mghirbi Abdelwaheb, Bhira Amal, Yosra Yahia, Mestiri Souhir, Guizeni Rami, Ghariani Brahim, Sassi Kari
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Clinical characteristics and risk factors of post-operative intestinal flora disorder following laparoscopic colonic surgery: A propensity-score-matching analysis
Gan-Bin Li, Chen-Tong Wang, Xiao Zhang, Xiao-Yuan Qiu, Wei-Jie Chen, Jun-Yang Lu, Lai Xu, Bin Wu, Yi Xiao, Guo-Le Lin
World Journal of Gastrointestinal Surgery.2024; 16(5): 1259. CrossRef
Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study
Hiroyuki Matsuzaki, Soichiro Ishihara, Kazushige Kawai, Koji Murono, Kensuke Otani, Koji Yasuda, Takeshi Nishikawa, Toshiaki Tanaka, Tomomichi Kiyomatsu, Keisuke Hata, Hiroaki Nozawa, Hironori Yamaguchi, Toshiaki Watanabe
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Prompt Management Is Most Important for Colonic Perforation After Colonoscopy: Hyun-Ho Kim, Bong-Hyeon Kye, Hyung-Jin Kim, Hyeon-Min Cho; Ann Coloproctol. 2014;30(5):228-231. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.228

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16 Citations

Abstract PDF

Purpose

The incidence of complications after colonoscopy is very low. The complications after colonoscopy that are of clinical concern are bleeding and perforation. The present study was conducted to determine the clinical outcomes and the risk factors of a colostomy or a colectomy after colonoscopic colon perforation.

Methods

From March 2009 to December 2012, the records of all patients who were treated for colorectal perforation after colonoscopy were reviewed retrospectively. The following parameters were evaluated: age, sex, purpose of colonoscopy, management of the colonic perforation, and interval from colonoscopy to the diagnosis of a colonic perforation. A retrospective analysis was performed to determine the risk factors associated with major surgery for the treatment of a colon perforation after colonoscopy.

Results

A total 27 patients were included in the present study. The mean age was 62 years, and 16 were males. The purpose of colonoscopy was diagnostic in 18 patients. The most common perforation site was the sigmoid colon. Colonic perforation was diagnosed during colonoscopy in 14 patients, just after colonoscopy in 5 patients, and 24 hours or more after colonoscopy in 8 patients. For the treatment of colonic perforation, endoscopic clipping was performed in 3 patients, primary closure in 15 patients, colon resection in 2 patients, Hartmann's procedures in 4 patients, and diverting colostomy in 3 patients. If the diagnosis of perforation after colonoscopy was delayed for more than 24 hours, the need for major treatment was increased significantly.

Conclusion

Although a colonic perforation after colonoscopy is rare, if the morbidity and the mortality associated with the colonic perforation are to be reduced, prompt diagnosis and management are very important.

Citations

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Iatrogenic colon perforation: endoscopic management or surgery
Seung Bum Lee
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Clinical outcomes and risk factors of post-polypectomy microperforation in patients with colorectal neoplasia: a case-control study
Seung Yong Shin, Min Soo Cho, Jinhoon Nam, Jie-Hyun Kim, Young Hoon Yoon, Hyojin Park, Jeonghyun Kang, Jae Jun Park
Therapeutic Advances in Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Iatrogenic colon perforation during colonoscopy, diagnosis/treatment, and follow-up processes: A single-center experience
Nihat Gülaydın, Raim İliaz, Atakan Özkan, A Hande Gökçe, Hanifi Önalan, Berrin Önalan, Aziz Arı
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Clinical Characteristics of Colonoscopic Perforation and Risk Factors for Complications After Surgical Treatment
Liang Li, Bing Xue, Chunxia Yang, Zhongbo Han, Hongqiang Xie, Meng Wang
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Treatment of colonoscopic perforation: outcomes from a major single tertiary institution
Carolyn R. Chew, Justin M. C. Yeung, Ian G. Faragher
ANZ Journal of Surgery.2019; 89(5): 546. CrossRef
Iatrogenic Colonic Perforations: Changing the Paradigm
Jose Luis Ulla-Rocha, Angel Salgado, Raquel Sardina, Raquel Souto, Raquel Sanchez-Santos, Juan Turnes
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Concurrent retroperitoneal, mediastinal, cervical and subcutaneous emphysema secondary to iatrogenic sigmoid colon perforation
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Alexander T. Hawkins, Kenneth W. Sharp, Molly M. Ford, Roberta L. Muldoon, M. Benjamin Hopkins, Timothy M. Geiger
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2017 WSES guidelines for the management of iatrogenic colonoscopy perforation
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Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
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Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation: Ki Hwan Song, Wu Seok Suh, Jin Sik Jeong, Dong Sik Kim, Sang Woo Kim, Dong Min Kwak, Jong Seong Hwang, Hyun Jin Kim, Man Woo Park, Min Chul Shim, Ja-Il Koo, Jae Hwang Kim, Dae Ho Shon; Ann Coloproctol. 2014;30(5):222-227. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.222

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Abstract PDF

Purpose

Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction.

Methods

In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale.

Results

The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B.

Conclusion

Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.

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Rehabilitation for Chronic Constipation: Integrative Approaches to Diagnosis and Treatment
Luana Alexandrescu, Ionut Eduard Iordache, Alina Mihaela Stanigut, Laura Maria Condur, Doina Ecaterina Tofolean, Razvan Catalin Popescu, Andreea Nelson Twakor, Eugen Dumitru, Andrei Dumitru, Cristina Tocia, Alexandra Herlo, Ionut Tiberiu Tofolean
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Acidifying agents impact erlotinib and gefitinib pharmacokinetic parameters and elevate liver enzymes in Wistar rats
Amsha S. Alsegiani, Aliyah Almomen, Maria Arafah, Nourah Z. Alzoman, Abdullah K.Alshememry
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White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial
Jeremy P Dwyer, Jonathan Y C Tan, Eldho Paul, Catherine Bunn, Dileep Mangira, Robyn Secomb, Peter R Gibson, Gregor Brown
JGH Open.2017; 1(1): 38. CrossRef
Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation
Jae Hyuck Jun, Koon Hee Han, Jong Kyu Park, Hyun Il Seo, Young Don Kim, Sang Jin Lee, Baek Gyu Jun, Min Sik Hwang, Yoon Kyoo Park, Myeong Jong Kim, Gab Jin Cheon
World Journal of Gastroenterology.2017; 23(32): 5986. CrossRef
Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder
Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong
Clinical and Experimental Emergency Medicine.2016; 3(2): 109. CrossRef
Combination could be another tool for bowel preparation?
Jae Seung Soh, Kyung-Jo Kim
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Min Jung Kim, Chang Won Hong, Byung Chang Kim, Sung Chan Park, Kyung Su Han, Jungnam Joo, Jae Hwan Oh, Dae Kyung Sohn
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Hyun Shig Kim
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Preoperative Body Mass Index, 30-Day Postoperative Morbidity, Length of Stay and Quality of Life in Patients Undergoing Pelvic Exenteration Surgery for Recurrent and Locally-Advanced Rectal Cancer: Jessica Beaton, Sharon Carey, Michael J Solomon, Ker-Kan Tan, Jane Young; Ann Coloproctol. 2014;30(2):83-87. Published online April 25, 2014; DOI: https://doi.org/10.3393/ac.2014.30.2.83

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Abstract PDF

Purpose

Malnutrition is associated with an increased risk of developing complications following gastrointestinal surgery, especially following radical surgeries such as pelvic exenteration. This study aims to determine if preoperative body mass index (BMI) is associated with 30-day morbidity, length of hospital stay and/or quality of life (QoL) in patients undergoing pelvic exenteration surgery for recurrent and locally-advanced rectal cancer prior to a prospective trial.

Methods

A review of all patients who underwent pelvic exenteration surgery prior to 2008 was performed. Patients were included if they had a documented BMI as well as a QoL measurement (Functional Assessment Cancer Therapy - Colorectal questionnaire).

Results

Thirty-one patients, with a mean age of 56 years, had preoperative height and weight data, as well as measures of postoperative QoL, and formed the study group. The numbers of patients with recurrent (n = 17) or locally-advanced rectal cancer (n = 14) were similar. The mean length of stay was 21 days while the mean BMI of the patients was 24.3 (± 5.9) kg/m². The majority of the patients were either of normal weight (n = 15) or overweight/obese (n = 11). The average length of hospital stay was significantly longer in patients who were underweight compared to those who were of normal weight (F = 6.508, P = 0.006) and those who were overweight and obese (F = 6.508, P = 0.007).

Conclusion

This study suggests that a lower body mass index preoperatively is associated with a longer length of hospital stay. BMI is not associated with long-term QoL in this patient group. However, further prospective research is required.

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Tarik Sammour, Oliver Peacock, Brian K. Bednarski, Arvind Dasari, Prajnan Das, Benny Johnson, Grace L. Smith, George J. Chang, John Skibber, Y. Nancy You
Colorectal Disease.2025;[Epub] CrossRef
Living After Pelvic Exenteration: A Mixed-Methods Synthesis of Quality-of-Life Outcomes and Patient Perspectives
Vlad Rotaru, Elena Chitoran, Aisa Gelal, Giuseppe Gullo, Daniela-Cristina Stefan, Laurentiu Simion
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Niamh McKigney, Fergus Houston, Ellen Ross, Galina Velikova, Julia Brown, Deena Pravin Harji
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Pia Persson, Peter Chong, Colin W Steele, Martha Quinn
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Andreas Denys, Yves van Nieuwenhove, Dirk Van de putte, Eva Pape, Piet Pattyn, Wim Ceelen, Gabriëlle H. van Ramshorst
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Preet G. S. Makker, Cherry E. Koh, Michael J. Solomon, James Ratcliffe, Daniel Steffens
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Lauren Reece, Helen Dragicevich, Claire Lewis, Caila Rothwell, Oliver M. Fisher, Sharon Carey, Nayef A. Alzahrani, Winston Liauw, David L. Morris
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Ying Guo, Eugene Chang, Mehtap Bozkurt, Minjeong Park, Diane Liu, Jack B. Fu
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Tasha M. Hughes, Kejal Shah, Sabrena Noria, Timothy Pawlik
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E. Rausa, M. E. Kelly, L. Bonavina, P. R. O'Connell, D. C. Winter
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Case Report

Transanal Evisceration Caused by Rectal Laceration: Aleix Martínez Pérez, María Teresa Torres Sánchez, Jose Manuel Richart Aznar, Eva María Martí Martínez, Manuel Martínez-Abad; Ann Coloproctol. 2014;30(1):47-49. Published online February 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.1.47

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Abstract PDF

Transrectal evisceration caused by colorectal injury is an unusual entity. This pathology is more frequent in elderly patients and it is usually produced spontaneously. Rectal prolapse is the principal predisposing factor. An 81-year-old woman was taken to the hospital presenting exit of intestinal loops through the anus. After first reanimation measures, an urgent surgery was indicated. We observed the absence of almost every small intestine loop in the abdominal cavity; these had been moved to the pelvis. After doing the reduction, a 3 to 4 cm linear craniocaudal perforation in upper rectum was objectified, and Hartmann's procedure was performed. We investigated and knew that she frequently manipulate herself to extract her faeces. The fast preoperative management avoided a fatal conclusion or an extensive intestinal resection. Reasons that make us consider rectal self-injury as the etiologic factor are explained.

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S Hajiev, A Ezzat, V Sivarajah, G Reese, N El-Masry
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Evisceración de asas intestinales a través de periné posterior por traumatismo en paciente anciano
Ana Alicia Tejera Hernández, David Fernández San Millan, Carlos David Trujillo Flores, Juan Ramón Hernández Hernández
Revista Española de Geriatría y Gerontología.2016; 51(1): 58. CrossRef
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Adama Sanou, Moussa Bazongo, Edgar Ouangré, Maurice Zida, Gilbert Patindé Bonkoungou, Rodrique Namékinsba Doamba, Sylvain Wendmi Karfo, Elie Yamba Sawadogo, Nayi Zongo, Si Simon Traoré
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Original Article

Mechanical Bowel Preparation and Prophylactic Antibiotic Administration in Colorectal Surgery: A Survey of the Current Status in Korea: Byung Mo Kang, Kil Yeon Lee, Sun Jin Park, Suk-Hwan Lee; Ann Coloproctol. 2013;29(4):160-166. Published online August 29, 2013; DOI: https://doi.org/10.3393/ac.2013.29.4.160

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Abstract PDF

Purpose

The usefulness of mechanical bowel preparation (MBP) in colon surgery was recently challenged by many multicenter clinical trials and meta-analyses. The objectives of this study were to investigate current national opinions about MBP and prophylactic antibiotics (PA) and to provide preliminary data for developing future Korean guidelines for MBP and PA administration in colorectal surgery.

Methods

A questionnaire was mailed to 129 colorectal specialists. The questionnaires addressed the characteristics of the hospital, the MBP methods, and the uses of oral and intravenous antibiotics.

Results

A total of 73 questionnaires (56.6%) were returned. First, in regard to MBP methods, most surgeons (97.3%) used MBP for a mean of 1.36 days. Most surgeons (98.6%) implemented whole bowel irrigation and used polyethylene glycol (83.3%). Oral antibiotic use was indicated in over half (52.1%) of the responses, the average number of preoperative doses was three, and the mean time of administration was 24.2 hours prior to the operation. Finally, the majority of responders stated that they used intravenous antibiotics (95.9%). The responses demonstrated that second-generation cephalosporin-based regimens were most commonly prescribed, and 75% of the surgeons administered these regimens until three days after the operation.

Conclusion

The results indicate that most surgeons used MBP and intravenous antibiotics and that half of them administered oral PA in colorectal surgery preparations. The study recommends that the current Korean guidelines should be adapted to adequately reflect the medical status in Korea, to consider the medical environment of the various hospitals, and to establish more accurate and relevant guidelines.

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Ik Yong Kim
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Zhaohui Xu, Hui Qu, George Kanani, Zhong Guo, Yanying Ren, Xin Chen
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Case Reports

A Stercoral Perforation of the Rectum: Seung-Jin Kwag, Sang-Kyung Choi, Ji-Ho Park, Eun-Jung Jung, Chi-Young Jung, Sang-Ho Jung, Young-Tae Ju; Ann Coloproctol. 2013;29(2):77-79. Published online April 30, 2013; DOI: https://doi.org/10.3393/ac.2013.29.2.77

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Abstract PDF

A stercoral perforation of the rectum due to a fecaloma is a rare disease with a high mortality rate. Although multiple case reports of colonic perforations have been published, the data regarding rectal perforations are limited. This case report will highlight one such case of a stercoral rectal perforation that was successfully treated with a laparoscopic operation.

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Acute Spontaneous Perforation of Rectosigmoid Junction in a Patient with Quadriplegia following Spinal Cord Injury
Oshan Basnayake, Chiran Rathnaweera, Umesh Jayarajah, Gishanthan Shanthamoorthy, Heshan Dayantha Siriwardena, Asela Jayathilaka, Paola De Nardi
Case Reports in Surgery.2020; 2020: 1. CrossRef
Stercoral perforation: A rare entity
Nisarg Mehta, Ahan Bhatt, Cici Zhang
World Journal of Colorectal Surgery.2019; 8(4): 114. CrossRef
Stercoral Perforation of the Colon: A Potentially Fatal Complication of Opioid-Induced Constipation
Andrew Davies, Katherine Webber
Journal of Pain and Symptom Management.2015; 50(2): 260. CrossRef
Stercoral Colitis
Maxim Saksonov, Gil N. Bachar, Sara Morgenstern, Abdel-Rauf Zeina, Margarita Vasserman, Orith Protnoy, Ofer Benjaminov
Journal of Computer Assisted Tomography.2014; 38(5): 721. CrossRef

Rectal Perforation Caused by Anal Stricture After Hemorrhoid Treatment: Yong Joon Suh, Heon-Kyun Ha, Heung-Kwon Oh, Rumi Shin, Seung-Yong Jeong, Kyu Joo Park; Ann Coloproctol. 2013;29(1):28-30. Published online February 28, 2013; DOI: https://doi.org/10.3393/ac.2013.29.1.28

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Abstract PDF

Inappropriate therapies for hemorrhoids can lead to various complications including anorectal stricture. We report a patient presenting with catastrophic rectal perforation due to severe anal stricture after inappropriate hemorrhoid treatment. A 67-years old man with perianal pain visited the emergency room. The hemorrhoids accompanied by constipation, had tortured him since his youth. Thus he had undergone injection sclerotherapy several times by an unlicensed therapist and hemorrhoidectomy twice at the clinics of private practitioners. His body temperature was as high as 38.5℃. The computed tomographic scan showed a focal perforation of posterior rectal wall. The emergency operation was performed. The fibrotic tissues of the anal canal were excised. And then a sigmoid loop colostomy was constructed. The patient was discharged four days following the operation. This report calls attention to the enormous risk of unlicensed injection sclerotherapy and overzealous hemorrhoidectomy resulting in scarring, progressive stricture, and eventual rectal perforation.

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The Complications of Hemorrhoidectomy From Patients' Perspective: A Qualitative Study
Masoumeh Ebrahimi Tavani, Yegane Partovi, Tahmineh Poursaki, Farid Gharibi
Health Science Reports.2025;[Epub] CrossRef
Laser hemorrhoidoplasty for hemorrhoidal disease: a systematic review and meta-analysis
Hendry Lie, Evelyn Franca Caesarini, Antonius Agung Purnama, Andry Irawan, Taufik Sudirman, Wifanto Saditya Jeo, Bernardus Parish Budiono, Erik Prabowo, M. Iqbal Rivai, Ryanto Karobuana Sitepu
Lasers in Medical Science.2022; 37(9): 3621. CrossRef

Original Articles

Clinical Significance of Lymph Node Ratio in Stage III Colorectal Cancer: Yo Han Park, Jae Im Lee, Jong Kyung Park, Hang Ju Jo, Won Kyung Kang, Chang Hyeok An; J Korean Soc Coloproctol. 2011;27(5):260-265. Published online October 31, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.5.260

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Abstract PDF

Purpose

Recent literature has shown that lymph node ratio is superior to the absolute number of metastatic lymph nodes in predicting the prognosis in several malignances other than colorectal cancer. The aim of this study was to evaluate the prognostic significance of the lymph node ratio (LNR) in patients with stage III colorectal cancer.

Methods

We included 186 stage III colorectal cancer patients who underwent a curative resection over a 10-year period in one hospital. The cutoff point of LNR was chosen as 0.07 because there was significant survival difference at that LNR. The Kaplan-Meier and the Cox proportional hazard models were used to evaluate the prognostic effect according to LNR.

Results

There was statistically significant longer overall survival in the group of LNR > 0.07 than in the group of LNR ≤ 7 (P = 0.008). Especially, there was a survival difference for the N1 patients group (LN < 4) according to LNR (5-year survival of N1 patients was lower in the group of LNR > 0.07, P = 0.025), but there was no survival difference for the N2 group (4 ≥ LN) according to LNR. The multivariate analysis showed that the LNR is an independent prognostic factor.

Conclusions

LNR can be considered as a more accurate and potent modality for prognostic stratifications in patients with stage III colorectal cancer.

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The prognostic performance of the log odds of positive lymph nodes in patients with esophageal squamous cell carcinoma: A population study of the US SEER database and a Chinese single‐institution cohort
Hongdian Zhang, Wanyi Xiao, Peng Ren, Kai Zhu, Ran Jia, Yueyang Yang, Lei Gong, Zhentao Yu, Peng Tang
Cancer Medicine.2021; 10(17): 6149. CrossRef
Lymph Node Ratio and Liver Metachronous Metastases in Colorectal Cancer
Giovanni Li Destri, Giuseppe Privitera, Gaetano La Greca, Roberto Scilletta, Antonio Pesce, Teresa Rosanna Portale, Erminia Conti, Stefano Puleo
International Surgery.2021; 105(1-3): 122. CrossRef
Rectal cancers with microscopic circumferential resection margin involvement (R1 resections): Survivals, patterns of recurrence, and prognostic factors
Gianpiero Gravante, David Hemingway, James Andrew Stephenson, David Sharpe, Ahmed Osman, Melissa Haines, Vafa Pirjamali, Roberto Sorge, Justin Ming Yeung, Michael Norwood, Andrew Miller, Kirsten Boyle
Journal of Surgical Oncology.2016; 114(5): 642. CrossRef
Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Rectal Cancer
Wafi Attaallah, Omer Gunal, Manuk Manukyan, Gulden Ozden, Cumhur Yegen
Annals of Coloproctology.2013; 29(3): 100. CrossRef
Prognostic Value of Total Lymph Node Identified and Ratio of Lymph Nodes in Resected Colorectal Cancer
Leila Ghahramani, Leila Moaddabshoar, Samira Razzaghi, Sayed Hasan Hamedi, Saeedeh Pourahmad, Mohammad Mohammadianpanah
Annals of Colorectal Research.2013; 1(3): 81. CrossRef
Prognostic Value of Lymph Node Ratios in Node Positive Rectal Cancer Treated with Preoperative Chemoradiation
Jamal Jafari Nadoshan, Ramesh Omranipour, Omid Beiki, Kazem Zendedel, Abbas Alibakhshi, Habibollah Mahmoodzadeh
Asian Pacific Journal of Cancer Prevention.2013; 14(6): 3769. CrossRef
Proposal of a New Classification for Stage III Colorectal Cancer Based on the Number and Ratio of Metastatic Lymph Nodes
Li‐Ping Wang, Hong‐Yan Wang, Rui Cao, Cong Zhu, Xiong‐Zhi Wu
World Journal of Surgery.2013; 37(5): 1094. CrossRef
An appraisal of lymph node ratio in colon and rectal cancer: not one size fits all
M. Medani, Niall Kelly, George Samaha, G. Duff, Vourneen Healy, Elizabeth Mulcahy, Eoghan Condon, David Waldron, Jean Saunders, J. Calvin Coffey
International Journal of Colorectal Disease.2013; 28(10): 1377. CrossRef

Impact on Prognosis of Lymph Node Micrometastasis and Isolated Tumor Cells in Stage II Colorectal Cancer: Tai Young Oh, Sun Mi Moon, Ui Sup Shin, Hyang Ran Lee, Sun Hoo Park; J Korean Soc Coloproctol. 2011;27(2):71-77. Published online April 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.2.71

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Abstract PDF

Purpose

Even though the importance of micrometastases (MMS) and isolated tumor cells (ITC) has been brought up by many physicians, its impact on the prognosis in stage II colorectal cancer is uncertain. In this research, we tried to investigate the clinical features of MMS and ITC and to prove any correlation with prognosis.

Methods

The research pool was 124 colorectal cancer patients who underwent a curative resection from April 2005 to November 2009. A total of 2,379 lymph nodes (LNs) were examined, and all retrieved LNs were evaluated by immunohistochemical staining with anti-cytokeratin antibody panel. Clinicopathologic parameters and survival rates were compared based on the presence of MMS or ITC and on the micrometastatic lymph node ratio (mmLNR), which is defined as the number of micrometastatic LNs divided by the number of retrieved LNs.

Results

Out of 124 patients (26.6%) 33 were found to have MMS or ITC. There were no significant differences in clinicopathologic features, such as gender, tumor location and size, depth of invasion, histologic grade, except for age (P = 0.04). The three-year disease-free survival rate for the MMS or ITC positive group was 85.7%, and that for MMS and ITC negative group was 92.8% (P = 0.209). The three-year disease-free survival rate for the mmLNR > 0.25 group was 73.3%, and that for the mmLNR ≤ 0.25 group was 92.9% (P = 0.03).

Conclusion

The presence of MMS or ITC was not closely correlated to the prognosis. However, mmLNR is thought to be a valuable marker of prognosis in cases of stage II colorectal cancer.

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Fluorescence indocyanine green (ICG) for sentinel-lymph-node mapping in colorectal cancer: a systematic review
Alexis Litchinko, Jeremy Meyer, Leo Buhler, Frederic Ris, Michel Adamina
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Xudong Zhu, Zhiyan Li, Wenxuan Zheng, Qingwei Zeng, Xingzhou Wang, Kai Chen, Qi Chen, Hanxiao Xu, Song Liu, Wenxian Guan
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Presumed early ovarian cancer with isolated tumor cells in para-aortic sentinel nodes
Stefano Uccella, Anna Fagotti, Gian Franco Zannoni, Robert L Coleman
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Impact of compliance with an enhanced recovery after surgery pathway on patient outcomes in open gynecologic surgery
Maria D Iniesta, Javier Lasala, Gabriel Mena, Andrea Rodriguez-Restrepo, Gloria Salvo, Brandelyn Pitcher, Lakisha D Washington, Melinda Harris, Larissa A Meyer, Pedro T Ramirez
International Journal of Gynecologic Cancer.2019; 29(9): 1417. CrossRef
Lymph Node Micrometastasis Cannot be Considered as Positive Lymph Node in Nonmetastatic Colorectal Cancer
Kwang Dae Hong, Jun Won Um, Byung Wook Min, Woong-Bae Ji, Jung-Woo Choi, Young-Sik Kim
The American Surgeon™.2017; 83(2): 127. CrossRef
Lymph node micrometastasis in gastrointestinal tract cancer—a clinical aspect
Shoji Natsugoe, Takaaki Arigami, Yoshikazu Uenosono, Shigehiro Yanagita, Akihiro Nakajo, Masataka Matsumoto, Hiroshi Okumura, Yuko Kijima, Masahiko Sakoda, Yuko Mataki, Yasuto Uchikado, Shinichiro Mori, Kosei Maemura, Sumiya Ishigami
International Journal of Clinical Oncology.2013; 18(5): 752. CrossRef
Prognostic significance of isolated tumor cells in patients with colorectal cancer in recent 10-year studies
YOSHITO AKAGI, TETSUSHI KINUGASA, YOSUKE ADACHI, KAZUO SHIROUZU
Molecular and Clinical Oncology.2013; 1(4): 582. CrossRef
Prognostic significance of histologically detected lymph node micrometastases of sizes between 0.2 and 2 mm in colorectal cancer
Bruno Märkl, C. Herbst, C. Cacchi, T. Schaller, I. Krammer, G. Schenkirsch, A. Probst, H. Spatz
International Journal of Colorectal Disease.2013; 28(7): 977. CrossRef
Molecular Detection of Tumor Cells in Regional Lymph Nodes Is Associated With Disease Recurrence and Poor Survival in Node-Negative Colorectal Cancer: A Systematic Review and Meta-Analysis
Nuh N. Rahbari, Ulrich Bork, Edith Motschall, Kristian Thorlund, Markus W. Büchler, Moritz Koch, Jürgen Weitz
Journal of Clinical Oncology.2012; 30(1): 60. CrossRef
Prognostic Significance of EpCAM-Positive Disseminated Tumor Cells in Rectal Cancer Patients With Stage I Disease
Sameer Dhayat, Sorina Sorescu, Daniel Vallböhmer, Sebastian Kraus, Stephan Ernst Baldus, Alexander Rehders, Feride Kröpil, Andreas Krieg, Wolfram Trudo Knoefel, Nikolas Hendrik Stoecklein
American Journal of Surgical Pathology.2012; 36(12): 1809. CrossRef
Prognostic Signifi cance of the Lymph Node Ratio Regarding Recurrence and Survival in Rectal Cancer Patients Treated with Postoperative Chemoradiotherapy
Ji-Yoon Kim, Su-Mi Chung, Byung-Ock Choi, In-Kyu Lee, Chang-Hyeok An, Jong-Man Won, Mi-Ryeong Ryu
Gut and Liver.2012; 6(2): 203. CrossRef

Case Report

Penetration of the Descending Colon by a Migrating Intrauterine Contraceptive Device: Jung Min Park, Chang Seog Lee, Min Seong Kim, Do Young Kim, Chul Young Kim, Young Bae Lim, Yong Kyu Lee, Dong Eun Park, Dong Hyun Lee; J Korean Soc Coloproctol. 2010;26(6):433-436. Published online December 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.6.433

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Abstract PDF

Foreign bodies in the gastrointestinal tract often cause serious complications, such as perforation, obstruction, abscess formation, or hemorrhage. This is a case in which a patient visited our hospital and complained of a vague lower abdominal pain that had been present for three months. She had an intrauterine device (IUD) inserted five years earlier. The abdominal X-ray, computed tomography and colonoscopy revealed that the IUD had penetrated into the descending colon. We tried to remove the IUD by colonoscopy but failed due to pain, so we removed the IUD surgically. Thus, we report a case in which a previously inserted IUD had penetrated into the descending colon and was surgically removed. We also present a brief review of the literature.

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Missing intrauterine device migrated to terminal ileum resembling adnexal mass: A case report
Mohammad Kamal Tani, Wais Farda, Haider Khan, Omer Malikzai, Zabihullah Sharif
International Journal of Surgery Case Reports.2024; 115: 109279. CrossRef
Robotic assisted removal of migrated intrauterine device
Marco Bertucci Zoccali, Osama Jabi
Colorectal Disease.2023; 25(8): 1718. CrossRef
Is It a “Colon Perforation”? A Case Report and Review of the Literature
Shuangshuang Lu, Xinyu Yao, Jun Shi, Jian Huang, Shaohua Zhuang, Junfang Ma, Yan Liu, Wei Zhang, Lifei Yu, Ping Zhu, Qiuwei Zhu, Ruxia Shi, Hong Zheng, Dong Shao, Yuyan Pan, Shizhen Bao, Li Qin, Lijie Huang, Wenjia Liu, Jin Huang
Frontiers in Medicine.2022;[Epub] CrossRef
Intestinal Perforation by a Migrated Intrauterine Contraceptive Device: A Review of This Rare but Important Complication
Antony Zacharias, Stephanie Clark, Chetan Parmar, Ayo Oshowo
SN Comprehensive Clinical Medicine.2021; 3(8): 1759. CrossRef
Incomplete Removal of an Intrauterine Device Perforating the Sigmoid Colon
Junseak Lee, Jung Hwan Oh, Jinsu Kim, Chul-Hyun Lim, Sung Hoon Jung
The Korean Journal of Gastroenterology.2021; 78(1): 48. CrossRef
Rectum migration of an intrauterine device
Rui Li, Hongmei Li, Jie Zhang, Huiqing Li
Journal of Minimal Access Surgery.2021; 17(1): 113. CrossRef
Pelvic abscess complicating sigmoid colon perforation by migrating intrauterine device
Omar Toumi, Houssem Ammar, Abdessalem Ghdira, Amine Chhaidar, Wided Trimech, Rahul Gupta, Randa Salem, Jamel Saad, Ibtissem Korbi, Mohamed Nasr, Faouzi Noomen, Mondher Golli, Khadija Zouari
International Journal of Surgery Case Reports.2018; 42(C): 60. CrossRef

Original Article

Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study.: Kim, Min Sang , Lim, Seung Woo , Park, Sung Jin , Gwak, Geumhee , Yang, Keun Ho , Bae, Byung Noe , Kim, Ki Hwan , Han, Sewhan , Kim, Hong Joo , Kim, Young Duck , Kim, Hong Yong; J Korean Soc Coloproctol. 2010;26(1):69-75.; DOI: https://doi.org/10.3393/jksc.2010.26.1.69

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Abstract PDF

PURPOSE
Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer.
METHODS
The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution.
RESULTS
The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17).
CONCLUSION
The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.

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The Metastatic Lymph Node Ratio is a Crucial Criterion in Colorectal Cancer Therapy Management and Prognosis
Gülçin Harman Kamalı, Sedat Kamalı
European Archives of Medical Research.2022; 38(1): 73. CrossRef
Acute Abdomen in the Oncology Patient
Katrina McGinty
Seminars in Roentgenology.2020; 55(4): 400. CrossRef
Nonobstetrical Acute Abdomen during Pregnancy as a Consequence of Colorectal Carcinoma Perforation: Case Report and Review of the Literature
Žana Žegarac, Željko Duić, Sandra Stasenko
Case Reports in Gastrointestinal Medicine.2019; 2019: 1. CrossRef
Prognostic Value of Perineural Invasion in Colorectal Cancer: A Meta-Analysis
Yuchong Yang, Xuanzhang Huang, Jingxu Sun, Peng Gao, Yongxi Song, Xiaowan Chen, Junhua Zhao, Zhenning Wang
Journal of Gastrointestinal Surgery.2015; 19(6): 1113. CrossRef
Surgical management of obstructed and perforated colorectal cancer: still debating and unresolved issues
Rudra K Maitra, Charles A Maxwell-Armstrong
Colorectal Cancer.2013; 2(6): 573. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Case Report

A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy.: Si, Youn , Kim, Shin Young , Choi, Seung Bong , Kim, Hyung Jin , Lee, Yoon Suk , Cho, Hyun Min , Kim, Jun Gi , Oh, Seung Tack , Lee, In Kyu; J Korean Soc Coloproctol. 2009;25(5):347-351.; DOI: https://doi.org/10.3393/jksc.2009.25.5.347

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Abstract PDF

Perforations that occur during colonoscopy are usually managed by surgical repair. When the patient's symptoms are mild and laboratory findings show minor abnormalities, a conservative treatment can be considered. Although an operation is the treatment of choice in patients with generalized peritonitis, in some selected patients, percutaneous abscess drainage can be an alternative to surgical intervention for drainage of deep-infected fluid collections or can act as a temporary measure until the patient becomes sufficiently stable for surgery. We report here on a 53-yr-old male patient who developed signs of localized peritonitis and had a pelvic abscess due to a colonic perforation after colonoscopy and was treated successfully by using percutaneous abscess drainage.

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A Case of Buried Bumper Syndrome Complicated by Abdominal Wall Abscess in an Elderly Patient
Chul Young Kim, Min Seong Kim, Do Young Kim, Young Bae Lim, Dong Yoon Kang, Tack Su Yun, Sang Seok Yoon, Jung Hyun Lee, Woo Young Kim, Yong Kyu Lee
Journal of the Korean Geriatrics Society.2010; 14(4): 265. CrossRef

Original Articles

The Impact of Bowel Preparation on Anastomotic Complications after Laparoscopic Colorectal Resection: A Prospective Comparative Study between Oral Polyethylene Glycol and Phosphate Enema.: Baek, Se Jin , Choi, Dong Jin , Kim, Jin , Woo, Si Uk , Min, Byung Wook , Kim, Seon Hahn , Moon, Hong Young; J Korean Soc Coloproctol. 2009;25(5):294-299.; DOI: https://doi.org/10.3393/jksc.2009.25.5.294

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Abstract PDF: PURPOSE
Although most randomized trials demonstrated no advantage of mechanical bowel preparation for colorectal resection, an oral solution is still widely used. The aims of this study were to evaluate whether a single phosphate enema is as effective as oral polyethylene glycol (PEG) solution in preventing anastomotic complications after laparoscopic colorectal surgery and to examine the clinical courses of anastomotic complications.
METHODS
Between September 2006 and December 2007, 309 patients underwent laparoscopic colorectal resection with primary anastomosis. The bowel preparation used was PEG solution during initial period (PEG group), but since February 2007, a single phosphate enema (enema group) was utilized. Postoperative data were prospectively recorded. In patients with anastomotic complications, the clinical course was compared between the two groups.
RESULTS
There were 150 patients in the PEG group and 159 patients in the enema group. Demographics did not differ between the two groups. Anastomotic leakage occurred in 3.3 percent of the patients in the PEG group and 5.7 percent of the patients in the enema group (P=0.326). The rates of anastomotic bleeding were 2.0 and 2.5 percent, respectively (P=0.761). The hospital stays for patients with anastomotic complication were not different between the two groups (P=0.137), but patients in the PEG group (80%) needed reoperation more frequently than those in the enema group (11.1%) (P=0.023).
CONCLUSION
These results suggest that laparoscopic colorectal surgery may be safely performed with a single phosphate enema instead of oral polyethylene glycol.

Feasibility of York-Mason Operation for Selective Advanced Rectal Cancer.: Jeong, Woon Kyung , Baek, Seong Kyu , Bae, Ok Suk; J Korean Soc Coloproctol. 2009;25(3):178-185.; DOI: https://doi.org/10.3393/jksc.2009.25.3.178

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Abstract PDF

PURPOSE
The York-Mason operation has been used as local therapy for benign rectal tumors not easily excised with a conventional transanal excision and for T1 rectal cancers having a low risk of lymph-node metastasis. This study evaluated whether a York-Mason operation could be an alternative therapy for selected patients with T2 or T3 rectal cancers.
METHODS
From February 2004 to March 2008, 11 patients with T2 or T3 rectal cancer, who refused rectal excision due to fear of abdominal surgery itself and perioperative side effects or unwillingness to have a permanent stoma, underwent a York-Mason operation. The data on the patients were analyzed retrospectively.
RESULTS
The distance from the anal verge to the tumor was 5 cm (median, 2-8 cm), and the tumor size was 3 cm (median, 1.5-4 cm). Histological examination revealed a pathological tumor (pT) stage 2 in eight patients, stage pT3 in one patient, and stage pTx in two patients. The distance from the resection margin to the tumor was 0.3 cm (median, 0.1-0.5 cm). Six patients (55%) had incomplete tumor excision. Radiotherapy was performed in one patient preoperatively and in eight postoperatively. Postoperative morbidity occurred in four patients (36%). During a median of 38.2 months, two patients (18%) developed local recurrence and liver metastasis. Postoperative mortality, which was not related to the procedure, occurred in one patient (9%).
CONCLUSION
The York-Mason operation could be considered as an alternative therapy for selected T2 or T3 rectal cancer patients who refuse rectal excision.

Citations

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Trans-Sacral Local Resection as a Posterior Approach
Bong Hwa Lee, Hyoung-Chul Park, Hae Wan Lee, Chang Nam An, Taeik Um, Young A Lim, Byoung Sup Kim, Mi Young Chang, Soo Hyoung Kim, Sung Wook Cho
Journal of the Korean Society of Coloproctology.2010; 26(3): 197. CrossRef

Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer.: Kang, Dong Baek , Shin, Chang Yeol , Lee, Jeong Kyun , Park, Won Cheol; J Korean Soc Coloproctol. 2009;25(3):165-171.; DOI: https://doi.org/10.3393/jksc.2009.25.3.165

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Abstract PDF

PURPOSE
Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome.
METHODS
A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors.
RESULTS
Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class.
CONCLUSION
The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

Citations

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Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer
Hyun Ho Kim, Sanguk Hwang, Jinbeom Cho
Langenbeck's Archives of Surgery.2025;[Epub] CrossRef
Surgical Outcomes and Risk Factors in Patients Who Underwent Emergency Colorectal Surgery
Dai Sik Jeong, Young Hun Kim, Kyung Jong Kim
Annals of Coloproctology.2017; 33(6): 239. CrossRef
Emergent Colorectal Surgery: What Should Be Considered?
Chang-Nam Kim
Annals of Coloproctology.2016; 32(4): 124. CrossRef
Outcomes and Risk Factors Affecting Mortality in Patients Who Underwent Colorectal Emergency Surgery
Nam Ho Oh, Kyung Jong Kim
Annals of Coloproctology.2016; 32(4): 133. CrossRef
Multivariate Analysis of the Survival Rate for Treatment Modalities in Incurable Stage IV Colorectal Cancer
Sung Kang Kim, Chang Ho Lee, Min Ro Lee, Jong Hun Kim
Journal of the Korean Society of Coloproctology.2012; 28(1): 35. CrossRef

Prognostic Factors for Complication and Mortality of Colonic Perforation.: Park, Keon Hwan , Choi, Pyong Wha , Kim, Jae Il , Noh, Tae Ho , Heo, Tae Gil , Park, Je Hoon , Lee, Myung Soo , Kim, Chul Nam , Chang, Surk Hyo; J Korean Soc Coloproctol. 2009;25(3):143-149.; DOI: https://doi.org/10.3393/jksc.2009.25.3.143

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Abstract PDF

PURPOSE
The present study was performed to assess the outcomes in patients with colonic perforation and to determine the prognostic factors for mortality.
METHODS
The cases of 42 patients who underwent surgery for colonic perforation between March 1999 and September 2008 were retrospectively reviewed. Age, sex, American Society of Anesthesiologists (ASA) classification, presence of preoperative shock, duration of symptoms, cause of perforation, location of perforation, degree of peritonitis, and the Mannheim Peritonitis Index (MPI) score were analyzed for their association with early outcome by using univariate and multivariate analyses.
RESULTS
Diverticulitis (46%, 19 patients) and colorectal cancer (36%, 15 patients) were the most common causes of noniatrogenic colonic perforation, and the sigmoid colon was the most common site of perforation (60%, 25 patients). The postoperative mortality was 21.4% (9 patients). The mortality in patients with preoperative shock, with a MPI score of more than 25, and with Hinchey stage III or IV peritonitis were 70.0%, 57.1%, and 53.3%, respectively (P<0.001). No statistical difference was observed in postoperative mortality with regard to age, sex, ASA classification, duration of symptoms, cause of perforation, and location of perforation. According to the multivariate analysis, preoperative shock proved to be the only significant prognostic factor for mortality (P=0.027) (odds ratio: 19.8, 95% confidence interval: 1.4-276.9).
CONCLUSION
Preoperative shock, a MPI score of more than 25, and Hinchey stage III or IV peritonitis were associated with high postoperative mortality in patients with colonic perforation. Especially, more intensive management and interest are required for patient s with preoperative shock due to colonic perforation.

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Ostomy in Nontraumatic Conditions: Our Experience and Review of the Literature
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Treatment of Colon Perforation Associated with Colonoscopy.: Park, Hae Ran , Baek, Seong Kyu , Bae, Ok Suk , Park, Sung Dae; J Korean Soc Coloproctol. 2008;24(5):322-328.; DOI: https://doi.org/10.3393/jksc.2008.24.5.322

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PURPOSE
Recently, non-operative conservative management or laparoscopic repair has been reported for the management of colonic perforation during colonoscopy. However, the preferred management strategy remains controversial. The purpose of the present study is to identify an appropriate strategy for the treatment of colon perforation during colonoscopy.
METHODS
The medical records of patients who developed colon perforation during colonoscopy between May 2003 and November 2007 were retrospectively reviewed. The mechanism and site of perforation, the treatment administered, complications, and clinical outcomes were analyzed.
RESULTS
In total, 16 perforations were evaluated. Of these, 11 developed during diagnostic colonoscopy and 5 during therapeutic colonoscopy. The most frequent perforation site was the sigmoid colon (12), followed by the transverse colon (2), the rectum (1), and unknown site (1). Six patients underwent surgery due to signs of diffuse peritonitis 10 were initially treated conservatively. Among the patients who underwent surgery, four underwent laparoscopic repair and two underwent open repair. Among the patients initially treated conservatively two patients required surgery due to clinical deterioration of peritonitis and rectovaginal fistula. These 2 patients underwent repair with proximal diverting stomas.
CONCLUSIONS
Colon perforation associated with colonoscopy is a rare event, but raises serious complications. Selected patients with colonoscopic perforation may be treated conservatively, but if these patients fail to respond to such treatments, extensive surgical procedures may be warranted.

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Management Outcomes of Colonoscopic Perforations Are Affected by the General Condition of the Patients
Jae Ho Park, Kyung Jong Kim
Annals of Coloproctology.2018; 34(1): 16. CrossRef
Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy
Jeongsoo Kim, Gil Jae Lee, Jeong-Heum Baek, Won-Suk Lee
Annals of Surgical Treatment and Research.2014; 87(3): 139. CrossRef
A Case of Successful Percutaneous Drainage of a Pelvic Abscess Complicating Colonoscopy
Youn Si, Shin Young Kim, Seung Bong Choi, Hyung Jin Kim, Yoon Suk Lee, Hyun Min Cho, Jun Gi Kim, Seung Tack Oh, In Kyu Lee
Journal of the Korean Society of Coloproctology.2009; 25(5): 347. CrossRef

Case Report

Rectal Perforation after Anorectal Manometry Following Preoperative Chemoradiotherapy and Low Anterior Resection: Report of a Cases.: Jeong, Woon Kyung , Chung, Tae Sung , Lim, Sang Woo , Park, Ji Won , Lim, Seok Byung , Choi, Hyo Seong , Jeong, Seung Yong; J Korean Soc Coloproctol. 2008;24(4):298-301.; DOI: https://doi.org/10.3393/jksc.2008.24.4.298

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Anorectal manometry is widely used to evaluate anorectal function. Few reports have described complications resulting from this procedure. A 47-year-old male underwent preoperative chemoradiotherapy and a low anterior resection for rectal cancer. The patient underwent anorectal manometry at postoperative 8 months. A rectal perforation was diagnosed shortly thereafter. The patient was initially managed conservatively using percutaneous drainage and parenteral antibiotics and then discharged on day 60 after the event. One month later, a colo-cutaneous fistula and expanding abdominal fasciitis developed. The patient underwent surgical exploration, drainage, resection of the rectum including the fistula, and redo-coloanal anastomosis with a diverting ileostomy. The patient discharged without complications on postoperative day 25. Anorectal manometry should be performed with particular care in patients who have undergone radiotherapy and anastomosis at the rectum.

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Christine Norton, Anton Emmanuel, Natasha Stevens, S. Mark Scott, Ugo Grossi, Sybil Bannister, Sandra Eldridge, James M. Mason, Charles H. Knowles
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Kyung Ha Lee, Ji Yeon Kim, Young Hoon Sul
Annals of Coloproctology.2017; 33(4): 146. CrossRef
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Gastroenterología y Hepatología.2013; 36(9): 577. CrossRef

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