EP.FRI.978 Colonoscopy perforation: A single centre experience

Aims Colonic perforation is an adverse event of colonoscopy. This is around 1/1500 in diagnostic colonoscopy, 1/500 in polypectomy procedures & 1/50 in EMR procedure. This study is to evaluate the management of colonic perforation at a single centre. Methods Colonoscopy carried out on patients with colorectal cancer symptoms, family history, colorectal cancer & polyp surveillance. Retrospective study carried out since 2012 on all colonoscopies with evaluation of colonoscopy perforation. Conclusion 7 colonoscopy perforations encountered over 8 years, with incidence of 0.03 - 0.06 % per year. Surgery undertaken in 5 cases with concomitant disease bowel (2 IBD’s & 3 diverticulitis). 2 cases of conservative management. Surgical resection of diseased bowel occurred in 4 cases with 4 cases of diversion stoma. One case of diversion stoma was subsequently reversed, whilst other 2 case were deemed medically unfit. Colonoscopy is carried out by JAG accredited endoscopists. Colonic perforation during colonoscopy is increased in: polypectomy (right colonic), therapeutic EMR, diseased bowel (IBD, diverticular disease), challenging colons. Management of colonoscopy perforation should individualized with early clinical & radiological diagnosis.

Early same admission closure of temporary bowel stomas: pros and cones

Background: Early closure of a temporary stoma is usually associated with low morbidity and mortality. However, some cases of stoma reversal may develop complications which may need surgical correction with subsequent major complications. We aim to evaluate early bowel stoma closure; de-functioning diversion stoma closure within the same admission (8-15 days) and study morbidity, health related quality of life (QOL) and length of stay at hospital (LOH). Methods: This study was done at general surgery department, Sohag faculty of medicine; in the period between March 2020 and March2021, 28 patients were closed early (at the same admission). Which are chosen randomly. The 28 patients who underwent early temporary stoma reversal following bowel surgery and abdominal exploration between March 2020 and March 2021 were included. The rate of complications (medical and surgical) following early stoma closure were assessed. Health-related QoL and LoH were assessed.Results: Total 28 patients were taken up for early stoma closure, reversal of stoma occurred between 8-15 days following its creation. Postoperative complications occurred in 53% of our patients, skin excoriation the commonest (28%). No difficulty was encountered during stoma closure surgery. Post-operative complications occurred in 53% of patients. 5 patients develop Ileus which were managed conservatively and one patient (3.5%) develop intra-abdominal abscess and treated with aspiration under sonographic guided. In our study no mortality occurred.Conclusions: Early stoma closure is feasible in selected patients, with reduced hospital stay, adhesions, bowel obstruction and medical complications and leads to better QOL, but a higher wound complication rate.

Primary Posterior Sagittal Anorectoplasty in male neonates with Anorectal Malformations: A tertiary care hospital experience

Background: The conventional surgical management for a male neonate with intermediate Anorectal Malformation (ARM) involves three stages – the creation of a diversion stoma in the neonatal period, a definitive pull-through procedure/ Posterior Sagittal Anorectoplasty (PSARP) followed by stoma closure. With this background, we present our experience with Single-stage primary definitive repair in selected male neonates with ARM. Methods: Medical records of male ARM cases managed from 2016 to 2018 were reviewed. Male neonates who underwent primary PSARP were analysed retrospectively. Results: A total of 35 records were found, out of which 12 male neonates underwent primary PSARP. The median gestational age and birth weight were 36.7 weeks and 2.75 kg respectively. Fistula with urinary tract was documented in all. The mean operative time was 65 minutes +/- 15 minutes. Two neonates had minor superficial surgical site infection at neo-anus. Anal dilatations were started after 2 weeks. At follow-up period of 3 years, 11 patients were continent; one patient had constipation with pseudo-incontinence which was successfully being managed by bowel management programme. Conclusions: A primary definitive procedure is feasible when performed on carefully selected male neonates with ARM and also avoids the morbidity of stoma and multiple surgeries and follow-up visits to hospitals.

Metastatic transitional cell carcinoma of the bladder in an ileal conduit stoma. A case report and literature review

Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer. Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen. Relevance: Urothelial cancer at all stages can metastasize to other organs. Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis. Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis. There are no clinical guidelines establishing their correct management. Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.

Feasibility of Rectal Stent Development for Fecal Diversion: A Porcine Experiment

Objective Since low rectal anastomosis leakage may cause severe morbidity, surgeons create diversion stoma to prevent complication. However, stoma requires additional surgery with morbidity. Therefore, rectal stent may help prevent these problems. This preliminary report details the development of new rectal stent in animal experiment. Thirteen female 12 week-old pigs weighing 30–35 kg each (four in the control group, nine in the experimental group) were included. Under general anesthesia, pigs underwent laparoscopic low anterior resection. In experimental group, a Niti-S fully covered stent (Taewoong Medical Inc.) was inserted by guidewire, under direct laparoscopic vision, and affixed near the anus. All pigs were sacrificed for autopsy. Including the anastomosis line, 10 cm length of bowel was obtained and a water-air leak and barium leakage X-ray tests were performed to confirm anastomosis integrity. Results Among the four control pigs, anastomosis leakage was confirmed in only one. For the experimental pigs, 36-mm-diameter stent was used. The last three pigs were subjected to additional intra-abdominal stent fixation by laparoscopic guidance, but all stents were removed. Despite natural stent removal, there were only two cases of intraoperative leakage. To overcome rectal pressure and fecal bulk, rectal stent development requires further investigation.