Vincenzo Vigorita

Gastrointestinal: Videocapsule retention: rationale for surgical indication

Small bowel resection containing the capsule with primary anastomosis was performed (Figure 2). The postoperative course was uneventful. Histopathologic evaluation of the resected bowel diagnosed a pT3N0M0 small bowel intestinal type adenocarcinoma. The term capsule retention is defined by a capsule remaining in the digestive tract for at least 14 days. The frequency of this complication depends mostly on the clinical indication for the capsule enteroscopy, and varies from less than 1% in patients with obscure gastrointestinal bleeding to 13% in Crohn’s disease. Most often capsule retention remains asymptomatic but acute small bowel obstruction and perforation may occur. Capsule retention has been described to occur with strictures due to non-steroidal anti-inflammatory drugs (NSAID), Crohn’s disease, small bowel tumors, radiation enteritis, and post-surgical anastomotic strictures. Retention may result in surgery in patients in whom medical treatment for Crohn’s disease or NSAID enteropathy would have sufficed. Therefore, in patients with known Crohn’s disease and/or inappropriate NSAID use, a “wait and see” policy may avoid unnecessary abdominal surgery. If a history of inflammatory bowel disease can be excluded, then capsule retention should be considered a clear-cut surgical indication. Contributed by

Efficacy of rectus muscle fragment welding in the control of presacral venous bleeding.

The incidence of presacral venous bleeding during rectal resection is low, but this complication can be severe and even lethal. Occasionally, the traditional methods – such as pelvic gauze packing and the use of metallic thumbtacks – are not effective. When combined with their complications and difficulties, these failures have resulted in numerous creative procedures with which to control this complication. In 1994, the indirect electrocoagulation method, which is performed via a fragment of the rectus abdominis muscle of the abdomen, was introduced to control presacral venous bleeding.

Presacral venous bleeding during mobilization in rectal cancer

AIM To analyze the anatomy of sacral venous plexus flow, the causes of injuries and the methods for controlling presacral hemorrhage during surgery for rectal cancer. METHODS A review of the databases MEDLINE® and Embase™ was conducted, and relevant scientific articles published between January 1960 and June 2016 were examined. The anatomy of the sacrum and its venous plexus, as well as the factors that influence bleeding, the causes of this complication, and its surgical management were defined. RESULTS This is a review of 58 published articles on presacral venous plexus injury during the mobilization of the rectum and on techniques used to treat presacral venous bleeding. Due to the lack of cases published in the literature, there is no consensus on which is the best technique to use if there is presacral bleeding during mobilization in surgery for rectal cancer. This review may provide a tool to help surgeons make decisions regarding how to resolve this serious complication. CONCLUSION A series of alternative treatments are described; however, a conventional systematic review in which optimal treatment is identified could not be performed because few cases were analyzed in most publications.

Education and imaging: gastrointestinal: videocapsule retention: rationale for surgical indication.

Small bowel resection containing the capsule with primary anastomosis was performed (Figure 2). The postoperative course was uneventful. Histopathologic evaluation of the resected bowel diagnosed a pT3N0M0 small bowel intestinal type adenocarcinoma. The term capsule retention is defined by a capsule remaining in the digestive tract for at least 14 days. The frequency of this complication depends mostly on the clinical indication for the capsule enteroscopy, and varies from less than 1% in patients with obscure gastrointestinal bleeding to 13% in Crohn’s disease. Most often capsule retention remains asymptomatic but acute small bowel obstruction and perforation may occur. Capsule retention has been described to occur with strictures due to non-steroidal anti-inflammatory drugs (NSAID), Crohn’s disease, small bowel tumors, radiation enteritis, and post-surgical anastomotic strictures. Retention may result in surgery in patients in whom medical treatment for Crohn’s disease or NSAID enteropathy would have sufficed. Therefore, in patients with known Crohn’s disease and/or inappropriate NSAID use, a “wait and see” policy may avoid unnecessary abdominal surgery. If a history of inflammatory bowel disease can be excluded, then capsule retention should be considered a clear-cut surgical indication. Contributed by

Gastrointestinal: Videocapsule retention: rationale for surgical indication: Images of Interest

Small bowel resection containing the capsule with primary anastomosis was performed (Figure 2). The postoperative course was uneventful. Histopathologic evaluation of the resected bowel diagnosed a pT3N0M0 small bowel intestinal type adenocarcinoma. The term capsule retention is defined by a capsule remaining in the digestive tract for at least 14 days. The frequency of this complication depends mostly on the clinical indication for the capsule enteroscopy, and varies from less than 1% in patients with obscure gastrointestinal bleeding to 13% in Crohn’s disease. Most often capsule retention remains asymptomatic but acute small bowel obstruction and perforation may occur. Capsule retention has been described to occur with strictures due to non-steroidal anti-inflammatory drugs (NSAID), Crohn’s disease, small bowel tumors, radiation enteritis, and post-surgical anastomotic strictures. Retention may result in surgery in patients in whom medical treatment for Crohn’s disease or NSAID enteropathy would have sufficed. Therefore, in patients with known Crohn’s disease and/or inappropriate NSAID use, a “wait and see” policy may avoid unnecessary abdominal surgery. If a history of inflammatory bowel disease can be excluded, then capsule retention should be considered a clear-cut surgical indication. Contributed by