Annals of Coloproctology

Volume 34(3); June 2018

Editorial

Selection of Adjuvant Treatment Without Neoadjuvant Chemoradiotherapy for Patients With Rectal Cancer: Room for Further Investigation: In Ja Park; Ann Coloproctol. 2018;34(3):109-110. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.05.27

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Pleiotropic Role and Bidirectional Immunomodulation of Innate Lymphoid Cells in Cancer
Zhengwen An, Fabian Flores-Borja, Sheeba Irshad, Jinhai Deng, Tony Ng
Frontiers in Immunology.2020;[Epub] CrossRef

Review

Colorectal Surgery Training in the Hong Kong Special Administrative Region and China: Joe King Man Fan, Zhonghui Liu; Ann Coloproctol. 2018;34(3):111-118. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.05.28

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Until 1st July 1997, Hong Kong was under the governance of the British Government; therefore, the British system of education was followed. After internship, 7 years of general surgical training is required to obtain registration and fellowship qualifications of the College of Surgeon of Hong Kong and Edinburg. After having become a specialist in general surgery, the surgeon could choose to specialize in colorectal surgery with an additional 3 to 5 years of specialist training in an accredited centre and 6 months of overseas training with subsidies. On the contrary, China has more than 600 medical schools, and students can enroll in different programs to become a medical practitioner. Despite a great discrepancy exists in the quality of teaching and supervision but there are comprehensive regulations governing the accreditation of hospitals, credentialing of operations, medical records, etc. to ensure medical and patient safety. Vast amounts of resources are being invested to strengthen the quality and to advance the technology used in patient care, not only by supporting basic and clinical research but also by providing extra resources to “import” experts and help develop services with clinical excellence. To accomplish this, the aim of the “three fames project” with a 5-year funding of 3 million United States dollar is to invite overseas experts to help build medical teams in specific areas. Due to its huge population (more than 1.3 billion people), China is a country full of potential for development in clinical research, collaboration, knowledge exchange, and the provision of premier medical services.

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Training in colorectal surgery in Europe and 20 years of the European Board of Surgical Qualification coloproctology examination, Teixeira Farinha et al[1]
S. K. Clark
Colorectal Disease.2020; 22(7): 736. CrossRef

Original Articles

Laparoscopic Posterolateral Rectopexy for the Treatment of Patients With a Full Thickness Rectal Prolapse: Experience With 63 Patients and Short-term Outcomes: Keehoon Hyun, Shi-Jun Yang, Ki-Yun Lim, Jong-Kyun Lee, Seo-Gue Yoon; Ann Coloproctol. 2018;34(3):119-124. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.01.31

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Purpose
Although numerous procedures have been proposed for the treatment of patients with a rectal prolapse, the most effective operation has not yet been established. Minimal rectal mobilization can prevent constipation; however, it is associated with increased recurrence rates. We describe our novel method for a laparoscopic posterolateral rectopexy, which includes rectal mobilization with a posterior-right unilateral dissection, suture fixation to the sacral promontory with a polypropylene mesh (Optilene), and a mesorectal fascia propria that is as wide as possible. The present report describes our novel method and assesses the short-term outcomes of patients.
Methods
Between June 2014 and June 2017, 63 patients (28 males and 35 females) with a full-thickness rectal prolapse underwent a laparoscopic posterolateral (LPL) rectopexy. We retrospectively analyzed the clinical characteristics and postoperative complications in those patients. The outcome of surgery was determined by evaluating the answers on fecal incontinence questionnaires, the results of anal manometry preoperatively and 3 months postoperatively, the patients’ satisfaction scores (0–10), and the occurrence of constipation.
Results
No recurrence was reported during follow-up (3.26 months), and 3 patients reported postoperative complications (wound infection, postoperative sepsis, which was successfully treated with conservative management, and retrograde ejaculation). Compared to the preoperative baseline, fecal incontinence at three months postoperatively showed an overall improvement. The mean patient satisfaction score was 9.55 ± 0.10, and 8 patients complained of persistent constipation.
Conclusion
LPL rectopexy is a safe, effective method showing good functional outcomes by providing firm, solid fixation for patients with a full-thickness rectal prolapse.

Citations

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Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy
Adel Zeinalpour, Alimohammad Bananzadeh, Mohammad Mostafa Safarpour, Sara Shojaei‐Zarghani, Seyede Saeideh Shahidinia, Seyed Vahid Hosseini, Ali Reza Safarpour
Surgical Practice.2024;[Epub] CrossRef
Clinical outcomes of surgical management for recurrent rectal prolapse: a multicenter retrospective study
Kwang Dae Hong, Keehoon Hyun, Jun Won Um, Seo-Gue Yoon, Do Yeon Hwang, Jaewon Shin, Dooseok Lee, Se-Jin Baek, Sanghee Kang, Byung Wook Min, Kyu Joo Park, Seung-Bum Ryoo, Heung-Kwon Oh, Min Hyun Kim, Choon Sik Chung, Yong Geul Joh
Annals of Surgical Treatment and Research.2022; 102(4): 234. CrossRef
Laparoscopic Posterolateral Suture Rectopexy for Recurrent Rectal Prolapse in Children
Sherif M. Shehata, Ahmed A. Elhaddad, Wael M. Abo Senna, Mohamed A. Shehat
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(10): 1292. CrossRef
Changing Trend of Rectal Prolapse Surgery in the Era of the Minimally Invasive Surgery
Suk-Hwan Lee
The Journal of Minimally Invasive Surgery.2019; 22(4): 135. CrossRef

Effects of Intraoperative Insufflation With Warmed, Humidified CO₂ during Abdominal Surgery: A Review: Ju Yong Cheong, Anil Keshava, Paul Witting, Christopher John Young; Ann Coloproctol. 2018;34(3):125-137. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.26

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Purpose
During a laparotomy, the peritoneum is exposed to the cold, dry ambient air of the operating room (20°C, 0%–5% relative humidity). The aim of this review is to determine whether the use of humidified and/or warmed CO₂ in the intraperitoneal environment during open or laparoscopic operations influences postoperative outcomes.
Methods
A review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, OVID MEDLINE, Cochrane Central Register of Controlled Trials and Embase databases were searched for articles published between 1980 and 2016 (October). Comparative studies on humans or nonhuman animals that involved randomized controlled trials (RCTs) or prospective cohort studies were included. Both laparotomy and laparoscopic studies were included. The primary outcomes identified were peritoneal inflammation, core body temperature, and postoperative pain.
Results
The literature search identified 37 articles for analysis, including 30 RCTs, 7 prospective cohort studies, 23 human studies, and 14 animal studies. Four studies found that compared with warmed/humidified CO₂, cold, dry CO₂ resulted in significant peritoneal injury, with greater lymphocytic infiltration, higher proinflammatory cytokine levels and peritoneal adhesion formation. Seven of 15 human RCTs reported a significantly higher core body temperature in the warmed, humidified CO₂ group than in the cold, dry CO₂ group. Seven human RCTs found lower postoperative pain with the use of humidified, warmed CO₂.
Conclusion
While evidence supporting the benefits of using humidified and warmed CO₂ can be found in the literature, a large human RCT is required to validate these findings.

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Performance of intraoperative surgical smoke management technologies for laparoscopic surgery: A comparative in-vivo pig study
Daniel Göhler, Levon Aslanyan, Kathrin Oelschlägel, Petru Bucur, Jonathan Buggisch, Nadia Azhari, Andreas Rudolph, Sébastien Roger, Michael Stintz, Dirk Bausch, Cédric Demtröder, Mehdi Ouaissi, Urs Giger-Pabst
Journal of Aerosol Science.2024; 177: 106309. CrossRef
Does intra‐operative humidification with warmed CO2 reduce surgical site infection in open colorectal surgery? A randomized control trial
Asiri Arachchi, Alice Lee, Manisha Metlapalli, Ellathios Antoniou, Ruben Rajan, Vignesh Narasimhan, Ashray Rajagopalan, Seraphina Key, William M. K. Teoh, Thang Chien Nguyen, James Tow‐Hing Lim, Hanumant Chouhan, Bruce P. Waxman, Julian A. Smith
ANZ Journal of Surgery.2023; 93(4): 970. CrossRef
The effects of CO2 pneumoperitoneum at different temperature and humidity on hemodynamic and respiratory parameters and postoperative pain in gynecological laparoscopic surgery: A prospective randomized controlled study
Ilkben Gunusen, Ali Akdemir, Asuman Sargın, Semra Karaman
Asian Journal of Surgery.2022; 45(1): 154. CrossRef
Incidence of inadvertent perioperative hypothermia in pediatric laparoscopic surgery: a prospective observational single-center study.
Recai DAĞLI, Ülgen ÇELTİK, Fatma ÇELİK, Zeynel Abidin ERBESLER, Zeynep KÖYLÜ
Ahi Evran Medical Journal.2022;[Epub] CrossRef
Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis
Francesco Marchegiani, Eric Noll, Pietro Riva, Seong-Ho Kong, Paola Saccomandi, Giorgia Vita, Véronique Lindner, Izzie Jacques Namer, Jacques Marescaux, Pierre Diemunsch, Michele Diana
Surgical Innovation.2021; 28(1): 7. CrossRef
Does the Laminar Airflow System Affect the Development of Perioperative Hypothermia? A Randomized Clinical Trial
Recai Dagli, Fatma Çelik, Hüseyin Özden, Serdar Şahin
HERD: Health Environments Research & Design Journal.2021; 14(3): 202. CrossRef
Randomized clinical trial of the effect of intraoperative humidified carbon dioxide insufflation in open laparotomy for colorectal resection
J. Y. Cheong, B. Chami, G. M. Fong, X. S. Wang, A. Keshava, C. J. Young, P. Witting
BJS Open.2020; 4(1): 45. CrossRef
The Pathogenesis and Prevention of Port-Site Metastasis in Gynecologic Oncology

Qianqian Gao, Ling Guo, Bo Wang
Cancer Management and Research.2020; Volume 12: 9655. CrossRef
Morpheus and the Underworld—Interventions to Reduce the Risks of Opioid Use After Surgery: ORADEs, Dependence, Cancer Progression, and Anastomotic Leakage
Robert Beaumont Wilson
Journal of Gastrointestinal Surgery.2019; 23(6): 1240. CrossRef
Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery
Liping Liu, Na Lv, Chunmiao Hou
Medicine.2019; 98(14): e15112. CrossRef
Single‐incision laparoscopic reversal of Hartmann's operation through the stoma site: comparative outcomes with conventional laparoscopic and open surgery
P. Thambi, D. W. Borowski, R. Sathasivam, R.‐B. Obuobi, Y. K. S. Viswanath, T. S. Gill
Colorectal Disease.2019; 21(7): 833. CrossRef
Clinical effects of warmed humidified carbon dioxide insufflation in infants undergoing major laparoscopic surgery
Tong Meng-Meng, Xu Xue-Jun, Bao Xiao-Hong
Medicine.2019; 98(27): e16151. CrossRef
Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients
Rongjuan Jiang, Yan Sun, Huaiming Wang, Min Liang, Xianfeng Xie
Medicine.2019; 98(41): e17520. CrossRef

Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis: Yong Sung Choi, Do Sun Kim, Doo Han Lee, Jae Bum Lee, Eun Jung Lee, Seong Dae Lee, Kee Ho Song, Hyung Joong Jung; Ann Coloproctol. 2018;34(3):138-143. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.06.08

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Purpose
While perianal disease (PAD) is a characteristic of patients with Crohn disease, it has been overlooked in patients with ulcerative colitis (UC). Thus, our study aimed to analyze the incidence and the clinical features of PAD in patients with UC.
Methods
We reviewed the data on 944 patients with an initial diagnosis of UC from October 2003 to October 2015. PAD was categorized as hemorrhoids, anal fissures, abscesses, and fistulae after anoscopic examination by experienced proctologists. Data on patients’ demographics, incidence and types of PAD, medications, surgical therapies, and clinical course were analyzed.
Results
The median follow-up period was 58 months (range, 12–142 months). Of the 944 UC patients, the cumulative incidence rates of PAD were 8.1% and 16.0% at 5 and 10 years, respectively. The incidence rates of bleeding hemorrhoids, anal fissures, abscesses, and fistulae at 10 years were 6.7%, 5.3%, 2.6%, and 3.4%, respectively. The cumulative incidence rates of perianal sepsis (abscess or fistula) were 2.2% and 4.5% at 5 and 10 years, respectively. In the multivariate analyses, male sex (risk ratio [RR], 4.6; 95% confidence interval [CI], 1.7–12.5) and extensive disease (RR, 4.2; 95% CI, 1.6–10.9) were significantly associated with the development of perianal sepsis.
Conclusion
Although the clinical course of PAD in patients with UC is not serious, in clinical practice, PAD is not rare in such patients. Therefore, careful examination and appropriate management for PAD is needed if the quality of life for patients with UC is to be improved.

Citations

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Analysis of the permeable and retainable components of Cayratia japonica ointment through intact or broken skin after topical application by UPLC-Q-TOF-MS/MS combined with in vitro transdermal assay
Xuelong Zhao, Ruixue Dai, Jing Wang, Liangliang Cao, Peidong Chen, Weifeng Yao, Fangfang Cheng, Beihua Bao, Li Zhang
Journal of Pharmaceutical and Biomedical Analysis.2024; 238: 115853. CrossRef
Problem with Hookups: Perianal Fistula After Ileal Pouch-Anal Anastomosis
Arafa Djalal, Serre-Yu Wong, Jean-Frédéric Colombel, Ryan Ungaro, Maia Kayal
Digestive Diseases and Sciences.2024; 69(4): 1102. CrossRef
Diffusion-Weighted MRI in Perianal Abscess: Role and Comparison With Contrast-Enhanced MRI
Pooja Aggarwal, Rajesh Malik, Radha Sarawagi, Aman Kumar, Jitendra Sharma
Cureus.2024;[Epub] CrossRef
Inflammatory bowel disease and risk for hemorrhoids: a Mendelian randomization analysis
HanYu Wang, Lu Wang, XiaoYu Zeng, ShiPeng Zhang, Yong Huang, QinXiu Zhang
Scientific Reports.2024;[Epub] CrossRef
Ulcerative colitis complicated with Fournier’s gangrene: A case report
Irina Bondoc, Marius Zamfir, Mara Mardare, Andrei Văcărașu, Alin Burlacu, Leila Ali, Ariana Hudita, Bianca Galateanu, Octav Ginghină, Georgios Georgiadis, Charalampos Mamoulakis
Public Health and Toxicology.2023; 3(1): 1. CrossRef
Causal Link between Inflammatory Bowel Disease and Fistula: Evidence from Mendelian Randomization Study
Zongbiao Tan, Shijie Zhu, Chuan Liu, Yang Meng, Jiao Li, Jixiang Zhang, Weiguo Dong
Journal of Clinical Medicine.2023; 12(7): 2482. CrossRef
Differences in Gut Microbiota between Healthy Individuals and Patients with Perianal Abscess before and after Surgery
Hezhai Yin, Bairu Luo, Qi Wang, Zhonghua Hong, Huilin Chen, Lidong Shen, Bin Shen, Bo Hu, Guangtao Xu
Mediators of Inflammation.2023; 2023: 1. CrossRef
Ulcerative colitis
Catherine Le Berre, Sailish Honap, Laurent Peyrin-Biroulet
The Lancet.2023; 402(10401): 571. CrossRef
Perianal Fistula After Ileoanal Pouch in Patients With Ulcerative Colitis: A Review of 475 Patients Operated on at a Major IBD Center
Tomas M. Heimann, Santosh Swaminathan, Gary I. Slater, Robert J. Kurtz
Diseases of the Colon & Rectum.2022; 65(1): 76. CrossRef
Prostaglandin E‐major urinary metabolite diagnoses mucosal healing in patients with ulcerative colitis in remission phase
Toshiyuki Sakurai, Yoshihiro Akita, Haruna Miyashita, Ryosuke Miyazaki, Yuki Maruyama, Tomoko Saito, Mariko Shimada, Takuji Yamasaki, Seiji Arhihiro, Tomohiro Kato, Tomokazu Matsuura, Masahiro Ikegami, Isao Okayasu, Masayuki Saruta
Journal of Gastroenterology and Hepatology.2022; 37(5): 847. CrossRef
Principles, Preparation, Indications, Precaution, and Damage Control of Endoscopic Therapy in Inflammatory Bowel Disease
Bo Shen
Gastrointestinal Endoscopy Clinics of North America.2022; 32(4): 597. CrossRef
Clinical characteristics and MRI-based phenotypes of perianal abscess formation in children with fistulizing Crohn's Disease
Azadeh Tabari, Jess L. Kaplan, Susanna Y. Huh, Christopher J. Moran, Michael S. Gee
Frontiers in Pediatrics.2022;[Epub] CrossRef
Inflammatory bowel diseases in Tamil Nadu: A survey of demographics, clinical profile, and practices
Rohan V Yewale, Kartik Natarajan, Jeyaraj Ubal Dhus, Sarojini Ashok Parameswaran, Kallipatti Ramaswamy Palaniswamy, Doraisamy Babu Vinish, Aravindh Somasundaram, Arulraj Ramakrishnan, Sibithooran Karmegam, Ramaswamy Saraswathy Arun, Ujjani Shankaraiah Man
JGH Open.2021; 5(11): 1306. CrossRef
Excisional haemorrhoidectomy: is it safe in patients with an ileal pouch–anal anastomosis?
A. L. Lightner, D. Kearney, D. Giugliano, T. Hull, S. Holubar, S. Shawki, S. R. Steele
Colorectal Disease.2020; 22(9): 1154. CrossRef
Hemorrhoidectomy and Excision of Skin Tags in IBD: Harbinger of Doom or Simply a Disease Running Its Course?
Nicholas P. McKenna, Amy L. Lightner, Elizabeth B. Habermann, Kellie L. Mathis
Diseases of the Colon & Rectum.2019; 62(12): 1505. CrossRef

Impact of Adjuvant Therapy Type on Survival in Stage II/III Rectal Cancer Without Preoperative Chemoradiation: A Korean Multicenter Retrospective Study: Byung Mo Kang, Jeong-Heum Baek, Sun Jin Park, Seong Kyu Baek, Ki-Jae Park, Hong-Jo Choi, Byung-Noe Bae, Sun Keun Choi, Kap Tae Kim, Jin-Su Kim, Suk-Hwan Lee; Ann Coloproctol. 2018;34(3):144-151. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.09.26.1

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Purpose
This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation.
Methods
This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified.
Results
The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566).
Conclusion
Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.

Citations

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Management and Outcomes of Pathologic Upstaging of Clinical Stage I Rectal Cancers: An Exploratory Analysis
Alisha Lussiez, Samantha J. Rivard, Kamren Hollingsworth, Sherif R.Z. Abdel-Misih, Philip S. Bauer, Katherine A. Hrebinko, Glen C. Balch, Lillias H. Maguire
Diseases of the Colon & Rectum.2023; 66(4): 543. CrossRef
The oncological outcomes of postoperative radiotherapy in patients with stage II and III upper rectal cancer
Ilknur ALSAN CETIN, Sıtkı Utku AKAY
Marmara Medical Journal.2022;[Epub] CrossRef
Selection of Adjuvant Treatment Without Neoadjuvant Chemoradiotherapy for Patients With Rectal Cancer: Room for Further Investigation
In Ja Park
Annals of Coloproctology.2018; 34(3): 109. CrossRef

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

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Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

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Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

Case Reports

Toothpick Colon Injury Mimicking Colonic Diverticulitis: Min Hyeong Jo, Hwan Namgung; Ann Coloproctol. 2018;34(3):157-159. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2018.04.23

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Although toothpick ingestion is rare, it can lead to fatal complications in the gastrointestinal tract. Diagnosing toothpick ingestion is difficult because most patients do not recall swallowing one. We report 2 cases of toothpick-ingestion-induced colon injury, mimicking diverticulitis. The first patient was a 47-year-old male who had received conservative treatment under the impression of his having diverticulitis in the cecum. Ultrasonography revealed a linear foreign body in the right lower abdomen; a subsequent laparoscopic examination revealed inflammation around the cecum, but no evidence of bowel perforation. A thorough investigation revealed a toothpick embedded in the subcutaneous fat and muscle layer of the lower abdominal wall; we removed it. The second patient was a 56-year-old male who had received conservative treatment under the impression of his having diverticulitis in the sigmoid colon. An explorative laparotomy revealed a toothpick piercing the sigmoid colon; we performed an anterior resection. Both patients were discharged without postoperative complications.

Citations

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Perforation of the Terminal Ileum Secondary to Mucosal Damage of Enteroaggregative Escherichia coli and a Toothpick
Nora A Rady, James Parrish
Cureus.2024;[Epub] CrossRef
Accidentally ingested wooden toothpick, perforation of a sigmoid diverticulum and mimicking acute colonic diverticulitis: A case report and literature review
Giuseppe Evola, Giulia Impellizzeri, Elia Pulvirenti, Maria D'Angelo, Martina Reina, Giuseppe Angelo Reina
International Journal of Surgery Case Reports.2023; 104: 107945. CrossRef
Toothpick perforates small bowel-mimicking diverticulitis
Ahmed A Fallatah, Hassan Mashbari, Hatoon Daghestani, Omar Mostafa, Nawaf Alshahwan, Ahmed Alburakan, Thamer Nouh
Journal of Surgical Case Reports.2023;[Epub] CrossRef

Toxocara canis Mimicking a Metastatic Omental Mass from Sigmoid Colon Cancer: A Case Report: Han-Gil Kim, Jung-Wook Yang, Soon-Chan Hong, Young-Joon Lee, Young-Tae Ju, Chi-Young Jeong, Jin-Kwon Lee, Seung-Jin Kwag; Ann Coloproctol. 2018;34(3):160-163. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.12.20

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Toxocara canis is an important roundworm of canids and a fearsome animal parasite of humans. Human infections can lead to syndromes called visceral larva migrans (VLM), ocular larva migrans, neurotoxocariasis, and covert toxocariasis. VLM is most commonly diagnosed in children younger than 8 years of age, but adult cases are relatively frequent among those infected by ingesting the raw tissue of paratenic hosts in East Asia. This research reports the case of a 59-year-old man with sigmoid colon cancer, who visited our institution for surgery. An intraperitoneal mass was found on preoperative computed tomography, and it was thought to be a metastatic mass from sigmoid colon cancer. A postoperative histologic examination and serum test showed eosinophilic granuloma due to toxocariasis. Diagnosis of VLM is often difficult and highly suspicious in adults. Researchers suggest, although rarely, that VLM be included in the differential diagnosis as a cause of intraperitoneal tumors.

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Human Toxocariasis in individuals with blood disorders and cancer patients: the first seroepidemiological study in Iran
Vahid Raissi, Nasrin Sohrabi, Fatemeh Bayat, Soudabeh Etemadi, Omid Raiesi, Pantea Jalali, Maryam Karami, Ali Abdollahi, Ziba Hoseiny, Mahdi Shayanfard, Gita Alizadeh, Mahmoud E. Gadalla, Asmaa Ibrahim
Journal of Parasitic Diseases.2021; 45(3): 643. CrossRef
Pulmonary Exacerbation of Undiagnosed Toxocariasis in Intensively-Treated High-Risk Neuroblastoma Patients
Szymon Janczar, Monika Bulas, Justyna Walenciak, Dobromila Baranska, Marek Ussowicz, Wojciech Młynarski, Beata Zalewska-Szewczyk
Children.2020; 7(10): 169. CrossRef
Toxocariasis Suspected of Having Infiltrated Directly from the Liver to the Lung through the Diaphragm
Masaki Kakimoto, Masayuki Murata, Fujiko Mitsumoto-Kaseida, Eiichi Ogawa, Yuji Matsumoto, Akira Kusaga, Kazuhiro Toyoda, Takeo Hayashi, Kazuya Ura, Keishi Kanno, Norihiro Furusyo, Susumu Tazuma
Internal Medicine.2019; 58(18): 2737. CrossRef

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