Annals of Coloproctology

Original Articles

Benign diesease & IBD,Rare disease & stoma

Determining the etiology of small bowel obstruction in patients without intraabdominal operative history: a retrospective study: Youngjin Jang, Sung Min Jung, Tae Gil Heo, Pyong Wha Choi, Jae Il Kim, Sung-Won Jung, Heungman Jun, Yong Chan Shin, Eunhae Um; Ann Coloproctol. 2022;38(6):423-431. Published online December 8, 2021; DOI: https://doi.org/10.3393/ac.2021.00710.0101

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Purpose
Most of the causes of small bowel obstruction (SBO) in patients without a history of abdominal surgery are unclear at initial assessment. This study was conducted to identify the etiology and clinical characteristics of SBO in virgin abdomens and discuss the proper management.
Methods
A retrospective review involving operative cases of SBO from a single institute, which had no history of abdominal surgery, was conducted between January 2010 and December 2020. Clinical information, including radiological, operative, and pathologic findings, was investigated to determine the etiology of SBO.
Results
A total of 55 patients were included in this study, with a median age of 57 years and male sex (63.6%) constituting the majority. The most frequently reported symptoms were abdominal pain and nausea or vomiting. Neoplasm as an underlying cause accounted for 34.5% of the cases, of which 25.5% were malignant cases. In patients aged ≥60 years (n=23), small bowel neoplasms were the underlying cause in 12 (52.2%), of whom 9 (39.1%) were malignant cases. Adhesions and Crohn disease were more frequent in patients aged <60 years. Coherence between preoperative computed tomography scans and intraoperative findings was found in 63.6% of the cases.
Conclusion
There were various causes of surgical cases of SBO in virgin abdomens. In older patients, hidden malignancy should be considered as a possible cause of SBO in a virgin abdomen. Patients with symptoms of recurrent bowel obstruction who have no history of prior abdominal surgery require thorough medical history and close follow-up.

Citations

Citations to this article as recorded by

Mesothelial cell responses to acute appendicitis or small bowel obstruction reactive ascites: Insights into immunoregulation of abdominal adhesion
Melissa A. Hausburg, Kaysie L. Banton, Christopher D. Cassidy, Robert M. Madayag, Carlos H. Palacio, Jason S. Williams, Raphael Bar-Or, Rebecca J. Ryznar, David Bar-Or, Eliseo A. Eugenin
PLOS ONE.2025; 20(1): e0317056. CrossRef
Spontaneous Right-Sided Diaphragmatic Hernia: A Rare Cause of Small Bowel Obstruction
Phoebe Douzenis, Ali Yasen Y Mohamedahmed, Sreekanth Sukumaran, Zbigniew Muras, Najam Husain
Cureus.2024;[Epub] CrossRef
Small bowel obstruction on food impaction after binge eating
E Van Eecke, L Crapé, I Colle
Acta Gastro Enterologica Belgica.2024; 87(3): 427. CrossRef
Colonic pseudo-obstruction in a patient with dyssynergic defecation: A case report
Yejun Jeong, Yongjae Kim, Wonhyun Kim, Seoyeon Park, Su-Jin Shin, Eun Jung Park
International Journal of Surgery Case Reports.2022; 98: 107524. CrossRef

Benign GI diease

The Management of Retained Rectal Foreign Body: Ju Hun Kim, Eunhae Um, Sung Min Jung, Yong Chan Shin, Sung-Won Jung, Jae Il Kim, Tae Gil Heo, Myung Soo Lee, Heungman Jun, Pyong Wha Choi; Ann Coloproctol. 2020;36(5):335-343. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2019.10.03.1

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5 Web of Science
7 Citations

Abstract PDF

Purpose
Because insertion of a foreign body (FB) into the anus is considered a taboo practice, patients with a retained rectal FB may hesitate to obtain medical care, and attending surgeons may lack experience with removing these FBs. We performed this study to evaluate the clinical characteristics of Korean patients with a retained rectal FB and propose management guideline for such cases based on our experience.
Methods
We retrospectively investigated 14 patients between January 2006 and December 2018. We assessed demographic features, mechanism of FB insertion, clinical course between diagnosis and management, and outcomes.
Results
All patients were male (mean age, 43 years) and presented with low abdominal pain (n = 2), anal bleeding (n = 2), or concern about a retained rectal FB without symptoms (n = 10). FB insertion was most commonly associated with sexual gratification or anal eroticism (n = 11, 78.6%). All patients underwent general anesthesia for anal sphincter relaxation with the exception of 2 who underwent FB removal in the emergency department. FBs were retrieved transanally using a clamp (n = 2), myoma screw (n = 1), clamp application following abdominal wall compression (n = 2), or laparotomy followed by rectosigmoid colon milking (n = 2). Colotomy and primary repair were performed in four patients, and Hartmann operation was performed in one patient with fecal peritonitis. No morbidity or mortality was reported. All patients refused postextraction anorectal functional and anatomical evaluation and psychological counseling.
Conclusion
Retained rectal FB is rare; however, colorectal surgeons should be aware of the various methods that can be used for FB retrieval and the therapeutic algorithm applicable in such cases.

Citations

Citations to this article as recorded by

A Perilous Plunge: A Unique Case of Rectal Foreign Body
Shehzadi Rimsha, Danish Aslam, Subas Ali, Shehanshah Muhammed Arqam, Ayesha Kausar
Cureus.2025;[Epub] CrossRef
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World Journal of Surgical Procedures.2024; 14(1): 1. CrossRef
Minimally invasive techniques as adjuncts in low- versus high-lying retained rectal foreign bodies of autoerotic nature in young men: a tailored management algorithm with two contrasting case reports from India
Shubham Kumar Gupta, Vivek Kumar Katiyar, Sumit Sharma, Shashi Prakash Mishra, Satyanam Kumar Bhartiya
Journal of Trauma and Injury.2024; 37(3): 238. CrossRef
Rectal foreign body of a cosmetic bottle treated successfully by transanal retrieval: A case report
Congcong Liu, Yuantao Li
Medicine.2024; 103(47): e40651. CrossRef
Caring for a patient with a rectal foreign body
Sophia Parsh, Hyun Ah “Esther” Oh, Bridget Parsh
Nursing.2023; 53(9): 11. CrossRef
Proposal of an algorithm for the management of rectally inserted foreign bodies: a surgical single-center experience with review of the literature
Stefan Fritz, Hansjörg Killguss, André Schaudt, Christof M. Sommer, Götz M. Richter, Sebastian Belle, Christoph Reissfelder, Steffan Loff, Jörg Köninger
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Deodorant aerosol spray can in the rectum: a potential fire hazard during surgery
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Clinical Characteristics of Primary Epiploic Appendagitis: Young Un Choi, Pyong Wha Choi, Yong Hwan Park, Jae Il Kim, Tae Gil Heo, Je Hoon Park, Myung Soo Lee, Chul Nam Kim, Surk Hyo Chang, Jeong Wook Seo; J Korean Soc Coloproctol. 2011;27(3):114-121. Published online June 30, 2011; DOI: https://doi.org/10.3393/jksc.2011.27.3.114

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29 Citations

Abstract PDF

Purpose

Primary epiploic appendagitis (PEA) is a rare cause of an acute abdomen. It can be clinically misdiagnosed as either diverticulitis or appendicitis on clinical examination because the clinical symptoms and signs of PEA are non-specific. The present study was performed to describe the clinical characteristics of PEA and to assess the differences between PEA and diverticulitis.

Methods

We reviewed the clinical records and radiologic findings of 31 consecutive patients with PEA and compared them with those of patients with diverticulitis without complications.

Results

In most cases, abdominal pain was localized to the right (13 cases, 41.9%) or left (13 cases, 41.9%) lower quadrants. Gastrointestinal symptoms such as nausea and vomiting were infrequent, and localized tenderness without peritoneal irritation was common. All patients were afebrile, and only 4 patients (12.9%) showed leukocytosis. In all cases except one, a pericolic fatty mass with a hyperattenuated ring was observed on computed tomography. Patients with left PEA were younger than those with diverticulitis (41.4 ± 11.9 vs. 69.7 ± 13.3, P < 0.001), and the mean body mass index was higher in patients with left PEA (26.4 ± 2.9 vs. 22.6 ± 3.4, P = 0.01). Whereas one patient (6.7%) with left PEA showed leukocytosis, the incidence of leukocytosis in patients with diverticulitis was 80% (8/10) (P < 0.001).

Conclusion

In patients with an acute abdomen showing localized tenderness without associated symptoms or leukocytosis, a high index of suspicion for PEA is necessary. For correct diagnosis and proper management, it would useful for surgeons to be aware of the computed tomographic findings and the natural course of the disease.

Citations

Citations to this article as recorded by

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Recurrencia en pacientes con apendagitis epiploica: un reporte de caso
Mía Alejandra Gómez Corrales, Fabian Andrés Chávez Ecos, Jackeline Alexandra Espinoza Utani, Carlos Alberto Dávila Hernández
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The Korean Journal of Gastroenterology.2023; 81(3): 125. CrossRef
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