Annals of Coloproctology

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ERAS

Clinical impact of a multimodal pain management protocol for loop ileostomy reversal: Jeong Sub Kim, Chul Seung Lee, Jung Hoon Bae, Seung Rim Han, Do Sang Lee, In Kyu Lee, Yoon Suk Lee, In Kyeong Kim; Ann Coloproctol. 2024;40(3):210-216. Published online June 19, 2024; DOI: https://doi.org/10.3393/ac.2022.01137.0162

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Purpose
As introduced, multimodal pain management bundle for ileostomy reversal may be considered to reduce postoperative pain and hospital stay. The aim of this study was to evaluate clinical efficacy of perioperative multimodal pain bundle for ileostomy.
Methods
Medical records of patients who underwent ileostomy reversal after rectal cancer surgery from April 2017 to March 2020 were analyzed. Sixty-seven patients received multimodal pain bundle protocol with ileostomy reversal (group A) and 41 patients underwent closure of ileostomy with conventional pain management (group B).
Results
Baseline characteristics, including age, sex, body mass index, American Society of Anesthesiologists classification, diabetes mellitus, and smoking history, were not significantly different between the groups. The pain score on postoperative day 1 was significant lower in group A (visual analog scale, 2.6 ± 1.3 vs. 3.2 ± 1.2; P = 0.013). Overall consumption of opioid in group A was significant less than group B (9.7 ± 9.5 vs. 21.2 ± 8.8, P < 0.001). Hospital stay was significantly shorter in group A (2.3 ± 1.5 days vs. 4.1 ± 1.5 days, P < 0.001). There were no significant differences between the groups in postoperative complication rate.
Conclusion
Multimodal pain protocol for ileostomy reversal could reduce postoperative pain, usage of opioid and hospital stay compared to conventional pain management.

Citations

Citations to this article as recorded by

Immunological changes and recovery-related factors in older patients with colon cancer: A pilot trial
Byeo Lee Lim, Young Il Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Yousun Ko, Kyung Won Kim, In Ja Park
Journal of Geriatric Oncology.2025; 16(3): 102200. CrossRef
Quadratus lumborum block for postoperative pain management in patients undergoing ileostomy closure: a prospective, randomized controlled trial
Su Jin Kang, Soo Yeun Park, Jun Seok Park, Jinseok Yeo
Journal of Yeungnam Medical Science.2025; 43: 5. CrossRef
Multimodal analgesia for postoperative pain: pursuing liberation from pain, not redemption
Soo Yeun Park
Annals of Coloproctology.2024; 40(3): 189. CrossRef
Clinical outcomes and future directions of enhanced recovery after surgery in colorectal surgery: a narrative review
Ji Hyeong Song, Minsung Kim
The Ewha Medical Journal.2024;[Epub] CrossRef
Optimizing postoperative pain management in minimally invasive colorectal surgery
Soo Young Lee
Annals of Coloproctology.2024; 40(6): 525. CrossRef

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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5 Web of Science
6 Citations

Abstract PDF Supplementary Material

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

Outcomes of Small Bowel Obstruction in Patients With No Prior Surgery: A Systematic Review
Kyle D. Klingbeil, Ami Hayashi, Erik Balians, Robert E. Johnson, Edward Livingston
Journal of Surgical Research.2026; 319: 185. CrossRef
Outcomes of small bowel obstruction management in previously unoperated patients with a mid-term follow-up: a retrospective cohort study
Liis Jaanimäe, Urmas Lepner, Ülle Kirsimägi, Virve Saarevet, Ceith Nikkolo
BMC Surgery.2026;[Epub] CrossRef
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

Case Report

Benign proctology,Rare disease & stoma

Extraperitoneal Spread of Anorectal Abscess: A Case Report and Literature Review: Papadopoulos S. Konstantinos, Dimopoulos Andreas, Kordeni Kleoniki, Filis Dimitrios; Ann Coloproctol. 2021;37(Suppl 1):S11-S14. Published online January 31, 2020; DOI: https://doi.org/10.3393/ac.2020.01.20

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154 Download
6 Web of Science
7 Citations

Abstract PDF

Supralevator abscess is a rare form of anorectal disease responsible for very rare but morbid manifestations, one of which is superior spread through fascial planes. We present a rare case of a spreading anorectal abscess in a patient who presented with only diffuse abdominal pain, and we review similar cases in the literature according to anatomical considerations, presentation, diagnostic procedures, and treatment options. We identified 7 previously reported cases of spreading anorectal abscesses. Most abscesses had a horseshoe morphology, and all patients presented or developed abdominal pain. All patients had perianal swelling and pain. Five out of 7 patients were previously mistreated. Only 2 abscesses spread through both the pre- and retroperitoneal planes. Abdominal pain is a dominant feature of extraperitoneal inflammation originating from anorectal abscesses. The absence of perianal signs is rare, and proper inspection of the patient along with the medical history can lead to quicker diagnosis and decisive treatment.

Citations

Citations to this article as recorded by

A case of supralevator abscesses involving the prostate and rectum with the formation of a deep and concealed fistula
Feng Chen, Xudan Weng, Yan Li, Jianquan Zhong
Asian Journal of Surgery.2026; 49(2): 1098. CrossRef
Fused Ischiorectal Phlegmon with Pre- and Retroperitoneal Extension: Case Report and Narrative Literature Review
Laurențiu Augustus Barbu, Liviu Vasile, Liliana Cercelaru, Ionică-Daniel Vîlcea, Valeriu Șurlin, Stelian-Stefaniță Mogoantă, Gabriel Florin Răzvan Mogoș, Tiberiu Stefăniță Țenea Cojan, Nicolae-Dragoș Mărgăritescu
Journal of Clinical Medicine.2025; 14(14): 4959. CrossRef
Ischiorectal abscess with retroperitoneal extension: masquerading as an appendicular abscess
Kalyani Dnyaneshwar Aher, Minakshi Gadhire, Naman Jain, Prafulla Salunkhe
International Surgery Journal.2025; 12(10): 1886. CrossRef
Innovative dual-access surgical strategy for advanced pelvic Fournier’s gangrene: a retrospective study assessing combined suprapubic and transsacral debridement
Zhi-Min Liu, Guo-Zhong Xiao, Jie Huang, Xin Jin, Neng-Sheng Lai, Xing-Yang Wan, Hong-Cheng Lin
BMC Gastroenterology.2025;[Epub] CrossRef
Perirectal Abscess with Anterior Extension to the Extraperitoneum and Space of Retzius: A Case Report
Hsiang Teng, Po-Hsien Wu
Medicina.2024; 60(2): 293. CrossRef
A Clinical-Anatomical-Radiological Study of Extraperitoneal Spaces: A Case Series
Giridhar Ashwath, Eshwar Kathiresan Manasijan, Logeshbalaji Seelampatti Palanisamy, Anthony P Rozario, Nachiket Shankar
Cureus.2024;[Epub] CrossRef
Complex Tunneling Perirectal Abscess: Intra-abdominal and Extraperitoneal Extension of a Persistent Perirectal Abscess
Abenezer S Tedla, Harsh R Parikh, Savni Satoskar, Jigyasha Pradhan, Shailja Kataria, Vinayak S Gowda
Cureus.2024;[Epub] CrossRef

Original Article

Benign GI diease, Functional outcomes

The Effects of Preoperative Pain Education on the Decision to Discharge Patients Following Single-Incision Laparoscopic Appendectomy: Ji Won Seo, Moon Jin Kim, Sung-Hoon Yoon, Kwang Yeol Paik, Sun Min Park, Won Kyung Kang, Dosang Lee, Chul Seung Lee; Ann Coloproctol. 2020;36(6):398-402. Published online January 24, 2020; DOI: https://doi.org/10.3393/ac.2020.01.16

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7 Web of Science
7 Citations

Abstract PDF Supplementary Material

Purpose
Few studies have analyzed the effects of preoperative pain education on the postoperative decision to discharge. The purpose of this study was to determine the effects of pain education and management on the decision to discharge patients after single-incision laparoscopic appendectomy (SILA).
Methods
We analyzed 135 patients who had undergone SILA for acute appendicitis between March 2017 and April 2018 in a single medical center. Of these, 72 patients (53.3%) had received preoperative pain education (group 1), and 63 (46.7%) had not (group 2). We compared perioperative outcomes and complications between the groups.
Results
Baseline characteristics of sex, age, body mass index, American Society of Anesthesiologist score, and systemic inflammation factors (neutrophil-lymphocyte ratio, C-reactive protein level) did not differ significantly between the groups. There were no postoperative complications for patients in either group. Perioperative consequences and pathologic findings were not significantly different between the groups; however, length of hospital was significantly shorter in group 1.
Conclusion
Preoperative pain education in relation to postoperative pain management influenced the decision to shorten the postoperative hospital length of stay after SILA.

Citations

Citations to this article as recorded by

Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis
I. K. Kim, C. S. Lee, J. H. Bae, S. R. Han, W. Alshalawi, B. C. Kim, I. K. Lee, D. S. Lee, Y. S. Lee
Techniques in Coloproctology.2024;[Epub] CrossRef
Effect of continuous wound infiltration on patients using intravenous patient-controlled analgesia for pain management after reduced-port laparoscopic colorectal surgery
Hyeon Deok Choi, Sung Uk Bae
Annals of Coloproctology.2024; 40(6): 564. CrossRef
Relationship Between Appendectomy Incidence and Computed Tomography Scans Based on Korean Nationwide Data, 2003–2017
Ki Bum Park, Jinwook Hong, Jong Youn Moon, Jaehun Jung, Ho Seok Seo
Journal of Korean Medical Science.2022;[Epub] CrossRef
Wound Irrigation Using Wet Gauze May Reduce Surgical Site Infection Following Laparoscopic Appendectomy
Abdullah Al-Sawat, Ji Yeon Mun, Sung Hoon Yoon, Chul Seung Lee
Frontiers in Surgery.2022;[Epub] CrossRef
Surgical rectus sheath block combined with multimodal pain management reduces postoperative pain and analgesic requirement after single-incision laparoscopic appendectomy: a retrospective study
Won Jong Kim, Ji Yeon Mun, Hee Ju Kim, Sung-Hoon Yoon, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Yoon Suk Lee, Do Sang Lee, Chul Seung Lee
International Journal of Colorectal Disease.2021; 36(1): 75. CrossRef
Clinical effect of multimodal perioperative pain management protocol for minimally invasive colorectal cancer surgery: Propensity score matching study
Chul Seung Lee, Soo Ji Park, Sang Hyun Hong, Jung-Woo Shim, Min Suk Chae, Seung-Rim Han, Jung Hoon Bae, In Kyu Lee, Dosang Lee, Yoon Suk Lee, Seong Taek Oh
Asian Journal of Surgery.2021; 44(2): 471. CrossRef
Comparing the Postoperative Outcomes of Single-Incision Laparoscopic Appendectomy and Three Port Appendectomy With Enhanced Recovery After Surgery Protocol for Acute Appendicitis: A Propensity Score Matching Analysis
Won Jong Kim, Hyeong Yong Jin, Hyojin Lee, Jung Hoon Bae, Wooree Koh, Ji Yeon Mun, Hee Ju Kim, In Kyu Lee, Yoon Suk Lee, Chul Seung Lee
Annals of Coloproctology.2021; 37(4): 232. CrossRef

Case Reports

Diverticula of Appendix Associated with Chronic Abdominal Pain: A case report.: Shin, Il Yong , Ahn, Chang Joon , Cheon, Joon Sung , Kim, Jeong Goo , Lee, Dong Ho , You, Young Kyoung , Lee, Hye Kyung; J Korean Soc Coloproctol. 2006;22(1):58-61.

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Abstract PDF: The incidence of an appendiceal diverticulum in instance of appendectomies has been reported to range from 0.004 to 2.1 percent. It is known that diverticulum of the appendix leads to diverticulitis, appendicitis, or perforation. Recently in the literature, appendiceal diverticulum without inflammation has been reported as a possible cause of chronic abdominal pain. We report the case of a 40-year-old man with appendiceal diverticula associated with chronic abdominal pain.

Two Cases of Misdiagnosis of Acute Appendicitis in a Patient with Hemorrhagic Fever with Renal Syndrome and a Patient with Tsutsugamushi Disease.: Seo, Jung Pil , Kim, Young Ok , Choi, Yun Seok , Kim, Eun Il , Yoon, Sun Ae , Chae, Hyun Seok , Song, Sun Wha , Kim, Nam Il , Yoo, Seung Jin; J Korean Soc Coloproctol. 2000;16(6):474-477.

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15 Download

Abstract PDF: Both tsutsugamushi disease and hemorrhagic fever with renal syndrome frequently cause abdominal pain with tenderness; therefore they are occasionally misdiagnosed as surgical abdomen. Two patients presented with symptoms of acute abdomen, and under the suspicion of acute appendicitis they underwent appendectomies. Nevertheless there were no operative findings of acute appendicitis in both patients, and the clinical conditions were deteriorated after the operation. Acute infectious disease was suspected by thrombocytopenia, elevated liver enzymes, and proteinuria. Indirect immunoflourescence test confirmed tsutsugamushi disease and hemorrhagic fever with renal syndrome, respectively. The patient with tsutsugamushi disease improved with administration of doxycycline and the patient with hemorrhagic fever with renal syndrome spontaneously improved.

Original Article

Surgical Treatment of Right Colon Diverticulitis.: Lee, Do Sang , Lee, Chul Soo , Sung, Gi Young , Song, Moo Hyung , Kim, Wook , Park, Il Young , Won, Jong Man; J Korean Soc Coloproctol. 2000;16(5):302-308.

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Abstract PDF: PURPOSE
Diverticular disease of the cecum and ascending colon is a relatively uncommon disease and there are some difficulties in the accurate preoperative diagnosis and the proper surgical treatment. This study is aimed to determine what is the proper procedure during the emergency operation of right colon diverticulitis.
METHODS
This study is a retrospective clinical analysis of 86 cases of the right colon diverticulitis from January 1992 to December 1999.
RESULTS
1) The incidence of right colon diverticulitis (RCD) was 2.1% of that of appendicitis and the RCD to sigmoid colon diverticulitis ratio was 9.6:1.2) The highest incidence was noted at the fourth decades and average age was 37 years. Male to female ratio was 1.9:1. 3) Most patients (73 cases, 85%) had right lower quadrant abdominal pain. 4) The duration of symptom was less than 3 days in 54 cases (63%). 5) The preoperative confirmation by radiologic work-up was not decisive, but barium enema might be more accurate than other studies and CT was more accurate method than ultrasound. 6) The correct preoperative diagnosis was made only in 13 cases (15%) and the remaining misdiagnoses were appendicitis with or without complications in 72 cases (83%). 7) Operative procedures varied markedly according to multiplicity, extent of inflammation and complications; diverticulectomy and appendectomy in 48 cases (56%), ileocecectomy in 15 cases (17%) and right hemicolectomy in 11 cases (13%). 8) The most commom postoperative complication was wound infection. 9) Among the 30 cases who took diverticulectomy or diverticulectomy and appendectomy, remained diverticulums were found in 14 cases (47%), especially 11 cases (37%) on the right colon. And so multiplicity of right colon reached about 37%.
CONCLUSIONS
The authors suggest that one should suspect RCD in fourth decade patients with right lower quadrant pain for more than 3 days with unusual clinical findings. Barium enema can be used because of the high accuracy rate but CT is a safe tool in complicated or urgent situation. The operative modalities should be selected on the extent of the disease and it is sufficient to treat a single diverticulitis with diverticulectomy or diverticulectomy and appendectomy but right hemicolectomy should be recommanded in the suspicious multiplicity or malignancy.

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