Intradermal botulinum toxin a for peristomal hyperhidrosis: a case study.

Background: Peristomal hyperhidrosis can interfere with pouch adherence, resulting in pouch leakage and peristomal skin damage.

Case: A patient with autonomic dysregulation resulting in excessive sweating (hyperhidrosis) experienced difficulty with adherence of her ileostomy appliance. Two hundred units of botulinum toxin A (BTX-A) were injected in the dermis of the surrounding skin in order to improve adherence of her pouching system and alleviate moisture of her peristomal skin.

Dysplasia in ulcerative colitis as a predictor of unsuspected synchronous colorectal cancer.

Background: Endoscopic surveillance of patients with ulcerative colitis aims to prevent cancer-related morbidity through the detection and treatment of dysplasia. The literature to date varies widely with regard to the importance of dysplasia as a marker for colorectal cancer at the time of colectomy.

Objective: The aim of this study was to accurately characterize the extent to which the preoperative detection of dysplasia is associated with undetected cancer in patients with ulcerative colitis.

Use of diagnostic laparoscopy in a patient with gastric pneumatosis and portal venous gas.

Gastric pneumatosis is a radiographic finding that represents a spectrum of conditions ranging from benign disease to abdominal sepsis and death. Along with portal venous gas, it is generally considered an ominous sign prompting emergent operative intervention. We report a rare case showing that diagnostic laparoscopy can be used to confirm or refute full thickness ischemic necrosis and that conservative management can be considered in some patients, recognizing the possibility of a benign process.

Integration of radiation oncology with surgery as combined-modality treatment.

Integration of surgery and radiation (external beam, EBRT; intraoperative, IORT) has become more routine for patients with locally advanced primary cancers and those with local-regional relapse. This article discusses patient selection and treatment from a more general perspective, followed by a discussion of patient selection and treatment factors in select disease sites (pancreas cancer, colorectal cancer, retroperitoneal soft-tissue sarcomas). Outcomes with combined modality treatment (surgery, EBRT alone or with concurrent chemotherapy, IORT) are discussed.

Eosinophilic enteritis confined to an ileostomy site.

Eosinophilic enteritis is a rather rare condition that can manifest anywhere from esophagus to rectum. Its description in the literature is sparse, but associations have been made with collagen vascular disease, malignancy, food allergy, parasitic or viral infections, inflammatory bowel disease, and drug sensitivity. We present the case of a 41-year-old male diagnosed with ulcerative colitis who underwent proctocolectomy with ileal pouch anal anastomosis and loop ileostomy formation utilizing Seprafilm®, who later developed eosinophilic enteritis of the loop ileostomy site.

The Association of Ménétrier Disease with Ulcerative Colitis: A Case Report with Implications on the Pathogenesis of Ménétrier Disease.

Ménétrier disease (MD) is a rare hypertrophic condition of the gastric mucosa. The unusual association of MD with ulcerative colitis (UC) has been reported in the literature in eight cases. Transforming growth factor-alpha (TGF-alpha) is overexpressed in UC and appears to play a role in colonic healing and repair.

Effect of perioperative immunosuppressive medication on early outcome in Crohn's disease patients.

Background: The aim of the present study was to examine the early outcome in patients undergoing intestinal resection for Crohn's disease (CD) while they are receiving perioperative immunosuppressive medication.

Methods: We reviewed patients with CD undergoing intestinal surgery from 1999 to 2007. Demographics and relevant perioperative information, including medication, were extracted from patient charts.

Intussusception in the adult: an unsuspected case of Peutz-Jeghers syndrome with review of the literature.

Peutz-Jeghers syndrome is an uncommon genetic defect in the signal pathways of growth. The incidence has most recently been estimated to be in the range of 1 per 120,000 live births [1]. It is characterized by hamartomas throughout the gastrointestinal tract, mucocutaneous melanotic spots and increased predisposition to malignancy.

Stratification of rectal cancer stage for selection of postoperative chemoradiotherapy: current status.

Disease relapse (local, distant) and survival rates (overall [OS], disease-free [DFS]) are dependent on disease stage at time of diagnosis. In rectal cancer pooled analyses of phase III North American trials, OS and DFS were dependent on TN stage (N substage within T stage), NT stage (T substage within N stage), and treatment method. Three risk groups of patients were defined: (1) intermediate T1-2N1, T3N0; (2) moderately high T1-2N2, T3N1, T4N0; and (3) high T3N2, T4N1, T4N2.

Parastomal hernia: short-term outcome after laparoscopic and conventional repairs.

The purpose of this study was to evaluate the short-term outcomes after laparoscopic and conventional parastomal hernia repairs. A retrospective review of parastomal hernia repairs was performed. Conventional repairs included primary suture repair, stoma relocation, and mesh repair.

Ischiorectal abscess after sacrospinous ligament suspension.

An ischiorectal abscess in a 66-year-old patient was determined to be an uncommon complication of sacrospinous fixation. The abscess was diagnosed 9 months after the patient had a sacrospinous ligament suspension. She was treated successfully with perianal incision, drainage, and intravenous antibiotics.

CT colonography with intravenous contrast material: varied appearances of colorectal carcinoma.

Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. Because colorectal cancer has a widely varying appearance at both endoscopy and CT colonography, familiarity with the gamut of morphologic appearances can help improve interpretation of the results. The addition of intravenous contrast material to CT colonography can aid differentiation of true colonic masses from pseudolesions such as residual stool and improves the depiction of enhancing masses that might otherwise be obscured by residual colonic fluid.

Wide local excision and split-thickness skin graft for circumferential Paget's disease of the anus.

Background: Our aim was to evaluate the results of wide local excision followed by split-thickness skin graft for circumferential perianal Paget's disease.

Methods: Between 1995 and 1999, 5 patients with perianal Paget's disease underwent wide local excision of the disease. The circumferential involvement was documented by preoperative mapping.

Reoperation on the abdomen encased in adhesions.

Purpose: To determine outcome after lysis of intestinal adhesions, relief of obstruction, closure of fistulas and drainage of abscesses in patients with an abdominal cavity obliterated by chronic postoperative adhesions.

Methods: Among 40 patients with an abdomen encased in dense adhesions after a mean of 5 previous operations, 31 patients also had intestinal obstruction, 25 enteric fistulas and 20 abdominal abscesses. Reoperation was done and outcome assessed from the medical records and by a mailed questionnaire.