Iranian Journal of Colorectal Research
Year:2014 | Volume:2 | Issue:1|Papers Count:9

Dear Editor: We read with great interest the recently published article by Ghahramani et al. (1). The authors found that in the third trimester of pregnancy, psyllium powder consumption could significantly prevent constipation, hemorrhoid and anal fissure. Although the authors discussed their findings comprehensively, we feel that there are some additional issues to be clarified.

Dear Editor: Ghahramani et al. recently published a well-organized, double blind, placebo-controlled clinical trial concerning the efficacy of psyllium powder laxatives in preventing constipation, hemorrhoids, and anal fissure during pregnancy (1). The authors concluded that psyllium powder consumption used during the third trimester of pregnancy could significantly prevent constipation, hemorrhoid, and anal fissure. Although the beneficial effect of psyllium on constipation is well known, this is the first published study in this topic. What can explain it? We think that the possible reason is safety. The Food and Drug Administration (FDA) is issuing a final rule establishing that over-the-counter (OTC) laxative drug products in granular dosage form containing the bulkforming psyllium ingredients are not generally recognized as safe and effective (GRASE) and are misbranded. Ninety-eight total events of esophageal obstruction associated with all dosage forms containing psyllium were reported between 1966 and 2000. The vast majority of obstruction and choking-related events associated with psyllium laxatives in granular dosage form, in which 59 required hospitalization or medical intervention including endoscopic procedures to remove the blockage (2).

Background: Laparoscopy is not an accepted procedure for complicated appendicitis in children for most pediatric surgeons. This procedure is associated with a higher incidence of postoperative abdominal abscess reported in some studies. Objectives: In this study, we investigated the security, efficacy and complications of laparoscopy in children with complicated appendicitis in Mofid Children's Hospital.Patients and Methods: From April 2010 to January 2013, we performed laparoscopic appendectomy (LA) in all cases of non-complicated and complicated appendicitis (including perforated appendicitis and localized or generalized peritonitis based on the operation findings and pathological reports). Primary outcomes were incidence of complications, intra-abdominal abscess and wound infection. Secondary outcomes were length of operation, length of hospital stay, resumption of diet, incidence of bowel obstruction, duration of antibiotic use and readmission. Laparoscopy appendectomy was performed with two working ports.Results: LA was performed in 123 children aged 2 to 14 years (mean of eight years) over a 3-year period, of whom only 34 cases had complicated appendicitis (either localized or generalized peritonitis). There was one conversion to open appendectomy (OA) in a patient with appendicular abscess with a mass, which excluded from our analysis. There were 6 patients with generalized peritonitis and 26 patients with localized abscess, and two patients with appendicular mass. The Average duration of symptoms was four days (ranged 3-6 days). The mean length of operation was 52 minutes (ranged 40-80 minutes). The average length of hospital stay was 4.4 days (ranged 4-7 days). They were able to restart oral intake from 16 to 48 hours postoperatively. Two patients (5%) had postoperative complications; one patient with intra-abdominal abscess who underwent reoperation and the second patient with umbilical wound infection was resolved with antibiotherapy. The average follow-up was 14 months (ranged from 4-36 months). Conclusions: We recommend laparoscopic approach for all children presenting complicated appendicitis as the initial procedure of choice.

Context: The management of complicated anal fistula is a serious issue in coloproctology. Various methods have been described but the choice must be made based on the course of the fistula tract in relation to the sphincter. As anal fistulas are caused by anal gland infection, the anal gland and ducts should be removed for the process of healing to begin and for the anal sphincter preservation. The aim of this study is to briefly explain and assess three new sphincter preserving surgical treatments, including fibrin glue and anal plug techniques and the procedure of ligation of intersphincteric fistula tract (LIFT) and also to evaluate the failure and success rates of these techniques. Evidence Acquisition: We conducted a search in the literature of the last decade, in the PubMed database, using the key word: anal Fistula, LIFT procedure, fibrin glue and anal plug.Results: Using anal fistula plug provides another option for the treatment of complex anal fistulas and does appear to be an effective technique in some cases. The technique of intersphincteric fistula tract ligation as a fistula treatment surgery, aims for total anal sphincter preservation and appears to be both safe and easy to perform, with encouraging early outcomes. The authors suggest further controlled studies comparing the LIFT procedure with standard therapies. Conclusions: Fibrin sealant injection should be in the armamentarium of the specialists' surgical treatments for fistula-in-ano. The surgeons and their patient should be aware of the limited success expectations, when using fibrin glue technique as the treatment.

Introduction: Volvulus of two segments of colon has been reported rarely, as either synchronous or metachronous events. Colonic volvulus involving both transverse and sigmoid colon is a rare medical problem frequently dismissed as a cause of large bowel obstruction. Case Presentation: A 73-year-old female presented with colicky abdominal pain, abdominal distension and anorexia for several days.Abdominal radiography showed distended intestinal loops. Patient went under laparotomy and transverse and sigmoid volvulus was discovered. Conclusions: In spite of transverse colon and sigmoid volvulus rarity, it is advised to include these in the differential diagnosis of patients with chronic abdominal pain associated with recurrent bowel obstruction.

Background: Rectal cancer is a common gastrointestinal cancer. It is tried to use sphincter preservation methods due to the location of the tumor and its proximity to the anal sphincter. Objectives: In this study, a new method of rectal resection through perineum is introduced.Patients and Methods: In this study, 15 patients with lower rectal cancer were enrolled from 2009 to 2011. After chemoradiation, releasing of the rectum and sigmoid through the abdomen were performed by open surgery or laparoscopy, then, the tumor was removed through perineal incision and anastomosis was performed.Results: There were eight women and seven men. The mean age of patients was 55 years. All patients had some degrees of stool incontinence. Eight patients had a score of 15-18, and seven below 15 according to the Cleveland criteria. The score of patients’ satisfaction was 8 from 10. Complications including infection, abscess or leak were not observed. Conclusions: Sphincter preservation method in lower rectal cancer through perineum is possible which is associated with low complications.

Background: Transanal Endoscopyic Microsurgery (TEM) has been a new method of micro invasive surgery for management of special conditions. Big deal of this procedure is avoiding of open abdominal surgeries or better exposure in transanal approches. Objectives: The purpose of this study was to present a single institutional experience in Shiraz, Iran regarding the application of Transanal Endoscopic Microsurgery (TEM). To our knowledge this is the first report from the Middle East.Patients and Methods: Between 2009 and 2012, thirty patients underwent TEM in our center. We assessed complications and recurrence rate. Patients with fewer than six months of follow-up were excluded.Results: Patients included 17 men and 13 women with a mean age of 44.4 years (ranged 17-80). The mean tumor distance from the anal verge was 9.8 cm. One patient with adenomatous polyp experienced recurrence 14 months postoperatively. Regarding procedure-related complications, one case developed hemorrhage and another case fever and infection in the site of operation. Two patients experienced incontinence for about 3 weeks after TEM surgery. Conclusions: Considering the cultural and religious context of the Middle East, we recommend TEM procedure in specialized centers in this region of the world.

Context: Colorectal cancer is one of the most common cancers and the leading cause of cancer death in Iran. This study aimed to identify the clinical and pathological characteristics, as well as survival rate of colorectal cancer in Iran. Evidence Acquisition: The articles published in PubMed without language and time restrictions were included in this review. Only original clinical articles were included in the review and non-clinical studies, including cellular, molecular, genetics, and animal reports, were excluded. The case reports, letters, reviews, and clinical reports with less than 100 patients were excluded, as well. All the clinical data regarding the patients’ demographics, tumor characteristics, and survival rate were collected.Results: A total of 178 studies were identified at the initial step of literature search. After applying the inclusion and exclusion criteria, 27 studies, including 37901 patients were eligible. The mean age of the patients was 57.2 years, and the male-female ratio was 1.38. Colon, rectum, and rectosigmoid junction accounted for 58%, 28%, and 14% of all colorectal primary sites, respectively. Moreover, the average proportion of the patients with stages 0-I, II, III, and IV was 9%, 39%, 36%, and 16%, respectively. Besides, tumor grades 1, 2, and 3 were reported in 52%, 37%, and 11% of the patients, respectively. Adenocarcinoma (96.8%) was the most frequent histological type. The mean and median survival rate was 80.1 and 55.2 months, respectively. Additionally, the average 5-year overall survival rate was 52.5%. Conclusions: In Iran, colorectal cancer tends to manifest at locally advanced stage with poor prognosis. Therefore, public health strategies, such as screening programs, should be planned for early detection of this aggressive neoplasm.

Introduction: A vermiform appendix in an inguinal hernia, inflamed or not, is known as Amyand’s hernia. Here we present a case with Amyand’s hernia. Case Presentation: A 63-year-old Caucasian man with a perforated vermiform appendix in the hernia sac (acute suppurative appendicitis), presented an incarcerated right groin hernia and underwent simultaneous appendectomy and hernia repair. Conclusions: A surgeon repairing hernia may encounter unexpected intraoperative findings, like Amyand’s hernia. It is important to be always prepared for such conditions and apply the appropriate treatment.