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Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease

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World Journal of Stem Cells 2024年第3期16卷 257-266页

作者： Min Young Park Yong Sik Yoon Jae Ha Park Jong Lyul Lee Chang Sik Yu Division of colon and rectal surgery Department of SurgeryYonsei University College of MedicineSeoul 03722South Korea Division of colon and rectal surgery Department of SurgeryUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease(CD).Anti-tumor necrotic factor(TNF)therapy combined with drainage procedure is effective as ***,previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula *** This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula(CPF)closure rates after stem cell transplantation with and without anti-TNF therapy,and to identify the factors affecting CPF closure and *** The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were *** data were compared according to anti-TNF therapy and CPF *** A total of 65 patients were *** median age of females was 26 years(range:21-31)and that of males was 29(44.6%).The mean follow-up duration was 65.88±32.65 months,and complete closure was observed in 50(76.9%)*** closure rates were similar after stem cell transplantation with and without anti-TNF therapy(66.7%vs 81.6%at 3 year,P=0.098).The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture(P=0.027,0.002,and 0.008,respectively).Clinical factors such as complexity,number of fistulas,presence of concurrent abscess,and medication were not significant for *** cumulative 1-,2-,and 3-year closure rates were 66.2%,73.8%,and 75.4%,*** Anti-TNF therapy does not increase CPF closure rates in patients with stem cell ***,both refractory and non-refractory CPF have similar closure rates after additional anti-TNF *** tract length,proctitis,and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.

关键词： Crohn’s disease Anus Fistula Stem cell transplantation Tumor necrosis factor-alpha inhibitors Infliximab

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Short- and long-term outcomes of surgical treatment in patients with intestinal Behcet’s disease

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World Journal of Gastrointestinal surgery 2024年第2期16卷 429-437页

BACKGROUND Behcet’s disease(BD),a chronic vasculitic disorder affecting multiple organs,is characterized by recurrent oral and genital ulcers,arthritis,vasculitis,and intes-tinal *** intestinal involvement of BD is common in East Asia,the efficacy and long-term outcomes of surgical treatment of intestinal BD still remain to be *** To evaluate the postoperative clinical course of intestinal BD and determine factors associated with its *** Data from patients who underwent surgical treatment for intestinal BD between January 2010 and August 2021 were retrospectively ***’demo-graphics,clinical features,postoperative course,complications,and follow-up data were *** We analyzed 39 surgeries in 31 *** mean patient age was 45.1 years,and the mean interval between the diagnosis of intestinal BD and surgical treatment was 4.9 years(range 1.0-8.0 years).The most common indication for surgery was medical intractability(n=16,41.0%),followed by fistula or abscess(n=11,28.2%).Laparoscopic approaches were used in 19 patients(48.7%),and 5 patients(12.8%)underwent emergency *** most common surgical procedure was ileocecal resection(n=18,46.2%),followed by right colectomy(n=11,28.2%).A diverting stoma was created in only one patient(2.6%).During a mean follow-up period of 45(range 8-72)months,eight cases(20.5%)of recurrence in five patients required *** interval between operations was 12.1 months(range 6.3-17.8 mo).Four patients(10.3%)experienced recurrence within 1 year postoperatively,and all eight recurrences occurred within 2 years of the initial *** reoperation rates at 1 and 3 years were 10.3%and 20.5%,respectively.A redo ileocolic anastomosis was performed in all recurrent *** multivariate Cox regression analysis,emergency surgery[hazard ratio(HR)9.357,95%confidence interval(CI):1.608-54.453,P=0.013]and elevated C-reactive protein(CRP)levels(HR 1.154,95%CI:1.002–1.328,

关键词： Behcet syndrome Intestinal General surgery Recurrence Risk factors

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Mucinous neoplasm of the appendix:A case report and review of literature

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World Journal of Gastrointestinal surgery 2024年第3期16卷 944-954页

作者： Hao-Cheng Chang Jung-Cheng Kang Ta-Wei Pu Ruei-Yu Su Chao-Yang Chen Je-Ming Hu department of surgery Tri-Service General HospitalTaipei 114TaiwanChina Division of colon and rectal surgery Department of SurgeryTaiwanChina Adventist HospitalTaipei 105TaiwanChina Division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105TaiwanChina Division of colon and rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114TaiwanChina department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105TaiwanChina department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 325TaiwanChina

BACKGROUND Appendiceal mucinous neoplasms(AMNs),although not classified as rare,are relatively uncommon tumors most often discovered incidentally during colorectal *** identification of AMNs is difficult due to non-specific sym-ptoms,overlapping tumor markers with other conditions,and the potential for *** underscores the urgent need for precision in diagnosis to pre-vent severe *** SUMMARY This case report describes the unexpected discovery and treatment of a low-grade AMN(LAMN)in a 74-year-old man undergoing laparoscopic hemicolectomy for transverse colon adenocarcinoma(AC).Preoperatively,non-specific gastroin-testinal symptoms and elevated tumor markers masked the presence of *** tumor,presumed to be an AMN peritoneal cyst intraoperatively,was con-firmed as LAMN through histopathological *** neoplasm exhibited mucin accumulation and a distinct immunohistochemical profile:Positive for Ho-meobox protein CDX-2,Cytokeratin 20,special AT-rich sequence-binding protein 2,and Mucin 2 but negative for cytokeratin 7 and Paired box gene *** profile aids in distinguishing appendiceal and ovarian mucinous *** recovery was uncomplicated,and the patient initiated adjuvant chemotherapy for the colon *** This case highlights the diagnostic complexity of AMNs,emphasizing the need for vigilant identification to avert potential complications,such as pseudomyxoma peritonei.

关键词： Adenocarcinoma Appendiceal neoplasms Low-grade appendiceal mucinous neoplasm Peritoneal neoplasms Pseudomyxoma peritonei Case report

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New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease

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World Journal of Gastrointestinal surgery 2024年第8期16卷 2592-2601页

作者： Jong Lyul Lee Yong Sik Yoon Hyun Gu Lee Young Il Kim Min Hyun Kim Chan Wook Kim In Ja Park Seok-Byung Lim Chang Sik Yu Division of colon and rectal surgery Department of SurgeryUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea department of surgery Gangdong Kyung Hee University HospitalSeoul 05278South Korea

BACKGROUND Medical treatment for Crohn’s disease(CD)has continuously improved,which has led to a decrease in surgical recurrence *** these advancements,25%of patients will undergo repeat intestinal *** of CD com-monly occurs on the mesentery side of the anastomosis *** To compare the new anti-mesenteric side-to-side delta-shaped stapled anasto-mosis(DSA)with the conventional stapled functional end-to-end anastomosis(CSA).METHODS This retrospective study included CD patients who underwent ileo-ileal or ileo-colic anastomosis between January 2020 and December *** DSA technique employed a stapler to maintain the concept of anti-mesentery side-to-side ana-stomosis by performing a 90°vertical closure of the open window compared with the CSA *** the corner where the open window is closed,the DSA avoids forming a pouch and creates an anastomosis resembling a delta shape within the intestinal *** compared demographics,preoperative condition,operative findings,and operative outcomes for the two *** The study included 175 patients,including 92 in the DSA group and 83 in the CSA *** two groups were similar in baseline characteristics,preoperative medical treatment,and operative findings except for the Montreal classification *** 30-days postoperative complication rate was signi-ficantly lower in the DSA group compared with the CSA group(16.3%vs 32.5%,P=0.009).Ileus incidence was significantly lower in the DSA group than in the CSA group(4.3%vs 14.5%,P=0.033),and the hospital stay was shorter in the DSA group than in the CSA group(5.67±1.53 days vs 7.39±3.68 days,P=0.001).CONCLUSION The DSA technique was feasible and showed comparable postoperative outcomes with lower short-term complic-ations compared with the CSA *** studies on CD recurrence and long-term complications are warranted.

关键词： Crohn’s disease surgery Anastomosis Complication Recurrence

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Stercoral perforation of the cecum:A case report

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World Journal of Gastrointestinal surgery 2024年第4期16卷 1189-1194页

作者： Hung-Chun Yu Ta-Wei Pu Jung-Cheng Kang Chao-Yang Chen Je-Ming Hu Ruei-Yu Su department of surgery Taichung Armed Forces General HospitalTaichung 411228Taiwan department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 11490Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of colon and rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 325Taiwan

BACKGROUND With less than 90 reported cases to date,stercoral perforation of the colon is a rare *** ulceration is thought to occur due to ischemic pressure necrosis of the bowel wall,which is caused by the presence of a stercoraceous *** underscore this urgent surgical situation concerning clinical presentation,surgical treatment,and results,we present the case of a 66-year-old man with a stercoral *** SUMMARY A 66-year-old man with a history of hypertension,hyperlipidemia,and gout presented at the emergency department with lower abdominal pain and a low-grade fever lasting for a few *** computed tomography indicated a suspected bezoar(approximately 7.6 cm)in the dilated cecum,accompanied by pericolic fat stranding,mild proximal dilatation of the ileum,pneumoperitoneum,and minimal ***,feculent peritonitis with isolated cecal perforation were ***,a right hemicolectomy with peritoneal lavage was performed.A histopathological examination supported the intraoperative *** In stercoral perforations,a diagnosis should be diligently pursued,especially in older adults,and prompt surgical intervention should be implemented.

关键词： Acute abdomen Colectomy Peritoneal lavage Pneumoperitoneum Bezoars Case report

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Cellular angiofibroma arising from the rectocutaneous fistula in an adult: A case report

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World Journal of Clinical Cases 2024年第10期12卷 1778-1784页

作者： Hao-En Chen Yu-Yang Lu Ruei-Yu Su Hong-Hau Wang Chao-Yang Chen Je-Ming Hu Jung-Cheng Kang Kuan-Hsun Lin Ta-Wei Pu department of surgery Taichung Armed Forces General HospitalTaichung 411Taiwan department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan department of Pediatrics Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan department of Pathology Tri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan department of Pathology and Laboratory Medicine Taoyuan Armed Forces General HospitalTaoyuan 32551Taiwan department of Radiology Tri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of colon and rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of Thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Rectocutaneous fistulae are *** infection originates within the anal glands and subsequently extends into adjacent regions,ultimately resulting in fistula *** angiofibroma(CAF),also known as an angiomy ofibroblastoma-like tumor,is a rare benign soft tissue neoplasm predominantly observed in the scrotum,perineum,and inguinal area in males and in the vulva in *** describe the first documented case CAF that developed within a rectocutaneous fistula and manifested as a perineal *** SUMMARY In the outpatient setting,a 52-year-old male patient presented with a 2-year history of a growing perineal mass,accompanied by throbbing pain and minor scrotal *** examination revealed a soft,well-defined,non-tender mass at the left buttock that extended towards the perineum,without a visible *** initial assessment identified a soft tissue tumor,and the laboratory data were within normal *** and pelvic computed tomography(CT)revealed swelling of the abscess cavity that was linked to a rectal cutaneous fistula,with a track-like lesion measuring 6 cm×0.7 cm in the left perineal region and attached to the left *** examination found no significant inner orifices.A left medial gluteal incision revealed a thick-walled mass,which was excised along with the extending tract,and curettage was *** examination confirmed CAF *** patient achieved total resolution during follow-up assessments and did not require additional *** CT imaging supports perineal lesion diagnosis and *** angiofibromas,even with a cutaneous fistula,can be excised transperineally.

关键词： Angiofibroma Perineal mass Rectocutaneous fistula Anorectal fistula Anal fistula Case report

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Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience

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World Journal of Gastrointestinal surgery 2024年第9期16卷 2787-2795页

作者： Yu-Hong Liu Tzu-Chiao Lin Chao-Yang Chen Ta-Wei Pu Division of colon and rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 105TaiwanChina Division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songshan BranchNational Defense Medical CenterTaipei 105TaiwanChina

BACKGROUND Stapled hemorrhoidopexy(SH)is currently a widely accepted method for treating the prolapse of internal *** anal stenosis is a critical complication of SH.A remedy for this involves the removal of the circumferential staples of the anastomosis,followed by the creation of a hand-sewn *** studies have reported modified SH procedures to improve *** hypothesized that our modified SH technique may help reduce complications of anal stenosis after *** To compare outcomes of staple removal at the 3-and 9-o’clock positions during modified SH in patients with mixed *** This was a single-center,retrospective,observational *** with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015,and January 1,2020,were *** operation time,blood loss,length of hospital stay,and incidence of minor or major complic-ations were *** Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1,2015 and January 1,2020,were *** time,blood loss,length of hospital stay,and incidence of minor or major complications were *** investigated 187 patients(mean age,50.9 years)who had undergone our modified SH and 313 patients(mean age,53.0 years)who had undergone standard *** the modified SH group,54%of patients had previously undergone surgical intervention for hemorrhoids,compared with the 40.3%of patients in the standard SH *** modified SH group included five(2.7%)patients with anal stenosis,while 21(6.7%)patients in the standard SH group had complications of anal *** was a significant relationship between the rate of postoperative anal stenosis and the modified SH:0.251(0.085-0.741)and 0.211(0.069-0.641)in multiple regression *** modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in

关键词： Anal canal Hemorrhoids Prolapse Stapled hemorrhoidopexy Postoperative anal stenosis Modified stapled hemorrhoidopexy

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colon perforation with severe peritonitis caused by erotic toy insertion and treated using vacuum-assisted closure:A case report

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World Journal of Clinical Cases 2024年第18期12卷 3548-3554页

作者： Cheng-You Lin Ta-Wei Pu department of surgery Division of Colon and Rectal SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan department of surgery Taichung Armed Force General HospitalTaichung 411Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songshan branchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Colorectal foreign bodies are commonly encountered during *** are frequently observed in men 20 to 90 years of age and have bimodal age *** management is necessary for cases of rectal ***,surgical site infections are the most common complications after colorectal *** SUMMARY We discuss a case of rectal perforation in a patient who presented to our hospital 2 d after its *** perforation occurred as a result of the patient inserting a sex toy in his *** peritonitis was attributable to delayed *** Vacuum-assisted closure was performed to treat the wound,which healed well after *** complications were noted.

关键词： Colorectal surgery Foreign bodies Intestinal perforation Surgical site infection Wound closure techniques Case report

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Treatment of benign rectal stricture caused by repeated anal insertion by endoscopy and balloon dilation:A case report

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World Journal of Gastrointestinal Endoscopy 2024年第2期16卷 91-97页

作者： Shih-Hung Liu Jung-Cheng Kang Je-Ming Hu Chao-Yang Chen Kuan-Hsun Lin Ta-Wei Pu department of surgery Tri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of colon and rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan Division of colon and rectal surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of Thoracic surgery Department of SurgeryTri-Service General HospitalNational Defense Medical CenterTaipei 114Taiwan Division of colon and rectal surgery Department of SurgerySongshan BranchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Benign rectal strictures can be categorized as primary(disease-related)and secondary(surgical anastomosis-related).Secondary strictures arise from surgical complications,whereas primary strictures have diverse etiologies,including various inflammatory *** strictures are usually managed by surgery and *** present an unusual etiology of benign rectal stricture caused by the repeated insertion of foreign objects into the rectum for sexual purposes,resulting in rectal injury and subsequent chronic *** SUMMARY A 53-year-old man presented to the outpatient clinic of the Colorectal surgery department with symptoms of chronic constipation and bloody *** patient previously experienced rectal injury due to foreign object insertion for sexual *** revealed benign circumferential narrowing of the *** underwent treatment by endoscopic argon plasma coagulation and balloon dilation and follow-up as an outpatient for 4 months.A colonoscopy at the end of the follow-up period revealed no evidence of rectal stricture *** A history of rectal injury,followed by chronic inflammation,should be considered in patients with benign rectal *** with endoscopic argon plasma coagulation and balloon dilation can prevent the need for surgical resection of benign rectal strictures.

关键词： Chronic rectal inflammation colonoscopy Benign rectal stricture Foreign body insertion rectal injury Case report

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Outcomes and efficacy of magnetic resonance imaging-compatible sacral nerve stimulator for management of fecal incontinence: A multi-institutional study

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World Journal of Radiology 2024年第2期16卷 32-39页

作者： Binit Katuwal Amy Thorsen Kunal Kochar Ryba Bhullar Ray King Ernesto Raul Drelichman Vijay K Mittal Jasneet Singh Bhullar department of surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States department of colon and rectal surgery Alina Health Abbott Northwestern HospitalMinneapolisMN 55407United States colon and rectal surgery Advocate Illinois MasonicPark RidgeIL 60068United States Volunteer Student Department of ResearchAscension Providence HospitalSouthfieldMI 48075United States colon and rectal surgery University of WisconsinMadisonWI 53715United States General and Colorectal surgery Ascension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States department of surgery Department of Medical EducationAscension Providence HospitalMichigan State University College of Human MedicineSouthfieldMI 48075United States

BACKGROUND Fecal incontinence(FI)is an involuntary passage of fecal matter which can have a significant impact on a patient’s quality of *** modalities of treatment exist for *** nerve stimulation is a well-established treatment for *** the increased need of magnetic resonance imaging(MRI)for diagnostics,the In-terStim which was previously used in sacral nerve stimulation was limited by MRI *** MRI-compatible InterStim was approved by the United States Food and Drug Administration in August 2020 and has been widely *** To evaluate the efficacy,outcomes and complications of the MRI-compatible *** Data of patients who underwent MRI-compatible Medtronic InterStim placement at UPMC Williamsport,University of Minnesota,Advocate Lutheran General Hospital,and University of Wisconsin-Madison was pooled and *** demographics,clinical features,surgical techniques,complications,and outcomes were *** the Reporting of Observational studies in Epidemiology(STROBE)cross-sectional reporting guidelines were *** Seventy-three patients had the InterStim *** mean age was 63.29±12.2 ***-seven(78.1%)patients were females and forty-two(57.5%)patients had *** addition to incontinence,overlapping symptoms included diarrhea(23.3%),fecal urgency(58.9%),and urinary incontinence(28.8%).Fifteen(20.5%)patients underwent Peripheral Nerve Evaluation before proceeding to definite implant ***-two(43.8%)patients underwent rechargeable InterStim ***(4.1%)patients needed removal of the *** of the external lead connection was observed in 7(9.6%)patients after the stage I *** explanation for one patient was due to ***(9.6%)patients had other complications like nerve pain,hematoma,infection,lead fracture,and *** mean follow-up was 6.62±3.5 ***-eight(93.2%)patients reported significant improvement of symptoms on

关键词： Fecal incontinence Sacral nerve stimulation InterStim Magnetic resonance imaging Sacral neuromodulation

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