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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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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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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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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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Cumulative incidence and risk factors for pouch adenomas associated with familial adenomatous polyposis following restorative proctocolectomy

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World Journal of Gastroenterology 2022年第30期28卷 4152-4162页

作者： Hyo Seon Ryu Chang Sik Yu Young Il Kim Jong Lyul Lee Chan Wook Kim Yong Sik Yoon In Ja Park Seok-Byung Lim Jin Cheon Kim division of colon and rectal surgery Department of SurgeryUniversity of Ulsan College of MedicineAsan Medical CenterSeoul 05505South Korea

BACKGROUND The emergence of restorative total proctocolectomy has significantly reduced the lifetime colorectal cancer risk associated with familial adenomatous polyposis(FAP).However,adenomas may develop in the ileal pouch over time and may even progress to *** evaluated the cumulative incidence,time to development,and risk factors associated with ileal pouch *** To evaluate the cumulative incidence,time to development,and risk factors associated with pouch *** In this retrospective,observational study conducted at a tertiary center,95 patients with FAP who underwent restorative proctocolectomy at our center between 1989 and 2018 were consecutively *** mean follow-up period was 88 *** Pouch adenomas were found in 24(25.3%)patients,with a median time of 52 mo to their first *** adenomas were detected in most patients(95.9%).There were no high-grade dysplasia or *** the 24 patients with pouch adenomas,13 had all detected adenomas *** the 13 patients who underwent complete adenoma removal,four(38.5%)developed *** 11(45.8%)patients with numerous polyps within the pouch,seven(63.6%)exhibited progression of pouch *** cumulative risks of pouch adenoma development at 5,10,and 15 years after pouch surgery were 15.2%,29.6%,and 44.1%,*** colorectal polyposis(with more than 1000 polyps)was a significant risk factor for pouch adenoma development(hazard ratio,2.49;95% confidence interval:1.04-5.96;P=0.041).CONCLUSION Pouch adenomas occur at a fairly high rate in association with FAP after restorative proctocolectomy,and a high colorectal polyp count is associated with pouch adenoma development.

关键词： Adenomatous polyposis coli Familial adenomatous polyposis Adenoma Intestinal polyps Proctocolectomy,restorative Ileal pouch anal anastomosis

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Cecocutaneous fistula diagnosed by computed tomography fistulography:A case report

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World Journal of Gastrointestinal surgery 2022年第10期14卷 1161-1168页

作者： Tung-Yen Wu Kuang-Hua Lo Chao-Yang Chen Je-Ming Hu Jung-Cheng Kang Ta-Wei Pu Department of surgery Tri-Service General Hospital Songsang BranchTaipei 105Taiwan Department of surgery Taipei Veterans General HospitalTaipei 112Taiwan division of colon and rectal surgery Department of SurgeryTri-Service General HospitalTaipei 114Taiwan division of colon and rectal surgery Department of SurgeryTaiwan Adventist HospitalTaipei 105Taiwan division of colon and rectal surgery Department of SurgeryTri-Service General Hospital Songsang BranchNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Enterocutaneous fistula(ECF) is an abnormal communication between the skin and the gastrointestinal tract and is associated with considerable morbidity and mortality. To diagnose ECF, X-ray fistulography and abdominal computed tomography(CT) with intravenous or oral contrast are generally used. If the anatomic details obtained from CT are insufficient, CT fistulography may help diagnose and determine the extent of the abnormal channel. However, CT fistulography is seldom performed in patients with insufficient evidence of a *** SUMMARY A 35-year-old man with a prior appendectomy presented with purulence over the abdominal wall without gastrointestinal tract symptoms or a visible opening on the abdominal surface. His history and physical examination were negative for nausea, diarrhea, muscle guarding, and bloating. Local abdominal tenderness and redness over a purulent area were noted, which led to the initial diagnosis of cellulitis. He was admitted to our hospital with a diagnosis of cellulitis. We performed a minimal incision on the carbuncle to collect the pus. The bacterial culture of the exudate resulted positive for Enterococcus sp. ECF was thus suspected, and we arranged a CT scan for further investigation. CT images before intravenous contrast administration showed that the colon was in close contact with the abdominal wall. Therefore, we conducted CT fistulography by injecting contrast dye into the carbuncle during the CT scan. The images showed an accumulation of the contrast agent within the subcutaneous tissues, suggesting the formation of an abscess. The contrast dye tracked down through the muscles and peritoneum into the colon, delineating a channel connecting the subcutaneous abscess with the colon. This evidence confirmed cecocutaneous fistula and avoided misdiagnosing ECF without gastrointestinal tract symptoms as cellulitis. The patient underwent laparoscopic right hemicolectomy with re-anastomosis of the ileum and transverse c

关键词： Cecocutaneous fistula Enterocutaneous fistula Computed tomography fistulography Laparoscopy Hemicolectomy Case report

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Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction

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世界临床病例杂志 2023年第24期11卷 5660-5665页

作者： Yi-Jie Wang Kuan-Hsun Lin Jung-Cheng Kang Je-Ming Hu Chao-Yang Chen Ta-Wei Pu Department of surgery Tri 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 SurgeryTaiwan Adventist HospitalTaipei 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 SurgerySongshan branchTri-Service General HospitalNational Defense Medical CenterTaipei 105Taiwan

BACKGROUND Ileostomies are commonly performed after colon and rectal ***-assisted ileostomy with adhesion lysis may have potential benefits over conventional open *** To compare the outcomes of laparoscopy-assisted and conventional *** Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively *** groups comprised 26 and 22 patients who underwent laparoscopic ileostomy(laparoscopic group)and conventional ileostomy(conventional group),respectively,performed by a single *** demographics,operative characteristics,postoperative outcomes,and 30-d morbidities and mortality rates were *** The two groups had comparable mean ages,sex distributions,American Society of Anesthesiologists scores,and body mass ***,the laparoscopic group showed similar operative time,better visualization for adhesion lysis,and lower visual analog scale scores than the conventional *** Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores,better intraoperative visualization for effective adhesion lysis,and similar operative time compared with conventional ileostomy.

关键词： Laparoscopy Ileostomy Colorectal cancer Bowel obstruction Tissue adhesion Retrospective study

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