PSJD - Yadda

1

Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation – case report

100%

Khuat D., Julkowska A., Chamarczuk F., Flont A., Horbacka K.

Polish Journal of Surgery

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2020

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vol. 92(5)

57-59

EN

Introduction: Chest pain is one of the most common symptoms with which patients report to the doctor. The reason for this is the fear of the sick, who often equate this symptom with dangerous diseases such as heart attack. The primary source of pain does not always have to be located within the chest. Colon perforation is a rare but possible complication of colonoscopy, which may result in free gas entering the mediastinum which is accompanied by chest pain. Case report: We present the case of a 78-year-old woman who reported to the hospital emergency department with chest pain, shortness of breath and abdominal pain. On the basis of imaging examinations, perforation of sigmoid affected by diverticulosis, complicated by pneumomediastinum and retroperitoneal emphysema, was suspected. The aforementioned ailments were caused by iatrogenic perforation of the sigmoid during diagnostic colonoscopy performed on an outpatient basis a few hours before reporting to the hospital. The patient was urgently qualified for laparotomy. Intraoperatively, perforation was confirmed at the rectosigmoid junction, which was the cause of retroperitoneal and pneumomediastinum with rightsided emphysema of the lateral neck region. No fluid or intestinal contents were found in the abdomen. The sigmoid colon and upper rectum were resected via double-stapled anastomosis performed between the descending colon and rectum. The patient was discharged home in good condition on the 7th postoperative day. Conclusions: Colonoscopy is a diagnostic and therapeutic procedure that is considered relatively safe, but also carries complications such as bleeding or perforation of the large intestine. Diverticular disease is a common condition which most often affects the sigmoid colon. In areas of the weakest resistance, diverticulum formation occurs as a result of increased intra-abdominal pressure, which is an additional risk factor for perforation during colonoscopy. It is important to remember the possible different clinical presentation of gastrointestinal perforation, which may also manifest as chest pain. With early detection and surgical treatment, life-threatening complications associated with the development of pneumothorax can be avoided.

2

Computed Tomography colonography in Preoperative Evaluation of colorectal cancer

100%

Rudzińska M., Rudziński J., Szyca R., Leksowski K.

Polish Journal of Surgery

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2010

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vol. 82

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issue 8

449-453

EN

Computed tomographic colonography (CTC) has the potential to become an accepted technique for detecting of colorectal cancer.The aim of the study was to evaluate usefulness of CTC in preoperative evaluation of colorectal tumors and the regions of colon endoscopically unavailable.Material and methods. A total of 49 patients with colorectal tumors identified at conventional colonoscopy were included. In all these patients CTC was performed and results were compared with colonoscopy. In addition in CTC infiltration of surrounding tissues, organs, lymph nodes and liver were assessed. Findings were compared with contrast-enhanced CT of abdomen.Results. Colonoscopy was completed to the caecum in 24 (48.9%) patients. CTC failed only in one patient. CTC was congruent with colonoscopy in evaluation of tumor location and morphological type. In CTC two additional tumors were found proximately to occlusive masses, it is in endoscopically unavailable regions. Sensitivity and specificity of CTC comparing to CT in diagnosis of fat tissue infiltration and surrounding organs infiltration at the site of tumor were 95.5% / 50% and 100% / 86.9% respectively. Concordance of results in evaluation of lymph nodes was 93.9% while sensitivity and specificity for CTC was 84.6% and 100% respectively. Concordance of evaluation of liver metastases was 78.8%, while sensitivity and specificity for CTC was 61.5% and 90% respectively.Conclusions. CTC is a useful method in diagnostics of colorectal tumors. It allows to diagnose tumor, determine local tumor staging and detect synchronous lesions in endoscopically unavailable regions.

3

Usefulness of CEA Concentration Measurement and Classic Colonoscopy in Follow-Up After Radical Treatment of Colorectal Cancer

100%

Banaszkiewicz Z., Jarmocik P., Frasz J., Tojek K., Mrozowski M., Jawień A.

Polish Journal of Surgery

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2011

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vol. 83

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issue 6

310-318

EN

There is always a certain rate of recurrence after radical treatment for cancer and to get on it an early detection of disease set back is crucial.Material and methods. Medical data of patients operated on for primarily detected colorectal cancer in years 1993-2002 was retrospectively reviewed. Usefulness of follow-up means such as physical examination, or CEA and endoscopic surveillance was analyzed. All mentioned above were applied to scheduled follow-up (in 3, 6 and 12 month intervals following an operation and annually after that by the year 5).Results. Complete and reliable data was obtained from 340 out of 502 follow-up intended subjects (67.7%). Elevated CEA was the most frequent predictor of recurrence within non-symptomatic subjects meeting follow-up appointments (60%). The cancer set back diagnosed by means of either physical or endoscopic examinations was the case only in one out of five patients (20.75% and 18.87% respectively). Clinical onset of recurrence making patients meet an unscheduled appointment was found increasing relative risk of nothing-but-palliative option either for them with local set back, or meta-static spread. Relative risk of onset of meta-chronous colonic cancer was significantly higher in patients being affected by synchronous advanced adenoma at time of surgery compared to those with one-fold changes.Conclusions. CEA scheduled follow-up after treatment for colorectal cancer CRC seems adequate to provide a good outcome of treatment for recurrent tumors. CRC patients presenting with synchronous advanced adenomas at time of surgery are probably to be under more intensive endoscopic surveillance.

4

Knowledge and Awareness of Colorectal Cancer

75%

Lewandowski M., Lipiński P., Bednarski I., Mik M., Dziki A.

Polish Journal of Surgery

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2020

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vol. 92(2)

34-41

EN

Introduction: Colorectal cancer (CRC) is the third most common malignancy in men and the second most common in women. The disease constitutes a significant civilization and social problem. The aim: The aim of the study is to assess the sudy group’s awareness and knowledge about CRC, as well as about its diagnostics and treatment. Material and methods: An online questionaire form was distributed in the study group regarding issues related to CRC, and followed by statistical analysis and interpretation of the obtained survey results. Results: After analysis, we found that a significant percentage of the surveyed sample group had basic knowledge and awareness in the area of CRC, whereas about half of the respondents did not consider themselves sufficiently informed about the disease. Conclusions: Considering the scale of the problem posed by CRC, it is necessary to undertake broader action to promote knowledge about this disease and to carry out this type of research on a larger and more socioeconomically diverse population.

5

Clinical value of colonoscopy and positron emission tomography with computed tomography for colorectal cancer diagnosis

75%

Nowicki A., Kula Z., Dobrzyń P.

Polish Journal of Surgery

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2019

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vol. 91(1)

6-9

EN

Introduction: Colonoscopy and PET / CT are among the major diagnostic tests for colorectal cancer. The sensitivity, specificity, and accuracy of these studies are still being assessed differently. Objective: The aim of the study was to compare the sensitivity, specificity and accuracy of colonoscopy and PET / CT in the diagnosis of colorectal cancer. Material and methods: The medical records of 125 patients with colonoscopy and PET / CT in the years 2014-2015 were analyzed retrospectively. The research was done at the Professor Franciszek Łukaszczyk Oncology Center in Bydgoszcz. Based on the macroscopic description of colonoscopy, the results were divided into two groups: with and without probability of cancer. The average SUV value in PET / CT for colorectal cancer was calculated and without this diagnosis. The average value of SUV 14 and higher was considered probable, while 11 or less had no probability of cancer. Standardized mathematical formulas were used to evaluate the sensitivity, specificity and accuracy. Results: More than half of the patients - 78 (62.4%) were males. The majority of patients -42 (36.6%) were aged 65-74. The majority (106) (68.8%) were diagnosed as polyps and 24 (15.6%) as tumor-like lesions. Polyps were placed in the rectum -32 (30.2%), in the sigmoid colon - 26 (24.5%) and 15 (13.2%) in the ascending colon. Tumors were located in the rectum - 11 (45.8%) and 4 (16.7%) in the recto-sigmoid junction. 38 (24.6%) adenocarcinomas and 67 (43.5%) adenomas were diagnosed. The detection rate of RJG was 32% in colonoscopy and PET / CT. The sensitivity of the colonoscopy was 80%, the specificity - 68.4% and the accuracy - 71.4%. The sensitivity, specificity and accuracy of PET / CT were 65%, 75%, 4% and 72.7%, respectively. Conclusions: Colonoscopy has a higher sensitivity in colorectal cancer diagnosis, but specificity and accuracy are higher in PET / CT. Keywords: colorectal cancer, colonoscopy, PET / CT, sensitivity, specificity, accuracy

6

Colonoscopy for colorectal cancer screening - is it effective in the hands of a general surgery resident?

75%

Matyja M., Pasternak A., Wysocki M., Pędziwiatr M., Szura M., Rembiasz K.

Polish Journal of Surgery

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2018

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vol. 90(5)

6-12

EN

INTRODUCTION: Colonoscopy is considered to be a gold standard for colorectal cancer (CRC) screening. Endoscopy training is an essential component of general surgery training program. Patients should receive care at the highest level possible, nevertheless residents need to gain experience. The aim of our study was to evaluate the effectiveness of colonoscopy performed by general surgery residents by comparing quality indicators between surgical trainees and consultants. MATERIALS AND METHODS: The analysis included 6384 patients aged 40–65 who underwent screening colonoscopy between October 2014 and February 2018. The patients were divided into two groups: group I – patients examined by residents, group II - patients examined by board-certified general surgeons. Quality indicators such as cecal intubation rate, adenoma detection rate and patient tolerance scale were compared between the two groups. RESULTS: Group I comprised 2268 (35.53%) and group II 4116 (64.47%) patients. The overall cecal intubation rate (CIR) was 95.99%, equal for both groups (p = 0.994). There was no statistically significant difference in adenoma detection rate: 29.30% among residents and 27.66% among consultants (p = 0.203). Patient tolerance of the examination was very good (4-point scale) in consultants group in 78.98% of cases and in 75.18% cases among residents (p < 0.001). CONCLUSION: In a proper learning environment general surgery residents are able to perform high-quality and effective screening colonoscopy. However, residents need to continue the progress in their technique to improve patient tolerance in order to reach the proficiency of a consultant.

7

Free gas in the peritoneal cavity after colonoscopy. Indication for immediate action or incidental finding in imaging tests after uncomplicated colonoscopy? Literature review

75%

Znamirowski P., Głuszek S.

Polish Journal of Surgery

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2020

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vol. 92(3)

44-50

EN

Colonoscopy is a routine diagnostic and therapeutic procedure. Along with the increase in the complexity of the procedures performed, the risk of complications increases. In 2017, WSES (World Society of Emergency Surgery) published the principles of safe colonoscopy. Intestinal perforation is one of the most common complications. The risk of perforation in treatment procedures such as mucosectomy or endoscopic dissection is significantly greater than the risk of diagnostic colonoscopy. The basic rule of the procedure in case of suspected perforation is close supervision over the patient’s condition and the soonest possible repair of damage. The role of the endoscopist is not only early recognition, but also early treatment of damage. Immediate endoscopic treatment of lesions is an effective, final and acceptable management strategy. In patients who have undergone imaging diagnostics for another reason, free gas in the peritoneal cavity can be recognized. It does not have to mean the need for urgent surgical intervention. Patients with asymptomatic pneumoperitoneum after colonoscopy should, however, be treated as patients with suspected perforation of the large intestine and undergo careful clinical observation in accordance with WSES recommendations. Colonoscopy is a procedure with a risk of complications, which should be reported to patients qualified for endoscopy, but appropriate management reduces the risk of morbidity and mortality associated with this procedure.

8

Pęknięcie śledziony po badaniu kolonoskopowym – opis przypadku

63%

Serwin D., Hebzda A., Szczeblowska D., Pokrzepa W., Wojtuń S., Gil J., Grys I.

Pediatria i Medycyna Rodzinna

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2012

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vol. 8

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issue 2

168-171

EN

Introduction: Colonoscopy is routinely performed test in the diagnosis and prevention of colon diseases. Splenic rupture is a rare complication, 80 cases described so far. Case study: Patient at age 72, hospitalized with anaemia. During the colonoscopy – polypectomy of sigmoid colon polyp. In the second day after treatment: the morning syncope, hypotension, positive peritoneal signs. Additional examinations: X‑ray: no change, USG and CT scan: splenic rupture with a large hematoma, a large amount of blood in the peritoneal cavity. The patient was qualified for laparotomy by which it was found: blood in the peritoneal cavity, spleen rupture, liver capsule ruptured, stomach with a small hematoma, mesentery colon hematoma, no perforation of the colon. Discussion: Splenic rupture is a rare but serious complication of colonoscopy. Mechanisms leading to splenic rupture: direct trauma, traction system ligament, pulling adhesions between the spleen and the purse. Start of symptoms could occur as from 1 hour up to 2.5 days, usually until 24 hours after colonoscopy. Time to determine the diagnosis: as from 2 hours up to 13 days, mostly before 24‑48 hours. The most commonly used methods for the diagnosis: CT scan, USG. Conclusion: Persons performing endoscopic examination as well as patients undergoing colonoscopy should be aware of the possibility of splenic rupture. In the case of indication of the factors predisposing to complications, in asymptomatic patients an observation for 24 hours after the colonoscopy is recommended as well as USG. If symptoms of splenic rupture appeared, USG and CT should be urgently carried out.

PL

Wprowadzenie: Kolonoskopia jest rutynowo wykonywanym badaniem w diagnostyce i profilaktyce chorób jelita grubego. Pęknięcie śledziony to rzadko odnotowywane powikłanie, dotychczas opisano 80 przypadków. Opis przypadku: Pacjent, lat 72, hospitalizowany z powodu niedokrwistości mikrocytarnej. W trakcie badania kolonoskopowego wykonano polipektomię polipa esicy. W drugiej dobie po zabiegu: poranne omdlenie przy próbie pionizacji, utrzymująca się hipotonia, dodatnie objawy otrzewnowe. W badaniach dodatkowych: RTG przeglądowe jamy brzusznej – bez zmian, USG jamy brzusznej – płyn w jamie otrzewnej, powiększona śledziona o nierównych obrysach. W KT jamy brzusznej – rozerwanie śledziony z rozległym krwiakiem, duża ilość krwi w jamie otrzewnej. Pacjenta zakwalifikowano do laparotomii zwiadowczej, w wyniku której stwierdzono: znaczna ilość płynnej krwi i skrzepów w jamie otrzewnej, śledziona z linijnym pęknięciem przy szypule, wątroba z pękniętą torebką oraz niewielkim uszkodzeniem miąższu i krwawieniem, na przedniej ścianie żołądka krwiak z niewielkim uszkodzeniem surowicówki, krezka okrężnicy – w pobliżu zagięcia śledzionowego krwiak, nie ujawniono perforacji jelita. Omówienie: Pęknięcie śledziony jest bardzo rzadkim, ale groźnym powikłaniem kolonoskopii. Wśród mechanizmów prowadzących do uszkodzenia śledziony wymienia się: bezpośredni uraz, pociąganie układu więzadłowego, pociąganie zrostów między śledzioną i okrężnicą. Pęknięcie śledziony może być natychmiastowe lub opóźnione. Początek objawów występuje od 1 godziny do 2,5 dnia, najczęściej do 24 godzin od wykonania kolonoskopii. Czas do ustalenia rozpoznania – od 2 godzin do 13 dni, najczęściej do 24‑48 godzin. Najczęściej stosowane metody ustalenia rozpoznania to KT jamy brzusznej i USG jamy brzusznej. Śmiertelność wskutek pęknięcia śledziony po kolonoskopii – opisano 2 przypadki. Leczenie – w większości przypadków splenektomia. Podsumowanie: Wykonujący badania endoskopowe, jak również pacjenci poddawani badaniu kolonoskopowemu powinni być świadomi możliwości wystąpienia pęknięcia śledziony. W przypadku wystąpienia czynników predysponujących do wystąpienia tego powikłania u pacjentów bezobjawowych wskazana jest obserwacja do 24 godzin po kolonoskopii oraz wykonanie badania USG jamy brzusznej. W przypadku wystąpienia objawów sugerujących pęknięcie śledziony należy w trybie pilnym wykonać USG i KT jamy brzusznej.

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Chest pain caused by pneumomediastinum as the first symptom of sigmoid perforation – case report

Computed Tomography colonography in Preoperative Evaluation of colorectal cancer

Usefulness of CEA Concentration Measurement and Classic Colonoscopy in Follow-Up After Radical Treatment of Colorectal Cancer

Knowledge and Awareness of Colorectal Cancer

Clinical value of colonoscopy and positron emission tomography with computed tomography for colorectal cancer diagnosis

Colonoscopy for colorectal cancer screening - is it effective in the hands of a general surgery resident?

Free gas in the peritoneal cavity after colonoscopy. Indication for immediate action or incidental finding in imaging tests after uncomplicated colonoscopy? Literature review

Pęknięcie śledziony po badaniu kolonoskopowym – opis przypadku