Diseases of the colon and rectum
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Iron deficiency anemia can be the first presentation of right-sided colon cancer. There is an impression that because this presentation is nonspecific it may be associated with a longer delay from referral to diagnosis compared with those patients with symptoms of change in bowel habit and/or rectal bleeding caused by more distal colorectal cancer. This study was designed to determine the incidence of colon cancers in patients referred to the hospital with iron deficiency anemia and to determine what proportion of these patients were referred and diagnosed urgently in line with cancer waiting time targets. ⋯ Males referred with iron deficiency anemia have a significant risk of having colon cancer. The risk seems lower in females; this gender difference has been observed in other studies and further evidence should be sought before advising any change in referral practice.
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Currently, surgeons specialize in colon and rectal surgery after a complete residency and certification in general surgery. The American Board of Surgery is proposing reorganization of surgical training; only two to four years of general surgery would be required followed by two to three years of specialization. The general surgery practice patterns of colon and rectal surgeons are unknown. ⋯ Currently, colon and rectal surgeons perform general surgery procedures in clinical practice. If general surgery residency of future trainees is shortened, the types of procedures colon and rectal surgeons will be competent to perform may need to be redefined. This will have profound implications on training programs, certification requirements, and future practice patterns.
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Patients with perineal burns and immobile hospitalized patients with severe excoriation from incontinence caused by excessive diarrhea pose difficult management problems, frequently requiring stoma formation. The Zassi Bowel Management System (Zassi Medical Evolutions, Fernandina Beach, Florida) multichannel intrarectal catheter was evaluated for its safety and its ability to divert feces away from perineal skin to allow wound and skin healing. ⋯ The Zassi Bowel Management System tube allows diversion of feces away from the perineum for wound healing. It is safe, effective, and may help avoid stoma formation.
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Multicenter Study
Detection of metachronous neoplasms in colorectal cancer patients: identification of risk factors.
Patients with colorectal cancer have a high risk of developing metachronous neoplasms. Identification of predictive factors associated with such conditions would allow individualized follow-up strategies in these patients. This study was designed to identify individual and familial factors associated with the development of metachronous colorectal neoplasms in patients with colorectal cancer. ⋯ Patients with previous or synchronous colorectal adenoma have an increased risk of developing metachronous colorectal neoplasms. Accordingly, this subgroup of patients may benefit from specific surveillance strategies.
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We studied preoperative and perioperative factors with particular attention to the role of immunomodulatory medication, which may impact the incidence of pouch-related septic complications. ⋯ Preoperative steroid use is associated with higher rates of early but not late pouch-related septic complications. We recommend that patients be weaned of steroids before ileal pouch surgery or be warned of the higher risk of postoperative sepsis.