Diseases of the colon and rectum
-
This study was designed to assess the role of fecal lactoferrin and calprotectin as markers of intestinal inflammation in patients with Crohn's disease who have undergone ileocolonic resection. ⋯ Crohn's disease patients maintain high fecal levels of lactoferrin and calprotectin at long-term follow-up after resection of the diseased bowel even in case of clinical remission. The significant correlation between the two fecal markers may be the expression of the ongoing intestinal inflammation. Only lactoferrin significantly correlated with C-reactive protein and showed a reliable threshold value for systemic inflammation. Lactoferrin fecal levels may be a reliable indicator for intestinal inflammation influencing the systemic inflammatory status. The third predictor of lactoferrin fecal level was the presence of episodes of clinical recurrence during the postoperative follow-up.
-
Despite the evolution in the management of traumatic colorectal injuries in both civilian and military settings during the previous few decades, they continue to be a source of significant morbidity and mortality. The purpose of this study was to analyze management and clinical outcomes from a cohort of patients suffering colorectal injuries. ⋯ Injury to the rectum or transverse colon is an independent predictor of mortality. The use of a diverting stoma varied by injury site and was associated with a decreased leak rate but demonstrated no impact on the incidence of sepsis or mortality.
-
Inflammation, villous atrophy, colonic metaplasia, and dysplasia have been observed within the mucosa of ileal pelvic pouches after restorative proctocolectomy. This study was designed to determine the prevalence of mucosal dysplasia in ileal pouch and any associated risk factors. ⋯ Clinical and microscopic evidence of ileal-pouch inflammation is common. Ileal-pouch mucosal dysplasia is uncommon, occurring in only 1 of 138 patients. Villous atrophy and colonic metaplasia were not observed in this series. Routine pouch surveillance with biopsies may not be warranted.
-
Behçet's disease is a chronic, relapsing, systemic inflammatory disease characterized by recurrent oral and genital ulcers, skin lesions, and ocular lesions. Gastrointestinal tract is occasionally involved in Behçet's disease, and the typical gastrointestinal lesions are punched-out, discrete mucosal ulcerations. Corticosteroids, 5-aminosalicylic acid derivatives, thalidomide, and immunomodulators have been used to treat Behçet's disease. ⋯ Abdominal pain from recurrent ulcers improved by the fifth day after the infliximab infusion and almost disappeared by the second week. An ileocolonoscopy performed 15 days after the infliximab infusion showed near complete healing of the recurrent ulcers. This report suggests that infliximab may be an effective novel therapy for the management of early postoperative complications and recurrences in gastrointestinal Behçet's disease.
-
Pudendal neuropathy and fecal incontinence frequently coexist; however, the contribution of neuropathy is unknown. The pudendal nerve innervates the external anal sphincter muscle, anal canal skin, and coordinates reflex pathways. Lateral dominance or a dominantly innervating nerve and its subsequent damage may have major implications in the etiology and treatment of fecal incontinence. This study was designed to establish the prevalence of pudendal neuropathy, in particular a unilateral one, and to examine the impact on anorectal function. ⋯ Unilateral pudendal neuropathy is a common abnormality in individuals with fecal incontinence and is significantly associated with both attenuated resting pressures and squeeze increments. Although there are limitations in the interpretation of pudendal nerve terminal motor latencies, this study demonstrates that further exploration of the concept of lateral dominance is needed.