Author Archives: E. Lawson

Article of interest: Volvulus of the Small Bowel and Colon

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Kapadia MR. Volvulus of the Small Bowel and Colon. Clin Colon Rectal Surg. 2017 Feb; 30(1):40-45.

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“Volvulus of the intestines involves twisting around a fixed point. It may occur anywhere along the gastrointestinal tract where there is a long, mobile intestinal segment with a narrow mesenteric attachment. Volvulus leads to luminal obstruction and can compromise intestinal blood flow. For this reason, it tends to be a surgical emergency which requires prompt attention. Failure to recognize the signs and symptoms of intestinal volvulus may lead to bowel ischemia and perforation.”

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.

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Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. doi: 10.1016/S0140-6736(20)30566-3. [Epub ahead of print]

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“191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.”

Stomal necrosis

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Murken DR, Bleier JIS. Ostomy-Related Complications. Clin Colon Rectal Surg. 2019 May;32(3):176-182.

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“Stomal necrosis has been reported to occur in up to 20% of ostomates in the immediate postoperative period ([Fig. 1]).[3] Specific risk factors for stoma necrosis include emergent operation, inadequate mobilization of the bowel, excessive mesenteric resection resulting in inadequate arterial blood supply to or venous drainage from the bowel, and constriction in the abdominal wall due to excessively small openings in the fascia, abdominal wall mesh, or skin.[10] [20] Importantly, the obese patient is seven times more likely to experience stoma necrosis than the nonobese patient.[21] Stoma necrosis is much less common for loop stomas given the dual blood supply to both the afferent and efferent limbs.”

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Kikuchi-Fujimoto disease

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Perry AM, Choi SM. Kikuchi-Fujimoto Disease: A Review. Arch Pathol Lab Med. 2018 Nov; 142(11):1341-1346.

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“Kikuchi-Fujimoto disease (KFD) is a rare entity characterized by subacute necrotizing lymphadenopathy and frequently associated with fever. Young adults of Asian ancestry are most commonly affected, but it has been reported worldwide. Despite many studies in the literature, the cause of KFD remains uncertain. Histologically, KFD is characterized by paracortical lymph node expansion with patchy, well-circumscribed areas of necrosis showing abundant karyorrhectic nuclear debris and absence of neutrophils and eosinophils. Three evolving histologic patterns — proliferative, necrotizing, and xanthomatous — have been recognized. By immunohistochemistry, histiocytes in KFD are positive for myeloperoxidase. There is a marked predominance of T cells in the lesions (with mostly CD8-positive cells) with very few B cells. The differential diagnosis of KFD includes infectious lymphadenitis, autoimmune lymphadenopathy (primarily systemic lupus erythematosus), and lymphoma.”

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Continent ileostomy modifications

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Today’s discussion topics included the Barnett continent intestinal reservoir.

Worsey J, Fazio VW. (2017). Continent Ileostomy. In: Current Therapy in Colon and Rectal Surgery, 3rd ed, pgs. 204-208. Elsevier: NY.

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Philadelphia Illustration Dept./Elsevier

FIGURE 40-3. Barnett modification of the continent ileostomy. (Cleveland Clinic Center for Medical Art & Photography.)

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Surgical Grand Rounds: EVAR, FEVAR, and Open Repair: What to make of alphabet soup

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Presented by Amanda Fobare, MD, Chief Resident

Department of Surgery, Emory University School of Medicine

February 27, 2020

The evidence: EVAR vs. open repair for elective AAA repair: 

  • EVAR 1 – Endovascular Aneurysm Repair Trial 1 (UK)- Lancet (2005, 2016)
  • DREAM – Dutch Randomized Endovascular Aneurysm Management Trial (Netherlands & Belgium)- NEJM (2004), JVS (2017)
  • OVER – Open versus Endovascular Repair Trial (USA)- JAMA (2009), NEJM (2012)

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