BACKGROUND: Crohn\'s disease (CD) is a chronic inflammatory bowel disease of a multifactorial pathogenesis. Recently numerous genetic variants linked to an aggressive phenotype were identified, leading to a progress in therapeutic options, resulting in a decreased necessity for surgery. Nevertheless, surgery is often inevitable. The aim of the study was to evaluate possible risk factors for postoperative complications and disease recurrence specifically after colonic resections for CD.
METHODS: A total of 241 patients who underwent colonic and ileocaecal resections for CD at our instiution between 2008 and 2018 were included. All data was extracted from clinical charts.
RESULTS: Major complications occurred in 23.8% of all patients. Patients after colonic resections showed a significantly higher rate of major postoperative complications compared to patients after ICR (p =  < 0.0001). The most common complications after colonic resections were postoperative bleeding (22.2%), the need for revision surgery (27.4%) and ICU (17.2%) or hospital readmission (15%). As risk factors for the latter, we identified time interval between admission and surgery (p = 0.015) and the duration of the surgery (p = 0.001). Isolated distal resections had a higher risk for revision surgery and a secondary stoma (p = 0.019). Within the total study population, previous bowel resections (p = 0.037) were identified as independent risk factors for major perioperative complications.
CONCLUSIONS: The results indicate that both a complex surgical site and a complex surgical procedure lead to a higher perioperative morbidity in colonic resections for Crohn\'s colitis.

Optimal surgical management of patients with intractable constipation and diffuse colonic motility is not well defined. We present a patient with such a history, who ultimately achieved successful surgical management of constipation through a stepwise approach. An 8-year-old female presents with longstanding constipation and diffuse colonic dysmotility demonstrated with colonic manometry. She initially underwent sigmoid resection and cecostomy which failed and required diverting ileostomy. We initially proceeded with an extended resection, colonic derotation (Deloyers procedure), and neo-appendicostomy (neo-Malone) which resulted in successful spontaneous stooling for 1 year. Her constipation recurred and she subsequently underwent completion colectomy with ileorectal anastomosis given that she previously demonstrated ability to stool independently. Six months from surgery the patient continues to stool daily with assistance of fiber and loperamide. This case highlights a stepwise surgical approach to managing constipation due to diffuse colonic dysmotility and demonstrates that diffuse dysmotility may benefit from an upfront subtotal resection; however, it is crucial to assess a patient\'s ability to empty their rectum prior.

Intussusception is a phenomenon commonly associated with the paediatric population. In adults, intussusception is frequently a result of a neoplastic process. We present the case of a 56-year-old gentleman who was diagnosed to the local Emergency Department with a 4-day history of worsening severe, left sided lower abdominal pain. The pain was colicky in nature. Computed tomography identified a long-segment intussusception involving distal small bowel, caecum, ascending colon, the entirety of transverse colon and its associated mesentery. The patient proceeded to theatre where a laparotomy and right hemicolectomy was performed. Histopathological analysis of the specimen identified an ileal myxoma as the lead-point of the intussusception. This report emphasises the value of prompt investigation in atypical clinical presentations.

Although rare, colo-renal fistulas pose diagnostic challenges due to their varied presentations and etiologies. Here, we present a unique case of a woman with recurrent pyelonephritis, severe anemia, and unintended weight loss, who was eventually diagnosed with a colo-renal fistula. Delayed imaging following intraoperative fluoroscopy revealed the abnormal connection between the colon and upper urinary tract. The patient underwent nephrectomy and colon resection. This case report emphasizes the need for suspicion in diagnosing such fistulas and highlights their varied management. This case adds to the literature by illustrating an unusual presentation and underscores the complexity of diagnosis and treatment.

The management of perforated non-faeculent diverticulitis has traditionally involved performing a colonic resection (CR). Laparoscopic lavage (LL) has emerged as a less invasive alternative in recent years. The aim of this meta-analysis was to assess the role of LL in the surgical treatment of perforated non-faeculent diverticulitis. To that end, we conducted a search on Embase, Medline, and Cochrane databases for comparative studies in the English language published till June 2021 [PROSPERO (CRD42021269410)]. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the methodological index for non-randomised studies (MINORS). Data were analysed using Cochrane RevMan. Pooled odds ratio (POR) and cumulative weighted ratios (CWR) were calculated. A total of 13 studies involving 1061 patients were found eligible, including seven studies based on three randomised control trials (RCTs). LL was associated with a reduced risk of wound infection, stoma formation, and need for further surgery by 77% [POR: 0.23, 95% confidence interval (CI): 0.07-0.74], 83% (POR: 0.17, 95% CI: 0.05-0.56), and 53% (POR: 0.47, 95% CI: 0.23-0.97) respectively. Duration of surgery and hospitalisation was reduced by 54% and 43% respectively. However, LL was associated with higher rates of unplanned reoperations (POR: 2.05, 95% CI: 1.22-3.42), recurrence (POR: 9.47, 95% CI: 3.24-27.67), and peritonitis (POR: 8.92, 95% CI: 2.71-29.33). No differences in mortality or readmission rates were observed. LL in Hinchey III diverticulitis lowers the incidence of stoma formation and overall reoperations without an increase in mortality but at the cost of higher recurrence rates and peritonitis. A limitation of this study was the inclusion of non-RCTs. An elective resection should be considered after LL. Guidelines for surgical techniques in LL need to be standardised.

Arterial anomalies of the viscera are not unusual. Of the arterial anomalies, the celiac and the superior mesenteric anomalies are well studied and reviewed in the literature. These variations are due to changes occurring during the development of vessels. Also, the variations in the colonic blood supply have been detailed in the context of conduit surgery in esophageal replacement and oncological resections. Of these, the rarer anomaly is the aberrant left colic artery (ab LCA). Previously described in various anatomic descriptions; it has never been reported in a clinical situation. A middle-aged female presented with abdominal pain and lower gastrointestinal (GI) bleed. On further evaluation, she was diagnosed to have transverse colon malignancy. She underwent extended right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy as classically described. During the dissection, she was found to have an LCA arising from the superior mesenteric artery (SMA) just below the inferior border of the pancreas two centimeters higher to the origin of the middle colic artery. This artery was carefully dissected and preserved. Injury of the ab LCA is possible given the unusual course of the artery. Implications of iatrogenic injury in colonic and pancreatic surgeries may result in additional morbidity which is discussed in detail.

Benign proliferations of smooth muscle cells are known as leiomyomas; these proliferations can occur in the colon and are typically found incidentally. Colonic leiomyomas are very rare and are most commonly found in the descending or sigmoid colon. A 59-year-old Hispanic female presented to the gastroenterology clinic for surveillance colonoscopy. The biopsy showed a submucosal microscopic leiomyoma in the transverse colon. The treatment of choice for most colonic leiomyomas is surgical excision. This rare case favors the notion that endoscopic polypectomy may be superior to surgical excision, ultimately providing a less-invasive and less-costly procedure without complications or recurrence.

The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome\'s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant.

The most common localization for intestinal Crohn\'s disease (CD) is the terminal ileum and ileocecal area. It is estimated that patients with CD have one in four chance of undergoing surgery during their life. As surgery in ulcerative colitis ultimately cures the disease, in CD, regardless of the extent of bowel removed, the risk of disease recurrence is as high as 40%. In elective surgery, management of isolated Crohn\'s colitis continues to evolve. Depending on the type of surgery performed, colonic CD patients often require further medical or surgical therapy to prevent or treat recurrence. The elective surgical treatment of colonic CD is strictly dependent on the localization of disease, and the choice of the procedure is dependent of the extent of colonic involvement and previous resection. The most common surgical options in colonic CD are total proctocolectomy (TPC) with permanent ileostomy, segmental bowel resection, subtotal colectomy. TPC completely removes all colonic and rectal disease and avoids the use of a potentially diseased anus. We will review current options for the elective surgical treatment of colonic CD, based on the current literature and our own personal experience.

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis, characterized by painful and erythematous papules, pustules or vesicles that rapidly become ulcerative and necrotic. These ulcers have multiple sub-types and can develop anywhere on the body. There are different postulations as to the mechanisms of development for each sub-type. More than half of patients with PG have an underlying disease, with the highest prevalence being inflammatory bowel disease (IBD), followed by inflammatory arthritis and hematological disorders. Post-operative PG should be considered in any patient undergoing surgery who subsequently develops characteristic necrotic lesions with delayed wound healing, fever and severe localized pain. The clinical manifestations and treatment may differ slightly depending on the type and cause of PG. Herein, we present a patient with myelodysplastic syndrome and arthritis, who underwent surgery for diverticulosis complicated by colovaginal fistula formation, and subsequently developed a very prolonged course of post-operative pyoderma gangrenosum. This report will address the types of PG, their various manifestations and pathogenesis, as well as the management specific to patients with myelodysplastic syndrome. It is our intent to better understand the sub-types in order to predict and prevent post-operative PG.