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Chyle leak following total colectomy for ulcerative colitis: a case report and review of the literature.
Brewer, CF, Al-Abed, Y
Annals of the Royal College of Surgeons of England. 2021;(7):e231-e233
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Abstract
Chyle leak is a rare complication in colorectal surgery. It occurs due to disruption of the lymphatic drainage network in the abdomen or retroperitoneum. We describe the first reported case of chyle leak following total colectomy for inflammatory bowel disease. Our patient underwent total colectomy for severe ulcerative colitis not responsive to medical treatment. Four days postoperatively, a milky fluid was noted in the drainage bag. Analysis of the fluid confirmed chyle. The patient remained well and was successfully managed conservatively with a fat-free elemental diet and was discharged from hospital on day 12 postoperatively. A review of the literature suggests that conservative management with dietary modification is a common and effective management strategy; however, medical and surgical options exist for refractory cases.
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Pouchitis: Treatment dilemmas at different stages of the disease.
Barreiro-de Acosta, M, Bastón-Rey, I, Calviño-Suárez, C, Enrique Domínguez-Muñoz, J
United European gastroenterology journal. 2020;(3):256-262
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Abstract
Pouchitis is a frequent complication in ulcerative colitis patients after proctocolectomy with ileal pouch-anal anastomosis. It is an unspecific inflammation of the pouch with unknown aetiology. First-line treatment for acute and chronic pouchitis is antibiotics. Some cases of severe chronic refractory pouchitis may benefit from biological treatment. Anti-tumour necrosis factor should be recommended as the first option, leaving the new biologicals for multirefractory patients. Permanent ileostomy may be an option in severe cases, after failure of medical treatment. Prophylaxis therapy with a probiotic mixture is recommended after the first episode of pouchitis, whereas it is not clear whether probiotics are useful for all patients after surgery. Here, we present a case report and review the treatment options in different forms of pouchitis.
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New-onset ulcerative colitis in pregnancy associated to toxic megacolon and sudden fetal decompensation: Case report and literature review.
Brunelli, R, Perrone, S, Perrone, G, Galoppi, P, De Stefano, MG, Maragno, AM, Cesarini, M, De Carolis, A, Masselli, G, Vernia, P
The journal of obstetrics and gynaecology research. 2019;(7):1215-1221
Abstract
Ulcerative colitis (UC) is a chronic inflammatory disease rarely arising during gestation. Because the available information is based on case reports or small retrospective studies, diagnosis may be difficult and treatment is still controversial. A case of toxic megacolon developing in late pregnancy associated to a sudden fetal decompensation is described. Diagnostic and clinical topics of acute UC onset in pregnancy are debated.A primipara, 34 years old, 33/0 weeks of gestation, was admitted with a diagnosis of preterm labor, associated to acute bloody diarrhea (up to 10 daily motions) and cramping abdominal pain. A diagnosis of new-onset early-stage UC was made by sigmoidoscopy. An intensive care regimen including hydrocortisone, antibiotics and parenteral nutrition was immediately started. Magnetic resonance imaging of maternal abdomen, fostered by the worsening patient conditions, evidenced dilatation of the entire colon and a severely hampered of fetal muscular tone.Toxic megacolon complicated by superimposed Clostridium difficile infection was associated to a sudden fetal decompensation diagnosed by chance during maternal abdominal magnetic resonance imaging. An emergency cesarean section was mandatory. According to a senior surgeon's decision, total colectomy was not immediately performed following cesarean section with reference to the absence of colonic perforation. We obtained a good short-term maternal outcome and an uncomplicated neonatal course. Counseling of those patients must be focused on timely and multidisciplinary intervention in order to improve the course of maternal disease and to prevent fetal distress.
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Immunoglobulin G4 (IgG4)-associated pouchitis - Part of IgG4 related disease? A case series and review of the literature.
Bilal, M, Gulati, A, Clarke, K
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 2016;(7):817-9
Abstract
BACKGROUND AND AIMS IgG4-mediated pouchitis was first described in 2011. The aetiology and pathogenesis of IgG4-associated pouchitis is unknown. Over the last four years, less than seventy cases of IgG-associated pouchitis have been reported from a pouchitis clinic in Cleveland. METHODS We report the first two cases of IgG4-associated pouchitis from our inflammatory bowel disease clinic and outside of Cleveland. CONCLUSION This highlights the fact that this entity could be more common than we think. It is important for general gastroenterologists to think about IgG4-mediated disease if the patient has refractory pouchitis, so early diagnosis and referral can be made. This would avoid the cost of expensive therapy and minimize antibiotic use which is what happened in our cases prior to this diagnosis being made.
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Febrile pleuropericarditis, a potentially life-threatening adverse event of balsalazide--case report and literature review of the side effects of 5-aminosalicylates.
Coman, RM, Glover, SC, Gjymishka, A
Expert review of clinical immunology. 2014;(5):667-75
Abstract
Ulcerative colitis (UC) is an idiopathic chronic inflammatory disorder that affects the colonic mucosa. One class among the drugs used for its treatment is the 5-aminosalicylates (5-ASAs). While highly efficacious in treating mild-to-moderate UC, 5-ASAs are associated with rare but potentially life-threatening side effects such as pericarditis, myocarditis and pneumonitis. These adverse events appear to be caused by a hypersensitivity reaction and resolve after cessation of 5-ASA drugs. This article presents a case report of febrile pleuropericarditis in a UC patient treated with balsalazide, and provides a thorough literature review of the rare side effects of 5-ASAs, their incidence, clinical presentation, differential diagnosis and treatment. In conclusion, the clinicians should be aware that this type of adverse events to 5-ASA compounds can be easily overlooked but it has significant morbidity if not promptly diagnosed.
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[Bariatric surgery in inflammatory bowel disease; case report and review of the literature].
Tenorio Jiménez, C, Manzano García, G, Prior Sánchez, I, Corpas Jiménez, MS, Molina Puerta, MJ, Benito López, P
Nutricion hospitalaria. 2013;(3):958-60
Abstract
Inflammatory bowel disease (IBD) is rarely associated with obesity, as malabsorption is a common feature of these diseases (1). However, some patients may experience morbid obesity and associated complications refractory to dietary treatment and benefit from bariatric surgery. It has even been postulated that surgery may result in improvement of IBD by reducing inflammatory markers (2). However, patients may experience a higher incidence of complications following surgery in the context of immunosuppressive therapy and prior malabsorption. Therefore, if surgery is performed, careful patient selection and individualization of technique are essential. We present a patient diagnosed with ulcerative colitis who presented severe protein malnutrition after bariatric surgery type bilio-pancreatic diversion and review the available literature.
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Fulminant Clostridium difficile-associated pouchitis with a fatal outcome.
Shen, B, Remzi, FH, Fazio, VW
Nature reviews. Gastroenterology & hepatology. 2009;(8):492-5
Abstract
Background. A 61-year-old woman who had undergone an ileostomy closure 10 days previously presented to a tertiary medical center with abdominal pain, vomiting, diarrhea, dehydration, and oliguria. The patient had undergone a staged total proctocolectomy with ileal-pouch-anal anastomosis and a loop ileostomy 8 months previously to treat her steroid-refractory ulcerative colitis.Investigations. Physical examination, abdominal and pelvic CT scan, blood laboratory tests, pouch endoscopy, and fecal testing for Clostridium difficle toxins A and B.Diagnosis. Fulminant C. difficile-associated pouchitis and enteritis, which led to Psuedomonas aeruginosa septicemia, intravascular coagulopathy, acute renal failure, hemorrhagic ascites and respiratory failure and eventual death.Management. Intravenous hydration, aggressive therapy with oral and intravenous antibiotics, supportive care, hemodialysis, and intubation.
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Pyostomatitis vegetans. Report of two cases and review of the literature.
Ruiz-Roca, JA, Berini-Aytés, L, Gay-Escoda, C
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2005;(4):447-54
Abstract
Pyostomatitis vegetans (PV) is a rare benign chronic mucocutaneous pustular disorder of unknown etiology, though it is usually associated with chronic inflammatory disease of the bowel-particularly ulcerative colitis. At the oral level PV manifests as an exophytic lesion with an erythematous perimeter and a creamy-yellow surface presenting a friable covering membrane which easily disintegrates, giving rise to the development of small ulcers or superficial erosions. The histology shows epithelial acanthosis and superficial ulceration. The underlying connective tissue exhibits neutrophil and eosinophil infiltration, with miliary abscesses in some cases. The present study describes 2 cases of PV associated with ulcerative colitis. The differential diagnosis should be established with Neumann type pemphigus vegetans, since in both cases the lesions are clinically similar and the histology reveals an important eosinophil response, acanthosis, and the formation of intraepithelial miliary microabscesses. The treatment of PV focuses on control of the disease. In the event the orofacial lesions persist, topical oral drugs such as corticoids, with additional antibiotherapy, multivitamin complexes, and nutritional supplements, can be provided.