1.
Megacystis microcolon intestinal hypoperistalsis syndrome: Case series and updated review of the literature with an emphasis on urologic management.
Wymer, KM, Anderson, BB, Wilkens, AA, Gundeti, MS
Journal of pediatric surgery. 2016;(9):1565-73
Abstract
INTRODUCTION Megacystis microcolon intestinal hypoperistalsis (MMIHS) is a rare disorder characterized by distended nonobstructed bladder, microcolon, and decreased intestinal peristalsis. MMIHS has a particularly poor prognosis; however, when appropriately managed, survival can be prolonged. STUDY DESIGN A systematic review (1996-2016) was performed with the key words "megacystis microcolon intestinal hypoperistalsis syndrome." In addition, a case series of four patients is presented as well as algorithms for the diagnosis and treatment of MMIHS. RESULTS 135 patients with MMIHS were identified in the literature. 73% (88/121) of the patients were female, 65% underwent diagnostic biopsy (64/99), and 63% (66/106) were identified with prenatal imaging. The majority of patients were treated with TPN as well as gastrostomy or ileostomy and CIC, however 15% (18/116) received multivisceral or intestinal transplant, and 30% (22/73) had a vesicostomy. The survival rate was 57% (68/121). CONCLUSION Appropriate management of MMIHS patients is crucial. An enlarged, acontractile bladder in a child with bowel motility problems should be considered diagnostic. Bladder distension can be managed with CIC or vesicostomy in addition to prophylactic antibiotics if frequent urinary tract infections are present. These patients often require gastrostomy or ileostomy as well as total parenteral nutrition. This management has led to significant improvement in survival rates.
2.
Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient: a case report and review of literature.
Takada, S, Hoshino, Y, Ito, H, Masugi, Y, Terauchi, T, Endo, K, Kimata, M, Furukawa, J, Shinozaki, H, Kobayashi, K, et al
Japanese journal of clinical oncology. 2015;(3):286-90
Abstract
Recently, bevacizumab has become a key drug for treatment of metastatic colorectal cancer. Molecularly targeted agents such as bevacizumab can cause life-threatening adverse effects, though they are generally considered less toxic than cytotoxic drugs. Here, we review the case of a 76-year-old male rectal cancer patient with liver metastasis who suffered extensive bowel necrosis after administration of 5-fluorouracil-based chemotherapy with bevacizumab, and required a subtotal colectomy and end-ileostomy. Microscopic findings revealed extensive mucosal necrosis in the resected colon specimen and necrosis at the muscularis propria of the descending colon. Pathological findings suggested that the mucosal damage induced by chemotherapy may be exacerbated by treatment with bevacizumab, resulting in extensive necrosis.
3.
Colonic necrosis in a young patient receiving oral kayexalate in sorbitol: case report and literature review.
Chou, YH, Wang, HY, Hsieh, MS
The Kaohsiung journal of medical sciences. 2011;(4):155-8
Abstract
Kayexalate (sodium polystyrene sulfonate) is a cation-exchange resin used to treat patients with hyperkalemia. Concomitant administration of kayexalate and sorbitol may induce gastrointestinal injury, which is potentially lethal. However, this well-documented complication is often underrecognized both clinically and pathologically. We propose a typical case along with colonoscopic photos and microscopic pictures. Additionally, we also present a review of the literature on this rare drug-induced side effect.
4.
The flatulent spine: lumbar spinal infection secondary to colonic diverticular abscess: a case report and review of the literature.
Hopton, B, Barron, D, Ambrose, S, Millner, P
Journal of spinal disorders & techniques. 2008;(7):527-30
Abstract
STUDY DESIGN A case report and literature review. OBJECTIVES To present a case of lumbar spinal infection secondary to colonic diverticular disease, their management and outcome. To review the published literature on spinal involvement with gastrointestinal disease with a view to establishing guidelines for management. SUMMARY OF BACKGROUND DATA There is only 1 previous case report of spinal involvement in diverticular disease and 9 reports of spinal infection secondary to Crohn disease. Psoas abscess, osteomyelitis, cord and nerve root compression, meningitis, and hydronephrosis have all been documented. Infection is usually advanced at presentation and all but 1 patient was taking immunosuppressive drugs. METHODS Case notes and online databases were reviewed. RESULTS Management is similar for both Crohn and diverticular disease. Total parenteral nutrition and antibiotic treatment are required as is coordination between orthopedic surgeons, colorectal surgeons, and microbiologists. The spine and abdomen are best imaged with plain radiographs, magnetic resonance imaging and contrast enhanced computed tomography. Surgery involved a defunctioning stoma, debridement of abdominal and spinal infection, and instrumented stabilization of the spine if instability or vertebral collapse is likely. Operative specimens are most likely to identify the multiple enteric bacteria and fungi involved. CONCLUSIONS A multidisciplinary approach with aggressive supportive therapy, combined with a planned surgical procedure and appropriate antibiotics can give a good outcome in most cases.