Search Results (75)

Background and Clinical Significance: Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum, most commonly associated with inflammatory bowel disease or haematologic disorders. Its occurrence in patients with solid malignancies is uncommon. PPG in an oncologic setting poses diagnostic and therapeutic challenges because systemic immunosuppressive therapy, wound care, and ongoing chemotherapy must be carefully balanced; Case Presentation: We report the case of a Japanese man in his 50s with stage IVB rectal adenocarcinoma who developed rapidly progressive peristomal ulceration clinically consistent with PPG around a colostomy 12 weeks after initiation of panitumumab-containing systemic chemotherapy. The diagnosis was made on clinical grounds and was strongly supported by the clinical morphology, exclusion of major mimickers, and response to systemic corticosteroid therapy, although histopathological confirmation was not obtained. Because existing diagnostic criteria for pyoderma gangrenosum are not specifically designed for peristomal disease, they were used as supportive rather than definitive diagnostic tools. Skin biopsy was avoided due to the risk of pathergy at the peristomal site. Superficial cultures were not obtained because frequent cleansing and faecal contamination were likely to compromise diagnostic accuracy. To minimise mechanical pathergy, the stoma appliance was changed from a one-piece soft convex system to a two-piece flat system. Multidisciplinary management, including systemic corticosteroids, meticulous stoma care, and selective ultrasonic debridement, resulted in complete epithelialisation by Week 26. Chemotherapy was temporarily withheld during the active inflammatory phase and later resumed. Despite successful control of the peristomal ulceration, the patient died from progressive malignancy at Week 34; Conclusions: This case highlights the clinical challenge of balancing immunosuppressive therapy for clinically suspected PPG with ongoing oncologic treatment. Mechanical pathergy related to stoma appliance use was considered a more likely precipitating factor than chemotherapy alone, although panitumumab may have contributed to impaired cutaneous repair. Close collaboration among dermatologists, oncologists, surgeons, WOC nurses, and family caregivers is essential for multidisciplinary decision-making in complex oncologic settings. Full article

Introduction: Low back pain is one of the commonly overlooked late complications of an intestinal stoma. Its severity may be associated with impaired quality of life across multiple dimensions of patient functioning. Objective: This cross-sectional study evaluated the impact of low back pain on self-reported health-related quality of life in colostomy patients. Material and Methods: The study was conducted using a cross-sectional questionnaire-based design across 12 regional branches of the Pol-ILKO Association in Poland between December 2023 and September 2024. The study sample consisted of 95 patients. The standardized Oswestry Disability Index (ODI) questionnaire, which assesses the level of disability in patients with back pain, and the WHOQOL-BREF questionnaire, which assesses health-related quality of life, were used in the survey. In addition, detailed data on medical history, past surgical interventions, and stoma self-care skills were collected using an author-developed tool. Results: Greater disability due to back pain is associated with lower self-rated quality of life. The higher the degree of disability as assessed by the Oswestry questionnaire and the higher the number of postoperative complications, the worse the subjective rating of health-related quality of life (HRQoL) (p < 0.05). Factors associated with a significantly (p < 0.05) increased risk of lower back pain include postoperative complications, irrespective of the time since stoma creation, as well as avoidance or restriction of full trunk movements. Preoperative agreement on the stoma site was associated with greater independence in stoma hygiene. Conclusions: The results underscore the importance of early and targeted interventions to improve physical and psychosocial well-being in the subject population, especially at the preoperative stage. More attention should be paid to the needs of colostomy patients, both in hospitals and in outpatient specialty care centers, to improve their overall quality of life and self-assessment of their condition. Full article

Background/Objectives: Quality of life (QoL) and functional recovery are essential outcomes in patients undergoing rectal cancer surgery. In addition to oncological results, bowel dysfunction and stoma-related issues may significantly affect postoperative well-being. We aimed to evaluate QoL changes at 1 and 6 months postoperatively and functional outcomes in rectal cancer patients who underwent curative surgical treatment, sphincter-preserving surgeries (SPS) or abdominoperineal resection (APR). Owing to its impact on QoL, several functions were assessed using the Low Anterior Resection Syndrome (LARS) score. Methods: This retrospective observational study consisted of 99 patients who underwent curative rectal cancer surgery, of which 38 patients had colostomy, and 61 no colostomy. To assess patient-reported outcomes related to QoL, the EORTC QLQ-C30 questionnaire, QLQ-CR29 questionnaire, and LARS instrument were sent to the patients at 1 and 6 months postoperatively. Changes over time were analyzed using paired statistical tests, and subgroup analyses were performed according to colostomy status and surgical approach. Results: Significant improvements were observed in the global health status and all major functional domains between 1 and 6 months postoperatively. The global health status increased from 74.9% to 86.5% (p < 0.001). Symptom burden decreased significantly, particularly for fatigue (−18.31), pain (−14.48), diarrhea (−12.46), and insomnia (−11.45), representing clinically meaningful improvements. Patients who underwent abdominoperineal resection or resection with colostomy had lower QoL scores at 1 month but showed substantial improvement at 6 months, becoming comparable to those who underwent SPS. LARS outcomes demonstrated progressive functional recovery, with the proportion of patients without LARS increasing from 39 to 46, while major LARS decreased from 7 to 3 patients. However, approximately 40% of patients in the SPS group continued to report moderate-to-severe LARS symptoms. Conclusions: In this study, QoL and bowel function improved significantly during the first 6 months after colorectal cancer surgery. Although most patients demonstrated recovery, persistent bowel dysfunction and stoma-related challenges remain important issues. These findings highlight the need for comprehensive postoperative care and routine assessment of both QoL and functional outcomes. Full article

Background/Objectives: This study aims to develop and validate a reproducible training model, built using common hospital items, for laparoscopic inguinal hernia repair with an intracorporeal suturing approach, specifically focusing on iliopubic tract redress in pediatric patients. Methods: Pediatric surgery residents and consultants were instructed on model building and engaged in training sessions. They practiced for four weeks with the handcrafted model and completed a post-simulation survey. The time taken to conclude the training task and the modified Objective Structured Assessment of Technical Skills score were compared between the initial and last sessions at the end of the training period. Additionally, the time required by consultants to perform the laparoscopic procedure in vivo, intraoperative complications, and recurrence rates were analyzed from the time they started the training. Results: A feasible model was created using a colostomy dressing support, Penrose drains, Foley catheters, feeding tubes, and surgical gloves to simulate. The sample involved a total of twelve residents and five consultants with an average age of 33 years old. All participants successfully completed the task during the session. Since the consultants started their training on the model, the operative results for laparoscopic inguinal hernia repair in the theater have improved. Conclusions: Training experience on this model led to improve laparoscopic skills such as cutting and dissection and intracorporeal tying and knotting. This study confirms that training outside clinical practice can significantly benefit laparoscopic proficiency and safety in vivo. Full article

Background/Objectives: Deep endometriosis is a chronic inflammatory disease that significantly affects fertility. The objective was to evaluate the magnitude of the effect of minimally invasive nerve-sparing complete excision of endometriosis on natural conception rate in women with documented infertility. Methods: This pre-planned interdisciplinary retrospective observational study included 45 patients who wished to conceive naturally (spontaneous pregnancy) and were followed for 12 months after surgery. Results: The spontaneous conception rate was 33.3% (95% CI: 20.0–46.7) and the mean time to conception was 6.7 months. Age, body mass index, and history of infertility showed no significant differences between the success and failure spontaneous pregnancy groups, but annual income was positively associated with reproductive success (p = 0.022). None of the procedures needed to be converted to open surgery, required colostomy/ileostomy, blood transfusion or abdominal drains. No cases of urinary retention were observed across different levels of nerve preservation. In addition, the absence of serious surgical complications (Clavien–Dindo III/IV) supports the safety of this intervention for infertile patients. Conclusions: The absence of serious surgical complications in this cohort supports the concept that minimally invasive nerve-sparing complete excision of endometriosis is a safe intervention when performed by an experienced team. The results underscore the importance of exploring socioeconomic-related factors through an individualized assessment of patients who wish to conceive naturally after minimally invasive nerve-sparing surgery. Future studies focusing on personalized management of endometriosis should attempt to identify socioeconomic-related covariates that influence natural conception. Full article

Background: Peristomal leakage is one of the most troublesome complications of living with a stoma, affecting skin integrity, quality of life, and healthcare costs. However, definitions, measurement methods, and prevalence estimates remain heterogeneous. This scoping review aimed to (i) map the international prevalence of peristomal leakage across stoma subtypes; (ii) identify associated or correlated factors; and (iii) describe the tools used to assess leakage. Methods: A scoping review was performed following the Joanna Briggs Institute (JBI) guidelines. MEDLINE, CINAHL, Scopus, Embase, and the Cochrane Library were searched, with publication language restricted to English and Italian. Primary studies and evidence syntheses addressing peristomal leakage were included. Results: Twenty-seven studies were included, most of which were primary observational studies conducted in Europe, North America, and the Nordic countries. Ileostomy was the most frequently investigated stoma type, followed by colostomy and urostomy. Across settings, peristomal leakage was highly prevalent, with most period or lifetime prevalence estimates exceeding 50%. Reported determinants clustered into anatomical, surgical, device-related, behavioral, care-related and psychosocial factors. Multiple tools were used, including leakage-specific and broader stoma questionnaires, but definitions and leakage grading were inconsistent. Conclusions: Peristomal leakage is a common, multifactorial, and largely preventable complication with substantial clinical, psychosocial and economic consequences. Clinical practice should prioritize early detection, validated assessment tools, patient education, specialized stoma nursing and structured follow-up. Future research should establish consensus definitions, robustly validate leakage-specific instruments, include under-represented regions and conduct high-quality economic evaluations to guide equitable, cost-effective care models. Full article

Background: Leakage is a major concern for individuals living with a stoma and may negatively impact quality of life (QoL). A digital leakage notification system (DLNS) recently launched in the UK provides timely notifications to users via their smartphone when faeces is detected underneath the baseplate. This provides predictability and enables users to take proactive measures to help avoid leakages outside the baseplate. Methods: A single-arm, observational, longitudinal study of the DLNS, including its associated support service, has been initiated to follow 300 users for a year in the UK to evaluate long-term health benefits of the DLNS and its implications for healthcare resource utilisation in a real-world setting. The DLNS is prescribed by healthcare professionals (HCPs), and all users were invited to participate in the study. Study participants complete questionnaires capturing data on QoL (using the Ostomy Leak Impact tool), number of leakages outside the baseplate, utilisation of ostomy products, interactions with HCPs, and work productivity (using the Work Productivity and Activity Impairment questionnaire) at baseline and then every third month for one year. Data from the planned interim analysis of the first 100 participants who had been in the study for 6 months is presented. Results: Use of the DLNS for 6 months together with the associated support service was associated with a 51% reduction in leakage episodes outside the baseplate (p < 0.001) and great improvements in QoL (p < 0.001). Use of the DLNS reduced the number of unplanned baseplate changes due to worry about leakage by 47% (p < 0.001) and overall was associated with a reduction in the number of baseplates used by 14% (p = 0.002). Total time spent with HCPs related to stoma care was reduced by 65% after 6 months compared with baseline (p < 0.001). Work absenteeism and presenteeism improved significantly with the use of the DLNS. Conclusions: The interim results of this prospective, longitudinal study provided first insights into the long-term benefits of the DLNS in a real-world setting. ClinicalTrials.gov ID: NCT06554015. Full article

Mushroom coffee—blends of coffee with “functional” mushroom powders—has surged in popularity, yet its hemostatic effects are poorly appreciated in perioperative care. We report a postoperative hemorrhage likely potentiated by a commercial mushroom coffee. A 62-year-old man with HIV, hepatitis C, and insulin-treated diabetes underwent colostomy reversal. On postoperative day 9, he developed brisk bleeding at the colonic anastomosis requiring angiography and embolization. Recurrent hemorrhage prompted a detailed supplement history, revealing daily use of mushroom coffee for two months preoperatively. The product’s labeled ingredients include an organic mushroom blend of cordyceps, lion’s mane (Hericium), reishi (Ganoderma), shiitake, turkey tail, and king trumpet, combined with arabica coffee, MCT oil, and coconut milk. Several constituents—reishi, cordyceps, lion’s mane, and chaga (Inonotus obliquus, used in some mushroom blends)—have published antiplatelet or antithrombotic activity in vitro and/or in vivo. After counseling, the patient discontinued mushroom coffee; no further bleeding occurred, and he recovered without additional intervention. This case highlights a clinically important but underrecognized risk: mushroom-based beverages can exert antiplatelet effects comparable to herbal supplements traditionally flagged in preoperative screening. We recommend that preoperative medication reconciliation explicitly query mushroom coffees and “adaptogenic” blends and that such products be held similarly to other agents with antiplatelet properties. Greater awareness among surgeons, anesthesiologists, and internists is needed as functional foods proliferate. Controlled studies are warranted to quantify bleeding risk from multi-mushroom products and to inform evidence-based perioperative guidance Full article

Background: Anastomotic leakage (AL) following rectal cancer surgery is a significant cause of mortality and morbidity. Although transanal drainage tubes are expected to reduce the rate of AL, their preventive effect remains controversial. Aim: To evaluate whether transanal drainage tube (TAD) provides protection against AL in patients without other protective methods after low anterior resection (LAR). Methods: A retrospective cohort study was performed in patients undergoing LAR for rectal cancer between 2018 and 2023. Based on postoperative management, patients were divided into four distinct groups as follows: in TAD group, after colorectal anastomosis, a 32F silicone tube was inserted through the anus by more than 5 cm above the anastomosis. The tube was secured around the anus with a skin suture and a drainage bag was attached. The tube was removed after 3–5 days after surgery. In the non-TAD group, no transanal drainage tube and no diverting stomas, respectively, were used after the anastomosis. In the ileostomy and colostomy group a stoma was often performed as a primary measure in preventing anastomotic leakage. Clinical characteristics and postoperative complications were compared among the groups. Complications were categorized as general (eventration, seroma) or septic (fistula, abscess) and further classified as early (<7 days after surgery) or tardive (between 7 and 30 days after surgery). Statistical significance was defined as a p-value < 0.05. Results: A total of 171 patients were included: 47 (27.5%) in the TAD group, 54 (32.2%) in the non-TAD group, 25 (14.6%) in colostomy group, and 45 (26.3%) in ileostomy group. Overall, eight patients (4.7%) developed anastomotic leakage (AL). In the non-TAD group, 3 patients experienced AL (all early); in the ileostomy group, 2 patients (1 early, 1 tardive); and in the colostomy group, 2 patients (both tardive). The TAD group had one patient with AL as a tardive complication. The incidence of early general complications was significant lower in TAD group compared with the non-TAD group (OR 0.23, 95% CI [0.06–0.85]; p = 0.004), while there was no significant difference in early septic complications between TAD and ileostomy group (p = 0.71). The incidence of tardive general complications was significantly more frequent in the ileostomy group (OR 0.10, 95% CI [0.02–0.44]; p = 0.0008) compared with TAD group. Overall, total complications were significantly lower in TAD group compared to non-TAD (OR 0.15, 95% CI [0.05–0.44]; p < 0.001), ileostomy (OR 0.20, 95% CI [0.07–0.56]; p = 0.003), and colostomy ((OR 0.46 CI [0.21–0.99]; p = 0.049) groups. Furthermore, the TAD group showed a reduction rate of AL compared to the ileostomy, colostomy, and non-TAD groups (2.12% vs. 4.4%, 8%, and 5.5%) but the incidence of AL was almost similar (p = 0.65). Conclusions: The elective use of TAD is a simple and effective protective method for the prevention of overall postoperative complications, also helping to reduce the rate of AL in patients. Nevertheless, there is limited information in the literature regarding the optimal size and material of TAD, despite these factors playing an important role in the viability and effectiveness of the method. Full article

Background/Objectives: Permanent colostomy requires significant physical and psychological adaptation. Patients often experience reduced physical activity, impaired quality of life, and fear of movement. Current exercise recommendations are inconsistent, and no consensus exists on safe return to activity. This study aims to evaluate the effect of a 12-week home-based graded exercise programme on physical activity, quality of life, kinesiophobia, exercise capacity, and self-efficacy in patients with permanent colostomies. Methods: This randomized controlled trial will recruit 51 adults with permanent colostomies, beginning six weeks post-surgery. Participants will be randomized (1:1) to an intervention or control group. The intervention group will receive a 12-week home-based exercise programme including patient education, resistance and core training, and progressive aerobic walking. The control group will receive standard medical care and an informational leaflet. Primary outcomes include physical activity (steps/day), quality of life (Stoma-QoL), kinesiophobia (Tampa Scale), exercise capacity (6-Minute Walk Test), and self-efficacy (General Self-Efficacy Questionnaire). Follow-up will be conducted at baseline, post-intervention, and six months. Data will be analyzed using intention-to-treat principles with a significance threshold of p < 0.05. Conclusions: This trial will be the first to assess the effects of a structured, home-based graded exercise programme in individuals with permanent colostomies. The findings are expected to provide evidence on the efficacy of exercise for improving physical and psychological outcomes in this population and to inform clinical guidelines for safe, individualized activity resumption. Full article

Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed. Full article

Large bowel evisceration is a rare but morbid presentation that requires timely diagnosis and management. We present the case of a 67-year-old woman with a history of recurrent pelvic organ prolapse (notably with a history of prior hysterectomy, mesh-augmented sacrocolpopexy, and transvaginal Uphold™ mesh placement). She presented with the subjective report of subacute worsening of her prolapse leading to urinary retention managed with a Foley catheter and an irreducible vaginal mass prompting evaluation. Clinical evaluation revealed bowel contents in the vagina with subsequent initiation of intravenous antibiotics, diagnostic laparoscopy converted to exploratory laparotomy, and resection of sigmoid and upper rectum with creation of left ileal end colostomy. Common risk factors for bowel evisceration include older age, postmenopausal status, history of pelvic surgery, and pessary use. In a patient with subacute worsening of prolapse and pain with the above risk factors, bowel evisceration should be considered and ruled out. Full article

Background and Clinical Significance: Extremely premature infants face complex medical challenges requiring comprehensive multidisciplinary care. Gastrointestinal malformations, while rare, pose significant diagnostic and therapeutic challenges in this vulnerable population. Case Presentation: We report a case of an extremely premature infant born at 26 weeks gestation with very low birth weight (950 g) who developed a digestive pathology rarely encountered in neonatal intensive care: microcolon, which required surgical consultation and intervention, followed by an atypical postoperative course. Conclusions: The early recognition of gastrointestinal malformations in extremely premature infants requires high clinical suspicion and prompt multidisciplinary intervention. Despite complex postoperative course, favorable outcomes are achievable with coordinated care. Full article

Background: Deficient mismatch repair rectal cancer represents approximately 10% of rectal malignancies and demonstrates exceptional responsiveness to immune checkpoint inhibitors, achieving unprecedented complete response rates approaching 100%. This creates a novel clinical dilemma: should patients achieving complete response undergo standard surgical resection or pursue organ preservation through watch-and-wait management? Methods: We conducted a comprehensive literature review of clinical trials and retrospective studies published through 2025, focusing on response assessment strategies, decision-making frameworks, oncological outcomes, and quality of life assessments. Results: Landmark studies demonstrated remarkable efficacy with dostarlimab achieving 100% clinical complete response, while surgical cohorts achieved 68–92% pathological complete response rates. Response assessment challenges included pseudoprogression and pseudoresidue phenomena that complicated conventional imaging interpretation and required specialised multimodal evaluation protocols. Comparative analyses suggest equivalent oncological outcomes between surgical and non-surgical approaches in complete responders, achieving 100% disease-free survival at 2–3 years across multiple studies. The watch-and-wait approach offered significant advantages by preserving organ integrity and avoiding surgical morbidity, including permanent colostomy (15.4%) and perioperative complications (19.3%). Conversely, surgical management provided distinct benefits through definitive tissue confirmation and anxiety relief from intensive surveillance requirements and potential recurrence concerns. Conclusions: The surgery versus watch-and-wait dilemma represents a choice between equally effective oncological approaches with different quality of life implications. Evidence supports individualised decision-making weighing functional preservation benefits against patient preferences and institutional capabilities in this evolving therapeutic landscape. Full article

The burgeoning Internet of Medical Things (IoMT) offers unprecedented opportunities for real-time patient monitoring and predictive diagnostics, yet the current systems struggle with scalability, data confidentiality against quantum threats, and real-time privacy-preserving intelligence. This paper introduces Med-Q Ledger, a novel, multi-layered framework designed to overcome these critical limitations in the Medical IoT domain. Med-Q Ledger integrates a permissioned Hyperledger Fabric for transactional integrity with a scalable Holochain Distributed Hash Table for high-volume telemetry, achieving horizontal scalability and sub-second commit times. To fortify long-term data security, the framework incorporates post-quantum cryptography (PQC), specifically CRYSTALS-Di lithium signatures and Kyber Key Encapsulation Mechanisms. Real-time, privacy-preserving intelligence is delivered through an edge-based federated learning (FL) model, utilizing lightweight autoencoders for anomaly detection on encrypted gradients. We validate Med-Q Ledger’s efficacy through a critical application: the prediction of intestinal complications like necrotizing enterocolitis (NEC) in preterm infants, a condition frequently necessitating emergency colostomy. By processing physiological data from maternal wearable sensors and infant intestinal images, our integrated Random Forest model demonstrates superior performance in predicting colostomy necessity. Experimental evaluations reveal a throughput of approximately 3400 transactions per second (TPS) with ~180 ms end-to-end latency, a >95% anomaly detection rate with <2% false positives, and an 11% computational overhead for PQC on resource-constrained devices. Furthermore, our results show a 0.90 F1-score for colostomy prediction, a 25% reduction in emergency surgeries, and 31% lower energy consumption compared to MQTT baselines. Med-Q Ledger sets a new benchmark for secure, high-performance, and privacy-preserving IoMT analytics, offering a robust blueprint for next-generation healthcare deployments. Full article