INTRODUCTION: Fournier's gangrene is the development of a progressive necrotizing infection in the genital and perianal region with findings of gangrenous and necrotic tissueinvolving the skin and subcutaneous tissue down to the fascia. This study aims to review cases of Fournier's gangrene in the Hospital from 2004 up to 2010 and to provide a profile of patients afflicted with the disease and describe its surgical management in this institution.?

METHODOLOGY: A retrospective chart and database review wasperformed involving patients with a diagnosis of Fournier's gangrene treated at the Hospital from 2004-2010. The following variables were analyzed: 1) total number of cases; 2) gender; 3) age range, distribution and mean age; 4) source of infection, whether the initial lesion started from the urogenital or perianal area; 5) associated co-morbid conditions; 6) the extent of infection, whether it's confined to the urogenital or perineal area or has involved adjacent areas; 7) the time between initial symptoms to the first hospital consult; 8) number of debridement done at the operating room for each patient; 9) the presence of other surgeries aside from debridement; 10) outcome (recovered or expired).?

RESULTS: The incidence of Fournier's gangrene is 8.7 patients per year in our institution. There were 36 patients included in this study. There is a male preponderance, affecting 4 males for every 1 female. The mean age is 49.5 years with a range of 18-73. Sixty four percent had infection starting from the perianal area while the rest had an initial lesion from the urogenital area. Seventy two percent had lesions confined to the perianal/urogenital areas while the rest had extended infections. Diabetes mellitus was the most common comorbid condition, involving 47 percent of the cases. Majority of the patients (70%) underwent just a single debridement. Ourinstitution mortality rate is 11 percent.No statistical significance was established between number of debridement and time of consult with mortality.?

CONCLUSION: The optimal management of Fournier's gangrene include all the ff: 1) appropriate anti-microbial therapy; 2)intensive pre and post-operative resuscitation; 3) aggressive and timely surgical intervention.While this disease may be rare, it always presents a challenge to the surgeon and the intensives, requiring a more thorough understanding of its presentation and treatment outcomes.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Gangrene ; Subcutaneous Tissue ; Debridement ; Fournier Gangrene ; Comorbidity ; Surgeons ; Fascia ; Genitalia ; Diabetes Mellitus

Benign mesenchymal tumors of the urinary bladder are extremely rare. This is a case of a 56- year old female presenting with an enlarging abdomen initially managed as a case of an ovarian new growth. Aside from the ruptured ovarian mass, a urinary bladder mass was also noted intraoperatively and a surgical dilemma was resolved by imaging review. The patient underwent exploratory laparotomy, enterolysis, total hysterectomy, bilateral salpingooophorectomy, and partial cystectomy. Final histopathology identified the bladder tumor to be a leiomyoma. The patient had an uneventful postoperative course. Awareness of this clinical entity and presentation will aid in diagnosis and management.
Leiomyoma

RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

RATIONALE/OBJECTIVES: The Turnbull-Cutait transanal pullthrough procedure with delayed coloanal anastomosis has been widely used before the advent of intestinal stapling devices. It is a viable option for rectal reconstruction for benign and malignant conditions, and is able to maintain intestinal continuity without the use of a temporary diversion. It has also been used in salvage operations for pelvic sepsis, failed anastomosis, and tumor recurrence that will otherwise require a permanent ileostomy. This study will describe the technique, as well as the outcomes of patients who underwent the procedure. METHODS: This is a retrospective descriptive study conducted to report the outcomes of patients who underwent the Turnbull-Cutait transanal pull-through with delayed coloanal anastomosis at the Philippine General Hospital from January 2008 to December 2013. Eleven patients were identified using an institutional retrospective database. Clinical data and outcomes were collected using a standard form. RESULTS: Ten of the 11 patients had an unremarkable postoperative course. One patient had an anastomotic dehiscence. The mean operative time was 229.9 minutes for the 1st stage and 28.2 minutes for the second stage, with a mean blood loss of 463.6 cc for both stages. The mean interval between the two stages was 7.9 days, with an average postoperative length of stay of 8.27 days. The average follow-up was 4.5 years. Functional outcomes were acceptable (average Wexner score 5.63), except for one patient who had an anastomotic dehiscence. No perioperative mortality was noted. CONCLUSION Turnbull-Cutait trans-anal pullthrough procedure with delayed coloanal anastomosis appears to be a safe procedure. The study suggests that it is an alternative strategy in rectal cancer in providing a sphincter-saving surgery, with the establishment of gastrointestinal continuity, and without the need for a proximal diversion. Stoma-less surgery has a notable health economic impact especially in developing countries because it eliminates the costs associated with the use of stoma appliances.

BACKGROUND: Hirschsprung’s disease (HD) is rare in adults, since a majority of cases are corrected in childhood. OBJECTIVES: The authors describe the profile of patients with HD who reached adulthood without having undergone corrective surgery. Also, they describe the outcomes of a modified Duhamel procedure in these patients, in terms of morbidity and mortality. METHODS: This retrospective study, included patients 18 years old and above, diagnosed with HD who reached adulthood without having undergone definitive repair and managed surgically by the Division of Colorectal Surgery, UP-PGH from January 1, 2004 to December 31, 2014. A review from the Department Surgical Database was used and patients’ hospital records were used to fill out a Data Collection Form. Descriptive statistics were used to summarize the data. RESULTS: The 13 patients included in the study were diagnosed at an average age of 16.6 (± 13.16) years. The mean age at the time of definitive surgery was 23.46 (± 6.96) years. The M:F ratio was 5.5:1. The most common presenting symptom was constipation (69.23%). All had a prior proximal bowel diversion, with a transverse loop colostomy (61.54%) being the most common. The transition zone was located in the sigmoid in a third of patients. The mean time from diagnosis to definitive surgery was 6.69 years. Eight (61.54%) have since undergone stoma reversal. There was only one (7.69%) morbidity, a superficial surgical site infection. No mortalities were reported. CONCLUSION The modified Duhamel procedure is a safe definitive surgical procedure for the adult patient with HD.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression. Methods: This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated. Results: Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality. Conclusion Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.

METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.

RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.

CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Human ; Colorectal Neoplasms ; Neoadjuvant Therapy ; Colorectal Surgery ; Rectal Neoplasms ; Chemoradiotherapy ; Colonic Neoplasms ; Polyps ; Patient Care Team

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has strained healthcare resources worldwide. Despite the high number of cases, cancer management should remain one of the priorities of healthcare, as any delay would potentially cause disease progression. Methods: This was an observational study that included nonmetastatic rectal cancer patients managed at the Philippine General Hospital from March 16 to May 31, 2020, coinciding with the lockdown. The treatment received and their outcomes were investigated. Results: Of the 52 patients included, the majority were female (57.7%), belonging to the age group of 50 to 69 years (53.8%), and residing outside the capital (59.6%). On follow-up, 23.1% had no disease progression, 17.3% had local progression, 28.8% had metastatic progression, 19.2% have died, and 11.5% were lost to follow up. The initial plan for 47.6% patients was changed. Of the 21 patients with nonmetastatic disease, 2 underwent outright resection. The remaining 19 required neoadjuvant therapy. Eight have completed their neoadjuvant treatment, 8 are undergoing treatment, 2 had their treatment interrupted, and 1 has yet to begin treatment. Among the 9 patients who completed neoadjuvant therapy, only 1 was able to undergo resection on time. The rest were delayed, with a median time of 4 months. One has repeatedly failed to arrive for her surgery due to public transport limitations. There was 1 adjuvant chemotherapy-related mortality. Conclusion Delays in cancer management resulted in disease progression in several patients. Alternative neoadjuvant treatment options should be considered while taking into account oncologic outcomes, acceptable toxicity, and limitation of potential COVID-19 exposure.

McKittrick-Wheelock syndrome is a rare and life-threatening disease characterized by the triad of (1) chronic mucous diarrhea, (2) renal function impairment with hydroelectrolyte imbalance, and (3) a giant colorectal tumor. Often, the tumor is a rectal adenoma. With the mortality being certain, if left untreated, it is important to raise awareness on the presentation, diagnosis, and management of this disease entity. Here, we presented 3 cases of McKittrick-Wheelock syndrome that were successfully managed with surgical resection at the Philippine General Hospital from August 2018 to May 2019. Resolution of their symptoms, reversal of their renal impairment, and correction of their electrolyte depletion were noted after removal of the tumor with a sphincter-saving operation.

Buschke-Lowenstein tumor (BLT) is a sexually transmitted infection (STI) caused by the human papillomavirus. This study investigated the profile, management, and outcomes of patients who underwent surgery for BLT from 2015 to 2019 at the Philippine General Hospital. Seven patients underwent surgery for BLT. All were male, with ages ranging from 21 to 41 years. Presenting symptoms were anal mass, foul-smelling discharge, pain, bleeding, and pruritus. All were positive for human immunodeficiency virus. All admitted to having engaged in both insertive and receptive anal intercourse, with multiple partners. All underwent excision with healing by secondary intention. Two had recurrence of warts. Four had an anal stricture. Of these, 3 underwent anal dilatation, while 1 had to undergo proximal bowel diversion. One had intraepithelial carcinoma without dermal invasion on histopathologic analysis. BLT is a rare STI characterized by local aggressiveness but with low malignant potential. Wide excision remains to be the mainstay of treatment.