Omental torsion is a rare cause of acute surgical abdomen from omental twisting leading to distal vascular compromise. Preoperative diagnosis has been a dilemma as clinical features, laboratory and radiographic findings are nonspecific and variable, closely mimicking acute appendicitis. Surgical excision has been suggested to offer rapid symptom relief and postoperative recovery. Presented here is a case of a 59-year-old male with omental torsion who presented with generalized abdominal tenderness and was preoperatively diagnosed as ruptured appendicitis who underwent laparotomy with uneventful post-operative course.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Abdomen, Acute ; Appendicitis

Cecal volvulus is a rare cause of intestinal obstruction caused by axial twisting of the cecum that occurs in 1–1.5 % of all intestinal obstruction, with an incidence of 2.8–7.1 cases per million annually. Cecal volvulus is potentially life-threatening without prompt surgical intervention. A 57-year-old woman presented with severe abdominal pain and distention. Laboratory examinations revealed normal white blood cell count with neutrophilic predominance. Diagnosis of acute cecal volvulus was made from a “whirl sign” on abdominal computed tomography. An exploratory laparotomy confirmed the diagnosis of cecal volvulus and a segmental ileocolic resection with primary anastomosis was carried out. The patient was discharged improved and returned to her normal activities of daily living.

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.

Background: This study aimmed to provide a local report on the peri-operative outcomes as well as the factors that cotribute to the development of complications on patients with primary distal rectal cancer who underwent abdominotransanal resection (ATAR) with total mesorectal excision (TME) and transanal handsewn coloanal anastomosis (CAA).Methods: This retrospective study was conducted by the Division of Colorectal Surgery of the Philippine General Hospital which evaluated 79 adult patients who underwent ATAR with TME and CAA due to primary distal rectal adenocarcinoma from january 1, 2008 to December 31, 2010. The variables such as age, general, comorbidities, pre-operative serum albumin level, smoking history, utilization of neoadjuvant therapy, distance of tumor from anal verge, surgical approach, quality opf surgical specimen, circumferential resection margin, pathologic stage, length of postoperative hospital stay, type of anesthesia, morbidity and mortality were recorded and analyzed.Results: Of the 79 patients, 19 patients (24.05%) had reported CAA dehiscence, 3 patients (3.8%) nessitated a relaparatomy with drainage of generakized intra-abdominal abscess, 6(7.59%) patients underwent transanal drainage of pelvic abscess and 10 (12.66%) patients who presented with pelvic abscess on computed tomography scan (3), purulent discharge with minor coloanal anastomotic disruption (3) and fistula (4) were managed non-operative. Diabetes mellitus (P=0.043) and history o0f smoking (p=0.037%) were found to be statistically significant factors associated with increased of CAA dehiscence.Conclusion: Diabetes mellitus and history of smoking lead to statistically significant increase in the development of anastomic dehiscence following ATAR with TME snd CAA for primary distal rectal cancer.
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OBJECTIVES: The study aimed to describe the use of an improvised vacuum-assisted closure (VAC) system in the management of enterocutaneous fistulas in patients admitted at the Philippine General Hospital (PGH) from January to December 2009. Demographic data as well as outcomes of patients were described.

METHODS: The study is a case series involving patients with enterocutaneous fistulas admitted at the PGH from January to December 2009 on whom an improvised VAC system was employed. Pertinent data were gathered, and frequencies and percentages were also computed.

RESULTS: The modified VAC system was employed in 19 patients. The most common etiology reported was iatrogenic (74%). Nine patients (47%) had spontaneous resolution during admission. The mean time to spontaneous closure with VAC usage was 17 days (range: 5 to 56). Three patients were discharged after a mean of 21 days (range: 8 to 44) on VAC, with efficient effluent collection using a stoma appliance. Of the three, 2 to patients had spontaneous fistula closure on follow up. Five patients declined further treatment. There was one mortality reported.

CONCLUSION: The use of an improvised VAC system may contribute to and hasten successful non-surgical treatment of patients with enterocutaneous fistulas.

Human ; Negative-pressure Wound Therapy ; Hospitals, General ; Iatrogenic Disease ; Philippines ; Intestinal Fistula ; Patient Discharge

Stercoral perforation commonly occurs in the colon, and is mainly due to a hard fecaloma obstructing the sigmoid and eventually perforating the wall due to increased intraluminal pressure causing ischemic necrosis and erosion. In the Philippines, we see cases of colon perforation from ingestion of fruit seeds, usually the santol, Sadoricum koetjape, which is abundant in the country. We report a rare case of a 46-year-old female who presented with an indirect inguinal hernia on the left, which on exploration was found to ahve incarceration of the terminal ileum and perforation from santol seeds. She subsequently underwent limited right hemicolectomy and primary hernia repair. From the literature avaliable, there has never been report of terminal ileal perforation from fruit seeds in Asian or Western countries.

Human ; Female ; Middle Aged ; Colon, Sigmoid ; Hernia, Inguinal ; Herniorrhaphy ; Fruit ; Philippines ; Intestinal Perforation ; Colonic Diseases ; Ileum ; Colectomy

For so many years, abdominoperineal excision has been the mainstay of surgical treatment for rectal cancer 7 cm and below the anal verge. With continued research and introduction of new technology, the management of rectal malignancies has involved making it possible to save the sphincter complex mechanism despite the distance from the verge. Concurrent with these developments is the introduction of a multidisciplinary team approach which the UP-Philippine General Hospital Colorectal Division has adopted in managing colorectal cancer cases. With the adoption of these advancements in the management of patients with rectal cancer, it is surmised that the institution's APR rates have decreased.

OBJECTIVES: The study aimed to document and compare the abdominoperineal resection (APR) rates at the Philippine General Hospital (PGH), before and after the introduction of a multidisciplinary team for colorectal cancer, over the course of 5 years (2005-2009).

METHODS: The study included all adult patients undergoing resection for low to mid rectal cancer, described as a tumor with distal extent of 11 cm or below from the anal verge (FAV), from January 1, 2005 to December 31, 2009. Data pertinent to the management were gathered. Frequencies and rates before and after the introduction of a multidisciplinary team approach were computed and compared.

RESULTS: There were a total of 230 rectal resection for cancer over a five-year period. The patients' mean age was 53 years (range: 26 to 83). There were 122 males and 108 females. Almost half of the patients (48.7%) presented with a clinical stage of Stage IIIB. Forty-three percent of patients underwent either pre-operative radiotherapy or combined chemoradiotherapy. Cumulatively, the APR rate was 30.90 percent (sphincter-saving rate 69.10%) The APR rate for 2009 was 12.82 percent (sphincter-saving rate 87.18) corresponding to a 39.18 percent decrease in APR rate from the highest APR rate recorded in 2006 (52%).

CONCLUSION: A multidisciplinary team (MDT) approach resulted in lower APR rates among patients with rectal cancer at the UP-PGH.

Human ; Aged 80 And Over ; Aged ; Middle Aged ; Colorectal Neoplasms ; Hospitals, General ; Philippines ; Rectal Neoplasms ; Rectum ; Chemoradiotherapy ; Digestive System Surgical Procedures ; Patient Care Team

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

Objectives:We described the technique of utilizing the marginal vascular arcade (MVA) of the right colon as blood supply to the ileal pouch in restorative proctocolectomy (RPC) with ileal pouch anal anastomosis (IPAA) after high ligation of the superior mesenteric artery (SMA). The results of having performed this surgical procedure on patients with familial adenomatous polyposis (FAP) and (UC) are presented.Methods:The method of RPC with IPAA using the above-mentioned mesentric lengthening technique is described.Results:There were 5 patients, all were male with a mean age of 37 years. Four (80%) had FAP, one (20%) had UC. Two (40%) of the patients had a family history of polyposis or colon cancer. Three (60%) had stapled anastomosis; the remaining (40%) were hand-sewn. All patients had a protecting stoma. The mean total hospital length of stay (LOS) was 21 days with a mean postoperative LOS of 8 days. Two morbidities were reported in a single patient an anastomotic leak and an ileoanal anstomotic structure. There were no mortalities. There were no intra-operative abandonments of the anal restoration.Conclusion:The technique of utilizing the MVA of the right colon provides a safe, reliable and durable alternate blood supply to the ileal pouch in patients undergoing RPC with IPAA.Key words: restorative proctocolectomy, familial adenomatous polyposis, ulcerative colitis
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