Iranian Journal of Colorectal Research
Volume:12 Issue: 3, Sep 2024

The interactions between dysbiosis of gut microbiota and development of colorectal cancers are well known. The effects of three different commercial probiotics, purchased from pharmacies, on several biological properties of enterococci (vancomycin resistant “VRE” and vancomycin susceptible “VSE”) in colon adenocarcinoma cell culture (HT-29) were investigated. Cell-free supernatants (CFSs) were prepared after the isolation of probiotic strains (Bifidobacterium lactis, Saccharomyces boulardii and Bacillus clausii). Bacterial growth was detected spectrophotometrically after three, six and 24 hours incubation. Adhesion and invasion assays were performed via colony counting method. Biofilm formation was performed using microtiter plate assay. After 24 hours incubation in culture medium, all three probiotics increased the growth of VRE and VSE. Bacterial growth was also increased in cell culture in the presence of probiotics. Adhesion of both enterococci was shown to be reduced by all probiotics. The invasion and biofilm formation were shown to be varied according to strains and probiotics tested. As conclusion, all of these findings indicate the potential risk of enhanced pathogenicity under certain circumstances, especially in immune suppression.

Colorectal cancer (CRC) is the third most common cancer globally, and the second most common cause of cancer death. CRC incidence is increasing in Nigeria, while its national demographic data distribution is limited. This study aims to determine the frequency of CRC found on colonoscopies in various parts of Nigeria. This was a retrospective study of CRCs diagnosed in Nigeria between 2021 and 2023. Data from endoscopy registers include patients’ demographics, regional location, preparation, scope used, tumour location, and histology. A Google form was used for data collection from all contributors. Data was analysed using SPSS version 20, means and standard deviations were used to summarise continuous variables, while frequencies and percentages were used for categorical variables. Categorical variables were compared using chi-square or Fisher exact tests. P values less than 0.05 were considered significant. A total of 2387 procedures were performed in 8 centres. Epsom salt with Dulcolax was the most commonly used cleansing agent with an average preparation score of 6.6. A total of 322 patients had suspected colonic tumour with a prevalence of 13.5%. After censoring for missing data, a total of 272 patients were analysed. The mean age ± standard deviation was 56.3 ± 15.5 years. Females were 53.3% with a M: F ratio of 1:1.14. A statistically significant difference was observed between genders across the country regions (P = 0.013). The most common indication was bleeding pre-rectum (38.24%) while screening colonoscopy was done only in 10 (3.8%). The most common tumour location was a recto-sigmoid colon (48.16%), while the commonest tumour histology was adenocarcinoma. Our study provides data on the prevalence of colon cancer in Nigeria. The findings suggest rectal bleeding is an important warning feature. This emphasizes the need for early detection of average-risk individuals and prompt treatment of cases.

Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract with a relatively high occurrence and its cause has not yet been precisely identified. Since calcium and magnesium play a role in inflammatory processes, this study investigates the changes in the saliva and serum of people with inflammatory bowel disease (IBD). This cross-sectional study included 30 subjects with IBD and 30 healthy individuals. Unstimulated saliva and serum were taken during a fasting state, and the amount of calcium and magnesium was measured by the photometric method. The data was analyzed using an unpaired Student’s t-test using SPSS version 22. P<0.05 is considered significant. The results showed that the amount of calcium and magnesium in the serum and saliva of patients with IBD was significantly lower than that of healthy individuals. Calcium and magnesium levels appear to be significantly impaired and reduced in patients with inflammatory bowel disease (IBD). This deficiency can contribute to various complications associated with IBD and highlights the importance of monitoring and controlling mineral levels in these patients.

Colorectal cancer is a leading cause of cancer mortality globally, ranking as the third most common cause of death in males and the second in females. In Sub-Saharan Africa, the estimated incidence is 4.04 per 100,000, with slightly higher rates in men than women.The liver is the most common site for colorectal cancer metastases, with about 50% of patients developing liver metastases during the disease. Multidisciplinary approaches involving colorectal and liver surgeons, oncologists, radiologists, and other specialists have become crucial in managing colorectal liver metastases (CRLM).Historically, liver resections began in the late 19th century, with significant advancements including the development of ultrasonic scalpels, preoperative portal vein embolization, and vascular staplers. The understanding of CRLM progression involves mutations in tumor suppressor genes and oncogenes, leading to uncontrolled cell growth, invasion, and metastasis. Surgical approaches include classical, synchronous, and liver-first strategies. Resectable CRLM typically involves wedge or anatomic resections. For unresectable cases, therapies like radiofrequency ablation, microwave ablation, and hepatic artery infusion could be used. Novel techniques such as two-stage hepatectomy and ALPPS, along with conversion chemotherapy, have improved resection rates and survival outcomes. Finally, the management of CRLM has evolved significantly with advancements in surgical techniques and therapies, emphasizing the need for specialized training and a multidisciplinary approach, particularly in regions like Sub-Saharan Africa.

Postoperative adhesive intestinal obstruction is a common sequela of laparotomy, with an incidence of 1-5%, higher in neonatal cases (6-8%). Conservative management is preferred, but 35-45% of cases require surgery. While laparoscopic adhesiolysis is well-documented in adults, pediatric data is scarce. This study assesses the feasibility of laparoscopic adhesiolysis in pediatric adhesive obstruction cases.

This retrospective study over one year included children with adhesive intestinal obstruction. Data collected: demographics, conservative management details, surgery type and findings, conversion to open surgery, postoperative course, and recurrence. Mean values were recorded.

Twelve patients (7 boys, 5 girls) were studied. Initial conservative management was attempted for 48 hours. Surgeries included stoma closure (33%), appendectomy (50%), trauma surgery (8%), and perforation repair (8%). Three patients required laparoscopic adhesiolysis. No conversions to open surgery occurred. Mean operative time was 56.2 minutes. Patients resumed oral intake within 24 hours and were discharged within 48 hours. Mean hospital stay was 42.5 hours. No complications were noted.

Laparoscopic adhesiolysis, established as safe in adults, is also feasible in pediatric patients, offering reduced morbidity and faster recovery. Placement of the first port requires caution due to potential adhesions. Experienced surgeons achieve better outcomes. Diagnostic laparoscopy is superior to laparotomy for identifying obstruction causes.

Laparoscopic adhesiolysis is safe and effective in pediatric patients, with minimal morbidity and early recovery.
Mean operative time was 56.2 minutes, with rapid recovery evidenced by early oral intake and short hospital stay (mean 42.5 hours).

Laparoscopic adhesiolysis is safe and effective in pediatric patients, offering minimal morbidity and facilitating early recovery.

To describe and characterize a rare case of pan-colonic diffuse benign cavernous vascular malformation.

This is a single case report with intraoperative figures, pathologic and histologic evaluation, and review of treatment decision making for a rarely described pan-colonic benign cavernous vascular malformation.

A 34-year-old male with a history of recurrent gastrointestinal bleeds starting early in life presented for evaluation. He was found to have multiple vascular proliferations in his rectosigmoid, cecum, liver, and small bowel mesentery on axial imaging and endoscopic evaluation. He underwent total proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pathologic analysis of the vascular proliferations was consistent with diffuse benign cavernous malformations. The patient recovered well postoperatively.

We present the first case known of total proctocolectomy with IPAA for diffuse benign cavernous vascular malformation. This is a safe treatment approach recommended for patients with pan-colonic vascular lesions. Gastroenterologists and colorectal surgeons should be familiar with this condition due to high morbidity and unique treatment algorithms.

Cavernous vascular malformations, while benign and rare can lead to significant morbidity, including chronic pain and bleeding. Mortality associated with massive gastrointestinal bleeding can be as high as 50%, therefore the management of these conditions in non-emergency setting is preferable. Interestingly, there are a number of syndromes that are associated with these lesions such as Osler-Weber Rendu syndrome, Proteus Syndrome, Kasabach-Merritt syndrome and Klippel-Trenaunay-Weber syndrome but only approximately 2% have gastrointestinal manifestations. Vascular malformations are usually seen at the rectosigmoid level, while colonic localization is very uncommon. The extension of the lesions and its morphology should be assessed by several diagnostic modalities which include colonoscopy, CT with contrast enhancement and other test such as capsule endoscopy, MRI etc. The case report of “Ileal Pouch-Anal Anastomosis for Diffuse Benign Cavernous Vascular Malformation” demonstrates a successful application of ileal pouch-anal anastomosis in a patient with diffuse benign cavernous vascular malformation expanding the indication for these procedures.