Background: Idiopathic slow-transit constipation (STC) is a clinically significant event of chronic constipation. Total colectomy with ileorectal anastomosis is considered the standard surgical option for medically refractory STC but is associated with relevant morbidity and long-term functional impairment. This study aimed to evaluate safety and functional outcomes of partial colectomy (segmental or subtotal resection) as a potential alternative in patients with limited colonic involvement. Methods: A retrospective observational single-center study was conducted on patients with STC refractory to medical and rehabilitative treatment (1998-2021). Five-year follow-up data were collected. Results: On a cohort of 76 patients, 10 (13.2%) underwent total colectomy, 63 (82.9%) segmental, and 3 (3.9%) subtotal resections (left hemicolectomy). No perioperative mortality occurred. Overall, 30-day morbidity was 25.0%, with major complications observed in 12.1% after partial colectomy. Median hospital stay was three days longer after total colectomy. Constipation recurred in 20.3% of patients, exclusively after segmental resection, at a median follow-up of 7.7 years. Constipation severity significantly decreased postoperatively (p < 0.001), with the mean Wexner score improving from 21.5 to 6.1 (p < 0.001). Rates of diarrhea and fecal incontinence were comparable between segmental and total colectomy. Quality-of-life significantly improved in more than 75% of cases across all SF-36 domains. Conclusions: Segmental colectomy may be a safe and effective alternative to total colectomy in patients with limited STC, potentially offering durable symptom relief and favorable quality-of-life outcomes.

A retrospective analysis was conducted to evaluate the clinical characteristics, diagnostic challenges, and management strategies in a child with perioral myoclonia with absences (PMA). The case involved a 10-year-old boy with a six-month history of intermittent seizure episodes, which had worsened over the previous month. Clinical manifestations included transient blank stares, cessation of movement, unresponsiveness to verbal cues, and rhythmic twitching at the corners of the mouth, without limb rigidity or urinary/fecal incontinence. The duration of the seizures ranged from 10 to 15 s. Video electroencephalography (VEEG) showed bilateral synchronous and symmetrical 3-Hz spike-wave discharges persisting for 10-15 s, with rhythmic twitching captured on perioral EMG. The patient became seizure-free for 8 months only with 1000 mg daily of valproate after 2 weeks treatment. PMA is an idiopathic generalized epilepsy syndrome characterized by typical absence seizures with perioral myoclonia. VEEG monitoring is crucial for definitive diagnosis. For children with typical absence seizures accompanied by perioral twitching, perioral EMG should be performed alongside routine deltoid EMG to clarify seizure type. PMA might be classified either as a special subtype of typical absence or as an independent seizure type. Paying close attention to the special phenomenon will help to clarify the clinical spectrum of this epileptic disorder.

Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD) serve as minimally invasive alternatives to excisional haemorrhoidectomy, reducing pain while preserving sphincter function. Long-term faecal incontinence remains a concern due to its quality-of-life impact. This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques.

Objective: To investigate the risk factors of long-term (>3 months) severe anastomotic complications after rectal cancer surgery. Methods: A case-control study was employed, with the following inclusion criteria for cases: (1) age between 18 and 80 years; (2) history of radical surgery for rectal cancer; (3) tumor located ≤10 cm from the anal verge; (4) occurrence of long-term (>3 months) severe anastomotic complications (e.g., refractory local infection or intestinal obstruction) requiring transverse colostomy; (5) complete clinical data. Exclusion criteria: (1) transverse colostomy due to local recurrence or extensive peritoneal metastasis; (2) transverse colostomy due to non-anastomotic complications(e.g., radiation enteritis, fecal incontinence, anal pain); (3) extensive liver or lung metastasis; (4) loss to follow-up. This study defined long-term severe anastomotic complications as complications requiring readmission for transverse colostomy, including anastomotic leakage, sinus tract formation, anastomotic stenosis, and intestinal obstruction. According to the above criteria, a retrospective collection was conducted on 107 patients who underwent transverse colostomy after rectal cancer surgery at Shanghai Changhai Hospital from May 2014 to June 2024 due to long-term severe anastomotic complications (severe anastomotic complications group). 737 patients who underwent radical surgery for rectal cancer at the same hospital from January 2019 to December 2019 were selected from the clinical database as the control group. The inclusion criteria for the control group are as follows: (1) age between 18 and 80 years; (2) history of radical surgery for rectal cancer in our hospital; (3)tumor located ≤10 cm from the anal verge; (4) complete clinical data. No transverse colostomy, recurrence, metastasis, death, or loss to follow-up were included. The observation indicators of this study were risk factors associated with long-term severe anastomotic complications. The variables analyzed included: gender, age, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), body mass index (BMI), preoperative hemoglobin, preoperative albumin, tumor distance from the anal verge, stoma construction status, postoperative tumor T stage, postoperative tumor N stage, maximum tumor diameter, KRAS mutation, NRAS mutation, BRAF mutation, neoadjuvant chemoradiotherapy status, adjuvant chemoradiotherapy status, and perirectal fat space (PFS). Preoperative images with fat quantification sequences of the rectum were acquired via the Picture Archiving and Communication System (PACS), followed by quantification of perirectal fat areas at superior and inferior tumor margins using ImageJ software. Results: Among 107 rectal cancer patients undergoing transverse colostomy for long-term severe anastomotic complications, 85 were male (79.4%) and 22 female (20.6%), with BMI (22.3±3.1) kg/m[2]. Twenty-nine patients (27.1%) had no radiotherapy exposure, while 78 (72.9%) received radiotherapy, including 31 (39.7%) preoperatively and 47 (60.3%) postoperatively. The long-term severe anastomotic complications comprised two categories:(1) fistulas in 47 cases (43.9%): including anastomotic, rectovaginal, rectourethral, and rectovesical fistulas; (2) anastomotic stenosis in 60 cases (56.1%). Univariate analysis demonstrated significantly higher proportions of male patients, advanced age, postoperative T/N stages, and radiotherapy history, but lower BMI in the severe anastomotic complications group versus controls (all P<0.05). Multivariate analysis identified male sex (OR=2.435, 95%CI:1.333-4.447, P=0.004), advanced age (OR=1.035, 95%CI:1.010-1.060, P=0.005), T4 stage (OR=14.634, 95%CI:2.096-102.187, P=0.007), N2 stage (OR=2.014, 95%CI:1.043-3.888, P=0.037), low BMI (OR=1.175, 95%CI:1.080-1.278, P<0.001), and radiotherapy (OR=9.759, 95%CI:5.517-17.264, P<0.001) as independent risk factors. Propensity score matching was further performed in patients receiving radiotherapy, with PFS measurements at both superior and inferior tumor margins. Matched cohorts comprised 78 patients each. Univariate analysis revealed higher male proportion but lower BMI, superior PFS, and inferior PFS in the severe anastomotic complications group (all P<0.05). Multivariate analysis confirmed male sex (OR=2.756, 95%CI:1.130-6.720, P=0.026), low BMI (OR=1.169, 95%CI:1.033-1.324, P=0.013), and reduced inferior PFS (OR=1.021, 95%CI:1.001-1.042, P=0.041) as independent predictors. Conclusion: Radiotherapy significantly contributes to long-term severe anastomotic complications. Male patients exhibiting low BMI and diminished PFS at inferior tumor margins demonstrate the highest risk profile.