Publications by authors named "Paul C M Verbeek"

7 Publications

  • Page 1 of 1

Severity of Diverticulitis Does Not Influence Abdominal Complaints during Long-Term Follow-Up.

Dig Surg 2019 9;36(2):129-136. Epub 2018 Feb 9.

Department of Surgery, Erasmus Medical Center, Havenziekenhuis, Rotterdam, The Netherlands.

Background: Diverticulitis can lead to localized or generalized peritonitis and consequently induce abdominal adhesion formation. If adhesions would lead to abdominal complaints, it might be expected that these would be more prominent after operation for perforated diverticulitis with peritonitis than after elective sigmoid resection.

Aims: The primary outcome of the study was the incidence of abdominal complaints in the long-term after acute and elective surgery for diverticulitis.

Methods: During the period 2003 through 2009, 269 patients were operated for diverticular disease. Two hundred eight of them were invited to fill out a questionnaire composed of the gastrointestinal quality of life index and additional questions and finally 109 were suitable for analysis with a mean follow-up of 7.5 years.

Results: Analysis did not reveal any significant differences in the incidence of abdominal complaints or other parameters.

Conclusion: This retrospective study on patients after operation for diverticulitis shows that in the long term, the severity of the abdominal complaints is influenced neither by the stage of the disease nor by the fact of whether it was performed in an acute or elective setting.
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June 2019

Endometriosis with an acute colon obstruction: a case report.

J Med Case Rep 2015 Jun 26;9:150. Epub 2015 Jun 26.

Department of General Surgery, Flevoziekenhuis, Hospitaalweg 1, 1315 RA, Almere, the Netherlands.

Introduction: The presentation of an acute bowel obstruction caused by endometriosis in an emergency department setting is rare, as it usually presents through years of complaints in the absence of a distinct acute onset. In this report, we present a case of a patient who was familiar with abdominal complaints and eventually required emergency surgery to treat an acute bowel obstruction caused by endometriosis. Endometrioses present infrequently in the acute phase, and only a few cases in which emergency surgery was required have been described in the literature.

Case Presentation: A 31-year-old Caucasian woman presented to the emergency room of our hospital with a distended abdomen, pain and nausea accompanied by a history of 14 years of chronic abdominal pain and constipation. An abdominal X-ray and subsequent computed tomographic scan showed a severely distended cecum of 9cm with stenosis in the sigmoid. Cecal blow-out was considered highly likely, and, during an emergency laparotomy, an obstructing process was found in the sigmoid. An oncologic resection of the sigmoid was performed with a primary anastomosis and loop ileostomy. A pathological examination revealed a tumor of 4cm in the sigmoid, which contained a tubelike structure with cytogenic stroma and the remains of focal bleeding. These are typical aspects of endometriosis.

Conclusions: Infiltrating endometriosis is an invalidating disease that can be misdiagnosed for a wide range of other diseases. Emergency room physicians and surgeons should be aware that it can present as an acute obstruction and should be considered in diagnosing women of childbearing age. After initial colonoscopy, emergency surgery is the best therapeutic approach if there is a complete obstruction.
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June 2015

[Patients with a therapy-resistant anal fissure: beware of malignancies].

Ned Tijdschr Geneeskd 2014 ;158:A7646

Flevoziekenhuis, Almere.

In this article we describe three patients aged 53, 39 and 70 with a therapy-resistant anal fissure. Each patient was inspected under anaesthesia. In all three cases a suspicious lesion or swelling was observed and all biopsies taken showed anal malignancies. Although anal malignancies are rare, their incidence has increased significantly over the past 22 years in the Netherlands (from 71 patients in 1989 to 215 in 2012). It is important to be aware of the possibility of malignancies among patients with a therapy-resistant anal fissure. Therefore, we recommend performing an inspection under anaesthesia in these patients to obtain tissue for histological analysis.
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April 2015

Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination.

Dig Surg 2013 12;30(4-6):472-5. Epub 2014 Feb 12.

Flevoziekenhuis, Almere, The Netherlands.

Background/aims: Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of gallbladder carcinoma (GBC). However, there is no evidence for the benefit of this costly practice. Our aim was to determine whether a selective strategy based on macroscopic appearance of gallbladder specimens is a reliable strategy to exclude them from histopathological examination.

Methods: A retrospective study was conducted from January 2007 until November 2011 in a large community hospital in The Netherlands. All gallbladder specimen reports (n = 1,393) after cholecystectomy were included and searched for abnormal findings. Reports were excluded when a full histopathological report was not available (n = 18).

Results: Out of the 1,375 patients, 185 had a macroscopically abnormal gallbladder specimen. Of these patients, 6 had GBC. All patients with GBC had macroscopic abnormalities, giving a negative predictive value of 100% to exclude gallbladder specimens from histopathological examination based on macroscopic abnormalities.

Conclusions: Based on our study it seems justified to exclude gallbladder specimens from histopathological examination based on the absence of macroscopic abnormalities. A more selective policy will reduce medical costs, saving EUR 1.3 million a year in The Netherlands alone, whilst maintaining patient safety.
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July 2014

A colo-urachal-cutaneous fistula in an 88-year-old male.

Int J Surg Case Rep 2012 3;3(2):55-8. Epub 2011 Nov 3.

University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.

Introduction: Urachus anomalies are remnants of the urachus, an embryonic connection between the fetal bladder and umbilicus. These anomalies usually remain asymptomatic but can cause symptoms in case of infection. An extremely rare complication of symptomatic urachal remnants is fistulizing to adjacant viscera. We describe the first case of diverticulitis associated sigmoid-urachal-cutaneous fistula.

Case Report: An 88-year-old male visited the outpatient clinic with intermittent bleeding and gassy discharge from his umbilicus. Examination showed a normal looking umbilicus with a small fissure at the bottom in which a 10 cm probe could be inserted. Laparotomy revealed a fistula extending from the umbilicus to a pus filled cyst superior to the bladder. A second fistula between the cyst and a mid-sigmoid diverticulum was identified. The involved sigmoid segment was resected. Pathological examination demonstrated no malignancy.

Discussion: Urachal remnants are extremely rare in adults. They typically present with abdominal pain or palpable masses. Additional imaging can aid the diagnostic process.

Conclusion: Due to the risk of recurrence and malignant transformation complete surgical excision of urachal anomalies is the treatment of choice. This can be done in a 1-step or 2-step procedure.
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October 2012

[Treatment of chronic anal fissures: diltiazem or isosorbide dinitrate as first choice?].

Ned Tijdschr Geneeskd 2011 ;155:A2594

Flevoziekenhuis, afd. Chirurgie, Almere, the Netherlands.

Chronic anal fissures are a painful condition frequently seen in general practice, with an incidence of 2,5/1000 per year. According to the practice guidelines of the Dutch College of General Practitioners, isosorbide dinitrate 1% ointment (ISDN) is the treatment of first choice for chronic anal fissures. Systemic side-effects such as headache are reported in 27% of all cases. This side effect in combination with the frequent application of ISDN (4-6 times daily) leads to a low compliance for this therapy. A meta-analysis of the Cochrane Collaboration showed similar efficacy of diltiazem compared to ISDN. Diltiazem has several advantages: the application frequency is only twice daily, no systemic side-effects have been reported, the total costs of treatment are lower than the costs of ISDN and a standard preparation of diltiazem ointment is available. Therefore, diltiazem 2% ointment should be the first line treatment for chronic anal fissures.
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August 2011

[Torsion of the gallbladder].

Ned Tijdschr Geneeskd 2010 ;154:A1796

Flevoziekenhuis, Almere, Afd. Chirurgie, the Netherlands.

An 18-year-old male presented at the casualty department with acute right upper abdominal pain. Laboratory examinations showed no abnormalities apart from a mildly elevated leukocyte count. Ultrasound examination revealed hydrops of the gallbladder, with thickening of the wall, with no indication of gallstones. Laparoscopy revealed a necrotic gallbladder due to torsion. The gallbladder was successfully removed. Torsion of the gallbladder is a rare condition, in which the organ twists on its longitudinal axis. It is found primarily in patients under 18 years or over 65 years of age. Laboratory and radiological investigations usually reveal non-specific abnormalities, which means that a correct diagnosis is made preoperatively in < 10% of patients. Treatment of choice is an emergency cholecystectomy. The prognosis is excellent with adequate treatment.
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September 2010