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PubMed1988

Therapeutic colonoscopy in the treatment of colonic pseudo-obstruction.

Colonic pseudo-obstruction has been recognized since Ogilvie described this disease in 1948. Metabolic, surgical, and medical causes have been implicated at various times. Treatment has included surgical decompression by cecostomy and colectomy. Successful nonoperative decompression by colonoscopy was first reported by Kukora and Dent in 1977. Since that report several authors have reported their results using this technique. Presented here is a series of nine patients with colonic pseudo-obstruction treated initially with colonoscopy. Patients presented with a variety of associated conditions, including post operative patients, orthopedic injuries, metastatic carcinoma, and an unusual case after a normal vaginal delivery. Eight patients responded well to colonoscopic decompression. One patient, the second in the series, was unable to be decompressed with colonoscopy and underwent a cecostomy under local anesthesia. Successive colonoscopy may be required to allow restoration of normal colonic function, as was the case in seven of our patients. One death occurred, due to unrelated causes. The authors have found colonoscopy to be a safe and reliable therapy for colonic pseudo-obstruction.

Adult↗
PubMed1978

Complications associated with the Baker tube jejunostomy.

1. The jejunostomy route for the intraoperative insertion of a Baker tube carries significant and probably excessive risks. 2. Such risks can be greatly reduced by introducing the Baker tube through a cecostomy or a gastrostomy. When possible, introduction through an ileal stoma or through the rectum when an ileoproctostomy has been performed, is probably even better. 3. For most patients, the cecostomy approach, if performed with great care, will prove to be safe, convenient, and effective.

Adult↗
PubMedDate not supplied

Acute pseudo-obstruction of the colon: a clinical contribution and review of the literature.

Acute idiopathic pseudo-obstruction of the colon, or Ogilvie's syndrome, is a rather unfrequent condition. Although it has been associated to a variety of pathological conditions, the etiology is still unknown. The authors refer upon a case of Ogilvie's syndrome observed by them and, confronting the data that emerged reviewing the literature with their experience, they retain that if the conservative therapy fails, and in absence of perforations or ischemic lesions, the treatment to prefer is the positioning of a cecostomy tube in local anesthesia. For elderly patients with unsufficiently good general conditions who present a recurrent acute pseudo-obstruction of the colon, it is advisable to confection a definitive cecostomy.

Acute Disease↗
PubMed2002

The management of cecal volvulus.

Cecal volvulus is second only to sigmoid volvulus in its frequency of occurrence. Diagnostic doubt is not uncommon in cecal volvulus; nonoperative decompression is rarely achievable; and if gangrene supervenes, mortality rises appreciably. Resection is mandatory for gangrene and a grossly distended, thin-walled cecum. Cecopexy and cecostomy seem less-effective and more morbid options than resection and anastomosis for viable bowel. However, their role needs reappraisal in the light of advances in minimally invasive techniques.

Cecal Diseases↗
PubMed1998

Changing diagnostic and therapeutic approaches to the 'Ogilvie syndrome'.

The only thing that has remained unchanged about the genuinely described 'Ogilvie syndrome' is its name. Recently it was considered to be an acute colonic pseudoobstruction, a clinical entity mimicking the mechanic ileus of the distal large intestine, without organic obstruction. It is almost always secondary to other diseases. Not all details of the pathogenesis are known, but it has become clear that the direct factor leading to the disturbance of the motility is a vegetative imbalance. X-ray findings are highly characteristic and critical in the planning of treatment. The danger for the patients is the progression of the state or the long duration of the process. Conservative treatment is suitable only for early cases, without complications. In case of failure non-invasive endoscopic or endoscopically assisted minimally invasive procedures may be mandatory. These methods have seen rapid advance in recent years. Uncertain diagnoses or complications call for open surgery. Cecostomy is the solution of choice anyway. The mortality is high in this group of elderly polymorbid patients. Authors compare six of their cases with data collected from the literature.

Adult↗
PubMedDate not supplied

[An acute pseudo-obstruction of the colon with a background of chronic lead poisoning].

The authors present the case of a male patient aged 51 years who, on the background of a chronic intoxication with lead, developed an acute, pseudo-obstructive dilatation of the colon. The diagnosis was established during surgery, and the therapeutic solution consisted in cecostomy with a favourable result. A synopsis is also presented, of the literature concerning this rarely encountered syndrome.

Cecostomy↗
PubMedDate not supplied

[Ogilvie's syndrome].

Ogilvie's Syndrome is defined as acute distension of the colon without any mechanical obstruction. We reported two new cases who underwent surgical treatment and the revision of the literature. Four hundred eight-six cases are described until now. The physiopathology is unknown. The diagnosis is done with abdominal x-ray, barium enema must be used with attention. The more frequent symptoms are nausea, vomiting, diarrhea, and abdominal pain. The perforation of the colon is possible with a diameter of 9-12 cm. The mortality was 11.3% in two hundred ninety patients (59.6%) who underwent conservative treatment. In one hundred ninety-six patients who underwent surgical treatment the mortality was 28.5%. The treatment is conservative, medical or endoscopic. The best surgical treatment is the tube cecostomy.

Aged↗
PubMedDate not supplied

[Indications for temporary diversions and for primary resections in emergency colon surgery].

The authors make a critical analysis of indications for temporary derivations, and for "d'emblée" resection in the emergency surgery of the colon. This study is based on a series of 267 cases where emergency surgery was necessary for various conditions of the colon. All were operated in the I-st Clinic of Surgery from Craiova. The authors stress the inefficiency of cecostomy for the solution of occlusions due to neoplasms of the colon, and list the present indications of this type of temporary derivation, which include: protection of a colo-colonic anastomosis, and the solution of perforations (diastatic, traumatic) of the caecum. Supratumoral anus is considered as the choice solution for cancers of the left colon complicated by occlusion. Latero-lateral ileo-transverse anastomosis is considered as a temporary derivation, and is indicated in tumours of the right colon also complicated by occlusion. In cases of emergency the authors practice colonic resections by necessity, but they also perform colonic exeresis with relative indications. In cases of colonic resections by necessity the problem is mainly the opportunity of recovery of the digestive transit. Emergency colectomies with relative indications concern colonic cancer, or volvulus of the colon, and particular conditions are necessary for their performance. The authors consider the protection of colo-colonic, or recto-colic anastomoses as useful.

Anastomosis, Surgical↗
PubMed1989

[Ogilvie's syndrome: how rare?].

Personal experience of a fairly rare disease is reported and it is stressed that the decisive factor in opting for surgery is the diameter of the colon, particularly the cecum, on the basis of direct X-ray of the abdomen. It is considered that cecostomy is not only the simplest operation but is also the one that offers the best possibilities of success.

Cecostomy↗
PubMed1994

Acute colonic pseudo-obstruction (Ogilvie's syndrome).

Acute colonic dilation without mechanical obstruction (Ogilvie's syndrome) was first described in 1948. The pathogenesis remains unknown but likely involves imbalance between sympathetic and parasympathetic colonic innervation. Patients are generally hospitalized with another serious illness when the syndrome develops. There are no controlled data on the efficacy of any therapy. A trial of conservative measures alone is appropriate in a subset of patients who lack significant abdominal pain, peritoneal findings, and who have one or more potential underlying factors that are reversible. Colonoscopy is the initial invasive therapeutic maneuver but fails in 31% of patients and is followed by recurrence in 40% of those in whom initial decompression is successful. Placement of a tube during colonoscopy may help to prevent recurrence. No pharmacological therapy is proven effective, although anecdotal successes with some agents suggest clinical trials that should be performed. A minority of patients still require surgical cecostomy, which has been recently performed via laparoscopy.

Cecostomy↗
PubMedDate not supplied

Long-term results of corticosteroid administration via appendicostomy in patients with ulcerative colitis involving the entire colon.

BACKGROUND: Ulcerative colitis (UC) of an unknown etiology frequently demonstrates repeated active and inactive stages. As a result, it is difficult to sustain long-term remission under conservative therapy. METHODS: Ten patients who presented suffering from UC involving the entire colon were treated. All patients had been previously treated at other hospitals usually with sulphasalazine and either corticosteroids or steroid enemas for the primary complaints of muco-bloody stool or frequent diarrhea. All patients underwent either an appendicostomy or cecostomy, and were injected with dexamethasone via an artificial fistula twice a day. RESULTS: This treatment led to remission, and, as a result, the symptoms of anal bleeding or muco-bloody stools disappeared in all patients. Radiological, endoscopic, and pathological studies revealed a dramatic response to steroid injection from the fistula. The mean follow-up period was 44.7 months (3-122 months). Eight patients remained free from any symptoms of UC. One underwent a proctocolectomy because of side effects due to steroid treatment. The other patient died suddenly of unknown causes. The mean symptom-free period after cecal injection was 39.5 months (1-119 months). The mean proportion of disease free period from UC, compared with the total follow-up period after surgery, was 88%. After remission, eight patients were able to return to a normal lifestyle at home using a peritoneal button. They could also take a bath and continue their school or social lives in almost the same way as healthy persons. CONCLUSIONS: We thus recommend this new, minimally-invasive therapy for patients with UC involving the entire colon who demonstrate resistance to conventional conservative therapy. As a result of such treatment, all patients were able to achieve a comfortable lifestyle after undergoing minimally-invasive surgery.

Adult↗
PubMed1977

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗
PubMed1996

Fecal incontinence successfully managed by antegrade continence enema in children: a report of two cases.

Two children with intractable fecal incontinence after correction of high anorectal malformations were successfully managed by the daily administration of a glycerin enema into the cecum via an appendicocecostomy or tubularized cecostomy, according to the method of Malone's antegrade continence enema (ACE). Fluoroscopic defecography performed during this procedure in each patient disclosed that the glycerin enema promptly evoked cecal peristalsis, which was transmitted to the distal colon and rectum, and squeezed out almost all the fecal matter, evacuating it from the anus. However, two enemas within a short interval were required to achieve a complete washout of feces. Although this report describes only two patients, our experience confirmed that the ACE was very effective and that adding the word "continence" to antegrade enema was justifiable. Moreover, fluoroscopic defecography was proven to play a significant role in determining the appropriate regimens of this technique to achieve complete washout of the feces.

Child↗
PubMed1988

Ogilvie's syndrome. Successful management without colonoscopy.

We reviewed the clinical presentation, management, and outcome of 25 patients with Ogilvie's syndrome (acute colonic pseudoobstruction) at Memorial Sloan-Kettering Cancer Center from 1982 through 1985. All patients had cancer and severe associated medical problems. Abdominal x-rays uniformly showed cecal distension ranging between 9 and 18 cm. Twenty-four of the 25 patients were treated with conservative nonendoscopic management. One patient had an exploratory laparotomy for prophylactic cecostomy after only one day of conservative therapy. Of the 24 patients treated conservatively, 23 (96%) improved by both clinical and radiologic criteria in a mean of 3.0 days. The remaining patient died of multisystem failure not related to the acute colonic pseudoobstruction. Colonoscopic decompression was not attempted in any of the 25 patients. There were no colonic perforations, and there were no pseudoobstruction-related deaths. This study questions the need for early endoscopic or surgical treatment in cancer patients with acute colonic pseudoobstruction.

Colonic Pseudo-Obstruction↗
PubMed1993

Creation of a pedicle valve unit (PVU) for establishment of enteric continence. Experimental observations.

The aim of this study was to develop a natural tissue valve that could be anastomosed into any area of the gastrointestinal (GI) tract to act as a fecal "brake" and so establish enteric continence at that site. A 4-cm-long valve created from an intussuscepted small bowel pedicle was anastomosed into the cecum and brought out through the abdominal wall as a stoma in 11 rabbits. The animals were re-explored five weeks later for assessment of valve viability and continence and microscopic appearance. In all cases, the valve was fully continent in vivo. All valves were viable, and there was no anastomotic leakage. Pressure testing of the valve at reoperation revealed that 7 of 10 valves tested withstood pressures of 30 mmHg before and after catheterization and 6 of 10 were fully continent to cecal "blanching" pressure (50 mmHg). Valve failure was due to deintussusception in three cases. In four cases, valves were continent over 50 mmHg and showed no tendency to incontinence to bursting pressure of the cecum. We conclude that a continent pedicle valve unit (PVU) for placement in a variety of locations in the GI tract is feasible. The PVU has implications in the management of short-gut syndrome, incontinent ileostomy, continent cecostomy, and as a continent valve placed in the perineum for restoration of perineal defecation following proctectomy.

Anastomosis, Surgical↗
PubMed1990

Colostomy irrigation in the elderly. Effective recovery regardless of age.

One hundred forty elderly cancer outpatients with colostomy in the authors' rehabilitation department were included in an analysis of the feasibility, effectiveness, and safety of periodic irrigation of remaining colon with lukewarm tap water with the aim of regaining full continence. Sixteen patients did not have a sufficiently long remaining bowel (cecostomy, transverse colostomy) and 17 were considered unsuitable to learn the technique because of advanced neoplastic disease with poor life expectancy, intercurrent disease, or stomal problems. One hundred seven patients were proposed to perform the irrigation: 17 refused to do so with the remaining 90 able to learn the method without problems. Nearly all patients achieved full continence for at least 24 hours. Three patients refused to continue, and nine interrupted for minor complications. The median duration of irrigation in the whole group is 257 days (range, 1 to 2669 days): 32 patients have been irrigating from one to five years, and 9 patients for more than 5 years. Based on these results, we recommend irrigation as standard rehabilitative treatment for elderly patients.

Age Factors↗
PubMed1977

Colonic ileus.

Nine cases of colonic ileus, characterized by selective or disproportionate distention of the large intestine without organic obstruction, are detailed. Massive cecal dilatation often dominates the radiographic presentation and may portend perforation. While management is generally conservative, cecostomy may be necessary to prevent peritonitis.

Adult↗