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PubMedDate not supplied

Colonic ileus complicating laminectomy.

Colonic ileus is an unusual form of adynamic ileus that often mimics true intestinal obstruction and that, if not recognized and adequately treated, may be fatal. We have encountered three patients in whom this syndrome followed apparently uncomplicated laminectomy for herniated disc or spinal stenosis. Two of our three patients required abdominal exploration for diagnosis and treatment of the complication. At operation, a large distended colon without volvulus or tumor was found. Cecostomy was performed in both patients. The third patient was treated conservatively. All three patients recovered without sequelae. The pathogenesis of the illness is unknown, but the most widely held view is that ileus results from increased sympathetic activity that inhibits the bowel. Conservative management consisting of correction of any fluid or electrolyte abnormalities, continuous gastric suction via nasogastric tube, and placement of a rectal tube may relieve the symptoms. Patients should, however, be followed carefully and, if distention of the cecum exceeds 12 cm, a decompressive operation is indicated.

Aged↗
PubMed1983

Pseudo-obstruction of the colon. A postoperative complication in orthopaedic patients.

Pseudo-obstruction of the colon is a problem of bowel motility that predominantly involves the large intestine and that can mimic the clinical and radiographic features of mechanical obstruction of the colon. It must not be confused with the much more common and less dangerous complication of post-operative ileus. Although it is most often seen in elderly patients who are confined to bed, it can occur in younger patients. Cecal dilation can develop rapidly to dangerous proportions, and recognition by thorough physical examination and early abdominal radiographs is essential if operative intervention is to be avoided. Nasogastric suction, intravenous fluids, and frequent turning of the patient are often successful if begun early, but are unlikely to be of benefit once cecal dilation approaches fourteen centimeters on plain radiographs. In these advanced cases, tube cecostomy or colostomy may be the only way to avoid necrosis of the bowel wall, perforation, and sepsis.

Adult↗
PubMed1985

The radiologic evaluation of gross cecal distension: emphasis on cecal ileus.

A retrospective review of plain abdominal radiographs in 46 patients with gross cecal distension (greater than 10 cm) was performed. In 25 (54%) of 46 patients, the cecum was dilated out of proportion to the rest of the colon and was rotated anteromedially. The term cecal ileus is used to describe this situation. Five (20%) of 25 patients with cecal ileus developed perforation. Four of these patients died as a result of the perforation. The risk of perforation was related more to duration of cecal distension than to absolute cecal size. Aggressive decompressive measures, including consideration of cecostomy, appear warranted in patients with gross cecal distension, especially when it is dilated out of proportion to the rest of the colon and has persisted for several days.

Adult↗
PubMed2000

Modified technique of antegrade continence enema using a stapling device.

PURPOSE: We present a stapling technique for constructing an antegrade continence enema (ACE) conduit that is helpful in cases of insufficient appendiceal luminal length or when a concomitant appendiceal Mitrofanoff stoma is required. MATERIALS AND METHODS: In 6 patients with a mean age of 9.5 years who required an ACE procedure the cecum was tubularized in continuation with the orthotopic appendix at its base, using a stapling device to construct an ACE conduit. The tubularized segment was imbricated with permanent suture material. In 3 cases appendiceal length after tubularization was sufficient to allow splitting for the concomitant creation of an appendiceal Mitrofanoff stoma. RESULTS: Patients have been followed an average of 16.5 months. Stomal continence was achieved in all cases as well as reliable catheterization of the appendiceal cecostomy in 6 and the Mitrofanoff conduit in 3. CONCLUSIONS: This modification of the ACE procedure with cecal tubularization in continuation with the appendix using a stapling device is an excellent approach in cases of inadequate appendiceal length. It successfully creates a catheterizable stoma with a reliable flap valve continence mechanism. The complex reconstructive procedure is simplified by eliminating the need to use tapered small intestine, while allowing the creation of a concomitant appendiceal Mitrofanoff stoma as necessary.

Adolescent↗
PubMed1993

[In Process Citation]

Prolonged decompression of the small intestine was used in the complex surgical treatment of 85 patients with acute ileus (67) and peritonitis (18). The main stage of the operation included liquidation of ileus and elimination of a source of peritonitis. Antegrade nasogastral intubation of the intestine was performed in 54 patients, via gastrostomy--in 3, retrograde intubation via cecostomy--in 15, via appendicostomy--in 4, via ileostomy--in 9. Performance of active transtubal sanation of the intestine by means of antiseptic solutions (53 cases) in combination with enterosorption (17) contributed to essential increase in the effectiveness of treatment.

Journal Article↗
PubMedDate not supplied

[Acute colonic pseudoobstruction: physiopathology and treatment].

The acute colonic pseudo-obstruction is a rare condition. Pathophysiological knowledges, nowadays, are still discussed. Several associated pathological conditions (cardiological, neurological, metabolic) would mainly cause, with different mechanisms, a sympathetic-parasympathetic imbalance. In Authors' experience with 19 patients the sudden onset and the rapid evolution to a serious condition set the difference with a mechanical obstruction. The radiological control was essential to the therapeutic options. The endoscopic decompression was successful in 2 cases; the tube cecostomy was effective in 13; the right emycolectomy was necessary in 1 case with multiple diastasic cecal perforations. Mortality rate: 3 patients (15.70%).

Acute Disease↗
PubMed2001

Ileocecectomy is definitive treatment for advanced appendicitis.

Although appendectomy is the most commonly performed emergency operation septic complications of appendectomy remain a major source of morbidity. Historically, advanced appendicitis has been treated by appendectomy with cecostomy and/or drainage tubes. Our objective was to evaluate the use of ileocecal resection for the immediate treatment of advanced appendicitis. We examined the cases of all patients undergoing ileocecal resection for appendicitis from August 1989 through April 2000. There were 92 patients (60 male and 32 female) with a median age of 34 (range 6-71). Abdominal pain was present in 98 per cent of patients with duration of 5.1+/-0.6 days. Right lower quadrant tenderness was present in 91 per cent with accompanying right lower quadrant mass in 30 per cent. Temperature on admission was 38.0+/-0.1 degrees C with a white blood cell count of 15,300+/-500. Preoperative radiological studies included abdominal X-rays (33), contrast enemas (two), CT scans (41), and abdominal ultrasound (17); these studies yielded a correct preoperative diagnosis in 89 per cent. Previous appendectomy had been performed in six patients with failed percutaneous drainage of intra-abdominal abscesses in five. There were 94 cecal resections performed in 92 patients. The extent of surgical resection varied between patients and ranged from partial cecectomy (34) to ileocecectomy (55) to ileocecectomy with diverting ileostomy (five). Intra-abdominal abscesses were present at operation in 46 cases (50%), and drains were placed in 38 (41%). Skin incisions were packed open in most cases (65); there was skin closure in 27. There was no mortality encountered in this period. There were 25 complications in 23 patients (25%). Complications included postoperative abscess (10; 11%), wound infection (10; 11%), partial small bowel obstruction (two) and pulmonary embolus (one). Reoperation was required in seven patients and CT-guided percutaneous drainage in five patients. Anastomic leaks occurred in two cases of partial cecectomy and required conversion to ileocecectomy. Mean hospital stay was 10.5+/-1.0 days with adjusted hospital costs of $31,689+/-3018. We conclude that definitive treatment of advanced appendicitis can be performed by resection of the involved areas of the ileocecum. This can be accomplished with a primary anastomosis obviating the need for ileostomy and secondary operation. This aggressive surgical approach may reduce infectious complications and reduce hospital costs.

Adolescent↗
PubMed2001

Gastrointestinal pseudo-obstruction: report of a patient with postoperative pseudo-obstruction.

Postoperative pseudo-obstruction is a rare state of protracted gastrointestinal paresis that may progress to paralysis without the presence of obstructive lesions. Pseudo-obstruction is usually, but not exclusively, associated with an abdominal operative procedure (laparotomy), however, it may occasionally occur following extra-abdominal operations. As differentiated from the usual, 'physiologic'postoperative paresis, pseudo-obstruction persists for more than 7 days. The pathogenesis of postoperative pseudo-obstruction is complex and as yet partially unknown. Whereas the 'physiologic' postoperative gastrointestinal paresis includes short-term functional cholinergic depression of the visceral organs, in pseudo-obstruction focal lesions in the region of Auerbach's plexus, manifesting as visceral neuromyopathy, are involved. That is why the 'physiologic' postoperative paresis never transforms into paralytic ileus, while in pseudo-obstruction such a risk is potentially involved. The treatment for pseudo-obstruction is as a rule conservative. Surgical treatment (cecostomy) is rarely required. Colonoscopic decompresive suction is usually enough to eliminate the risk of colon rupture due to extensive distention by fast growing meteorism. A patient with postoperative pseudo-obstruction is presented.

Aged↗
PubMed1975

Volvulus of the colon.

The results of treatment for volvulus of the colon during 13 years in a community hospital are analysed, It is concluded that sigmoid volvulus should be treated with proctoscopic examination and insertion of a rectal tube, unless signs of gangreana or peritonitis are present. In patients without accompanying sever diseases, elective resection should be performed later. Repeated tube decompressions should be attempted in patients with recurrence and high operative risk. Unsuccessful tube decompressions or signs of a non-viable colon should be followed by emergence laparotomy and, probably, resection of the sigmoid colon whether gangraena is present or not. Volvulus of the cecum should be treated with operative reduction and pexia or cecostomy, unless gangreana necessitating a hemicolectomy is present.

Aged↗
PubMed2003

Ogilvie's syndrome--acute colonic pseudo-obstruction. Case report and review of the literature.

We present a rare entity of colonic pseudo-obstruction, characterised by severe colonic dilatation in absence of any organic obstacle. Clinical symptoms, diagnostic approach, and therapeutic measures are analysed and discussed. Many factors have been associated with this syndrome which include electrolyte imbalance, systemic infection, drugs, and occasionally, neurologic disease. Reported here is a case of acute colonic pseudo-obstruction which developed in a patient with restrictive respiratory dysfunction. Colonic decompression by means of colonoscopy, the most effective therapeutic approach for pseudo - obstruction failed, and surgical cecostomy was required. The acute colonic pseudo-obstruction, Ogilvie's Syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilatation in the absence of a mechanical cause and may lead to cecal perforation in absence of treatment. When colonic obstruction is suspected, one should always consider the possibility of the occurrence of Ogilvie's syndrome

Aged↗
PubMed2003

[Cecal prolapse after appendectomy].

Patient N.N. is received to surgery department Canton Hospital "dr Irfan Ljubijankić" Bihac, because operative procedures of prolapsa cecuma with terminal ileum part and proximal colon input part past appendectomy of performed appendix of peritonitis four years ago and the patient didn't get in touch to controlling review. The patient is treated by the way of relaparatomy that is delivered cranial-caudal with primary closing of cecum with cecostomy that is impulsive closed. The way that we access to treatment is correct and good because it is made instential passing and the postoperative flow is ordinary, the common patient's stand and the cosmetician look is good and satisficially with further quality living.

Appendectomy↗
PubMedDate not supplied

[Ogilvie's syndrome: clinical reality or nosographic error?].

The authors report their experience in the management of Ogilvie's syndrome, a rare form of large bowel acute pseudo-obstruction. The study includes fifteen cases of the disease. There were ten males and five female, with a mean age of sixty-two years (range 45-92). Three patients were only treated with medical and conservative measures, one with unsuccessful colonoscopy and twelve (two with colonic perforation) underwent laparotomy. The surgical procedures performed were tube cecostomy (40%), colonic resection with primary anastomosis (27%) and exploratory laparotomy with decompression (13%). The overall morbidity and mortality rate were respectively 0 and 13%. Our epidemiological, clinical and therapeutic results are similar to those reported in the international literature. The pathophysiology of the syndrome is still unknown. It can be "idiopathic" or can complicate other diseases or surgical procedures (urological and gynaecological procedures mostly). Plain abdominal roentgenogram is the most useful diagnostic test, but colonoscopy may be an alternative diagnostic (and therapeutic) weapon. Conservative treatment is the method of choice but when the cecal diameter is more than 12 cm. (impending perforation), when the colon is perforated or when medical measures are unsuccessful, surgical procedure is compulsory. The age of the patient, cecal size, delay in colonic decompression are the most important prognostic factors. Even with a proper management, the prognosis is severe and the mortality rate is high (3-50%).

Aged↗
PubMedDate not supplied

[Complicated colon cancer: the experience at an Operative Surgery Unit].

INTRODUCTION: Prognosis of colon cancer is worse if complications are present at the moment of diagnosis. The high mortality rate with surgery in emergency in such cases needs a careful reflection about the best suitable operation to perform. MATERIALS AND METHODS: 107 consecutive patients observed along a 9 year-period for colon-rectal cancer are retrospectively analysed. 27 of them were complicated at the presentation for obstruction (19 patients), colon perforation (6 patients) or rectal hemorrhage (2 patients). In the whole experience 5 patients underwent primary resection of the tumour and direct anastomosis; 5 only a decompressive colostomy; 6 were primarily resected and anastomized under the protection of a cecostomy; 6 other patients underwent a Hartmann procedure; 2 were treated with only an intestinal by-pass; 1 was treated with Miles procedure; 1 with an anterior rectal section and the last one was resected-anastomosed in two steps, after a temporary decompressive colostomy. RESULTS: Intraoperative mortality was of 11.1% (3 patients) and morbidity 18.5% (5 patients). General 5 years survival was 62.1% among the cases complicated at presentation. The recurrence rate was 8.45%. Both these figures are below a statistical significance (p = 0.57). CONCLUSIONS: The necessity to treat in emergency the colon cancers reduces the possibility to adopt the best rules of modern programmed oncologic surgery giving up the chemotherapy w/o neoadjuvant radiotherapy with which a preoperative down-staging of the tumour were possible. For these reasons in emergency not only mortality and morbidity are higher than in case of elective surgery, but also metastasization and recurrence are worse because of a more difficult radicality in surgery.

Adenocarcinoma↗
PubMed2003

[Present state in the surgical treatment of acute cecal diverticulitis].

BACKGROUND: Cecal acute diverticulitis is a rare disease with symptoms similar to acute appendicitis and is therefore difficult to diagnose. OBJECTIVES: To evaluate therapeutical conduct according to clinical for ms of presentation and the intraoperative findings. LOCATION: Emergency Service of Clinical National Hospital. U.N.C. (Cordoba National University), and the ABC group. DESIGN: Retrospective observation. MATERIALS AND METHODS: Twenty-four patients with cecal diverticulitis were treated surgically, of which seventeen were men and seven were women with an average age of 47 years. The first group was formed with 16 patients and the second with 8. All patients presented abdominal pain, fever, nausea and vomiting when they were admitted, but one showed enterorrhagia and 2 abdominal distention and ileus. Physical examination produced pain and tenderness in RLQ, but in 6 peritoneum was not involved and in 4 a tumor was palpable in that region. Two patients, had a perforating acute abdominal condition. RESULTS: Sixteen right hemicolectomies were performed. In the remaining eight a cecostomy was decided. One patient died due to TEPA (Acute pulmonary thromboembolism). Abdominal wall abscesses appeared in six patients, and in four of them an incisional middle hernia appeared in postoperative period. CONCLUSIONS: We consider that in those patients presenting serious problems in deciding whether the inflammatory condition was benign or malignant, or when perforated cecal diverticulum with vascular compromise and subsequent cecal wall necrosis has been suspected, we believe that the resection is the best treatment.

Acute Disease↗
PubMed2004

Acute bowel obstruction - the main complication of colorectal cancer. Therapeutical options.

AIM: to choose the proper therapeutical approach in obstructing colorectal cancer. MATERIAL AND METHOD: 77 (29.2%) obstructing colorectal cancers, 88.15% aged between 61 and 80 years, selected from 260 patients admitted in the last 10 years were analyzed. We noticed associated cardiovascular (42 cases=55.2%) and/or respiratory (18 cases=23.6%) disease in 89,55% of cases. The distribution of the obstructing lesions throughout the colon and rectum was: 39 cases on the left colon, 18 cases on the right colon, and 20 cases on the rectum, with the following pTNM staging: stage II 10%, stage III 67% and stage IV 23%. The infiltrative character of the primary tumor (61 cases) and the extension to the adjacent structures (24 cases) were the main causes of the acute bowel obstruction. The diagnosis was established on the clinical aspects and plain X-ray findings. The delay between the onset of the acute obstruction and the admission was 3 days on average, and we noticed severe biological disorders pertaining to the acute bowel obstruction in more than 75% of cases. 76 patients (99.6%) were operated on. We performed primary resection in 8 cases and staged-procedures (cecostomy or ileotransversostomy followed by resection and anastomosis after 3 weeks on average) in 33 cases. In 35 cases we performed one of the so called "exigency procedures" (colostomy, internal diversion or Hartman colectomy). RESULTS: 55 (72.36%) patients had a fair evolution. We registered 21 deaths, with a general mortality rate of 27.6%, and a mortality rate of 25% for primary resection, 9.09% for staged surgery and 47.05% for the so called exigency procedures. CONCLUSIONS: Acute bowel obstruction is the most common complication of the colorectal cancer, charged by multiple major risk factors. An adequate colon decompression and the treatment of the biological disorders are the main therapeutical objectives. Surgery of the obstructing colorectal cancer is always a palliative one. Staged surgery is the safest therapeutical option for colorectal cancers with acute bowel obstruction.

Adult↗
PubMed1992

[The indications and methods for decompression of the gastrointestinal tract in injuries to the abdominal cavity organs].

The article analyses the treatment of 122 patients with injuries of organs in abdominal cavity. One of the most important elements in intra- and postoperative treatment for paresis or paralysis of intestines was an abdominal decompression. Its basic methods were the following: nasoenteral drainage, gastroenterostomy by Iu. M. Dederer's method (31), enterostomy by I. D. Zhitniuk (25), and cecostomy (2). The application of decompression made it possible to treat the patients with severe peritonitis caused by gunshot injuries.

Abdominal Injuries↗
PubMedDate not supplied

[The complications of colostomies].

The evaluation of the frequency of complications that arise after colostomies performed for colorectal and genital neoplasm, and also the treatment possibilities for these complications. In Colţea Hospital, Surgical Department during 1984-2002 there have been admitted and surgically treated 891 patients with colorectal cancers, among which, 484 had rectosigmoidal neoplasm. We have treated 25 patients with complicated genital neoplasm (19 rectovaginal and recto-bladder-vaginal fistulas following cervical cancers, 5 pelvic tumoral blocks following ovarian cancers and a vulvar cancer with local invasion). For all these patients we performed: 25 Hartmann resections, 75 Reybard resections, 73 Dixon resections and 147 rectal amputations, with 294 colostomies (30 iliac anus in continuity-Audrey, 18 on a stick, 232 terminal and 14 cecostomies for protection or decompression). There were 48 complications following the colostomies: 10 cases of stenosis, 14 prolapses, 7 intestinal loop necroses and 17 parastomal hernias, all of them surgically managed. Terminal colostomies and colostomies for protection are still frequently used in surgical departments, having strict indications. Because they are frequently performed as emergencies, at patients with poor biological status they are often enough followed by complications, most of them with little gravity. The complications can be avoided by a proper therapeutic choice and in most cases can be managed with a surgical intervention.

Adult↗
PubMedDate not supplied

[Intestinal obstruction due to perforated cecal volvulus. Case report].

Cecal volvulus is an uncommon cause of large-bowel obstruction. Its developement is due to an abnormal mobility of the ileocecal loop because of lacking attachement of ascending colon. Clinical features are frequently aspecific and should be differentiated from sigmoid volvulus and neoplastic obstruction. Therapy depends on visceral circulatory conditions at the moment of diagnosis. Possible options include endoscopic decompression, cecopexy with or without cecostomy, right colectomy with immediate or delayed anastomosis. The present paper reports the case of cecal volvulus in a 44 year old woman, successfully treated with right colectomy and primary anastomosis.

Adult↗