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PubMedDate not supplied

Successful treatment for rupture of pancreaticoduodenal artery aneurysm: two case reports.

We report 2 cases of ruptured pancreaticoduodenal artery aneurysm (PDAA) treated by transcatheter embolization (TAE). In the first case, a 63-year-old man complained of sudden abdominal pain and was transferred to our hospital because he collapsed in a state of shock. Abdominal computed tomography (CT) revealed retroperitoneal hematoma and ascites. Abdominal angiography showed bleeding from one of the branches of the inferior pancreaticoduodenal artery. The ruptured PDAA was terminated by TAE. In the second case, a 65-year-old man experienced sudden abdominal pain. Abdominal CT revealed a retroperitoneal hematoma. He received TAE to terminate bleeding from a PDAA, but his abdominal pain worsened. At operation, ileus caused by the hematoma compressing the transverse colon was diagnosed, and cecostomy was performed. He recovered well and was discharged a few days later. In summary, a patient with a ruptured PDAA should first be treated by TAE, followed if necessary by surgery.

Aged↗
PubMed2005

[A case of advanced gastric cancer with direct invasion of the transverse colon responding to paclitaxel/5'-DFUR combined therapy].

A 50-year-old man was diagnosed with non-resectable scirrhous gastric cancer of antrum accompanied with colon ileus due to direct invasion of the transverse colon. As the ileus improved after cecostomy, chemotherapy with TS-1/cisplatin(CDDP) was performed. Because of no response, 4 cycles of paclitaxel (PTX)/doxifluridine (5'-DFUR) therapy was performed as second-line chemotherapy. Since the stenosis of transverse colon dilated completely and the tumor disappeared, we performed total gastrectomy and right hemicolectomy, and could resect completely. Though 2 cycles of PTX/5'-DFUR therapy was performed postoperatively and the patient's postoperative condition was good, he was suffering from carcinomatous peritonitis complicated by ileus and obstructive jaundice 4 months after operation. He died 1 year after the first medical examination, but his QOL was fairly good for 10 months. PTX/5'-DFUR therapy, which has only slight complications, may be useful for patients with recurrent gastric cancer who had been treated with 5-FU administration as first-line chemotherapy. But the future problem was how to control dissemination after surgery in a resectable case after chemotherapy.

Adenocarcinoma, Scirrhous↗
PubMed2005

[Large-bowel necrosis following open-heart surgery].

In the last 2 years 9 patients have been operated on in our surgical department because of colon necrosis which developed after open heart surgery. The symptoms--abdominal distension, circumscript peritonitis in the right lower part of the abdomen--developed 2-4 days after the heart operation. Laparotomies were carried out within 2 days from the onset of symptoms in all but one patient. In 7 patients the necrosis of the right colon, while in 2 other patients extreme dilatation of the colon was found. In 6 patients right hemicolectomy was carried out. One operation was finished without anastomosis with double stomas. In the 2 patients with no necrosis catheter-cecostomy was performed. All patients but one after hemicolectomy with reconstruction died after several reoperations because of suture leak. The other 3 patients were cured. We examined and analysed the pre-, intra- and postoperative circumstances of the heart operations, which lead to the severe complications. We think the cause of the problems was the liberal use of wide spectrum antibiotics with caused severe dysbacteriosis and Clostridium difficile toxicosis in the colon. This condition could lead to a pseudomembraneous colitis which resulted in the colon necrosis.

Aged↗
PubMed1991

Volvulus of the colon.

The charts of all patients with colonic volvulus at the University of Louisville Hospitals between 1983 and 1988 were reviewed. A total of 45 patients were identified, and there were 17 with cecal volvulus and 29 with sigmoid volvulus (1 had both). Two-thirds of the patients were either demented, bedridden, or used constipating drugs. Initial nonoperative decompression was achieved in 26 of 29 patients with sigmoid volvulus but in only three of nine patients in which it was attempted with cecal volvulus. Two of these recurred, and 16 of the 17 cecal volvulus patients underwent operation. One-third of the sigmoid volvulus patients had at least one recurrent episode on the index admission. Fourteen of the 29 had an operation, and half of these patients died following surgery. Fifteen sigmoid volvulus patients chosen to be treated with successive nonoperative treatment had no mortality. Mortality was higher following emergent (4 of 5) than elective (2 of 9) operation for sigmoid volvulus, and one of three died after operation for a successfully decompressed first episode. Mortality for nonoperative reduction of an early recurrence was zero of four patients, while operative mortality for recurrence was two of seven (all had successful preoperative deflation). There was no mortality or recurrence in four patients with cecal volvulus treated by cecopexy alone, but all three patients died in whom tube cecostomy was performed. Two of nine patients died following right hemicolectomy. These data suggest that if an elective operation is to be performed for sigmoid volvulus, it should be done following one or more recurrences and that nonoperative decompression can be safely performed on successive occasions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Acute pseudo-obstruction of the colon.

Fourteen patients with acute pseudo-obstruction of the colon (Ogilvie's syndrome) were treated over a 16-year period. Ten patients (71.4%) had a recent history of mental illness and were treated with hypnotic and sedative drugs uninterruptedly for many months. The clinical picture and abdominal radiographs on admission to hospital were typical of acute mechanical obstruction of the colon; 1 patient had a perforation of the transverse colon. Obstruction was ruled out by barium enema in 9 patients, by colonoscopy in 3 and by immediate laparotomy in 2. Twelve patients were treated conservatively by nasogastric tube, correction of fluid and electrolyte imbalance, enemas, cessation of all hypnotic and sedative drugs, and decompression of the colon using a rigid rectoscope and rectal tube. There were no complications and no deaths. Ogilvie's syndrome should be suspected in patients with symptoms of large-bowel obstruction whose history discloses intake of hypnotic and sedative drugs. After mechanical obstruction is ruled out, conservative management is indicated. It should include cessation of all psychopharmacological agents and decompression of the colon by rectal intubation or colonoscopy. If conservative measures fail and the caecum increases in size, operative decompression by transverse colostomy rather than cecostomy is indicated.

Acute Disease↗
PubMed1991

[Treatment of perforated appendicular peritonitis].

The article analyses the results of treatment of 104 patients with generalized appendicular peritonitis. Sixty-four patients were admitted for acute disease and 40 patients for chronic disease. Twenty-three patients had been previously subjected to appendectomy for destructive appendicitis at other clinics. Among 100 patients who were operated on 60 were treated by appendectomy: cecostomy was established in 5 and ileostomy in 3 patients with incompetence of the stump of the vermiform process; in nonviability of the wall of the small intestine (11 patients) the wall was resected and an anastomosis formed in 7 and enterostomy was performed in 4 cases. The method of "closed evisceration" was employed in 24 patients with neglected forms of peritonitis. Thirty-three hemosorption sessions were conducted in 30 patients in the terminal stage of peritonitis. Four patients died in the preoperative period and 12 died after the operation. Seventeen complications were encountered after the operation: intestinal fistulas 4, abscess of Douglas' space 2, suppuration of wounds 5, and pneumonia 6.

Adult↗
PubMed1990

[The Ogilvie syndrome].

The authors observed 3 patients with the Ogilvie syndrome. The Ogilvie syndrome is a peculiar form of acute intestinal obstruction characterized by acute dilatation of the colon without obstruction of its distal portions and often developing against the background of other grave diseases. For a timely diagnosed pathology the conservative treatment including a colonoscopic decompression of the colon and epidural anesthesia++ proved to be effective. In cases of ineffective conservative measures a cecostomy was put, resection of the injured portion was used for necrosis and perforation of the over-stretched++ gut.

Adult↗
PubMed1990

[Decompression of the intestine in peritonitis in children].

On the basis of the experience with the use of different methods of intestinal decompression in 56 children with severe peritonitis of appendicular genesis, the authors came to conclusion that intubation of the small intestine via a cecostomy is safe, technically simple, convenient for the care, provides reliable intestinal decompression, do not require the reoperation.

Cecum↗
PubMed1989

[Combined surgery in cancer of the colon].

The study was concerned with the short- and long-term results of 80 radical and 27 palliative combined resections and hemicolectomy for colonic cancer involving other organs or accompanied by solitary distant metastases. Tumor elements were morphologically identified in other resected organs (53.3%). 15.9% of surgical patients died within short periods after operation. Colon was anastomosed immediately in 97 patients (90.7%), cecostomy being performed in two of them shortly after operation. Five--year survival was 53.5% in radically--operated patients and 31.6%--in cases of palliative treatment.

Adult↗
PubMed1989

[Surgical treatment of intestinal injuries].

The results of treatment of 235 sufferers with open (142) and closed (93) intestinal injuries are analysed. One hundred and twenty one patients had isolated, 114-combined intestinal injuries. Suturing of the small, large intestine and other hollow organs was performed in 192 sufferers, resection of the small intestine-in 28, resection of the large intestine-in 5, resection of the large intestine with unloading cecostomy-in 4, right hemicolectomy-in 3, colostomy-in 3. Twenty eight patients developed complications after the operation, 14 (6.4%) died.

Adult↗
PubMed1988

Cecal volvulus: review of 12 cases.

We reviewed the records of patients with cecal volvulus at three affiliated hospitals of Eastern Virginia Medical School to elucidate its incidence, patterns of presentation, and current methods of surgical management. We identified 109 patients in whom a discharge diagnosis of intestinal obstruction due to volvulus was made from 1966 to 1985. In 12 patients (11%) laparotomy showed the volvulus at the terminal ileum and cecum. The presenting symptoms in this group were distention in ten (83%), pain in seven (58%), obstipation or constipation in two (17%), and diarrhea in one (8%). Diagnosis was achieved by plain abdominal films in five (45%); barium enema was obtained in six patients and was diagnostic in five (83%). Two patients had delay in diagnosis with subsequent gangrene of cecum; one of them died. No deaths occurred in the group with viable bowel. Treatment was by simple detorsion without fixation in two (17%), detorsion with cecopexy in two (17%), tube cecostomy in three (25%), and ileocolectomy in three (25%). Simple detorsion was not followed by recurrence of the volvulus in any case in this series. Cecopexy for viable colon and ileocolectomy for gangrenous colon appeared to have the lowest rates of complications.

Acute Disease↗
PubMed1988

[Spontaneous perforation of the cecum after cesarean section].

The literature concerning perforation and imminent perforation of the caecum after cesarean section is reviewed. One case has been observed by the author. Increasing caecal diameter above 10 cm gives rise to suspicion of an imminent perforation of the caecum. Medical treatment and colonoscopy may be tried. In case of unresponsiveness or if occurrence of a cecal perforation, surgical intervention (cecostomy) is indicated.

Adult↗
PubMed1988

Surgical management of pseudomembranous colitis.

The authors recently studied two cases of pseudomembranous colitis (PMC) that required surgery and combined them with previously reported cases in the literature, which required surgery to propose guidelines for the surgical management of PMC. A total of 21 patients were studied. Indications for surgery included refractory disease in seven patients, toxic megacolon in 12 patients, and perforation in two patients. Operative management ranged from decompressive cecostomy to total proctocolectomy. The best results were obtained with subtotal colectomy and ileostomy. It is concluded that PMC should be managed surgically in a manner analogous to ulcerative colitis. If there is no improvement after 7 days of aggressive medical management, surgical intervention, ileostomy with subtotal colectomy is indicated to prevent complications. Complications of PMC, toxic megacolon and perforation, should also be managed with ileostomy and subtotal colectomy as simple decompression or segmental resection does nothing to alter the underlying disease process.

Colectomy↗
PubMed1978

[Cesostoma in tumors of the large intestine and a method for its closure].

Cecostomy is found to prevent effectively suture incompetency of entero-entero-anastomosis in intraabdominal resections in the large intestine in obese patients suffering diabetes and also in aged patients. The method of closing the cecostoma described may be also recommended for elimination of parietal fistulas constructed in other portions of the large intestine. Taking into account a simple technic of closure, using mechanic suture, the availability of suturing apparatuses in many hospitals, it may be recommended for a wide practical use.

Cecum↗
PubMed1987

[An experiment of acute fulminant severe ulcerative colitis in a 75- year-old male--a case report and a consideration of the surgical treatment of elderly patients with severe ulcerative colitis].

This is a case report of 75 year-old male patient with acute fulminant severe ulcerative colitis who underwent proctocolectomy after emergency ileostomy and decompression colostomy, and consideration of surgical treatment for elderly patients with severe ulcerative colitis are also discussed. A 75 year-old male was hospitalized as emergency case with complaints of high fever, severe abdominal pain and diarrhea. He was diagnosed as acute fulminant ulcerative total colitis by colonoscopy and barium enema examination. He had urgent operation of ileostomy and decompression cecostomy in the presence of severe disease after intensive medical treatment had failed. After a few days toxic signs gradually disappeared and general status was slightly improved. And then, radical operation of proctocolectomy and permanent ileostomy was successfully performed 3 weeks after the previous operation. We wish to emphasize in the elderly patients, namely 60 years and over with severe ulcerative colitis, that radical surgical treatment such as proctocolectomy or total colectomy should be performed after minimal laparotomy with decompression colostomy and ileostomy, because they do not survive so readily as the younger patients.

Acute Disease↗
PubMed1986

[Diastatic perforations of the colon of neoplastic origin. Apropos of 15 cases].

Typical findings in 15 patients with diastatic perforation of colon due to neoplasm were the preferential site of perforation in cecum and of obstruction in left colon, and the very poor prognosis with postoperative mortality of approximately 50%. The very varied therapeutic attitude is the result of difficulties in deciding which operative procedure is required. When perforation and obstruction are adjacent, a fairly rare observation, radical excision of the segment of intestine involved appears the most suitable operation. When the two lesions are separated then in addition to conservative treatment (suture of perforation and anus bypass or cecostomy alone or combined with colon bypass) an increasing number of authors recommend initial subtotal colectomy.

Aged↗
PubMed1986

Volume capacity and pressure characteristics of the continent cecal reservoir.

In 11 patients with continent cecostomy, the volume capacity and pressure characteristics of the cecal reservoir were studied at several intervals postoperatively. The reservoir volume stabilized at 400 milliliters four months postoperatively. The basal pressure increased during filling to approximately 9 centimeters of H2O. Pressure waves appeared at all filling volumes in the reservoir but increased in frequency and amplitude with increasing volume. The area underneath the pressure waves was calculated and used as a quantitative measurement of the motor activity. In this manner, a significant increase in motor activity was seen with increasing reservoir volume, although no significant change of motor activity was seen with increasing time after operation. Data from the cecal reservoir were compared with corresponding data from the ileal reservoir obtained in a previous study at our laboratory. This comparison showed a smaller volume capacity and higher basal pressure in the cecal reservoir at identical filling volumes. The motor activity in the cecal reservoir was 20 times greater than that in the ileal reservoir. Thus, the cecal reservoir has a low adaptability to distension compared with the ileal reservoir.

Adolescent↗
PubMed1986

[Ogilvie's syndrome: results of endoscopic exsufflation in a series of 29 cases].

The aim of this study was to assess the value of endoscopic decompression of the colon in a series of 29 patients affected with Ogilvie's syndrome. During the first period (1980-1982), 14 patients were treated by colonoscopic decompression alone. During the second period (1982-1985), 15 endoscopic decompressions were systematically completed by intubation of the colon. The tube was removed after 2 to 13 days. Whatever the procedure, endoscopic decompression was successfully achieved in all cases. The death rate (8/29) and number of cecostomies (2/29) were similar in the two groups of patients. Only one death was directly related to Ogilvie's syndrome itself, whereas 7 patients died from other severe underlying diseases. However, colonic dilatation recurred in 6 patients in the first group and in one patient in the second group (p less than 0.05). No complications due to the endoscopic procedures occurred in this series. It may be concluded that endoscopic treatment of Ogilvie's syndrome is a safe and effective procedure. Our results also suggest that colonoscopic intubation should be used prophylactically in order to avoid recurrences, frequently observed after simple endoscopic decompression.

Acute Disease↗