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At least 343 records · Page 19Linked to original sources
PubMed2001

Intestinal cannulation: model for study of the midgut of the pig.

PURPOSE: To develop a pig model that would enable repeated biopsy specimen collection and endoscopic monitoring of the gut. This would increase precision of the experiment and reduce the number of experimental animals required. METHODS: Six 10-week-old Yorkshire pigs underwent surgery, and a cannula was inserted in the cecum. Two pigs served as non-operated controls. The health status of the animals was monitored by clinical, hematologic, and biochemical examinations and by studies of gut motility and microbial flora. The experimental period lasted for eight weeks and approximately 45 biopsy specimens were obtained from each animal. RESULTS: Repeated endoscopy was performed and biopsy specimens were taken. Adverse effects on the animal's health were not apparent, and differences were not evident in transit time of digesta or in diversity of the gut microbial flora. After surgery there was a transient increase in the concentrations of haptoglobin, serum amyloid A, and plasma cortisol, and in body temperature and white blood cell count. CONCLUSIONS: It is possible to use an intestinal cannula in the cecum both for endoscopy and biopsy specimen collection. The procedures did not influence health status of the pigs, nor alter gut function. The method will be useful in experimental infection studies as well as in other physiologic investigations.

Animals↗
PubMed2002

[Appendicostomy for fecal incontinence in children and young people with myelomeningocele].

BACKGROUND: Myelomeningocele is a congenital condition where the central nervous system is affected; it may cause paresis in the bladder, colon and lower extremities. For the patients, faecal incontinence and obstipation are troublesome problems that are difficult to treat successfully. MATERIAL AND METHODS: 13 persons were included in the study. Faecal incontinence was the main indication for appendicostomy for antegrade irrigation. Five patients underwent laparoscopic surgery, the rest had an open laparotomy. The appendix was pulled out and anastomosed to the skin. In that way it made a channel through which a catheter could be introduced. Water could be instilled and the bowel emptied by irrigation. RESULTS AND INTERPRETATION: No patient continued major soiling. Five leaked small quantities of faeces, in two there was some mucus discharge from the stoma, and one patient had problems with the irrigation. All patients were able to carry out the irrigation themselves, but a main problem was to motivate them to be responsible. This seemed to be correlated to the age of the child. Appendicostomy is therefore an effective method in the treatment of faecal soiling when all other conservative methods have failed.

Adolescent↗
PubMed2003

Ogilvie's syndrome treatment.

INTRODUCTION: Ogilvie's Syndrome (OS) is a rare condition caused by parasympathetic dysfunction of large bowel characterized by acute and massive colon distension without mechanical obstruction. Rarely this disease has to be treated by the surgeon but operations may be indicated in case of medical treatment failure. METHODS: A retrospective analysis was carried out at the Emergency Surgery DPT of St Orsola-Malpighi University Hospital Bologna Italy. From 1995 to 2002 11 patients were treated for severe OS: they were 8 males and 3 females and the mean age was 68 yrs. All these subjects had large bowel distension with caecum diameter more than 8 cm without any evidence of mechanical obstruction. RESULTS: In 4 patients (36%) OS was caused by trauma or surgical procedures whereas in 7 cases (64%) was produced by other conditions. Only in 3 cases (27%) conservative treatment was successful; the remaining 8 patients were submitted to surgical therapy. 6 patients were submitted to decompressive caecostomy and in 2 cases a subtotal colectomy was done. Mortality was 36%. DISCUSSION AND CONCLUSIONS: Surgical treatment of OS is indicated when there is a conservative treatment failure. The high mortality is related to diagnostic and therapeutic delays, advanced age and comorbidities.

Aged↗
PubMed1992

Surgery for invasive bladder cancer.

Bladder substitution, in whole or in part, represents a growing field within the specialty of surgery. The principles and procedures associated with bladder augmentation are well established and include the use of spatulated, rather than intact, bowel segments and appreciation of the importance of adequate protection of the augmented bladder from urinary extravasation by means of both the suprapubic and ureteral catheter drainage. The principles pertinent to continent urinary diversion by means of total bladder replacement have not been as well defined. Problems still exist with each of the described procedures. There has yet to be an operative technique that will allow for orthotopic micturition that is free from the difficulty of enuresis. With those operations employing a continent abdominal stoma requiring intermittent catheterization, the competence of the continence mechanism is not assured in every case. Nevertheless, the psychologic advantages of freedom from urinary collection devices can stimulate patients to seek out total bladder substitution when facing cystectomy. An additional large patient group already diverted by means of urinary conduits is seeking conversion to total bladder substitution. It is certain that this large patient population will stimulate the operative technique of bladder substitution so that we will have a dependable procedure to employ in future years.

Anastomosis, Surgical↗
PubMed2005

[Defecation disorders in children: treatment with colonic irrigation through an appendicostomy].

In 3 patients with serious constipation or faecal incontinence the appendix was sewn open-ended into the abdominal wall (Malone-stoma) allowing antegrade bowel washouts. The patients were a 4-year-old boy with Hirschsprung's disease, a 15-year-old boy with chronic functional constipation and encopresis, and a 5.5-year-old boy with incontinence associated with a meningomyelocele. Following the procedure they were free from bowel problems. Faecal incontinence has a major detrimental effect on the psychosocial development of children. Severe constipation and faecal incontinence which do not optimally respond to conventional therapy can be treated by this procedure. Treatment is effective in around three-quarters of these children. Complications occur in an equal number of children, stenosis being the most frequently seen.

Adolescent↗
PubMed2005

Alleviating debilitating, chronic constipation with colostomy after appendicostomy: a case study.

Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances.

Appendix↗
PubMed2006

[Appendicostomy in the treatment of severe defecation disorders in children].

INTRODUCTION: The Malone antegrad colonic enema (MACE) has been an option in the treatment of children with severe faecal incontinence or intractable constipation at Odense University Hospital. MATERIALS AND METHODS: We did a retrospective review of 32 case records and questionnaires completed by the patients. Pre-existing conditions included anorectal anomaly, myelomeningocele, Hirschsprung's disease and idiopathic constipation. The mean age at operation was 8.7 years (range 4-16 years), and the mean follow-up time was 2.5 years (range 1-8 years). RESULTS: Of the 32 patients, 31 returned the questionnaire. Three children had obtained satisfactory colonic function, and 2 patients had had a colostomy because of an unsatisfactory result. Of the remaining 26 patients, all reported improvement and 46% were completely clean. Complications related to the stoma included stomal stenosis (41%) and stomal leakage (62%), and 54% had experienced some degree of abdominal pain during the procedure. The patients' satisfaction with the MACE procedure and their improvement in general well-being was evaluated on a scale from 1 to 10 (1 = no satisfaction/improvement; 10 = fantastic satisfaction/improvement). The results ranged from 5 to 10 (mean 9). The same results were achieved regarding well-being. CONCLUSION: The MACE is a successful management option in children with faecal incontinence or intractable constipation. Patients' stool pattern, quality of life and satisfaction are greatly improved. However, the method is not without problems.

Adolescent↗
PubMed1991

[The Mainz pouch. Ileocecal reservoir, Mainz pouch].

The surgical technique for creation of the Mainz-pouch uses 12cm of cecum and ascending colon and 2 ileal loops of the same length for construction of an urinary reservoir, which has proven to be applicable for bladder augmentation, bladder substitution as well as for continent urinary diversion. For the creation of a continent nipple in urinary diversion 6cm of ileum in addition are necessary. As a modification we use the non-infected submucosal imbedded appendix as continence mechanism. Since 1986 a total of 247 patients underwent a Mainz-pouch procedure: 54 for bladder augmentation, 27 for bladder substitution and 166 for continent diversion. The appendix as continence mechanism was used in 30. Postoperative mortality rested under 1%, early complications have been observed in 4.4% and late complications in 13.7% (mean follow-up of 35 months). In the bladder augmentation group 52 patients are completely dry, 2 patients have urge and frequency and 5 patients are on intermittent self catheterisation to avoid residual urine. In the bladder substitution group all patients are continent at daytime. At nighttime 3 patients have leakage if they don't empty their bladder all 4 hours. In the urinary diversion group all but 3 are completely dry and are on intermittent catheterization. The main problem of our initial series was prolapse of the continent nipple which has been solved by staple fixation of the nipple to the bowel wall and to the ileocecal valve or by using the submucosal imbedded appendix.

Adult↗
PubMed1991

[Pelvectomy and continent diversion].

We owe to N.G. Kock and to M. Camey the extraordinary recent development of continent urinary diversion and of bladder replacement. During sixty-six months, 145 Kock pouches were constructed: 79 for continent cutaneous diversion (44 men, 35 women), 54 bladder replacements by men, 12 ileo-rectal diversions (10 women, 2 men). The mortality during the six first postoperative weeks reaches 6/145 patients (4.13%). 17 patients out of c139 (12.23%) presented postoperative complications; 15 patients required surgical revision (10.70%)(10 intestinal obstructions).

Cecostomy↗