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PubMed1987

Volvulus of the cecum.

Twenty-six cases are reported of ileo-cecal volvulus admitted to three community hospitals over a period of six years. The operative management of ileo-cecal volvulus is discussed. Based on the results and review of the literature the authors recommend a right hemicolectomy in the presence of gangrene or perforation, in other cases a cecopexia with fixation in combination with intestinal tube decompression when needed.

Adult↗
PubMed1993

The influence of caecostomy and colonic irrigation on pathophysiology and prognosis in acute experimental pancreatitis.

OBJECTIVE: To find out if the presence of a stoma had any influence on the pathophysiology or prognosis of necrotising pancreatitis in rats. DESIGN: Randomised controlled study. MATERIAL: 112 male Wistar rats. INTERVENTIONS: Induction of pancreatitis by intraduodenal injection of 2 ml sodium taurocholate 2% with 10,000 units of trypsin; the duodenum and common bile duct were occluded for three minutes. The control group (n = 36) had no further procedure, but the remaining rats were randomised to have either caecostomy (n = 40) or colonic irrigation (n = 36). MAIN OUTCOME MEASURES: Mortality, histological grading of the pancreatitis, white cell count, serum amylase activity, and haemoglobin and endotoxin concentrations in blood. RESULTS: Operative mortality was 14% (n = 5) in the control group, 10% (n = 4) in the caecostomy group, and 8% (n = 3) in the irrigation group, leaving 31, 36, and 33 for assessment. Later mortality was 23% (n = 7), 17% (n = 6), and 9% (n = 3), respectively. The control group had a significantly higher median endotoxin concentration (219 ng/l) than both the caecostomy group (79.2 ng/l, p < 0.05) and the irrigation group (71.7 ng/l, p < 0.05). The amount of endotoxin was mirrored by the changes in the colonic mucosa in the different groups. CONCLUSION: Our results support the hypothesis that both caecostomy and colonic irrigation have a favourable effect on the outcome of necrotising pancreatitis in rats.

Acute Disease↗
PubMedDate not supplied

Acute caecal volvulus: report of 22 cases and review of literature.

The management of 22 patients with acute caecal volvulus is described along with a review of literature. The preoperative diagnosis of caecal volvulus was made in 60 percent of the cases based on clinical findings and plain abdominal roentgenograms. Eleven patients had signs of peritonitis either due to gangrene or perforation of the caecum. On laparotomy all patients had mobile caecum but precipitating factors were not evident in any patient. The authors recommend resection and primary end-to-end ileocolic anastomosis in the presence of gangrene or perforation of the caecum. In non-complicated cases of caecal volvulus, detorsion and caecopexy are preferable because of low mortality, morbidity and recurrence rates.

Adolescent↗
PubMed1995

Technique for creating a permanent cecal fistula in the rat.

A method was developed to surgically implant a silicone/stainless steel fistula-cannula in the cecum of freely moving rats. The specially designed fistula-cannula allows sampling of cecal contents at any time without disturbing the physiologic functions of the intestinal tract, as evaluated by observation of general well-being and postmortem macroscopic inspection. The fistula-cannula was implanted in 12 male rats under general anesthesia. The animals remained in good health during the postoperative period lasting up to 9 weeks. They gained weight normally compared with a control group (n = 8) that had not undergone surgery. Samples of 0.2 to 1.0 g of contents could be collected with a microspatula, without the need to anesthetize the animal. The model provides a useful system for sampling cecal contents without the need to sacrifice the animal. Because it allows cross-over studies to be carried out, this approach may result in significantly reducing the number of animals required for digestive studies.

Animals↗
PubMed1996

The Malone antegrade colonic enema enhances the quality of life in children undergoing urological incontinence procedures.

PURPOSE: Functional alterations of the gastrointestinal and genitourinary tracts, and physical limitations in children with spina bifida, imperforate anus and spinal cord injury challenge the ability to have independent fecal and urinary continence. Urologists have successfully helped these patients achieve urinary continence. We report our experience with the antegrade colonic enema procedure, which allows select individuals to achieve continence of stool, enhancing quality of life. MATERIALS AND METHODS: Since December 1992, 18 antegrade colonic enema procedures were performed in 12 female and 6 male patients 5 to 31 years old of whom 14 had spina bifida, 2 had imperforate anus and 2 had spinal cord injury. Simultaneous urological continence procedures were performed in 8 patients, including appendicovesicostomy in 4, augmentation cystoplasty in 2 and augmentation cystoplasty plus an ileal Mitrofanoff procedure in 2. Four patients previously underwent urological reconstruction. RESULTS: In 24 months of followup (average 6.6) all patients with a functioning stoma remained continent of stool and 17 were continent of urine. Complications related to the antegrade colonic enema procedure occurred in 4 children (22%) of whom 3 required further surgery. Three patients (17%) had minor stomal stenosis. CONCLUSIONS: The antegrade colonic enema procedure is easily performed and it should be considered for any child with significant physical limitations and/or refractory fecal incontinence before urological continence promoting procedures are done.

Adolescent↗