[J-reservoir in the treatment of ulcero-hemorrhagic rectocolitis].
The Authors report their experience on ileal-anal anastomosis with a J-pouch. A videotape illustrates the surgical technique. At last functional results are shown.
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The Authors report their experience on ileal-anal anastomosis with a J-pouch. A videotape illustrates the surgical technique. At last functional results are shown.
Carcinoma complicating ulcerative colitis, although an uncommon event, is well known but follow-up of patients to detect high-grade dysplasia as a potential indicator for colectomy is very difficult. Retrospective morphological and cytometrical analysis of three resected colons harboring carcinoma coming from patients with ulcerative colitis were performed. It allowed to confirm the value of this technique. Histogram patterns varied between narrow unimodal in quiescent mucosa to broad unimodal with high IP (proliferation index) in regenerative mucosa and aneuploid in high dysplasic mucosa and carcinoma. In addition to histopathology and in spite of a patchy distribution of aneuploidy, different degrees of dysplasia in mucosa and technical sensibility DNA (desoxyribonucleic acid) analysis in long-standing ulcerative colitis seems to be helpful in the detection of potential malignancy.
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The authors give the differential characters of dysenteric amoebae and cells observed in the feaces of patients affected by recto-colitis. In this purpose, they recall the usefullness of cultures for both the presence and the possibility of determination of the Amoebae. In short, they deplore the misappreciation of these advantages.
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Surgical indications in URC are examined in relation to various situations of election, emergency and urgency. The various possible surgical procedures are analysed, stress being laid on criteria of choice which take account of the seriousness of the disease and of the different technical solutions now available. A series of 30 operations in 145 cases of URC is presented and complications examined in relation to the type of operation performed and to the indications. Stress is laid on the importance of intervening adequately so as to achieve the best prognostic results.
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This case report documents severe autoimmune thrombocytopenia in a 20 yrs. old patient with ulcerative colitis. Diagnosis of idiopathic thrombocytopenic purpura was made on the presence of bound antiplatelet antibodies and on the absence of any other disorder capable of provoking a platelet fall. Colonic lesions were moderate but were resistant to steroids and total parenteral nutrition. Thrombocytopenia resisted to steroids and vincristine and a major fall in the platelet count (less than 10,000/mm3) occurred in two instances. However, platelets rose transiently after high-dose intravenous gamma-globulins. The patient underwent splenectomy, colectomy and ileostomy because of life-threatening colonic hemorrhage. The platelet count rose to normal levels within one week after surgery. Ileorectal anastomosis was subsequently performed. One year later the patient was in good health and his platelet count had returned to normal.
The clinical aspects, surgical treatment and outcome of 16 consecutive patients treated for toxic megacolon secondary to ulcerative colitis at the 1st department of surgery at the university of Rome between 1976 and 1987 were reviewed. The surgical management consisted in total colectomy and immediate ileo-rectal anastomosis, without protective ileostomy in 14 patients and total colectomy with terminal ileostomy and ileorectal anastomosis in 2 patients, 5 months later. No postoperative mortality was observe the immediate complications were: anastomotic leakage, (one case) and rectal bleeding (three cases). The late complications were: ileo-anastomotic stump fistula and perforation (two cases). Protectomy, due to colitis recrudescence, in the rectal remnant 10 months after surgery. These results encourage the total colectomy with immediate ileorectal anastomosis for the treatment of toxic megacolon.
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We compared the postoperative evolution of patients in whom an ileoanal anastomosis was performed, with (group 1, n:9) an without (group 2, n:7) an ileal reservoir. 3 of the 9 patients in group 1 developed intractable diarrhea, it was necessary to reoperate these children and to construct an ileal reservoir. It was not necessary to reoperate any of the group 2 patients; 2 of whom still have an ileostomy due to the presence of preanastomotic abscess. These 2 last patients where excluded from the following analysis. 2 months after surgery, children in group 1 had 16 +/- 2 bowel movements a day, compared with 8 +/- 2 in group 2, p less than 0.05. Children in group 1 did less well than those in group 2 when the following parameters were compared: fecal incontinence (7/9 vs 0/5), perianal dermatitis (6/9 vs. 1/5), treatment with antidiarrheal agents (5/9 vs 0/5), missing school (4/9 vs 0/5) and diminished social activities (4/9 vs 0/5). We conclude that in children who require colectomy, better results are obtained when an ileoanal anastomosis with ileal reservoir is performed.
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Planned treatment of 30 cases of haemorrhagic colitis is reported. Its protocol included salazopyrine and benzodiazepine per os, salazopyrine and prednisone per rectum, and parenteral ACTH depot. Administration for 60 days brought good results in cases of slight or average severity. Recurrences, albeit less severe, were not prevented, however. Attention is drawn to the need to follow up this group of patients for a longer period. Even so, it is felt that the effect of this form of treatment is primarily symptomatic.
Severe forms of ulcerative colitis are somewhat rare but have a severe prognosis. Apart from the usual predisposing factors, the amebic graft must be especially emphasized, at least in those countries where the parasite is endemic. Entamoeba histolytica was consistently identified in 19 cases of the severe form that we found out of a total of 126 cases of ulcerative colitis. Usually the parasite was found in the shape of massive infestation and in most cases it proved to be resistant to the amebicides currently available. The clinical picture shown by the 19 patients was identical to that given in the literature for severe forms of ulcerative colitis. Therapeutically, it was essential to combine one (or, if necessary, several) course(s) of treatment with amebicides with the usual therapeutic measures until the parasite was destroyed in the intestine. This work suggests that any attack on ulcerative colitis must automatically include an anti-amebic course of treatment, and this should strictly precede any corticosteroid therapy, even administered as enemas.
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