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PubMed1975

The relationship of anaemia to gastric secretion more than 15 years after vagotomy and gastro-enterostomy.

Iron deficiency anaemia is common following vagotomy and gastro-enterostomy, and this study has shown that all the anaemic patients had low gastric secretion. After correction of their anaemia, gastric secretion was increased, but was still very low, and when these levels were compared with secretion in fit non-anaemic patients it was found that the latter group had a significantly higher secretion, and that a high proportion of them showed evidence of incomplete vagotomy. These results suggest that there is a relationship between the levels of gastric secretion in patients after vagotomy and gastro-enterostomy and the development pf anaemia. It may be that inadequate gastric secretion impairs the release of elemental iron from the diet and its subsequent absorption.

Anemia, Hypochromic↗
PubMed1979

Meconium ileus: laparotomy without resection, anastomosis, or enterostomy.

During the 14 yr from 1965 through 1978, 49 infants presented shortly after birth with intestinal obstruction due to impacted meconium. Three of these patients did not have fibrocystic disease. Eight patients were cured by a Gastrografin enema. There were 18 patients who had complications that included associated atresia, volvulus, and/or peritonitis. Various operations were done including resection with either primary anastomosis or enterostomy or varieties of the foregoing. Twenty-three babies had the simple uncomplicated form of meconium ileus. Eleven of these underwent resection and six patients died. Twelve patients were treated by laparotomy, ileotomy through a purse-string suture and prolonged irrigations using acetylcysteine. Of this group only one succumbed. This latter course of management is recommended for patients with simple uncomplicated meconium ileus as it involves no resection, no enterostomy, nor any primary anastomosis.

Cystic Fibrosis↗
PubMed1985

Revision of porto-enterostomy in congenital biliary atresia.

For the patients with insufficient bile flow following porto-enterostomy for congenital biliary atresia, removal or resection of granulation or scar tissue at the porta hepatis has been performed. Of 11 reoperations, constant bile excretion was obtained in four. Sufficient resection of scar tissue at the porta hepatis was most important for revision of porto-enterostomy. For resection of scar tissue, a special scissors devised by us was used.

Bile↗
PubMedDate not supplied

Stone's enterostomy crushing clamp for modified Duhamel's procedure.

AIM: To evaluate the safety and advantages of the use of Stone's enterostomy crushing clamps in modified Duhamel procedure. MATERIAL AND METHODS: Prospective study at a tertiary care paediatric surgery centre between February 1994 through February 1998 involving all cases undergoing modified Duhamel procedure for Hirschsprung's disease. RESULTS: Twenty eight patients, ranging from 5 months to 14 years were included in the study. The clamp was found to be easier to apply, needed no extra pelvic dissection and there were no immediate or delayed complications. The children were more comfortable and could be mobilized out of bed sooner post-operatively. It is a much cheaper option than staplers. CONCLUSION: The Stone's enterostomy crushing clamp is a reasonably cheap, reusable, safe and effective alternative for the Kocher's clamp and stapling devices for modified Duhamel procedure.

Adolescent↗
PubMed1987

A simple technique for constructing a loop enterostomy which allows immediate placement of an ostomy appliance.

A technique for constructing a loop enterostomy using a red Robinson catheter as a stabilizing "rod" is described. The catheter is placed subcutaneously and exits through skin stab wounds placed far enough from the stoma to allow immediate placement of a standard ostomy appliance. By eliminating the skin level rod common to most descriptions of loop enterostomy construction techniques, difficulty with good fixation of skin appliances is eliminated.

Catheterization↗
PubMed1977

[2 variants of angular enterostomy].

To accelerate the self-healing of an intestinal fistula the author developed 2 variants of enterostomy based on the principle of valvular closure of the serous canal after the removal of the tube. The serous canal around the tube forms from the lateral walls of both bends of intestinal loop a fold in the shape of an angle. In the first variant the tube enters the intestinal lumen along the intestinal loop curvature line; in the second - through the lateral wall of one of the intestinal loop bends. The angular jejunostomy was applied as feeding fistula in 49 cases. The angular ileostomy was carried out on 24 cases to obtain the decompression of the small intestine. There were no cases of complications or fatal outcome resulting from the application of the angular enterostomy method.

Humans↗
PubMed1980

Feeding by tube enterostomy.

Feeding by tube enterostomy is safe, economical and well tolerated by most patients. It will ameliorate or reverse the catabolic effects of protein-calorie malnutrition. Feeding tube enterostomy is indicated in patients with the combined findings: a need for long term nutritional therapy; inability to ingest adequate nutrients by mouth, and a normally functioning gastrointestinal tract. These feedings are most efficaciously delivered into the stomach and jejunum and the surgeon must be thoroughly familiar with the differences in commercial formulations prior to their use.

Duodenum↗
PubMed1988

Enterostomy as an adjunct to treatment of intra-abdominal sepsis.

In 60 patients a small bowel enterostomy was constructed as part of the treatment of various intra-abdominal infectious and obstructive conditions. Eleven patients (18 per cent) died in the immediate postoperative period from continuing sepsis. In one patient closure of the stoma was not considered because of disseminated malignancy. In the remaining 48 patients continuity of the gut was subsequently restored. In 22 patients (46 per cent) complications occurred, 12 (25 per cent) of which were intra-abdominal septic complications. The occurrence of intra-abdominal complications was found to be linked to premature (i.e. within 3 months) closure of the stoma. Reasons for premature closure were stomal difficulties and prerenal azotaemia. Stomal closure was attended by a 10 per cent mortality rate.

Abscess↗
PubMed2006

Pregnancy and delivery in patients with enterostomy due to anorectal complications from Crohn's disease.

BACKGROUND AND AIMS: Enterostomy is often undergone by patients with Crohn's disease (CD) due to severe anorectal lesions such as rectovaginal fistula (RVF). Reports of successful pregnancy and delivery, which are important determinants of quality of life for female CD patients with stoma, are limited. Thus, we investigated problems associated with pregnancy and delivery in female CD patients at our hospital. MATERIALS AND METHODS: Between 1985 and 2003, five female CD patients with enterostoma carried seven pregnancies and delivered eight babies in our hospital. For this study, we investigated CD activity, fetal growth, stoma complications, and the outcome of delivery in these seven pregnancies. RESULTS: Among the five patients, four underwent loop ileostomy and one loop sigmoidostomy for treatment of RVF or severe stricture of the rectum or sigmoid colon. Except for one case, no fertility treatment was done. During pregnancy, a flare-up was observed in one patient and was successfully treated with corticosteroids. Although home enteral or parenteral nutrition was required in two cases, fetal growth was within the normal range in all pregnancies. Preterm delivery occurred in one case with a twin pregnancy. The mean diameter of stoma increased during pregnancy (p<0.01), and a mucosal laceration of stoma by the edge of an ostomy appliance occurred in one case. All deliveries were safe, with six cesarean sections and one transvaginal delivery. After each delivery, the stoma returned to pre-pregnancy size. CONCLUSIONS: Pregnancy and delivery in CD patients with stoma is safe and should be encouraged. However, special attention to disease activity, nutritional support, and stoma-related complications is recommended.

Adult↗
PubMed1992

Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions.

Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.

Enterostomy↗
PubMed1993

Duodenal manometry in postobstructive enteropathy in infants with a transient enterostomy.

Intestinal motility was studied in 11 children with a transient enterostomy secondary to a neonatal organic small intestine obstruction (5 total colon Hirschsprung's disease, 2 necrotizing enterocolitis, 1 intussusception, 3 ileal atresia). Eight children presented with a postobstructive enteropathy (severe grade I [5], moderate grade II [3]) and three were considered as controls (grade III). They were assigned to one of the three groups on the basis of the duration of parenteral nutrition and constant rate enteral nutrition needed and the oral feeding tolerance. Barium small intestine transit showed no persistent partial obstruction or peritoneal adhesions. The abnormal inert marker transit times were statistically correlated with the clinical groups as well as duodenal manometric abnormalities. Manometric recordings were characterised by the absence (grade I) or abnormal phase III (grade II) of the migrating motor complex and decreased motility index (grades I and II). This study confirms that this enteropathy is due to a chronic alteration in motility induced by prenatal or postnatal obstructions.

Barium Sulfate↗
PubMed1992

Transfer of an inferior rectus abdominis myocutaneous flap following enterostomy.

A rectus abdominis myocutaneous flap was successfully transferred in a patient in whom a mucous fistula had previously been brought through the midportion of the muscle. The flap was used to close a large defect in a paraplegic. Previous enterostomy is not a contraindication to the use of this flap. Preoperative arteriography to confirm the presence of a patent deep inferior epigastric artery is recommended prior to flap transfer.

Abdominal Muscles↗
PubMed1990

Percutaneous enterostomy with the Cope suture anchor.

Eighty-two percutaneous enterostomies were performed at three institutions with the Cope suture anchor for stomach or jejunal wall stabilization during alimentation tube placement. The anchors were successfully placed into the stomach or jejunum in 81 cases. Early in the series, two anchors were misplaced, with no sequelae. There were no other complications at the time of placement. In all successful cases, excellent immobilization of the viscus was achieved. Tract dilation and tube placement were easily performed, and there were no guidewire or tube dislodgments.

Adult↗
PubMedDate not supplied

Secondary excision of choledochal cysts after previous cyst-enterostomies.

BACKGROUND/AIMS: Patients with a choledochal cyst previously treated by internal drainage should undergo secondary cyst excision. The results of such secondary excisions have not yet been reported. METHODOLOGY: Over a 27-year period, 121 patients underwent excision of a choledochal cyst at our hospitals. Of these, 14 patients underwent secondary cyst excision following internal drainage. These patients were compared retrospectively with the remaining 107 patients who underwent primary cyst excision. RESULTS: Blood loss and operative time were greater, and early and late post-operative complications were significantly more frequent in the secondary excision group. Wound infection (early complication), pancreatic stones (late complication), and hepatolithiasis (late complication) were significantly more common in the secondary excision group. Histologically, inflammation and biliary glands were more frequently seen in the resected bile ducts in the secondary excision group. CONCLUSIONS: The long-term results of secondary excision of choledochal cysts are worse than after primary excision. The frequent late complications may be related to the development of biliary glands as a consequence of cyst-enterostomy.

Adolescent↗
PubMedDate not supplied

[Psychological disorders in patients with enterostomy. The influence of age].

A retrospective study of patients who had undergone enterostomy and subsequent follow-up in the past 9 years was carried out with the aim of identifying differences with relation to symptoms of depression, the deterioration of social relations and sexual disturbances between elderly (age greater than or equal to 65) and non-elderly patients (age less than 65). Depressive symptoms were present to a greater extent in elderly (48.6%) than in non-elderly patients (34.8%), whereas sexual disturbances were experienced more in non-elderly (34.8%) than elderly (21.6%) patients. No striking differences were noted with regard to the deterioration of social relations. The differences observed, although marked in terms of percentage, were not statistically significant given the relatively small number of cases examined.

Age Factors↗
PubMed1991

[Disabling outcomes and psychological disorders in the patient with an enterostomy].

The authors carried out a retrospective study of patients undergoing enterostomy during the past 9 years. From 1981 to present a total of 60 patients (39 males and 21 females) were operated and subsequently followed-up. The aim of the study was to examine the following factors: the diagnosis which led to operation, the type of stoma used, early and late complications, the behaviour of the alvus, psychological disorders and Karnofsky's Performance-Status Index. After having presented the findings, the surgical results obtained are discussed together with the patient's psychological reactions to stoma. All types of early surgical complications were absent in 66.6% of patients, whereas late complications were absent in 41.6%. Even in those cases where surgical techniques and prostheses permitted a satisfactory post-operative outcome, the sociopsychological and sexual problems relating to the wound and the perceived difference between the real and ideal Ego are highlighted.

Adult↗
PubMed1990

[Experimental studies of the significance of pancreatico-enterostomy on the chronic pancreatitis].

Little is known about endocrine function of the pancreas after it was treated with pancreatico-enterostomy for its chronic inflammation. In order to study this, an experimental model of chronic pancreatitis was made by ligating the canine main pancreatic duct, which was reconstructed eight weeks later by performing pancreatico-duodenostomy in the study group. Pancreatic endocrine function was studied before ligating the main pancreatic duct, 4, 8, 12, and 16 weeks after the ligation in the control group, or 4 and 8 weeks after the reconstruction in the study group. Histological changes of the whole pancreas were also examined when animal was sacrificed. The results of our study are as follows. 1) The endocrine function, which was studied by using IVGTT and calculating K-values, showed significant deterioration eight weeks after the main pancreatic duct ligation. 2) The endocrine function was significantly recovered eight weeks after the reconstruction. 3) Histological evidence of chronic pancreatitis was demonstrated 8 weeks after the main pancreatic duct ligation which was progressed to acinus loss and fibrosis after 16 weeks. The islets of Langerhans were shown to be structurally preserved 8 weeks after the ligation, but ultrastructural alternations 16 weeks after the ligation included apparent degeneration of islet cells. 4) Compared with the control group, fibrotic change of the pancreas was restrained and most of islets did not show degeneration 8 weeks after the reconstruction in the study group. 5) These results suggest that early surgical intervention is to be warranted for chronic pancreatitis, in order to preserve and recover the endocrine function.

Animals↗