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PubMed1989

Mesenteric fibromatosis in Gardner's syndrome.

Gardner's syndrome, first described in the 1950s, is a composite clinical entity characterized by intestinal polyps, osteomas, fibromas, and epidermal cysts. A case of mesenteric fibromatosis in Gardner's syndrome is presented. Whereas most of the literature on this subject stresses the significance of the intestinal polyposis and its premalignant potential, in this paper the serious significance of the intraabdominal fibromas is stressed. This case demonstrates an unusual complication of erosion of this tumor into the small intestine, resulting in multiple intestinal fistulae with abscess formation. Surgical management of this problem necessitated resection of the fibroma and involved small intestine. A review of the literature is presented.

Adult↗
PubMedDate not supplied

Laparoscopic resection of intestinal endometriosis: a 5-year experience.

STUDY OBJECTIVE: To describe the clinical manifestations, surgical techniques, and complications observed in patients undergoing laparoscopic resection of intestinal deeply infiltrating endometriosis (DIE). DESIGN: Prospective nonrandomized (Canadian Task Force Classification II-3). SETTING: University hospital and private practice. PATIENTS: We evaluated 125 patients with intestinal DIE treated from February 2000 through September 2005. INTERVENTIONS: Laparoscopic radical excision of DIE followed by resection of the rectosigmoid colon. MEASUREMENTS AND MAIN RESULTS: The clinical examination of our patients demonstrated that 66.4% of patients had tenderness, whereas 80.8% had nodules on the pouch of Douglas. In 95.2% we observed pain caused by cervical mobilization, and all the patients had pain during the pouch of Douglas mobilization. Regarding bowel infiltration, preoperative investigation with rectal endoscopic ultrasonography was positive in all cases. Endoscopic rectal ultrasonography demonstrated the depth of intestinal infiltration. Superficial lesions were observed in 9.6% of patients and muscularis involvement in 71.2%. The segmental resection was performed in most of the patients (92%) and the linear resection in 6.4% of them. Median surgical time was 110 minutes, and the median hospital stay was 7 days after the surgery; the patients continued fasting for 3 to 7 days. The return to normal activity was achieved in a median 15 days after the surgery. The surgical procedure and the postoperative follow-up demonstrated no complications in 90.4% of the patients. Minor complications were observed in 4% of the cases. Major complications occurred in 5.6% of the patients, including 2 cases of intestinal fistulas (1.6%) and 3 cases of long-lasting urinary retention (2.4%). CONCLUSION: Clinical symptoms of patients with intestinal endometriosis are not specific. Operative laparoscopy is a safe and effective method to treat intestinal endometriosis. To avoid major complications, special attention must be paid to the intestinal anastomosis and to the nerve preservation.

Adult↗
PubMed1976

Total parenteral nutrition.

Total parenteral nutrition (TPN) is a relatively new innovation in patient care which allows us to replace and maintain essential nutrients in patients in whom oral or tube feedings are contraindicated or inadequate. Insertion of a catheter into a large central vein permits one to concentrate hypertonic dextrose calories in normal daily fluid requirements. In addition, TPN solutions contain synthetic amino acids or protein hydrolysates, macroelements, electrolytes, and vitamins. Indications for TPN include intestinal fistulas, severe short bowel syndrome, unresolving pancreatitis, advanced inflammatory bowel disease, delayed postoperative gastrointestinal function, developmental anomalies of the intestinal tract, protracted diarrhea of infancy, and hypermetabolic states. Complications encountered in patients receiving TPN are catheter-related mechanical problems, infections, and metabolic abnormalities. In select patients, who otherwise would require repeated hospitalizations for malnutrition, encouraging results have been achieved by the use of TPN in the home.

Amino Acids↗
PubMed1987

Management of infected pancreatic necrosis by open drainage.

Twenty-eight consecutive patients with infected pancreatic necrosis were managed by extensive unroofing of the superior retroperitoneum, blunt pancreatic sequestrectomy, laparotomy pad packing of the lesser sac over a layer of Adaptic gauze, and scheduled re-explorations at intervals of 2-3 days (open drainage). Wounds were permitted to heal by secondary intention. All patients were maintained on intravenous hyperalimentation. Three of the 28 patients died (11%); none died of sepsis. Procedure-specific complications included: pancreatic fistula (10 patients), incisional hernia (8 patients), persistent functional gastric outlet obstruction (2 patients), retroperitoneal venous hemorrhage (2 patients), and intestinal fistula (1 patient). Limited initial experience with dynamic pancreatography and serial monitoring of acute phase reactants as indicators of pancreatic necrosis is promising. Compared with historic controls, open drainage of infected pancreatic necrosis represents a significant advance over more conventional surgical approaches. Controlled studies and more widespread experience are necessary for further evaluation of this procedure.

Adult↗
PubMed1979

[Variations in electrolytes in the smooth muscle tissue of the alimentary canal (author's transl)].

Electrolytes in the smooth muscle tissue of the alimentary canal were measured and their behavior under various conditions were studied on the basis of values measured. The results are summarized as follows: 1. Organic changes due to edema and the like are more prominent in the region near the wound in cases of damaged intestine. Utmost care should therefore be exercised when surgical treatment including resection of the intestine is given. 2. Variations in electrolytes are slight in cases of mesenteric hematoma, and surgical treatment is not necessary. 3. Variations in electrolytes are rather prominent in cases of intestinal fistula, and full consideration should be given to the balance of electrolytes, particularly supplement of K. 4. In casees of intestinal anastomosis, the rate of variation is the highest near the site of anastomosis and on the third day after surgery. Therapeutically, therefore, attention should be given to prevention of complications such as incomplete suture. 5. In cases of intestinal obstruction, variations are more marked and rapid. It brings about a high degree of disequilibrium of intra-tissue electrolytes in the upper intestinal tract; hence the early and adequate treatments are needed.

Animals↗
PubMed1991

Fatal embolization of intestinal contents through a duodenocaval fistula.

Embolization of intestinal contents to the lung is an exceedingly rare event, which to our knowledge, has never been reported as a cause of death. Equally rare is duodenocaval fistula resulting from a penetrating duodenal peptic ulcer. We present the case of a 51-year-old man whose duodenal ulcer led to a fistulous tract with the inferior vena cava and subsequently to progressive pulmonary embolization of intestinal contents, ultimately resulting in death from respiratory failure.

Duodenal Diseases↗
PubMed1994

Expanding uses of octreotide.

This chapter reviews the therapeutic use of octreotide in a variety of pancreatic disorders, including acute pancreatitis, in the prevention of postoperative and post-ERCP pancreatitis, in the control of postoperative pancreatic fistulae, and in chronic pancreatitis for the control of pain and of pseudocysts and ascites. The review also discusses the use of octreotide in intestinal disorders of motility, gastrointestinal bleeding, intestinal fistulae and refractory diarrhoea, including the diarrhoeas of AIDS, diabetes, short gut, chemotherapy, ileostomy and gastric surgery. The use of octreotide in neuroendocrine tumours, both for therapy and diagnostic imaging, is reviewed briefly. The paucity of adequately controlled studies in many of these situations is indicated and the potential usefulness of octreotide estimated.

Humans↗
PubMed1989

[Diagnosis of smooth muscle tumor of the small bowel].

In this report, the experience in the diagnosis of smooth muscle tumor of the small bowel in 32 cases (14 leiomyomas and 18 leiomyosarcomas) was presented. The authors discussed the clinical features, the pathological classification of the tumor, the diagnosis of intestino-intestinal fistula, and ways to improve its preoperative diagnosis.

Adult↗
PubMed1979

Effects of a combined oestrogen-progestin preparation on gastric acid and pepsin secretion, serum gastrin concentration and biliary secretion of bile acids, phospholipids, and cholesterol in the cat.

1 Daily ethinyloestradiol (50 mug) and norethisterone acetate (1 mg) treatment (Minovlar) was investigated on gastric acid and pepsin secretion, and fasting serum gastrin concentration in six conscious female cats prepared with chronic gastric fistulae. The effect on biliary secretion of bile acids, phospholipids, and cholesterol was investigated in three conscious female cats prepared with chronic gastric and intestinal fistulae, and cholecystectomy.2 Treatment for 49 days did not alter the gastric acid or pepsin response to either intravenous pentagastrin infusions or a food stimulus. The fasting serum gastrin concentration remained unaltered throughout the study.3 Treatment for 18 days did not alter the percentage concentration of cholesterol in the bile, but reduced the percentage concentration of phospholipid. This was mirrored by a rise in the percentage concentration of bile acids in the bile. These trends were quickly reversed on cessation of treatment.4 There was no sign of cholestasis associated with the treatment. Intestinal flow remained constant throughout the study, there was no lithocholic acid or other abnormal bile acids detectable in any samples, and there was no change in serum aspartate aminotransferase concentration.5 The results suggest that in female cats, treatment with a combined oestrogen-progestin preparation does not exert any beneficial effects on the aetiology of peptic ulceration through the reduction of acid or pepsin secretion, or the lowering of serum gastrin concentration. The preparation shows a tendency to produce more lithogenic bile, and this may partly explain the greater incidence of gall stones in women on the contraceptive pill.

Animals↗
PubMed2005

Educational and nursing problems of parents of children with stoma.

In children, it is usually one of the stages of treatment of lower alimentary congenital defects. Such patients require long-term professional medical and nursing attention as well as solicitous care of the parents at home. The aim of the study was the analysis of educational and nursing problems that are faced by parents of children with stoma, the influence of a nurse on the quality of their care, and determination of nurse educational assignment in preparing the parents for the care at home. The study was performed in the group of 30 parents of children, 0-2 years old, with lower alimentary congenital defects who had intestinal stoma inserted in 2003. The questionnaire revealed that the main causes of the stoma were Hirschsprung disease (40%), anal atresia (37%), perianal fistula, intestinal perforation and necrosis (10% each). All responders stated that the knowledge acquired in the ward was of great help while nursing a child at home. The results showed that above 80% of parents had the opportunity to change the stomal sacks by themselves, once or more times, in the presence of medical staff. Skin changes (33%) were the most common complications in case of stoma, which could encounter for inappropriate care. Other complications included hemorrhage (20%), prolapse (13%), and stoma narrowing (10%).

Adult↗
PubMedDate not supplied

Self-adhesive drape (Opsite) for management of leaking abdominal wounds.

BACKGROUND: Leaking abdominal wounds (LAW) are associated with high patient morbidity. OBJECTIVES: To evaluate the efficacy of a self-adhesive drape (Opsite) with suction drains for the management of LAW. METHODS: Twenty patients with LAW (14 intestinal fistula, 4 biliary fistula, 2 ascites leak) were subjected to the use of a self-adhesive drape with a Romovac suction drain. Conventional wound management was used for the first 5 days, followed by the application of Opsite drape. The parameters evaluated were quantity of the effluent, skin integrity, ease of application, patient comfort and cost effectiveness. A discomfort score (based on four parameters: mobility, skin excoriation, wetness and unpleasant odor) was recorded on day 1 (pre conventional), day 5 (post conventional-pre Opsite), and day 5 after Opsite application. Opsite drape was changed whenever required. RESULTS: The discomfort score was not altered with conventional therapy but was lower following Opsite application: mobility (0 vs 2), skin excoriation (0 vs 2), wetness (0.5 vs 2) and odor (0 vs 1). Opsite drape allowed accurate measurement of the effluent in all patients. The drape required change after a median of 14 days (range 10 to 18). CONCLUSIONS: Opsite drape is easy to apply on LAW, is effective in containing the effluent, and is associated with low patient morbidity.

Adult↗