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Intussusception in chronic renal failure.

Spontaneous intussusception in adults is rare. Recently, we managed two patients with chronic uremia in whom intussusception developed. Histologic examination of the resected segments showed intestinal intramural hemorrhage. We postulate that the coagulopathy associated with uremia may allow for intestinal intramural hemorrhage, thus forming a nidus from which intussusception may be initiated.

Adult↗

A case of pneumococcal typhlitis.

A 29-year-old man had abdominal pain for 24 hours. This and the results of an abdominal examination were typical of acute appendicitis. He had suffered sinusitis for two weeks. At operation, the appendix was normal; there was an abscess in the cecal wall, the exudate of which grew pneumococci. Incidental appendectomy was done and the patient was treated successfully with lincomycin hydrochloride, and later, cephalexin monohydrate. It is possible that the typhlitis was secondary to the upper respiratory infection.

Adult↗

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗

Diastatic perforation of the cecum without distal obstruction. Case report and review of the literature.

We present the first reported case to our knowledge of diastatic rupture of the normal cecum following cardiac surgery. All other reported cases of diastatic rupture of the cecum are reviewed. Nasotracheal intubation, hypoxemia, and enemas are thought to contribute to this complication. Prophylactic cecostomy for cecal diameters greater than 9 cm is recommended. Cecostomy and drainage are generally the treatment of choice should perforation occur.

Cecal Diseases↗

Cecal volvulus. A case for nonresectional therapy.

Sixteen cases of acute cecal volvulus were retrospectively evaluated. A follow-up was obtained averaging 5.6 years. The average age of the 14 female and two male patients was 47 years. Sixty-two percent of the patients were younger than 50 years of age. Eighty-one percent of the patients had undergone prior operation, with four of these 13 patients having been operated on within the preceding 30 days. Gynecologic procedures accounted for 40% of the previously performed operations. Plain abdominal films and results of barium enema examination were diagnostic or highly suspicious of cecal volvulus. Fourteen nonresectional procedures were performed. No subsequent abdominal operations for recurrence have been required. The concept that this lesion requires resection in the absence of necrosis cannot be supported by our data.

Adult↗

Neutropenic typhlitis in adults.

Typhlitis is a necrotizing process of the cecum, occurring in neutropenic patients who are usually receiving combined chemotherapy. The atonic cecum is affected because of its poor arterial perfusion, the presence of colonic bacteria, and the milieu of immunosuppression. It is a serious but not inevitably fatal complication of the patient's basic illness. Resection of necrotic bowel is necessary. Because this will usually be done on an emergency basis in a very ill patient with unprepared bowel, a two-stage procedure rather than primary anastomosis is advisable. Surgical results may be better in adult than pediatric patients. The incidence of the problem has probably increased since the advent of aggressive drug therapy of the leukopathic states. Judging from the low number of reported adult cases and the apparent inaccuracy of preoperative diagnosis, there may be inadequate physician awareness of typhlitis.

Agranulocytosis↗

Diagnosis and management of nonspecific colon ulcer.

This report describes seven cases of nonspecific colon ulcers and analysis of the additional 120 cases reported in the literature through 1980. The total current series is compared with the two earlier reviews. Our findings showed that nonspecific colon ulcers occur in all age groups, predominantly 40 to 60 years, with slight predilection to female sex. The man clinical manifestations include abdominal pain mimicking appendicitis (50%), lower gastrointestinal hemorrhage (33%), perforation (19%), and abdominal mass (16%). The usual location of the ulcers is the cecum and ascending colon (67%), then transverse, hepatic, and splenic flexures (18%), and descending and sigmoid colon (15%). The diagnosis is best established by colonoscopy. The nonoperative conservative management is probably indicated in the uncomplicated cases with follow-up colonoscopic studies to ensure complete healing. The etiology of this condition is still unknown.

Adult↗