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PubMed1984

[Problems posed by massive hemorrhages of colorectal origin. Apropos of 12 case reports].

Urgent surgical operation to treat massive hemmorrhage of colorectal origin was necessary in 12 patients: --colon diverticulosis: 7 cases, --cecal angiodysplasia: 1 case, --pancreatocolic fistula: 1 case, --ischemic colitis: 2 cases, --post-radiation therapy rectitis: 1 case. Lesions exclused from discussion in this report and provoking hemorrhage were colorectal tumors, chronic inflammatsry colitis, rectosigmoid angiomatosis, and post-traumatic or iatrogenic lesions. After a definition of massive hemmorrhage based on pre-operative transfusional requirements, the exploratory procedures necessary for localization of the site of the hemorrhage or for detecting a right colon angiodysplasia are discussed. Bimesenteric arteriography represents the exploration of choice, but its usefulness is limited in patients with several risk factors and an average age of 70 years. The respective values of a barium enema and peroperative endoscopy in this particular context are also discussed. Elective surgery should be performed only when the exact site of bleeding has been determined or when an angiodysplasia is present. Particular problems arise when treating diffuse colon diverticulosis hemorrhage, and that provoked by the association of an angiodysplasia and a diverticulosis, as well as hemorrhagic lesions that may require emergency therapy in much rarer affections: ischemic colitis, pancreatocolic fistula, iliosigmoidal fistula, colorectal varices, colon and rectal ulcers, and colorectal radiolesions.

Aged↗
PubMed1984

[Surgical treatment of colovesical fistulas (our experience)].

The Authors study the statistics of the Verona Surgical Centre, concerning 5 cases of colovesical fistula. They support the two-time operation, that is, the colon resection with colo-colic anastomosis sheltered by a decompressive transversostomy and stitching of the vesical breach. They affirm the usefulness of the operation according to Hartmann in patients facing a greater operative risk.

Colonic Diseases↗
PubMed1983

[Fistulas in diverticular disease of the colon: study of 29 cases].

In analysing 29 patients with diverticular disease of the colon complicated by fistula, the authors encountered four types of fistula: colovesical, colovaginal, coloileal and colocutaneous. The commonest was the colovesical fistula (50%), which was diagnosed by the history and the suggestive cystoscopic findings. Colovaginal fistula was also suspected by the history and the presence of a pelvic mass in hysterectomized patients. Colocutaneous fistulas are demonstrated by fistulography whereas coloileal fistulas, which do not have clinical signs, are discovered only at operation. Surgical treatment, consisting of resection and anastomosis of the involved segment of the colon, is necessary. A one-stage procedure is usually feasible with little morbidity if the delay between the acute phase and the operation is longer than 3 months. When the operation is attempted sooner, the surgeon may have to use more than one stage with a longer period of disability and the possibility of more complications. Because the development of a fistula with diverticular disease seldom needs urgent surgical exploration, the authors recommend 3 months of conservative therapy after the acute phase to allow the local inflammatory reaction to subside so a one-stage operation can be performed.

Adult↗
PubMed1983

[ Pathology of the colon associated with diverticulosis of the descending colon and the sigmoid. Instrumental clinical study ].

A retrospective survey was carried out on 87 patients with diverticulosis and 223 control subjects with a view to studying the incidence of colon pathology in association with diverticulosis of the colon. All subjects were given colonoscopies of the distal section of the colon. The survey revealed that the group of diverticulosis patients was, on average, older than the control group (72 v. 59 years). There was no significant difference in the performance or totality of the endoscopic examination. Subjective and objective symptomatology revealed no a priori evidence of pathology associated with diverticulosis. There was no statistically significant difference in the incidence of polyps, neoplasias, haemorrhoids or colon melanosis in the two groups.

Aged↗
PubMed1983

[Retroperitoneal novocaine block in the treatment of diseases of the colon].

Novokain retroperitoneal blockades were used in 150 patients with non-specific ulcerative colitis, diverticulosis and functional disturbances of the colon. The blockades allowed improving results of the treatment, normalizing the motor function, cupping off the inflammatory process, shortening the time of staying at the hospital.

Adolescent↗
PubMed1983

Follow-up results of a new colomyotomy in the treatment of diverticulosis.

In the present study, we report upon the preliminary results of our technique of myotomy--combined colon-myotomy at L shaped or transversal T shaped--which includes a simultaneous incision of both longitudinal and circular muscle fibers, avoiding a large bloody area. Ten patients have been operated upon by this method, the results of follow-up examination of seven patients who were given roentgenologic and motility studies for a maximum of 24 months being reported upon. It appears that the technique is quite safe, with no mortality or morbidity being observed in the first ten patients operated upon. Even functional results are most satisfactory. On the basis of this preliminary study, the technique seems to offer better results than do other types of colomyotomies currently being used.

Adult↗
PubMed1983

A study of colovesical fistulae in a district hospital.

A retrospective study of 32 patients with colovesical fistula was carried out. The most frequent presenting symptoms were urinary; an abdominal mass was found in 40% of patients. Urine culture grew bowel organisms in 93% of patients and the diagnosis was most accurately confirmed by barium enema which showed evidence of a fistula in 55% of patients examined. Surgical treatment varied from staged resection to primary resection and anastomosis, disconnection of the fistulous tract or colostomy alone. The results are compared and suggest a higher success rate with a multi-staged procedure. Different methods of diagnosis are discussed as well as possible causes for varying success rates among the surgical procedures.

Adult↗
PubMed1981

[Haemoccult and Colorectal: a comparative prospective study on the detection of occult blood in the feces].

Comparison of Colorektal and Haemoccult in 600 stool samples from 200 ambulatory, non-selected patients over the age of 40 revealed an equal number of positively reacting specimens (Colorektal 5.8%, Haemoccult 5.7%). Comparison of the results in relation to patients showed 28 positive cases with Colorektal and 18 with Haemoccult. Diagnostic workup disclosed a lesion potentially responsible for the bleeding in 67% of the cases with Haemoccult-positive and 54% with Colorektal-positive stool samples.

Adult↗