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At least 919 records · Page 51Linked to original sources
PubMed2005

[Surgical treatment of acute obstructing colorectal cancer: a report of 297 cases].

OBJECTIVE: To evaluate surgical treatment of obstructing colorectal cancer. METHODS: From July 1993 to July 2003, clinical data of 297 cases undergoing emergency operation for obstructing colorectal cancer were analyzed retrospectively. There were 103 cases with right-sided lesion and 194 cases with left- sided lesion. RESULTS: All patients received emergency operation. Stage i tumor resection and anastomosis were performed in 126 patients including 98 cases with right- sided lesion and 28 with left- sided lesion, total or subtotal colectomy in 108,Hartmann operation in 36,Dixon operation in 9, ileocolic anastomosis in 11,and colostomy in 7 cases. Postoperative complications occurred in 53 cases (17.8% ) including incision infection, intraperitoneal infection and intestinal fistula. There were 17 perioperative deaths. Two hundred and eighty cases healed (94.3% ). CONCLUSION: Stage i tumor resection and anastomosis and total or subtotal colectomy are feasible and safe surgical procedures for obstructing colorectal cancers.

Adult↗
PubMed1991

Surgical management of intestinal obstruction after treatment for cancer. Case reports.

Eighty-five consecutive patients operated on for malignant intestinal obstruction after earlier treatment of cancer were studied retrospectively. The overall postoperative mortality was 22% (19/85) and morbidity 42% (36/85). Intra-abdominal sepsis (N = 5) and intestinal fistula (N = 3) were the most common complications, and seven deaths were attributed primarily to the underlying malignant disease. Emergency procedures (p less than 0.003) and age greater than 70 years (p less than 0.025) were significantly associated with fatal outcome. Just over half of the patients were relieved of their symptoms. The median survival was 8 months for the 25 patients who underwent resection and 2 months for the 60 patients for whom no resection was made. The cumulative 5-year survival was significantly better for patients who underwent resection than for those who did not (p less than 0.01) and in patients with regional cancers compared with those with distant growths (p less than 0.001). We conclude that operative treatment for malignant intestinal obstruction is indicated if widespread carcinomatosis and extensive tumour growth are excluded and that this surgery should be done urgently while there is still time to resuscitate the patient.

Abdominal Neoplasms↗
PubMed1982

Management of urinary and bowel complications after ileal conduit diversion.

Serious urinary and bowel complications after ileal conduit diversion are associated with significant morbidity and mortality rates. We reviewed 9 patients treated at our institution during the last 5 years for sequelae after ileal conduit diversion for bladder cancer. Of these patients 8 are well and 1 died postoperatively of a myocardial infarction. In all, 33 operations were required to treat complications after initial diversion. A variety of surgical procedures, including anastomotic revision, ileal ureter, stomal revision, transverse colon conduit and nephrectomy, was used to treat urinary complications. A treatment outline emphasizing an initial conservative approach, the importance of nutritional support and the appropriate options for reconstruction is presented.

Abscess↗
PubMed2003

Bowel surgery for epithelial ovarian cancer--an early case series.

OBJECTIVES: The aims of this study were to review our local experience with bowel surgery for epithelial ovarian cancer at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, and to document the outcome of such surgery as well as their complication rates. MATERIALS AND METHODS: The retrospective medical records of 38 patients with epithelial ovarian cancer who underwent surgery including bowel surgery from January 1997 to May 2002 at the Gynaecological Cancer Centre, KK Women's and Children's Hospital, Singapore, were reviewed. RESULTS: Indications for surgery were predominantly debulking of disease. Fifty-eight per cent of patients had primary debulking surgery, 34% had debulking of recurrence and 3% had interval debulking. Only 5% of patients had bowel obstruction as the only indication for surgery. Rectosigmoid resection was the most common bowel operation overall, being performed in 76.3% of patients. The stoma rate for rectosigmoid resection was 61%. The remaining procedures included 7 colectomies, 1 intestinal bypass procedure and 1 intestinal diversion procedure. Optimal debulking (defined as < 1 cm of residual disease) was achieved in the majority (71%). The median operating time was 4 hours. The median blood loss was 1300 mL. The major complication rate was 10.5%. Major complications encountered were as follows: 1 patient (2.6%) had an anastomotic leak, 2 patients (5.3%) had intra-abdominal abscess and 1 patient (2.6%) developed intestinal fistula. Three patients (7.8%) required a re-operation within 30 days. There were 3 deaths (7.8%) within 30 days of surgery. CONCLUSION: Bowel surgery is commonly indicated for epithelial ovarian cancer to facilitate optimal debulking. Such surgery is feasible with acceptable complication rates in our local centre.

Adult↗
PubMed1975

Successful long-term intravenous hyperalimentation in the hospital and at home.

Experience with long-term intravenous hyperalimentation in the hospital and at home in one patient over a 22-month period is reported. After multiple operative procedures the patient was left with only her stomach, duodenum, and 5 cm of the proximal part of the jejunum. During a 12-month period in the hospital, despite many life-threatening complications and with high-output intestinal fistulas, her weight increased from 40.7 kg (90 lb) to 70.1 kg (155 lb) on intravenous hyperalimentation therapy. During the past ten months, the patient has managed her intravenous feeding at home. A silicone elastomer catheter inserted into her superior vena cava through her facial vein has been used for the past ten months with no catheter sepsis. Although costly, home intravenous alimentation seems justifiable in selected patients because of the possible feasibility of bowel transplants in the near future.

Adult↗
PubMed1978

Mechanical small bowel obstruction due to adhesions.

During the years 1971-1975, 103 patients were operated on for adhesive small bowel obstruction, giving an incidence of 80 per 1 million inhabitants per year. Previous laparotomy caused the obstruction-provoking adhesions in 90% of the cases. Appendicectomy, gynaecological operations, and operations on the intestine were the three most common surgical procedures performed prior to the obstruction. In 40 cases with clinically less severe symptoms and signs follow through radiological studies with contrast medium secured the diagnosis of obstruction. The mortality rate was 5.8% and increased with the duration of symptoms. Two patients died of complications caused by intestinal fistula following lysis of extensive, firm adhesions. Bypass or bowel resection might be safer procedures in those cases. Bowel resection did not affect the mortality rate. None of the 23 patients with strangulation died. This may be due to early operation since the mortality rate in the series as a whole doubled when symptoms had lasted for more than 24 hours. Recurrence rate after operation for adhesive small bowel obstruction was 27.8% and eight patients required relaparotomy.

Adolescent↗
PubMed1994

Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model.

PURPOSE: The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. METHODS AND MATERIALS: Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. RESULTS AND CONCLUSION: Dogs receiving IORT to the retroperitoneum through a 4 x 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses > or = 30 Gy. Radiation changes were present in the aorta and vena cava at doses > or = 40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed a few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT.

Anastomosis, Surgical↗
PubMedDate not supplied

[The role of adrenergic receptors in the realization of hypothalamic effects on the motor function of the digestive tract in hypophysectomized dogs].

Chronic experiments on hypophysectomized dogs with gastric and small intestinal fistulas as well as with hypothalamus-implanted electrodes have shown that blockade of alfa-adrenoreceptors by phentolamine increases the number of the excitatory motility responses while stimulating hypothalamic structures during rest of the gastrointestinal tract and decreases inhibitory effects of the stomach while stimulating hypothalamic structures during work of the digestive tract. The blockade of beta-adrenoreceptors by obsidan induces weakening of excitatory responses of the digestive tract and intensification of inhibitory ones while stimulating hypothalamic structures in hypophysectomized dogs.

Animals↗
PubMedDate not supplied

[Complications of the management of secondary peritonitis with contained-open abdomen. Comparison of the Bogota's bag vs polypropylene mesh].

BACKGROUND: Surgery is the cornerstone regarding the treatment of secondary peritonitis, although the complications of the contained-open abdomen are common, and are usually severe. OBJECTIVES: To identify the complications with the use of the "Bogotá's bag" compared with polypropylene mesh in contained-open abdomen. To identify other possible morbidity and mortality risk factors, independently of the mesh type usage. METHODS: One hundred patients with secondary peritonitis were included in this retrospective cohort study. They were treated from January 2000 to March 2002. Fifty subjects were operated on with the "Bogota's bag " (50%) and 50 with the polypropylene mesh (50%). Mannheim's peritonitis severity index, complications and mortality using central tendency and dispersion means, the logistic regression analysis, prevalence and prevalence-ratios were analyzed. RESULTS: Most frequent etiologies of secondary peritonitis were intestinal anastomosis dehiscence, hollow viscera perforation, and severe pancreatitis. Observed complications were: perforation and intestinal fistula in 13 cases (13%); 10 (20%) out of these belonged to the polypropylene mesh group, and 3 (6%) to the Bogota's bag group (p = 0.036). Evisceration was observed in 8 cases (8%); 2 (4%) in the polypropylene mesh group, and 6 (12%) in the Bogota's bag group (p = 0.140). Hemorrhage was present in 30 cases (30%); 16 (32%) in the polypropylene mesh group, and 14 (28%) in the Bogota's bag group (p = 0.662). Colonization was present in 24 cases (24%); and this was mainly evident in the polypropylene mesh group (p = 0.019). Mortality reached 42% (42 cases), and was associated to postoperative bleeding (p = 0.004), peritonitis' severity (p = 0.0012), and surgical reinterventions. CONCLUSIONS: The contained-open abdomen is the best surgical option to treat infection and the compartmental abdominal syndrome in secondary peritonitis, however, complications may be relevant. These results demonstrated a direct relationship between peritonitis severity, the need for surgical re-interventions and mortality. The use of polypropylene mesh was related to an increased risk of intestinal fistulization and prothesis-associated infection.

Abdomen↗
PubMedDate not supplied

[Early closure of temporary stoma of the small bowel].

AIM: Transient small bowel stoma is usually closed 9-12 weeks after initial operation (late closure). Since these stoma have a poor physiological and psychological impact with frequent social consequences, we wanted to estimate feasibility and results of early closure of small bowel stoma. PATIENTS AND METHOD: From January 1998 to December 2001, 39 patients (21 women and 18 men, mean age: 64 years) with a transient small bowel stoma were elected for early closure. Early closure was performed only if the patient was in good condition, and without developing wound or general sepsis. In the other patients, the stoma was closed in the usually recommended delay (> 8 weeks). Fifteen patients had an early closure of their stoma in a mean delay of 10.0 +/- 0.8 days after the initial procedure. Twenty-four patients had a late closure of their stoma in a mean delay of 11.4 +/- 3.7 weeks. RESULTS: There were no postoperative deaths and no intestinal fistula. Four (10%) wound abscesses occurred and were managed without any surgical procedure, 3 in the early closure group (20%) and 1 in the late closure group (4%) (P=0.85, NS). Time to recovered bowel activity and to resumed oral feeding were equivalent in the two groups. The mean length of hospital stay was longer in the delayed group (34.5 +/- 18.6 days) than in the early group (23.1 +/- 4.6 days) (P<0.01). CONCLUSION: Early closure of bowel stoma can be performed without major complications in elective patients. This procedure shortens hospital stay.

Adult↗