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PubMedDate not supplied

Factors influencing the morbidity of colostomy closure.

In a series of 80 colostomy closures, a total complication rate of 26 per cent was found, with a wound infection rate of 14 per cent and an anastomotic leak rate of four per cent. Patients having preoperative systemic antibiotics had fewer wound infections than those who did not (eight per cent versus 19 per cent). Delayed primary skin closure or closure by secondary intention was associated with less wound morbidity than was primary closure (ten per cent versus 17 per cent). However, the use of preoperative systemic antibiotics decreased the incidence of wound infection in those having primary skin closure (five per cent versus 27 per cent). Patients having diverticular disease had more wound infections (40 per cent) and greater overall morbidity (70 per cent). Older patients had a higher incidence of complications (24 per cent if less than 40 years and 45 per cent if greater than 50 years). Closure of left-sided colostomies was associated with a higher infectious complication rate (26 per cent versus 13 per cent). The time interval to colostomy closure was found to alter subsequent morbidity with a waiting period of one to two months associated with zero complications.

Adolescent↗
PubMed1987

A comparison of emergency resection and staged management in perforated diverticular disease.

This retrospective view examines the outcome of surgical treatment of perforated diverticular disease in one hospital in the period 1976 to 1983. Of the 78 patients, 38 underwent emergency colonic resection (group A) whereas 40 (group b) were treated by proximal colostomy and drainage (37 patients) or suture of the perforation with drainage (three patients). There was no significant difference between groups A and B in terms of operative mortality (21 percent vs. 24 percent, respectively). Mortality rates were highest in patients with generalized peritonitis treated by colostomy and drainage (36 percent), whereas those with localized disease undergoing resection had a mortality rate of 17 percent (P less than .05). Eight of the 40 patients in group B developed fistulas whereas none of the group A patients had this complication. Only four (16 percent) of the surviving group A patients were left with a permanent colostomy as opposed to 15 (56 percent) of their counterparts in group B. In the presence of perforated diverticular disease, emergency resection carries a lower morbidity than colostomy and drainage, although the present review shows no statistically significant differences in terms of mortality.

Adult↗
PubMed1975

Rectosigmoidal mucosal puckering and diverticulosis.

The association of diverticulosis with a thickened muscle wall in the pelvic colon is well known. There appeared to be a possibility that this muscular thickening might give rise to the rectosigmoidal mucosal puckering often seen through a sigmoidoscope. In 278 colonic motility studies, mucosal puckering was correlated with patient age, diverticulosis, and the symptomatology of the irritable colon syndrome. The prevalence of mucosal puckering increased with age at the same rate as that of diverticulosis, but the different percentage levels were reached some 25 years earlier in life. Mucosal puckering, which persisted in all subsequent examinations, showed no correlation with the clinical characteristics of irritable colon syndrome. Resistance of the bowel wall to distention was significantly greater in association with puckered rectosigmoidal mucosa than when the mucosa appeared smooth. It is concluded that rectosigmoidal mucosal puckering is probably caused by thickening of the underlying muscle; it is a precursor of diverticulois, and patients who have it should be kept on a high-residue diet.

Adult↗
PubMed2000

[Virtual coloscopy with multi-slice computerized tomography. Preliminary results].

SUBJECT: Using multi-slice computed tomography (MSCT) large body areas can scanned with high spatial resolution. In this study, MSCT was employed for virtual colonoscopy in various pathologies of the colon. MATERIALS AND METHODS: For MSCT a Somatom Plus 4, Volume Zoom scanner, (Siemens, Forchheim) was employed, equipped with four parallel detector rows. Twenty-five patients were included in this trial, prior to colonoscopy or partial colon resection. After cleaning the colon, distension was achieved by insufflation of room air using a rectal tube. The parameters of acquisition and reconstruction were as follows: collimation 4 x 1 mm and 4 x 2.5 mm respectively; tube charge per slice: 140-160 mAs; pitch 5-6; i.v. contrast medium: 120 ml Ultravist 300 (Schering) with a flow rate of 3 ml/s; delay: 35 s. For 3D reconstruction we used edge-enhanced volume rendering, virtual colonoscopy and extraluminal views of volume-rendered images. RESULTS: Nine polyps and four of five colon carcinomas were detected using MSCT virtual colonoscopy. In three patients with ulcerative colitis virtual coloscopy revealed morphological alterations compatible with this disease. In two of four patients with multiple diverticula of the colon the true extent of the disorder could be assessed in virtual colonoscopy. CONCLUSION: Utilizing virtual MSCT colonoscopy polyps and cancer of the colon can be reliably detected, if proper cleaning and distension is provided. On axial images alone smaller polyps may be assessed. The high z-axis resolution of MSCT offers superior conditions for CT-based virtual colonoscopy.

Colitis, Ulcerative↗
PubMed2000

Laparoscopic management of colonoscopic perforations.

Colonic perforation is a dangerous complication of colonoscopy, both diagnostic and therapeutic, and its management has become controversial. The question of conservative vs operative treatment is still under debate. Despite the recent expansion and wide acceptance of laparoscopy by surgeons, the feasibility of this technique as a means of treating abdominal emergencies has also been questioned. Of 575 patients admitted to our institution for abdominal emergencies between 1993 and 1998, 365 were treated via a laparoscopic approach. Two of these patients were treated for colonoscopic perforations, one after a diagnostic procedure and one after an operative procedure. Our technique employs an open umbilical approach with two other trocars introduced in the right iliac fossa and left flank. In the first case, a diverticular perforation of the subperitoneal rectum was suspected. The abdomen was copiously irrigated with saline solution and a drain was left in the pelvis. In the second patient, localized peritonitis was found in the left iliac fossa due to a microperforation of the sigmoid colon. It was repaired with a single absorbable suture. The postoperative course was unremarkable in both cases. In patients with an emergency abdomen due to a postcolonoscopy perforation, we consider the laparoscopic approach feasible and safe in experienced hands. It allowed us to avoid an unnecessary laparotomy and other time-consuming and expensive diagnostic investigations. This approach represents an excellent means of managing this type of emergency abdominal situation.

Abdomen, Acute↗
PubMed1984

Differential mucin staining in colorectal neoplasms. Potential clinical application.

Screening techniques that can identify histochemically different mucin production by colonic mucosa have been claimed to be able to identify early dysplastic changes in the colon and rectum. Controversy has arisen regarding interpretation of these changes, and this study has attempted to address this issue. Utilizing a high iron diamine-alcian blue staining technique, several benign and malignant pathologic conditions of the colon were evaluated. Significantly abnormal staining patterns were identified at the resection margins of all patients in whom either anastomotic recurrence or metachronous carcinomas developed compared with patients who were without recurrence for more than 5 years. It is postulated that this technique may be useful in prospectively identifying this group of patients at high risk for the development of recurrence.

Colitis, Ulcerative↗