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At least 1,333 records · Page 74Linked to original sources
PubMed2003

Hand-assisted laparoscopic colectomy: a single-institution experience.

The purpose of this study was to examine the results of a single institution experience with hand-assisted laparoscopic colon resection for benign disease. We conducted a retrospective study of consecutive cases performed by experienced laparoscopic surgeons at a single institution. From August 1999 to June 2001, 37 patients underwent hand-assisted laparoscopic colon resection. Seventeen patients were male, and 20 were female. Median patient age was 58 years (range 20-80). Indications for surgery were: polyp (13), uncomplicated diverticular disease (eight), complicated diverticular disease (i.e., colovesicular fistula, phlegmon, etc.) (seven), chronic constipation (four), rectal prolapse (two), ulcerative colitis (one), endometriosis (one), and fecal incontinence (one). Procedures performed were: sigmoidectomy (14), right colectomy (nine), low anterior resection (seven), subtotal colectomy (five), cecectomy (one), and transverse colectomy (one). Variables examined were: conversion to open procedure, operative time, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. There were no deaths. One case was converted to celiotomy (unable to rule out malignancy). The median operative time was 122 minutes (range 32-240) with a median operative blood loss of 132 mL (range 0-300). Return of flatus was noted (median) at postoperative day 3 (range 1-5), and the median length of stay after operation was 4 days (range 2-8). One patient developed a superficial wound infection, and there was one pelvic abscess (drained percutaneously). One patient developed urinary retention. There were no reoperations. In this single-institution experience hand-assisted laparoscopic elective colectomy for benign disease was successful in both straightforward and complicated cases. A low conversion rate to celiotomy and favorable operative times compared with published "pure" laparoscopic results suggest a flatter learning curve for handoscopy while retaining the benefits of "minimally invasive" surgery such as early return of flatus and short postoperative hospital stay. For these reasons hand-assisted laparoscopy should be considered an acceptable technique in elective colon resection for benign disease.

Adult↗
PubMedDate not supplied

[Spontaneous perforations of the large intestine].

Spontaneous perforation of colon is a rare disease and physiopathologic basis are actually unknown. Surgical treatment is standardized and post-operative survival is over 60%, morbidity and mortality rate depends on peritoneal contamination. In 1984 J.A. Berry classified spontaneous perforations into "stercoral" and "idiopathic" perforations on the basis of etiopathogenetical causes of lesions. Anatomopathologically stercoral and idiopathic perforations present different characteristics. Macroscopically stercoral perforation origines from an ulcerative lesion often situated on the sigmoid colon or rectum. Microscopical characteristic is represented by a superficial ischemic necrosis of mucosa (caused by fecalomas) followed by an extension to sub-mucosa and muscular tissues of the colonic wall. On the contrary, "idiopathic perforation", frequently situated on the sigma, is a linear laceration of anti-mesenteric side of the colon without pathologic modifications of the colon. Physiopathologic basis of spontaneous perforations of the colon were also discussed. Stercoral perforation is often a consequence of chronic constipation. Instead, two hypoteses are advanced as regards idiopathic perforations. S.V. Kessing e coll. (1962) hypotized a parietal suffering caused by ischemia of anti-mesenteric side of the colon, depending on ipoperfusion of colonic tissues; they also hypotized a constitutional weakness of colonic wall as a cause of idiopathic perforation. Others hypotized an intraluminal hypertension caused by intestinal hernias (J.W. Eadie, 1955; K. Cronin, 1959), rectal prolapse or abnormal depth of Douglas cavity (D.C. Lyon, 1969). In these cases, lesion is caused by contraction of abdominal muscles during defecation, which presses colonic wall during distension.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

[Most frequent causes of constipación in our environment].

At the Digestive Motility Department on gastroenterology floor of the "Hospital de Clinicas Jose de San Martin", 165 patients were evaluated due to chronic constipation, underlying the most frequent causes in our environment. The use of the present diagnostic methods is suggested following a suitable clinical orientation. The most frequent causes of constipation after this test were: chronic idiopathic constipation in 112 cases (67.87%) and with megarectum, megasigma and megacolon 32 cases (19.09%), rectocele in 9 cases (5.45%), rectal prolapse in 5 cases (3.03%), enf. De Hirschprung 5 cases (3.03%) and anal estenosis 2 cases (1.21%).

Adolescent↗
PubMed2003

[The use of Floseal in the prevention and treatment of intra- and post-operative hemorrhage in the surgical treatment of hemorrhoids and colporectocele. Preliminary results].

Stapled hemorrhoidectomy (PPH) is a modern approach to the treatment of hemorrhoids removing a circumferential strip of mucosa. In the same way the circumferential resection of the rectal prolapse (STARR) is successfully used for effective treatment of colporectocele and obstructed defecation syndrome. These surgical procedures offer several advantages over conventional techniques including reduced postoperative pain, stenosis and recurrences, an earlier recovery time and return to work. Furthermore, bleeding is one of the most common immediate complication (first week) and one of the possible late complication in these procedures. Our results with this surgery (153 PPH and 37 STARR) confirmed the data of many other Authors regarding the incidence of intra and early post-operative haemorrhages (1.3% in PPH and 2.7% in STARR). With the aim to reduce this complications, which represents the only negative side-effect of these procedures, we employed the FloSeal, a gelatine based haemostatic sealant with thrombin component, to control intraoperative bleeding. The preliminary results obtained in 10 PPH and in 7 STARR confirmed the theoretical usefulness of FloSeal in reducing this hemorrhagic complications.

Adult↗
PubMed1992

Surgical management of anal incontinence.

The complex nature of the continence mechanism is reflected in the difficulties experienced in the surgical management of patients with faecal incontinence. Apparent anatomical abnormalities may be identified but the functional outcome following surgery may be unsatisfactory. It is therefore important to improve both the selection of patients as well as the surgical procedures themselves. Selection of patients for appropriate treatment should be based on clinical findings as well as anorectal physiology tests. Most patients referred for assessment fall into one of six categories: incontinence with a normal sphincter; minor incontinence due to local anal conditions; direct sphincter injury; neurogenic ("idiopathic") incontinence; rectal prolapse; generalised neurological condition. Minor anal conditions causing incontinence must be carefully identified for appropriate treatment. A large amount of work has been done over the past ten years on the pathophysiology of major incontinence and new surgical procedures have been developed. A common difficulty is deciding whether anterior sphincter attenuation or neurogenic weakness is the dominant lesion causing incontinence; overlapping sphincter repair is indicated for the former and postanal repair for the latter. Anorectal physiology studies can be helpful in differentiating these conditions and are now used routinely in the assessment of patients.

Electromyography↗
PubMed1992

Senecio spp poisoning in cattle in southern Brazil.

Epidemiological, clinical, necropsy and histopathological data were accumulated during the study of 15 outbreaks of Senecio spp poisoning in cattle occurring during the last 3 y in the State of Rio Grande do Sul, Brazil. Morbidity averaged 17% and mortality was virtually 100%. The peak mortality occurred during spring and early summer. The most constant clinical signs included anorexia, depression, tenesmus often followed by rectal prolapse, and rough hair coat. Affected animals remained apart from the rest of the herd, lost weight, presented ascites, and had signs of digestive and neurological disturbances. Icterus, photodermatitis, polydipsia, and dependent subcutaneous edema were occasionally noticed. Two main clinical courses could be distinguished. In the protracted form, progressive weight loss terminated with death within many weeks or months. Alternatively, an acute or subacute course led to death in a few days. In both forms, necropsy and histopathological findings included diffuse fibrosis of the liver, hepatomegalocytosis, and biliary hyperplasia. Extrahepatic lesions included gastrointestinal and mesenteric edema, distension, edema and adenomatoid hyperplasia of the gallbladder, and spongy degeneration of the cerebral white matter. S brasiliensis and S oxyphyllus were the species involved in the field outbreaks.

Animals↗
PubMedDate not supplied

Prognostic indicators in haemolytic uraemic syndrome.

OBJECTIVE: This study aims to review the clinical presentations of Haemolytic Uraemic Syndrome (HUS) and to compare the poor prognostic indicators with mortality. METHODS AND MATERIALS: Prospective study carried out in Renal Dialysis ward of Dhaka Shishu Hospital, Bangladesh from September 2001 November 2003 for a period of 26 months. All children admitted to renal dialysis ward with oliguria or anuria with pallor was included in this study. HUS was confirmed after laboratory investigations showing features of hemolytic anaemia, thrombocytopenia and renal insufficiency. Various clinical presentations were reviewed. Then bad prognostic factors were compared with mortality. RESULTS: There were total 25 cases of HUS in 26 months.17 (68%) were males and 8(32%) females.21 (84%) children were < 5 years. Only 4(16%) were > 5 years. Before onset of HUS 40% children had bloody diarrhoea, 36% had acute watery diarrhoea and 24% had others symptoms. The other presentations noted were fever 88%, respiratory distress and convulsion 52% and oliguria 40%, anuria 60%, reluctant to feed 40% and cough 28%. The main physical findings noted were irritability 40%, pallor 100%, dehydration 28%, puffy face with oedema 32%, high blood pressure 16%, hepatomegaly 28%, jaundice, sclerema and petechial rashes 8%, lethargic 16%, acidotic breathing 48% and rectal prolapse 12%. 44% children died after HUS and 56% recovered from the illness. Mortality was 66% when duration of illness before onset of HUS was > 14 days. With duration of anuria < 3 days there was no mortality but it was 91% and 100% with anuria > 3 to 8 days and >8 days respectively. Mortality was 78% when age was < 18 months and it was 75% when age was > 5 years. Diarrhoea associated HUS had 27% and non diarrhoea associated HUS had 85% mortality. Mortality was 77% and 100% respectively when HUS was associated with convulsion and hypertension. WBC > 30,000 had mortality 100% and decreased platelet count < 30,000 had mortality 80%. With creatinine level > 700 micromol/L mortality was 80% and with Serum potassium level 5.6 to 7.5 mmol/L mortality was 67%. CONCLUSION: HUS comprised of varieties of presentations. Diarrhoea was the commonest preceding illness before onset of HUS. The bad prognostic indicators carrying high mortality was duration of illness before onset of HUS >14 days, anuria > 3 days, age < 18 months and >5 years, Non diarrhoea associated HUS, HUS associated with convulsion and hypertension, WBC > 30,000/cumm, platelets < 30,000/cumm, creatinine level > 700 micromol/L and serum potassium level 5.6 to 7.5 mmol/L. Since bad prognostic factors may progress rapidly to mortality, consultation with paediatrician and transfer to a tertiary care centre should be done when HUS is diagnosed so that it can be managed appropriately in time.

Child, Preschool↗
PubMedDate not supplied

Colitis cystica profunda of the rectum: report of a case and review of the literature.

Colitis cystica profunda is a rare intestinal lesion. Because of its clinical expression (rectorrhagia, mucorrhea and abdominal pain) and the way it appears to current imaging techniques this disease presents features which can be associated with colon neoplasm. Its diagnosis has to be confirmed histologically, and its etiology remains unclear. The following is a case report of colitis cystica profunda recurring 20 years after a first episode in a white woman, who had had an anterior resection of the sigmoid colon and upper rectum to deal with a colitis cystica profunda-induced stenosis of the sigmoid colon and at 41 underwent the transanal removal of a polypoid lesion. A review of 20 cases in the literature showed that colitis cystica profunda has a predilection for the male and generally affects the medial and lower rectum and the sigmoid colon. The literature also confirmed the association with ulcerative rectocolitis, Crohn's disease and rectal prolapse. The type of treatment varies from surgical, medical, and endoscopic to no treatment at all.

Adult↗
PubMed2006

A new modification of transanal Soave pull-through procedure for Hirschsprung's disease.

BACKGROUND: One stage transanal Soave pull-through procedure (TSPP) is a recent popular operation in the treatment of Hirschsprung's disease (HD). With no visible scar and a short hospital stay, it is well accepted by surgeons and mothers. In the conventional Soave procedure, a long rectal muscular cuff left for anocolic anastomosis might increase the incidence of postoperative enterocolitis and constipation. This study presents a modified transanal Soave pull-through procedure (MTSPP) which includes an oblique mucosectomy and an oblique anastomosis with a short split muscular cuff. METHODS: A review of two groups of HD patients was made: 112 underwent conventional transanal Soave procedure from 1999 to 2001 (group 1) and 140 underwent modified transanal Soave procedure from 2002 to 2004 (group 2). A comparison was made between the two groups on operative data and postoperative complications. The data included: age at the operation, operating time, blood loss, time to feeds and hospital stay, occurrence of postoperative enterocolitis or constipation, need for anal dilatation, postoperative bowel function and perianal skin problems. RESULTS: There was no significant difference between two groups with respect to age, gender, length of colon resected, operating time, blood loss and hospital stay. However occurrence of postoperative enterocolitis, constipation, anastomotic stricture and time needed for anal dilatation were evidently less in group 2 (MTSPP). The mean operating time in group 1 was (106 +/- 39) minutes with a range of 60 to 170 minutes; in group 2 was (101 +/- 36) minutes with a range of 66 to 190 minutes. The average length of the bowel resected in group 1 was (24 +/- 7) cm, range 15 to 58 cm; in group 2 was (26 +/- 8) cm, range 15 to 70 cm. Two patients, one in each group, required laparoscopic assistance because of long aganglionic colon. Another patient in group 2 required laparotomy because of total colonic aganglionosis. Postoperative complications in group 1 included: temporary perianal excoriation in 34 patients (26 were < 3 months of age), enterocolitis in 21, anastomotic stricture in 11, recurrent constipation in 12, cuff abscess in 1, anastomosis leak in 1, soiling in 3 and rectal prolapse in 1. In group 2 post operative complications included: transient perianal excoriation in 37 patients (30 were < 3 months of age), enterocolitis in 13, anastomotic stricture in 5, recurrent constipation in 6, anastomotic leak in 1, adhesive bowel obstruction in 1 and soiling in 4. Complete bowel continence was found in 97 children (86.6%) in group 1 and in 129 children (92.1%) in group 2 at one year followup after operation. CONCLUSIONS: Modified transanal Soave pull-through procedure for HD with oblique mucosectomy and anastomosis and a short split muscular cuff is a safe and feasible operation with low incidence of postoperative complication. It is an encouraging improvement of the conventional transanal Soave pull-through procedure. MTSPP is a preferable choice in the surgery of HD.

Adolescent↗
PubMed1991

[Treatment of ulcerative colitis and familial polyposis].

Total colectomy with mucosal protectomy and ileal pouchoanal anastomosis (IPAA) is a promising surgical development for the treatment of ulcerative colitis and familial polyposis. It avoids the need for an ostomy to the exterior, removes all affected tissue and maintains reasonable bowel control by the anal sphincter. 58 patients who underwent IPAA (Group A) were compared with 40 who underwent total proctocolectomy with Kock's pouch (KP) or Brooke's ileostomy (BI), or ileorectostomy (Group B). The indications for surgery were intractable disease, recurrent acute colitis, nonresolving acute colitis, dysplasia, toxic megacolon, perforation, hemorrhage and malnutrition. In Groups A and B duration of operation was, respectively, 6.9 and 5 hours (p less than 0.001); postoperative complications were intestinal obstruction (8 cases versus 14, p less than 0.05), pelvic inflammation (4 vs 3), pouchitis (4 vs 2), and wound infection (3 vs 1). Additional complications in Group A were pouchovaginal fistula (2), and single cases of transient brachial plexus palsy, anastomal stenosis, and rectal prolapse. There were no sexual or urinary complications, no cases in which pouch resection was necessary, nor was there any postoperative mortality. Additional complications in Group B were pouchocutaneous fistula (3) and neurogenic bladder (1?). Among those with KP, there were 9 cases of nipple slippage and 2 cases needed total pouch resection. Among those with BI there were 3 cases of ileostomal prolapse. Mortality in Group B was 4. Total hospital stay in groups A and B, respectively, were 30 and 56 days (p less than 0.0005). Fecal output was 6.3 and 5.9 movements per day in Groups A and B, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenomatous Polyposis Coli↗
PubMed1991

[Disorders of anorectal function].

Since sophisticated function tests of the anorectal continence organ become more and more available, dysfunction of the anorectum is increasingly diagnosed and differentiated. The examination includes measurements of the pressure in the rectum and anal canal (anorectal manometry), rectal distension by an inflatable balloon to test the sensibility, electromyography and radiological defecography. By these methods the etiology and pathogenesis of the most important anorectal disorders, such as anal incontinence, different forms of constipation and rectal prolapse, may be differentiated. Nowadays, many of these disorders are successfully treated by a specific management which includes a special diet, drugs, surgery and biofeedback training programs.

Anal Canal↗
PubMed1990

Outbreak of Salmonella food poisoning amongst delegates at a medical conference.

An outbreak of Salmonella typhimurium DT9 food poisoning due to contaminated chicken pieces affected at least 196 delegates at a medical conference. Twelve per cent of the cases reported suffering parasthaesiae. Nine reported serious complications of infection which included rectal prolapse and perianal abscess. Antibiotic therapy did not measurably reduce the duration or severity of diarrhoea. Over 1,600 doctor-days were lost to the NHS. Most doctors sought expert infection control advice before returning to work but the advice given differed between hospitals.

Adult↗
PubMed1991

Circumcostal cloacapexy in a python.

A chronic cloacal prolapse in an Indian python was repaired by modification of a cloacapexy technique. After isolation of the cloaca, stay sutures were placed through the lumen of the cloaca and through the musculature of the body wall, incorporating a rib within the pexy.

Animals↗
PubMed1990

[Simplified defecography technique. Description and results].

Defecography is a useful paraclinical examination to explore disturbances of continence or defecation. The purpose of this study was to present a simplified defecography technique and assess its validity in subjects without defecation problems (n = 10) and in patients complaining of idiopathic chronic constipation (n = 35). The anorectal angle at rest (RAA) and when straining at stool was not significantly different in constipated patients and in controls. Defecography often gave abnormal results. Anterior rectocele was found in almost 50 percent (17/35) of constipated patients and in 20 percent (2/10) of controls (P less than 0.05). None of the patients had posterior rectocele. Persistent imprint of the puborectal muscle during straining was present in 36 percent (9/35) of constipated patients and in 10 percent (1/10) of controls (NS). The imprint was not always associated with closure of the RAA between rest and straining; this closure was never found in controls but was observed in 6 out of 17 constipated patients (35 percent; P less than 0.05). Perineal descent (PD) varied from 0.6 to 3.7 cm (mean +/- s.e.m.: 2.0 +/- 0.63 cm) in controls, as against 0.6 to 7.9 cm (mean +/- s.e.m.: 2.7 +/- 0.45 cm) in constipated patients. In 24 percent of the constipated patients PD was greater than 3.7 cm (the maximum value recorded in controls). All constipated patients with closure of the RAA during defecation had a PD of less than 1 cm, thus confirming the concept of "pelvic floor muscle hypertonia". Disorders of rectal statics are more frequent in subjects with constipation, but their significance is varied. Some abnormalities could be the cause of constipation (e.g. anismus) and others its consequence (anterior rectal prolapse, anterior rectocele, PD).

Adult↗
PubMed1990

[Preliminary experiences of the University of Parma study group on "The diagnosis and treatment of chronic constipation"].

The authors present a report of their study on a group of patients affected by serious chronic constipation undergoing multidisciplinary evaluation by a radiologist, a neurologist and, if necessary, also a psychiatrist. From June 1989 to October 1990, 40 patients were examined using anal manometry, intestinal transit time, proctogram and electromyography of the pelvic floor. The examinations carried out by the different specialists led to the following results: 10 patients were found to be affected by slowed transit due to right colon constipation; in 16 cases, spastic pelvic floor syndrome (S.P.F.S.) was diagnosed; 5 subjects showed a rectocele which in 3 was associated with S.P.F.S.; 3 patients presented with an anterior rectal prolapse; in 6 cases the diagnosis was perineal descent syndrome, associated in 3 cases with S.P.F.S.; the remaining 6 subjects manifested a diminished ampullary sensitivity. This experience reveals the complexity of the alterations that, alone or in association, cause chronic idiopathic constipation. The authors' conclusion is that a correct diagnostic approach requires close collaboration between various specialists, who, by careful examination of different aspects of the colo-recto-anal region, arrive at an accurate physiopathological diagnosis leading to the most suitable therapy.

Adolescent↗
PubMed1990

[The role of colorectal resection in severe constipation after promontory rectopexy].

Abdominal rectopexy to the promontory is an effective treatment for total rectal prolapse, internal procidentia and solitary ulcer. This paper is designed to stress the risk of severe constipation following rectopexy, a complication which required surgical resection in 5 cases. This raises the problems of the physiological mechanisms of this complication, the definition of a possible high risk population (young women, patients who were constipated preoperatively?), and an alternative to promontory rectopexy: sacral fixation of the rectum, associated sigmoidectomy, Delorme's operation?

Adult↗
PubMed1990

Clinical, pathological and histopathological findings in lambs implanted with a growth promoting product containing progesterone and oestradiol.

Six live wether lambs and the urogenital tracts of 4 others from 4 separate farms were presented for examination. In each case the wethers had been implanted several weeks previously with a growth promoting product containing progesterone and oestradiol. The affected wethers presented with dorsal retroflexion of a markedly distended bladder which caused persistent straining, bulging of the perineal muscles and rectal prolapse. Enlargement of the bulbo-urethral glands and seminal vesicles, with an increase in the volume and viscosity of the secretion of the bulbourethral glands was evident on gross examination. Histopathological examination of the prostate and bulbourethral glands revealed cystic dilation of the glands and hyperplasia and squamous metaplasia of the glandular epithelium. Desquamated cells and eesinophilic-staining material were present in many of the dilated lumens. In the seminal vesicles, interstitial fibrosis had resulted in the obliteration of large areas of glandular tissue. The enlargement of the prostate and bulbo-urethral glands, and particularly the increased viscosity of the gland secretions, probably hindered urination, resulting in only partial evacuation of the bladder. Attempts to urinate by active contraction of the abdominal muscles may have accounted for the dorsal retroflexion of the distended bladder. The oestrogenic influence of the growth implants is thought to be responsible for these changes.

Animals↗