[Ileo-sigmoid-vesical fistulas caused by Meckel's diverticulitis and sigmoiditis; diverticulectomy and resection of the sigmoid in therapy of therapy of the fistulas].
Explore the source record for details and available documents.
Colon↗
SEARCH · Search PubMed
Results for “SIGMOID”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Laparoscopic-assisted sigmoid colectomy for sigmoid volvulus.
A 75-year-old black man came to the emergency room because of nausea, vomiting, abdominal pain, and distension and obstipation. An abdominal radiograph revealed a sigmoid volvulus. This was nonoperatively reduced in the emergency room. Following a mechanical and antibiotic bowel preparation, the patient underwent elective exploration. We report, for the first time, operative treatment of sigmoid volvulus with a laparoscopic-assisted sigmoid colectomy and primary anastomosis. Because of dense fibrous scarring of the sigmoid mesentery produced by chronic mesosigmoiditis, the redundant sigmoid was exteriorized and resected extracorporeally. A stapled, side-to-side, functional end-to-end anastomosis was constructed. The patient experienced little postoperative pain and virtually no postoperative ileus. We believe that laparoscopic-assisted sigmoid resection may offer distinct advantages for the treatment of the typically elderly, debilitated patient in whom sigmoid volvulus develops. Furthermore, because of the characteristic mesosigmoiditis associated with sigmoid volvulus, we suspect that exteriorization and extracorporeal resection may prove the easiest and most rapid laparoscopic approach to this disease.
Aged↗
Laparoscopic sigmoidopexy by extraperitonealization of sigmoid colon for sigmoid volvulus: two cases.
Sigmoid colectomy-open or laparoscopic-has been advocated as the treatment of sigmoid volvulus. This has a higher incidence of morbidity and mortality. We have successfully treated 2 cases of recurrent sigmoid colon volvulus with laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon. Laparoscopic sigmoidopexy by this technique has not been reported before. The first patient was a 20-year-old male and the second was a 72-year-old female. In both patients, initial detorsion of volvulus was achieved by rectal tube. As the colon was nongangrenous, elective laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon was performed 4 days after the detortion. Operative times were 50 minutes and 70 minutes. Both patients were discharged from the hospital on the third postoperative day. There has been no recurrence of volvulus over a period of 6 and 7 months. There were no complications. In conclusion, laparoscopic sigmoidopexy by extraperitonealization of the sigmoid colon may become a superior alternative for the treatment of sigmoid volvulus with nongangrenous colon.
Adult↗
[Injuries of the sigmoid colon following radiation therapy of carcinoma of the uterine cervix--a method of estimating the radiation dose to the sigmoid colon].
Grade 2 or 3 injuries of the sigmoid colon were observed in 4 out of 42 patients with carcinoma of the uterine cervix who were treated by radiation therapy. The irradiation was planned as the combination of the external irradiation (whole pelvic 30 Gy and 20 Gy with central shielding by 25 fractions, 5 weeks) and the intracavitary irradiation (RALS, 19 Gy at point A by 3 fractions). To analyze the causes of the radiation sigmoiditis, we have investigated the following factors: age, dose at point A, dose at point C, grade of tandem dislocation, uterine angle, obesity score, evidence of previous surgery to the pelvic cavity and hypertension. The dose at point C and the grade of tandem dislocation were determined from the confirming X-Ps at RALS therapy and external irradiation. The superimposition of these films was performed with corrections for the angle between the projection direction of the X-Ps and the vertical magnification factor of the central shielding area. Point C was defined as a point 2 cm anterior to the intersection of the tandem axis and a curvilinear line 1 cm outside from the margin of central shield on the X-Ps. Grades of tandem disclocation were decided as the number of tandem tips which were outside of the central shielding area on X-Ps. As the results, the doses at point C showed very high statistical significance (p less than 0.001) with the evidence of radiation sigmoiditis. All the cases with radiation sigmoiditis were received over 1290cGy at point C. Age had also some significance (p less than 0.05) with radiation sigmoiditis.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
Histology of the mucosa in sigmoid colon specimens with diverticular disease: observations for the interpretation of sigmoid colonoscopic biopsy specimens.
We examined retrospectively 100 sigmoid colon resection specimens removed for diverticulitis (DD [diverticular disease]-diverticulitis), 53 adenocarcinoma specimens that also had diverticulosis (DD-adenocarcinoma), and 50 adenocarcinoma specimens that did not have DD (adenocarcinoma only) to study the mucosal changes that occur in DD. Documenting these histologic features could be helpful in deciphering changes seen in colonoscopic biopsy specimens from the sigmoid colon in older patients. Prominent mucosal folds were present in approximately 90% of all DD specimens. Increased mucosal lymphoplasmacytic inflammation at the bases of the prominent folds was present in 15% and 9% of DD-diverticulitis and DD-adenocarcinoma specimens, respectively. Eleven percent of the DD-diverticulitis and 4% of the DD-adenocarcinoma specimens had prolapselike mucosal abnormalities of the mucosa on the surface of the prominent mucosal folds. Mildly increased lymphoplasmacytic inflammation surrounded the diverticulosis ostia in approximately 25% of all DD specimens. All the diverticulitis ostia had neutrophilic and lymphoplasmacytic inflammation in the surrounding mucosa. No specimens had crypt distortion. Diverticular disease-related inflammation may be one cause of mild patchy inflammation that is occasionally observed in sigmoid colon biopsy specimens. Diverticular disease also should be considered as a cause of mucosal prolapse changes in sigmoid colon biopsy specimens. Other diseases should be considered when markedly increased mucosal inflammation, crypt distortion, or granulomas are present. Distinction between a DD-related incidental finding and a significant pathologic abnormality frequently can be made with the procurement of multiple biopsy specimens.
Adenocarcinoma↗
Uninhibited sigmoid colon syndrome (sigmoid hyperreflexia): description of a new clinicopathological entity.
PURPOSE: To present 10 patients who complained of passage of frequent loose stools which was found to be due to sigmoid colon hyperreflexia, a condition that, to our knowledge, has not been described before. PATIENTS AND METHODS: Ten patients (6 women, 4 men, mean age 46.6 years) complaining of frequent loose stools of 5-8 years' duration and 10 healthy volunteers (controls) matching the patients in age and gender, were included in the study. Colonoscopy, barium enema and intestinal transit studies were normal in all. The anorectal physiological studies comprised: recording of rectal, anal and intra-abdominal pressures, EMG of the external and internal anal sphincters and levator ani muscles, sigmoidometry and determination of the sigmoido-rectal junction reflex. RESULTS: Apart from sigmoidometry, all the aforementioned anorectal physiological studies were in accordance with those of the controls. Sigmoidometry showed that balloon expulsion occurred at a distending volume of 32.4 ml and a sigmoid colon pressure of 86.4 cmH2O in the patients, and of 86.2 ml and 98.6 cmH2O, respectively, in the controls. The tone limb exhibited major fluctuations (mean pressure rise 43.8 cmH2O) in the patients, while it was smooth or showed minor fluctuations (insignificant pressure changes) in the controls. CONCLUSIONS: The sigmoid colon contractions produced by small volumes of stools and the lack of proper storage necessary for water absorption from the stools, are suggested to explain the frequent loose stools in the studied patients and to be the result of sigmoid colon hyperreflexia.
Adult↗
[Continent urostomy: sigmoid reservoir and sigmoid hydraulic valve].
We report our experience of continent sigmoidostomy. The technique consisted in urinary diversion with sigmoid pouch and hydraulic valve. Eleven patients underwent this procedure (10 men and 1 women, mean age 48 years, range 20 to 77 years). Indications were bladder tumor in 7 cases, bladder exstrophy in 2 patients, neurogenic bladder in 1 case and 1 bladder with a small capacity secondary to a stricture of traumatic urethra. The pouch was made according to the detubularized model. The sigmoid was opened on its antimesenteric edge, leaving the distal portion of the sigmoid intended to do the sigmoid valve. The posterior edges of the colonic segment opened were alined then secured by a Dexon 3/0 whipping then the anterior adges were secured, as the former after reimplantation of the ureters according to Camey Leduc or Politano Leadbetter's procedure. The post operative follow-up was marked by a fistula of the pouch in one case treated by securing it. All the patients were continent day and night. The purpose of this study was the description of the technique and the results of the continent sigmoïdostomy.
Adult↗
Caecal volvulus following laparoscopy-assisted sigmoid colectomy for sigmoid volvulus.
CASE PRESENTATION. We report a case of caecal volvulus in a patient who underwent laparoscopy-assisted sigmoid resection for sigmoid volvulus 1 year previously. DISCUSSION. Clinico-radiological features and the management of metachronous sigmoid and caecal volvulus are discussed.
Adult↗
Intermittent volvulus of the sigmoid colon.
Three patients in the younger age group are described who are thought to have had intermittent volvulus of the sigmoid colon. Successful treatment was effected by sigmoid colectomy and end-to-end anastomosis. The incidence and aetiology of sigmoid volvulus are reviewed, with particular reference to its occurrence in younger patients.
Adult↗
Technically difficult colonoscopy, a non-radiologic sign of sigmoidal obstruction: value of sigmoid colectomy for intractable symptoms.
Technical difficulty in passing the colonoscope was assessed in 371 patients undergoing 627 colonoscopies during 1989-91 and were graded as 0: no difficulty and cecum reached (71.43%); 1: difficult but cecum reached (20.22%); 2: difficult and cecum not reached although lumen beyond seen (4.85%); and 3: difficult and cecum not reached as lumen beyond could not be seen (3.5%). Frequency of patients with chronic lower abdominal pain and/or disturbed bowel habits in each grade increased as grade of obstruction increased: 0 (25.66%), 1 (36%), 2 (77.77%), and 3 (100%). During 1983-91, 54 patients with lower abdominal pain and/or disturbed bowel habits for a mean of 30.5 months, unresponsive to conventional medical measures, and who also had a grade 2 or 3 sigmoidal obstruction, elected to undergo sigmoid colectomy. Operative and pathologic studies showed that the primary cause was fixation of the sigmoid colon to the pelvis in two or three loops by adhesions from previous pelvic surgery, endometriosis, ovarian cyst, or diverticulitis. All patients had relief of symptoms that was maintained during the 1-9 year follow-up.
Abdominal Pain↗
[Sigmoid-vesical fistula as a consequence of sigmoid tumor].
Because of unusual rarity of neoplastic sigmoid-vesical fistula in young patients the case of 43 years old woman, in whom the fistula was the consequence of sigmoid adenocarcinoma infiltration of urinary bladder, was presented. The patient was treated radically by resection of the sigmoid and partial resection of the urinary bladder within healthy tissue. After operation the patient was exposed to radiotherapy, after which chemotherapy followed (6 courses of 5-day chemotherapy with fluorouracil and calcium folinate). 18 months after operation, 16 months after radiotherapy and 14 after chemotherapy patient's general condition was good and control laboratory tests did not indicate the relapse of the neoplasm.
Adenocarcinoma↗
Intraluminal pressure in the sigmoid colon. II. Patients with sigmoid diverticula and related conditions.
Patients with lower abdominal symptoms, indicating colonic disorder, were classified into predefined clinical syndromes. Two important syndromes were colicky sigmoid syndrome and chronic diverticular disease. The first one, characterized by presence of colicky lower abdominal pains but absence of colonic diverticula, probably covers what is generally referred to as 'irritable bowel syndrome'. The second one was characterized by presence of lower abdominal colics and of colonic diverticula. The results showed a significant correlation between the presence of lower abdominal colics and a high pressure activity in the sigmoid colon after intravenous neostigmine. There was, however, no correlation between the presence of diverticula and a high pressure activity. The generally accepted theory of a high pressure activity as the dominant factor in the pathogenesis of colonic diverticula, therefore, was questioned, as was the equally accepted theory of a gradual development of chronic diverticular disease from the adiverticular colicky sigmoid syndrome.
Adult↗
[Coincidence of sigmoid cancer and sigmoid diverticulitis].
From 1985 to 1989 265 patients with a carcinoma of the sigmoid or sigmoid diverticulitis have been operated in our clinic. 23 of the treated patients synchronously had a carcinoma and a diverticulitis. The carcinoma in these cases was found to be significantly more frequent in a stage T1 or T2. We also found a significantly higher rate of perforations in this group of patients.
Adenocarcinoma, Mucinous↗
Incompletely resected rectum, recto-sigmoid, or sigmoid carcinoma: results of postoperative radiotherapy and prognostic factors.
Postoperative radiotherapy was given in 40 patients with gross or microscopic pathologically proven residual disease after surgical resection of rectum, recto-sigmoid, or sigmoid carcinoma. The radiotherapy target volume included the pelvis with (9 patients) or without (31 patients) the perineum. Median total dose of radiation was 50 Gy (range 30-60). One patient received 30 Gy, 10 received greater than 30 to 40 Gy, 13 received greater than 40 to 50 Gy, and 16 patients received greater than 50 to 60 Gy. The median follow-up in the survivors (16 patients) was 53 months (range: 16-85). Probability of survival with censoring for death due to intercurrent disease was 36% at 5 years. Survival for patients with microscopic residual disease (21 patients) was 40% at 5 years compared to 12% for those with gross residual disease (19 patients) (p = 0.09). Twenty-five patients relapsed. All but one relapse occurred earlier than 50 months after radiotherapy. Approximately half (12/25) of the relapses were observed within 6 months after radiotherapy. Local relapse inside the radiotherapy portals was observed in 9/40 (22%) patients. Therapy-related urogenital complications occurred in no patient and gastro-intestinal complications in three patients (7%). In one patient they were scored WHO grade 4 and in two patients WHO grade 3. Prognostic factors were analyzed using the Cox proportional hazards model. For survival differentiation, grade (p less than 0.001), stage (p = 0.04), and perineal irradiation (p = 0.03) were independent prognostic factors. With relapse-free survival as the endpoint, only stage (p = 0.003) was a statistically significant prognostic factor. There was a trend toward a better relapse-free survival when the perineum was included in the radiation portals (p = 0.09).
Carcinoma↗
Multicentre, randomized clinical trial of primary versus secondary sigmoid resection in generalized peritonitis complicating sigmoid diverticulitis.
BACKGROUND: The best way to manage generalized peritonitis complicating sigmoid diverticulitis is controversial. This randomized clinical trial involved a comparison of primary resection and suture, drainage with proximal colostomy followed by secondary resection. METHODS: From January 1989 to December 1996, 105 patients of mean(s.d.) age 66(14) (range 32-91) years were randomized to undergo primary or secondary resection. The main endpoint was occurrence of generalized or localized postoperative peritonitis. The Mannheim Peritonitis Index score was calculated for each patient to check for comparability of groups. RESULTS: Postoperative peritonitis occurred less often after primary than secondary resection whether considering the first procedure only (one of 55 patients versus ten of 48; P < 0.01) or all procedures (one of 55 versus 12 of 48; P < 0.001). Likewise, early reoperation was performed less often following primary resection than secondary resection (two of 55 versus nine of 48 (P < 0.02) and two versus 11 (P < 0.01)), leading to a shorter median first hospital stay for patients having primary resection (15 days) than for those undergoing secondary resection (24 days) (P < 0.05). The mortality rate did not differ significantly with regard to operative policy (primary resection 24 per cent versus secondary resection 19 per cent) or type of peritonitis (faeculent 27 per cent versus purulent 19 per cent). No patient died following a second or third procedure. CONCLUSION: Primary resection is superior to secondary resection in the treatment of generalized peritonitis complicating sigmoid diverticulitis because of significantly less postoperative peritonitis, fewer reoperations and shorter hospital stay.
Adult↗
Role of the sigmoid colon in the defecation mechanism with evidence of sigmoido-anal inhibitory and ano-sigmoid excitatory reflex.
In spite of voluminous literature that has been written on defecation, the exact mechanism has not yet been fully cleared up. The current study investigated the effect of sigmoid colon (SC) distension on anal motile activity and of anal distension on SC motility. Sixteen healthy volunteers (age 36.2 +/- 11.6 SD years, 10 men) were studied. The SC was distended by a balloon in 10 ml increments of CO2, and the anal, rectal and SC pressure response was recorded before and after their individual anesthetization. The anal, rectal and SC pressure response to anal distension in increments of 2 ml of CO2 was also registered. SC distension with big volumes (mean 86.2 +/- 1.9 ml) effected a SC pressure increase (p<0.05) and no rectal pressure response (p>0.05); the balloon was expelled to the exterior. Distension of the anesthetized SC caused no SC, rectal or anal pressure response (p>0.05, p>0.05, p>0.05, respectively); the response returned after the anesthetic effect had waned. SC distension while the rectum had been anesthetized, affected a significant SC pressure rise as well as an anal pressure decrease and balloon expulsion to the exterior. Anal balloon distension produced a significant pressure rise of the SC (p<0.001) and rectum (p<0.01). Distension of the anesthetized rectal neck (anal canal) caused no SC or rectal pressure response (p>0.05, p>0.05, respectively); response returned after the anesthetic effect had disappeared. SC distension appears to effect anal dilatation while anal distension causes SC contraction. This reciprocal action is suggested to be reflex and mediated through the "sigmoido-anal inhibitory reflex" and the "ano-sigmoid excitatory reflex". These 2 reflexes are believed to keep the SC contracting and the rectal neck dilated until complete SC evacuation occurs. The study seemingly negates the role of rectal distension as a prerequisite for balloon expulsion.
Adult↗
[Progress in laparoscopic sigmoid resection in elective surgical therapy of sigmoid diverticulitis].
The full significance of laparoscopic technique in elective surgery of sigmoid diverticulitis has yet to be determined. However, it seems worthwhile to evaluate how minimally invasive surgery could be integrated into the surgical treatment of diverticulitis disease. Between January 1995 and August 1996, 26 patients with sigmoid diverticulitis underwent elective surgery. Following diagnostic laparoscopy, seven patients were treated with primary conventional resection, 15 patients with laparoscopic resection and four patients with laparoscopic-assisted surgery. One laparoscopic resection had to be converted to a median laparotomy. Postoperative complications (n = 2) only appeared in the group of conventional resections. Conventional resections required less time than laparoscopic or laparoscopic-assisted resections, but postoperatively, patients with laparoscopic resection were able to defecate sooner and required a shorter hospital stay. For 60% of the patients with diverticulitis disease of the colon, elective laparoscopic resection may prove to be the best alternative of surgical treatment. In selected patients it is a sound technique with a low complication rate. We recommend that all patients with diverticulitis disease requiring elective surgery undergo diagnostic laparoscopy to determine whether or not laparoscopic resection is a viable option.
Aged↗
[Sigmoid-vesical fistula in the course of long-term conservative treatment for recurrent sigmoid diverticulitis].
The authors describe a case of sigmoidovesical fistula developed in a man with sigmoid diverticular disease. Appropriate surgical procedure has been done thanks to proper diagnosis. In authors' opinion early operation performing is the best therapy of colon diverticulitis even if a patient suffer from other serious disorders.
Diverticulitis↗