摘要:

&NA;If, during restorative proctocolectomy, the most distal segment of the terminal ileum is not incorporated into the reservoir during J‐pouch construction, it will remain as an appendage and may twist upon itself and obstruct. Two cases in which this resulted in significant complications are described.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;One hundred sixteen patients with acute colorectal diseases, operated upon emergently and needing an intestinal stoma, were reviewed to determine the cost and morbidity of treatment of patients with colorectal trauma compared to other surgical illnesses. The first group (57 patients) had perforating colonic or rectal trauma, the second (30 patients) perforated colonic disease, the third (24 patients) nonperforated colonic disease, and the fourth (five patients) a colonic injury, unrecognized initially but requiring subsequent treatment with a stoma. For the initial operation, hospital stay, complications, mortality, and costs were less for patients in group 1 (colonic injury) than in groups 2 and 3 (inflammatory or neoplastic diseases). Colostomy closure, whatever the antecedent disease or injury, required an average ten‐day hospitalization, had no mortality, a complication rate of 0 to 6 percent, and an average hospital cost of $6,500. The hospital stay and costs for the total treatment were slightly higher for nontraumatic illnesses, although the rate of colostomy closure was significantly less (68 and 77 percent versus 86 percent,P=.05).

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;Spontaneous internal fistulas involving intestine, rectum, bladder, or vagina in patients without predisposing illnesses were studied. Twelve of 20 (60 percent) were receiving steroids or other anti‐inflammatory medication at the time the fistulas developed. Fifteen of the 20 patients subsequently had diverticular disease identified. It is proposed that there is an association between anti‐inflammatory medication and fistulas that develop from intestine to other pelvic viscera, spontaneously or in association with colonic diverticula.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;A series of 44 patients with complete or partial left‐colon obstruction underwent laparotomy and intraoperative colonic lavage. Irrigation was unsuccessful in three, the operation being concluded by a Hartmann resection. In the remaining 41, the achievement of an empty colon allowed primary anastomosis after resection of the obstructing lesion. Seven patients (17.1 percent) died, none of dehiscence of the colorectal anastomosis, although minor anastomotic leaks occurred in four. The median postoperative hospital stay was 12 days. Two patients developed peritonitis (one fatal) from leakage of ileal contents when the irrigating catheter was introduced through an ileotomy and retained postoperatively, and this aspect of the technique is not recommended. The operation offers a single‐stage alternative for patients with unprepared or ill‐prepared bowels who require resection of left‐colon lesions. The results compare favorably with the authors' previous experience of two‐or three‐stage resections (in‐hospital mortality rate, 42 percent).

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The long‐term outcome of Crohn's disease was reviewed in 139 patients who were treated at the Cleveland Clinic for a minimum of 15 years. At the time of diagnosis, 38 (27 percent), 39 (28 percent) and 62 (43 percent) patients had small‐bowel, large‐bowel, and ileocolic patterns of disease, respectively. The disease progressed with time and, eventually, 104 (75 percent) patients had ileocolic disease. One hundred twenty‐two patients (88 percent) underwent at least one definitive operation for the disease. Forty‐four (32 percent) patients had proctocolectomies and 65 (47 percent) have ileostomies. Associated manifestations of Crohn's disease occurred in a high proportion of patients; perianal disease in 78 (56 percent), intestinal fistulas in 45 (32 percent), extraintestinal disease in 49 (35 percent). Six patients died of causes directly related to the disease. Specific complications tend to occur at definite times in the course of the disease. Crohn's disease is not a benign condition. There is a relentless progression of the disease and a high incidence of complications when patients are followed over a long period.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

&NA;The incidence of metachronous colorectal cancer has been reported to be 1 to 5 percent, with most of the cases being discovered within ten years of the initial cancer. A retrospective review of all colorectal cancer patients was conducted at the Southern Illinois University Affiliated Hospitals to determine the incidence of metachronous colorectal cancer at the authors' institution. In this study, a metachronous cancer was defined as a second colorectal primary occurring at least three years following discovery of the initial lesion. Between 1978 and 1984, there were 24 patients with metachronous colorectal cancer identified in an operative series of 707 patients for a frequency of 3.4 percent. These metachronous cancers were discovered at intervals ranging from 3 to 35 years. Sixteen (67%) metachronous lesions occurred 11 years of more after the original cancer. Synchronous or interval adenomatous colorectal polyps were noted in 17 (71 percent) of the patients. Thirteen of the metachronous cancers appeared in the right colon, while six were distributed throughout the transverse and descending colon, and five were in the rectosigmoid region. The incidence of late‐appearing metachronous colorectal cancers and the propensity to occur in the right colon underscores the need for evaluation of the entire colon as part of lifelong follow‐up of the colorectal cancer patient.

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1987

数据来源: OVID