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12/31/1969 03:59 PM
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Continent Ileostomy
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The continent ileostomy, consisting of a valve and a pouch, makes available an alternative system in which intestinal discharge can be stored and controlled after coloproctectomy. Earlier concerns regarding valve slippage with resulting malfunction have been largely eliminated by recent modifications in the technique of valve contruction. A continent ileostomy was provided for 19 patients. In the first five, an antiperistaltic (Kock) valve was constructed and two had dessusception which necessitated reoperation. In the 16 cases in which an isoperistaltic valve was fashioned, there has been no slippage. These improvements, along with the significant enhancement of the quality of life, indicate a need to reexamine the advisability of providing a spout-type ileostomy in those cases favorable to the construction of a continent ileostomy.
(C) 1983 Southern Medical Association
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12/31/1969 03:59 PM
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Ileostomy: Construction and Management
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The authors believe that by use of newer technics and appliances, well-functioning ileostomies can be formed with a minimum of complications. Acceptance by the patients has been gratifying.
(C) 1964 Southern Medical Association
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12/31/1969 03:59 PM
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Technical Complications of Ileostomy
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A review of 45 patients with ileostomy revealed a complication rate of 24%. A higher incidence of complications was seen in those patients who were obese (80%), who had chronic ulcerative colitis (45%), or who had an emergency ileostomy because of a surgical complication (50%). Strict attention to technic should prevent the majority of these complications.
(C) 1980 Southern Medical Association
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12/31/1969 03:59 PM
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Ileostomy-Site Adenocarcinoma
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ILEOSTOMY-SITE ADENOCARCINOMA. Department of Surgery, Western Reserve Care System, Youngstown, Ohio.
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12/31/1969 03:59 PM
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Uretero-Ileostomy: Experience With 55 Cases
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The authors have had a most satisfactory experience with use of this procedure whenever the urinary stream needed diversion. They emphasize the need for following the technic meticulously.
(C) 1965 Southern Medical Association
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12/31/1969 03:59 PM
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Variceal Bleeding From an Ileostomy Stoma
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Variceal Bleeding From an Ileostomy Stoma. From the Department of Gastrocnterology, Vandcrbilt University School of Medicine and Veterans Administration Medical Center, Nashville, Tenn.
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12/31/1969 03:59 PM
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Loop Ileostomy: A Reliable Method of Diversion
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LOOP ILEOSTOMY: A RELIABLE METHOD OF DIVERSION.
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12/31/1969 03:59 PM
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Surgical Treatment of Ulcerative Colitis: Problems of the Ileostomy
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In many patients having ulcerative colitis there comes a time when surgical interference must be considered. The indications and methods of attack are presented by the authors. It appears much is to be said for a one-stage ileostomy and colectomy for acute exacerbation of ulcerative colitis
(C) 1957 Southern Medical Association
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12/31/1969 03:59 PM
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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 Southern Medical Association
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12/31/1969 03:59 PM
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The Construction and Care of Ileostomy and Colostomy
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So much depends upon the care of the ileostomy or colostomy insofar as its acceptance by the patient is concerned. At best it is a serious psychologic hurdle. Therefore every attempt must be made to have a properly functioning stoma and one that can be cared for with a minimum of trouble.
(C) 1959 Southern Medical Association
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease and Cholelithiasis: The Association in Patients With an Ileostomy
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colon; Sixty-nine patients were evaluated prospectively by sonography and history to determine the presence of cholelithiasis. Sixteen patients (23%) had a positive diagnosis. A control group was also prospectively evaluated. We have determined that patients above age 50 with a permanent ileostomy are at statistically significant risk of having cholelithiasis, and their risk is greater than that of a control group matched for age and sex. Radiologists should recognize this association and carefully evaluate the gallbladder of any patient with a permanent ileostomy who has abdominal pain.
(C) 1984 Southern Medical Association
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12/31/1969 03:59 PM
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One Stage Colectomy, Proctectomy and Ileostomy for Diffuse Ulcerative Colitis
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The surgical attack on ulcerative colitis has become more bold in recent years with antibiotics and a better understanding of fluid and electrolyte balance. The author proposes a one stage operation be used when the indications for surgery are present.
(C) 1960 Southern Medical Association
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12/31/1969 03:59 PM
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Ileoanal Reservoir: Functional Results and Management
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colon; Restorative proctocolectomy with ileoanal reservoir is an alternative to Brooke ileostomy. This study of 56 patients emphasizes functional results and management of the loop ileostomy, transient incontinence, frequency of bowel function, constipation, perianal skin, and psychosocial issues.
(C) 1984 Southern Medical Association
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12/31/1969 03:59 PM
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Continent Intestinal Reservoir
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colon; In this series, 170 patients have received a continent intestinal reservoir, with follow-up of one to eight years. In 126 a conventional ileostomy was converted to a continent intestinal reservoir, 38 at the time of coloproctectomy. Six had an unsatisfactory ileoanal or ileorectal anastomosis initially, and 26 (15%) required revisional surgery for problems involving the reservoir or valve. The incidence of valve slippage was 3%. Eighty-five percent achieved a normally functioning small bowel reservoir with one operation, and 19 more patients were added with one additional operation, for an ultimate good result of 96% with two operations at most. The average reservoir capacity is 400 ml, and most patients empty the pouch two or three times per day. Under favorable circumstances, the continent intestinal reservoir is preferable for most patients after coloproctectomy.
(C) 1987 Southern Medical Association
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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Early Diagnosis of Parastomal Hernia
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is not uncommon following the formation of an ileostomy or colostomy. Although most patients are is not an uncommon complication after ileostomy or colostomy. The reported incidence of parastomal
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12/31/1969 03:59 PM
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A Primary Case Presentation of Nephrolithiasis from Enteric Hyperoxaluria Due to Crohn's Disease
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A Primary Case Presentation of Nephrolithiasis from Enteric Hyperoxaluria Due to Crohn's Disease. supplementation. In severe recurrent cases, an ileostomy may be indicated.
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12/31/1969 03:59 PM
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Paradoxical Inflammatory Reaction to Seprafilm: Case Report and Review of the Literature
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This report describes a paradoxical inflammatory reaction to Seprafilm caused by extensive adhesion formation early in the postoperative period. A female patient had development of small bowel obstruction immediately after an uneventful low anterior resection for rectal carcinoma with placement of Seprafilm. The obstruction did not improve with nonoperative therapy. At laparotomy, extensive adhesions necessitating bowel resection and ileostomy were noted. Pathology results showed a giant cell foreign body reaction to Seprafilm. A literature search yielded only two other instances of adverse reactions to Seprafilm. The information provided by this and other atypical reports suggests that further studies aimed at identifying the incidence and pathophysiological mechanisms for such paradoxical reactions are needed.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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CME Questions: Pediatric Obesity: Impact and Surgical Management
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CME Questions: Pediatric Obesity: Impact and Surgical Management.
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12/31/1969 03:59 PM
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Cecoanal Intussusception in an Adult Caused by Cecal Polyp
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Cecoanal Intussusception in an Adult Caused by Cecal Polyp. Division of Gastroenterology, Dallas Veterans Affairs Medical Center and University of Texas Southwestern Medical School, Dallas, TX
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12/31/1969 03:59 PM
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Diffuse Malignant Peritoneal Mesothelioma Presenting as Intestinal Obstruction
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Diffuse malignant peritoneal mesothelioma (DMPM) represents 90% of all peritoneal forms of mesothelioma. It affects mainly patients 50-69 years old. In 50% of cases there is a history of asbestos exposure. The clinical presentation of the disease is not characteristic: nonspecific abdominal pain, weight loss, and abdominal distension are common. Ascites occurs in 90% of the patients. Bowel obstruction is a late manifestation. We present three patients with DMPM, without a history of asbestos exposure and without ascites, who presented with complete bowel obstruction. All patients underwent emergency operations, and palliative surgical procedures were performed. Each patient died within 3 to 6 months postoperatively.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
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Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was attributed to UC, as hypercoagulable testing was negative. IBD is certainly a hypercoagulable state, and aggressive thromboembolism prevention should be considered for hospitalized patients with active disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Massive Fecal Impaction Presenting with Megarectum and Perforation of a Stercoral Ulcer at the Rectosigmoid Junction
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A 25-year-old male with lifelong constipation presented to the emergency department with an acute abdomen. Initial resuscitation was performed, and the patient underwent urgent laparotomy. He was found to have feculent peritonitis with megabowel involving the rectum and sigmoid colon and a stercoral ulcer with full thickness erosion, and perforation was also identified on the anti-mesocolic surface at the rectosigmoid junction. Abdominal irrigation and subtotal colectomy with proximal fecal diversion was performed. This case illustrates that recognition of severe, chronic constipation should lead to interventions including disimpaction and aggressive medical management. When indicated, megabowel can be managed surgically in an elective setting based on anatomic findings and physiologic studies. Peritonitis is an ominous late finding in patients with severe constipation.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2 Section of rectum showing submucosal hemorrhage and giant cell reaction (hematoxylin and eosin stain, original magnification × 20).
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1A, Section of omentum showing acute and chronic inflammation with giant cells (arrow), hemorrhage, and fibrosis (hematoxylin and eosin stain, original magnification × 20).B, Section of omentum showing fat necrosis and hemorrhage (hematoxylin and eosin stain, original magnification × 20).
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