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07/01/1997 12:00 AM
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En Bloc Pancreaticoduodenectomy and Colectomy for Duodenal Neoplasms
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colon; Duodenal malignancy is rare and generally considered to have both a low resectability rate and a poor prognosis. Historically, the involvement of the colon or its mesentery has been considered a criterion for unresectability by many surgeons because of the overall magnitude of surgery involved with an en bloc colectomy and pancreaticoduodenectomy. In the past few years, several reports have noted a decrease in morbidity and mortality rates for pancreaticoduodectomy. The current safety of the procedure suggests that the classical criteria for resectability can now be reevaluated for certain neoplasms. We report two cases of pancreaticoduodenectomy with en bloc colectomy done as attempted curative resections for primary duodenal malignancies. The procedure was well tolerated by both patients; there were no major complications, and it provided both prolonged survival and effective palliation.
(C) 1997 Southern Medical Association
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05/01/1997 12:00 AM
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Outpatient Bowel Preparation For Elective Colon Resection
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colon; To determine the safety and cost-effectiveness of outpatient preoperative bowel preparation with polyethylene glycol-electrolyte lavage solution, we retrospectively analyzed 726 cases of colectomy done by colon and rectal surgeons between July 1987 and July 1991. Included were 319 patients who had elective segmental or total abdominal colectomy with primary anastomosis. Patients who required protective proximal stoma were excluded. Patients requiring emergency surgery, colostomy closure, and restorative proctocolectomy were excluded. Patients were separated into two groups equally matched by age, sex, procedure done, and comorbidity: 145 had bowel preparation as outpatients and 174 as inpatients. Both groups had similar numbers of days hospitalized, days receiving nothing by mouth, and days requiring nasogastric intubation or gastrostomy tube, as well as similar postoperative complications. There was one wound infection, one anastomotic leak, and one death in each group. Cost of outpatient preparation was approximately $40. Cost of inpatient preparation, including a semiprivate room, was approximately $400. Outpatient preparation with polyethylene glycol-electrolyte lavage solution and oral antibiotics before elective colon resection can be done with equivalent safety and at a substantial cost savings.
(C) 1997 Southern Medical Association
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01/01/1974 12:00 AM
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Vascular Malformations of the Intestine: An Important Cause of Obscure Gastrointestinal Hemorrhage*
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Case reports of five patients are presented who had obscure massive bleeding from various vascular malformations of the gastrointestinal tract. The small size and vascular nature of these lesions make the diagnosis by routine roentgenographic studies difficult or impossible. They are equally difficult to find even during exploratory laparotomy. Selective mesenteric angiography is probably the best diagnostic aid and may be carried out even if the patient is not actually bleeding at the time. Arteriovenous malformations are more frequent in the right colon. When such a lesion is suspected and all radiographic studies are negative, blind right colectomy is more apt to cure the patient than any other procedure.
(C) 1974 Southern Medical Association
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03/01/1989 12:00 AM
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Surgical Management of Colonic Inertia
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colon; Fourteen patients with chronic constipation due to colonic inertia were treated with total abdominal colectomy and ileorectal anastomosis at the Cleveland Clinic Foundation from 1981 to 1986. All patients were white women ranging in age from 28 to 64 years (mean 41 years). The duration of symptoms averaged 21 years (range six to 47 years) and the average time between bowel movements was ten days. The preoperative evaluation included barium enema in 12 patients and colonoscopy in five (some patients had both studies). Anorectal dysfunction was excluded by manometry in ten patients and by rectal biopsy in six. Colonic transit studies were accomplished in only two patients. The hospital stay averaged 13 days, and there was no operative mortality. Postoperative morbidity included one case of small bowel obstruction, necessitating operative correction on postoperative day 9. Follow-up ranged from three months to five years. At their last clinic visit, the patients averaged two bowel movements per day. All patients had excellent bowel control and were happy with the procedure.
(C) 1989 Southern Medical Association
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01/01/2003 12:00 AM
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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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10/01/2008 12:00 AM
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Perforated Stercoral Ulcer of the Sigmoid Colon
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No abstract available
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03/01/2009 12:00 AM
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The Water Jet Deformation Sign: A Novel Provocative Colonoscopic Maneuver to Help Diagnose an Inverted Colonic Diverticulum
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Colonoscopic differentiation of an inverted colonic diverticulum from a true colonic polyp is important because a true colonic polyp usually requires colonoscopic snare polypectomy or at least biopsy, whereas these maneuvers are contraindicated for an inverted diverticulum due to the risk of colonic perforation. Previously described diagnostic maneuvers to evert an inverted diverticulum include probing it with a closed biopsy forceps or intraluminal air insufflation during colonoscopy. On colonoscopy, a 59-year-old female had two intraluminal colonic projections. Probing these projections and using air insufflation failed to indent or evert them. Spraying these lesions with a water jet, however, flattened or partly everted them. This novel maneuver provided conclusive evidence that these intraluminal projections represented inverted diverticula. The proposed pathophysiology is that water pressure causes an inverted diverticulum to indent or evert due to its thin wall. The currently reported maneuver may be easier and safer than probing an inverted diverticulum with biopsy forceps and may prove a more reliable diagnostic maneuver than air insufflation.
(C) 2009 Southern Medical Association
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11/01/2007 12:00 AM
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Surgical Oncology in the Community Hospital: Can It Be Done Safely?
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Background: Many studies have documented the fact that outcomes and survival are improved when major surgical oncology cases are performed at high-volume centers. Consolidation of such cases in tertiary centers, however, is often not possible or practical, due to a number of factors.
Methods: A retrospective review was performed of the operative experience of a single surgical oncologist at a community hospital in Mississippi during a noncontinuous 36-month period. Data were obtained regarding all major inpatient cancer operations, as well as complication and death rates. This review was limited to major inpatient procedures and resections performed with intent to cure.
Results: A total of 171 major cancer cases were performed during the study period. This represented 23.7% of the total inpatient procedures performed and 47.5% of all major inpatient procedures. Distribution of surgical sites was as follows: liver-9; stomach-8; esophagus-3; pancreas-4; colon and rectum-76; breast-33; lung-13; intra-abdominal (sarcoma)-9; and thyroid-16. There were 5 complications within this group (2.9%); two of these resulted in death (1.2%).
Conclusions: In the hands of a single surgeon operating at a community institution, major resections for cancer and major surgical oncology cases could be done safely with acceptable complication rates and results. Whether or not such major cancer cases should be done at the community level, however, depends on a number of factors and requires further evaluation of both surgeon and hospital capabilities.
(C) 2007 Southern Medical Association
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01/01/2008 12:00 AM
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Gastrointestinal Tract Bleeding in Intellectually Disabled Adults
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Background: Gastrointestinal (GI) tract bleeding in intellectually disabled (ID) individuals presents peculiar diagnostic and management difficulties. This study details the experience of a tertiary referral teaching hospital in Central Saudi Arabia in the management of GI bleeding necessitating admission in ID adults.
Patients and Methods: Prospective collection of data was taken on consecutive ID adults admitted for GI bleeding from January 2000 through December 2004. Demographic details, clinical presentation, diagnosis, associated physical and neurologic disabilities, etiology of bleeding and treatment outcome were analyzed.
Results: Thirty-nine ID adults accounted for 44 admissions during the period under review. Twenty-six (66.7%) patients were admitted with upper, and 13 (33.3%) for lower GI bleeding. Reflux esophagitis (57.7%) remained the most common cause of upper GI bleeding. Five out of 26 patients with upper and 6 of 13 with lower GI bleeding needed operative treatment. Various congenital anomalies or malformations were observed frequently associated with lower GI bleeding.
Conclusions: Bleeding GERD remained the most common etiology of upper GI bleeding necessitating admission. Endoscopy is the mainstay in diagnosis and initial management of ID patients. Continued surveillance endoscopy is recommended for early diagnosis of Barrett changes. Bleeding from developmental malformations may have association with intellectual disability.
(C) 2008 Southern Medical Association
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10/01/2009 12:00 AM
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Giant Ulcerated Lipoma of the Colon Causing Iron Deficiency Anemia Successfully Treated with Endoscopic Ultrasound-Assisted Resection
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Colonic lipomas are frequently small and asymptomatic. Giant colonic lipoma (GCL) is an uncommon finding at endoscopy, and ulceration with occult blood loss leading to iron deficiency anemia (IDA) is even rarer. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. We hereby report a case of an ulcerated GCL that presented with occult bleeding and IDA. IDA resolved after the GCL was removed successfully combining endoloop ligation and snare cautery technique under endoscopic ultrasound (EUS) guidance. With the advent of EUS, endoscopic resection of submucosal tumors can be performed relatively safely by providing a viable and useful alternative to surgery.
(C) 2009 Southern Medical Association
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07/01/2005 12:00 AM
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Pilot Study on Gastric Electrical Stimulation on Surgery-associated Gastroparesis: Long-term Outcome
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Objectives: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis.
Methods: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time.
Results: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying.
Conclusions: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.
(C) 2005 Southern Medical Association
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03/01/2006 12:00 AM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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