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02/01/1936 12:00 AM
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Concerning Colostomy
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CONCERNING COLOSTOMY .
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02/01/1963 12:00 AM
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Colostomy and Its Management
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At best to live with a colostomy must be somewhat of a burden. Nevertheless the unpleasantness accompanying a colostomy can be reduced to a minimum by a successful operative procedure and subsequent training of the patient in the care of the bowel. These points are well stressed by the author.
(C) 1963 Southern Medical Association
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12/01/1954 12:00 AM
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The Modern Management of Colostomy
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THE MODERN MANAGEMENT OF COLOSTOMY .
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12/01/1980 12:00 AM
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Low Complication Rate of Colostomy Closures
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Colostomy closure, a procedure often relegated to the less experienced member of the surgical team, is not a benign procedure. Early reports in the literature have clearly indicated that colostomy closure is attended by an exorbitantly high complication rate. The complication rate of 12% at the Medical Center of Central Georgia from 1972 to 1977 was very much lower than those reported in the literature in the past decade. We believe this relatively low rate of complication is basically due to: (1) proper mechanical and chemical preparation of the colon preoperatively, (2) delayed primary closure of wounds, and (3) meticulous attention to detail in surgical technic.
(C) 1980 Southern Medical Association
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10/01/1995 12:00 AM
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Colostomy Closure: Ochsner Clinic Experience
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COLOSTOMY CLOSURE:
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11/01/1958 12:00 AM
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The Colostomy: technic, Management and Complications*
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The problems of colostomy, both for surgeon and patient have been considered. the advantages of the single barrel type are urged.
(C) 1958 Southern Medical Association
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05/01/1949 12:00 AM
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Transverse Colostomy in Chronic Ulcerative Proctocolitis
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TRANSVERSE COLOSTOMY IN CHRONIC ULCERATIVE PROCTOCOLITIS.
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09/01/1993 12:00 AM
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Safe and Effective Alternative To Temporary Colostomy
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SAFE AND EFFECTIVE ALTERNATIVE TO TEMPORARY COLOSTOMY .
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10/01/1959 12:00 AM
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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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10/01/1997 12:00 AM
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Surgery: LAPAROSCOPIC COLOSTOMY FOR NONMA-LIGNANT DISEASE IN ELDERLY
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LAPAROSCOPIC COLOSTOMY FOR NONMA-LIGNANT DISEASE IN ELDERLY.
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02/01/1944 12:00 AM
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The Elimination of Abdominal Colostomy and Other Intestinal Fistulas
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THE ELIMINATION OF ABDOMINAL COLOSTOMY AND OTHER INTESTINAL FISTULAS.
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06/01/1987 12:00 AM
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Conversion of Percutaneous Endoscopic Gastrostomy to a Tube Colostomy
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Conversion of Percutaneous Endoscopic Gastrostomy to a Tube Colostomy .
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08/01/1983 12:00 AM
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Use of an Elemental Diet as a Nutritionally Complete "Medical Colostomy"
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During the past 24 months I have used a defined formula diet (High Nitrogen Vivonex) as a nutritionally complete "medical colostomy" (NCMC) in 16 patients. This diet," via continual gastric drip, provided an average of 2,238 kcal/day and 92.4 gm of protein per day. Separately or in combination, loperamide HCl, diphenoxylate HCl, or codeine was used to slow the bowel. No patient had a bowel movement within less than three days postoperatively and the mean between bowel movements was 5.6 days. Defined formula diet, used as an NCMC, can give 2.4 times more kcal than clear liquid and provides protein as well. NCMC is a safe, cost-effective way of preventing fecal contamination while providing adequate nutritional support for wound healing.
(C) 1983 Southern Medical Association
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05/01/1970 12:00 AM
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Sigmoid-Amniotic Fistula in Advanced Ovarian Pregnancy: Use of Preliminary Colostomy
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Use of Preliminary Colostomy .
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09/01/1989 12:00 AM
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Penetrating Injuries to the Colon: Analysis by Anatomic Region of Injury
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The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P < .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.
(C) 1989 Southern Medical Association
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08/01/1993 12:00 AM
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Necrotizing Infections of the Perineum
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colon; During a 6-year period, 10 patients were treated for severe necrotizing infections of the perineum (Fournier's gangrene) at the Edward Hines Veterans Administration Hospital (Hines, Ill). All were male, and their average age was 60 years. When known, duration of symptoms was 2 to 5 days. Prodromal signs such as edema, erythema, and pain frequently developed into rapidly spreading, full-thickness cutaneous gangrene in less than 24 hours. All patients had significant concomitant disease; 60% were diabetic. All patients had expedient and aggressive initial debridement, usually within 24 hours of presentation to the surgical service. Each patient had a "second-look" debridement within 1 or 2 days. Debridement was done an average of 2.6 times per patient. The cause of the infection was noted in seven patients-five with perirectal abscess and two with urethral trauma. Suprapubic catheters were placed in both patients with urethral trauma. Diverting colostomy was done on two patients who had perirectal abscess as a nidus; eight patients were treated without colostomy. Polymicrobial bacteriologic flora were found in all patients, with a predominance of Escherichia. coli, Bacteroides sp, and staphylococci. Broad spectrum antibiotics and early nutritional supplementation were given. Hospital stay averaged 4 weeks (range, 3 to 12 weeks). One patient died (mortality of 10%). Successful management of these patients requires expedient diagnosis, aggressive nutritional supplementation, and early and repeated debridement as clinically indicated. We have not found diverting colostomy to be a necessary part of the management of these patients even when the nidus is perirectal.
(C) 1993 Southern Medical Association
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07/01/2009 12:00 AM
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Early Diagnosis of Parastomal Hernia
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No abstract available
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12/01/1993 12:00 AM
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Overlapping Sphincteroplasty for Acquired Anal Incontinence
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colon; Overlapping sphincter repair is the operation of choice for incontinence due to obstetric injuries, trauma, or previous anorectal surgery. We present our experience from 1981 to 1990 using the overlapping sphincter repair for anal incontinence resulting from childbirth in 21 patients (58%), previous anorectal surgery in 7 (19%), trauma in 1 (3%), gynecologic surgery in 1 (3%), multifactorial causes in 1 (3%); the incontinence was idiopathic in 5 (14%). All 36 patients were operated on by one surgeon and had identical care. There were no deaths. Two patients required colostomy for wound sepsis. Two additional patients (with idiopathic incontinence) elected to have a colostomy after failure of sphincter repair. Long-term follow-up was possible in 33 patients (92%). Twenty-four patients (73%) were considered to have good to excellent results. Eliminating those patients with idiopathic anal incontinence improved the results significantly. Twenty-two patients (85%) reported good to excellent results. Twenty-four patients (92%) consider their continence better now than before surgery and 25 patients (96%) would undergo the procedure again. In conclusion, overlapping sphincteroplasty has a definite role in treatment of anal incontinence due to obstetric injury, anorectal surgery, and trauma, but a more limited role in treatment of idiopathic anal incontinence.
(C) 1993 Southern Medical Association
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10/01/2004 12:00 AM
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Port Site Metastasis Remote from the Time of Initial Laparoscopy.: GYN/OB-2
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and descending end colostomy with Hartmann's pouch formation. In June 2002, the patient underwent a colostomy reversal with no evidence of disease at surgery.
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12/01/2009 12:00 AM
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Rectal Stents as an Alternative to Surgery
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No abstract available
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12/01/2009 12:00 AM
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Palliation of Malignant Rectal Obstruction from Invasive Prostate Cancer with Multiple Overlapping Self-Expanding Metal Stents
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Self-expandable metal stents (SEMS) are used for colonic neoplastic and extracolonic metastatic obstruction relief. Limited data exists on their use for locally invasive prostate cancer. We describe a unique approach using overlapping SEMS to alleviate a rectosigmoid obstruction from locally invasive prostate cancer. A patient with locally advanced prostate cancer presented with obstipation and lymphedema. Placement of overlapping rectosigmoid SEMS was performed, relieving the visualized rectosigmoid obstruction.
(C) 2009 Southern Medical Association
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10/01/1984 12:00 AM
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Ileosigmoid Knot
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SUMMARY: A 30-year-old black man had emergency surgery for an acute abdominal condition. Intraoperative diagnosis of an ileosigmoid knot was made and gangrenous bowel was resected, with ilioileostomy, reanastomosis, end colostomy, and Hartmann pouch.
(C) 1984 Southern Medical Association
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11/01/1965 12:00 AM
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Complications of Abdominoperineal Resection
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The authors in reviewing the complications of radical surgery for carcinoma of the rectum emphasize the special importance of adequate preparation of the patient, careful attention to blood loss at the time of operation and adequate preparation of the colostomy.
(C) 1965 Southern Medical Association
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12/01/1980 12:00 AM
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Reconstructing Colonic Continuity After the Hartmann Operation
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We present our experience in a series of 25 cases involving reconstruction of bowel continuity after the Hartmann operation for perforated diverticulitis. The term "colostomy closure" has been judiciously avoided because in no way are these procedures comparable. Careful timing and restraint are encouraged to allow adequate recovery from the initial disease process and resultant surgery. Some technical aids are mentioned which may assist in limiting morbidity and mortality.
(C) 1980 Southern Medical Association
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09/01/1982 12:00 AM
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Management of Cecal Volvulus in Debilitated Patients
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We retrospectively evaluated ten cases of cecal volvulus. The average age of these patients was 57 years. Five patients were more than 60 years old and three were over 70. All patients had significant delays in coming to the hospital, and all had concomitant medical problems that made them poor operative risks. Our data and data in the recent literature support a conservative approach in debilitated patients with acute cecal volvulus. We do not recommend resection of the cecum if it is viable at the time of operation. Resection remains the treatment of choice when gangrene is present, but primary ileotransverse colostomy is contraindicated in this population of patients.
(C) 1982 Southern Medical Association
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02/01/1983 12:00 AM
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Transverse Colon Volvulus: Diagnosis and Treatment
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ABSTACT: Although considered rare, transverse colon volvulus (TCV) may actually comprise as many as 10% of all cases of colon volvulus. Correct identification clinically is necessary in order to reduce the high mortality. Unlike the treatment of sigmoid volvulus, conservative treatment of TCV is thought to be inadequate. Furthermore, simple proximal colostomy may lead to bowel necrosis. Bowel resection, rather than detorsion procedures, is advocated. The barium or diatrizoate enema examination can readily differentiate TCV from sigmoid and cecal volvulus if one pays careful attention to detail.
(C) 1983 Southern Medical Association
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04/01/1991 12:00 AM
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Endoscopic Palliative Management of Rectal Cancer
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colon; Laser ablation and bipolar coagulation have been used to palliate rectal cancer and avoid surgery. Indications are distal metastatic disease, extensive local invasion, obstruction and bleeding from nonresectable rectal tumor, or refusal of surgery. From Jan 1, 1986, to Jan 1, 1989, I saw 26 patients who met those criteria; 19 already had metastatic disease and three repeatedly refused abdominoperineal resection. A two-laser approach using both CO2 and Nd:YAG lasers was used in patients with low-lying lesions; others were treated by the Nd:YAG laser only. For rectal tumors, bipolar esophageal tumor probes were used via the rigid sigmoidoscope. The number of laser sessions averaged three per patient, and the number of bipolar coagulation sessions averaged five per patient. Bleeding followed bipolar coagulation in one patient. There were no perforations in either treatment group, and no patient has required colostomy. Of the 19 patients who already had metastatic disease, 12 are still alive, the longest survival being 20 months. Of those medically unfit for surgery, three have died of coincidental disease, and one is alive with controlled rectal cancer after 16 months. All three patients who refused surgery are alive; the longest survival is 13 months.
(C) 1991 Southern Medical Association
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06/01/1983 12:00 AM
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Severe Systemic Sepsis Resulting From Neglected Perineal Infections
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Eleven patients with severe necrotizing fasciitis involving the soft tissues and muscles of the perineum, abdominal wall, buttocks, and thighs were treated on the Tulane Surgical Service in New Orleans between 1979 and 1981. The etiologic factor in ten of these patients was a neglected or inadequately drained perirectal abscess. Three of the 11 patients died of the disease and ensuing multiple organ failure, for a mortality of 27%. All of the patients had signs of systemic sepsis. Initial radical debridement of all involved tissues, diverting colostomy, and aggressive medical support of the multisystem failure that ensues from sepsis are essential for successful management. To decrease the prohibitive mortality, early treatment is essential. A preventive measure appears to be operative drainage under adequate anesthesia of all perirectal abscesses.
(C) 1983 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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01/01/1987 12:00 AM
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Cervical Cancer
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colon; This conference concerns economic, psychosocial, preventive, and medical aspects of the care of an indigent, unemployed, 22-year-old mother of three who died of an invasive, large cell, nonkeratinizing cervical cancer 35 months after her last Pap smear, 19 months after the onset of vaginal discharge, 12 months after consulting a physician, 10 months after an exploratory laparotomy, nine months after initiation of radiation therapy, five months after performance of a colostomy, four months after initiation of chemotherapy, and three months after treatment of small bowel obstruction with hyperalimentation and resection. We discuss the cost effectiveness of preventive programs.
(C) 1987 Southern Medical Association
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01/01/2004 12:00 AM
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Celiac Disease as a Manifestation of Munchausen by Proxy
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In typical cases of Munchausen by proxy maltreatment, a mother feigns or produces illness in her child. Her primary goal is to accrue emotional gratification, and no mental disorder better accounts for the behavior. We present the first published case in which the principal manufactured ailment was celiac sprue. In addition, a panoply of other ailments ranging from seizures to behavioral abnormalities was reported. The case is also very unusual in the involvement of the paternal grandmother and, to a lesser extent, the paternal grandfather as the perpetrators. Although definitive intervention to protect the child occurred only after 7 years had passed, multidisciplinary teamwork ultimately resulted in a successful outcome for the child, who is now doing well.
(C) 2004 Southern Medical Association
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09/01/2006 12:00 AM
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Atypical Presentation of Colonic Obstruction in a Senior Patient
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The patient was taken for exploratory laparotomy with subsequent sigmoid resection and colostomy .
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02/01/2010 12:00 AM
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Desmoid Tumor Arising in the Site of Previous Surgery in the Left Lower Quadrant of the Abdomen
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A desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic structures. The pathogenesis is still not clear. A 79-year-old woman who developed a desmoid tumor in the left lower abdomen after surgical resection of an abdominal lipoma seven years previously is presented. Preoperative computed tomography showed a large left lower abdominal mass. Pathology showed the spindle fibroblastic cell pattern typical of desmoids.
(C) 2010 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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10/01/2007 12:00 AM
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Purple Urine Bag Syndrome: A Rare and Interesting Phenomenon
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Discoloration of urine is not uncommonly encountered in clinical practice and may indicate a significant pathology. However, the majority of instances are benign and occur as the result of trauma to the urological system during procedures or ingestions of substances such as medication or food. Purple discoloration of a urinary catheter bag is rare and can be alarming to both patients and healthcare workers. This phenomenon is known as the purple urine bag syndrome. It is associated with urinary tract infections occurring in catheterized patients, generally elderly females with significant comorbidities and constipation. The urine is usually alkaline. Gram-negative bacteria that produce sulfatase and phosphatase are involved in the formation of pigment, indirubin and indigo. Tryptophan metabolism is involved in the pathogenesis. We present two cases of this rare and interesting phenomenon and discuss the underlying pathogenesis.
(C) 2007 Southern Medical Association
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02/01/2009 12:00 AM
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Adult Segmental Hirschsprung Disease
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Hirschsprung disease (HD) is characterized by aganglionosis, which mainly occurs in the rectum and distal sigmoid colon. Typical HD is seldom diagnosed in adulthood, and segmental involvement is very rare. A 37-year-old man suffered from refractory constipation for 20 years. He could only defecate once a week and frequently needed an enema for defecation. A barium enema showed an annular stenotic segment of the rectosigmoid colon of 8 cm in length, which started 10 cm above anal circulation and showed dilated colon above the stenotic segment. The distal rectum was normal. The narrowed segment of the rectum was resected. At one-year follow up, the patient had normal defecation without laxatives.
(C) 2009 Southern Medical Association
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10/01/2005 12:00 AM
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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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10/01/2008 12:00 AM
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Rare Case of Breast Tumor Secondary to Rectal Adenocarcinoma
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Primary breast cancer is the most common malignancy in women. Metastatic cancer to the breast is very rare. Colorectal cancers usually metastasize to the liver and the lung; other sites of metastasis from colon cancer are uncommon and are usually found in association with extensive liver and/or lung metastases. This is a report of a rare case of aggressive rectal cancer with metastasis to the breast without liver or lung metastases.
(C) 2008 Southern Medical Association
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04/01/2010 12:00 AM
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Subcutaneous Emphysema, Muscular Necrosis, and Necrotizing Fasciitis: An Unusual Presentation of Perforated Sigmoid Diverticulitis
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With advancing age and the affluent, low-fiber Western diet, the incidence of diverticular disease is increasing. Fortunately, most cases can be managed conservatively without resorting to surgical intervention. Life-threatening complications such as perforation, especially when it is associated with gross fecal contamination, requires urgent aggressive surgical intervention. A 75-year-old man with absolute constipation and pain in the left iliac fossa underwent urgent laparotomy following fluid and antibiotic resuscitation. A posterior perforated sigmoid diverticulitis associated with myofascial necrosis and generalized pelvic emphysema was identified. In cases where perforation occurs posteriorly and the only external manifestation is surgical emphysema, the outcome is generally favorable.
(C) 2010 Southern Medical Association
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05/01/2006 12:00 AM
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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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03/01/2004 12:00 AM
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Anorectal Melanoma: Report of Three Cases with Extended Follow-up
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Primary anorectal melanoma is rare. There is controversy regarding the best surgical treatment because of its poor prognosis. Three cases with extended follow-up are reported in this article. A 53-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. The patient died with distant metastases 8 months later. An 80-year-old woman with rectal bleeding was diagnosed with a melanoma of the rectum and underwent a transanal local excision. She remains alive 4 years later but with locally recurrent disease. A 78-year-old man with rectal bleeding was diagnosed with a melanoma of the rectum and underwent an abdominoperineal resection. He died with local and metastatic disease 25 months later. Recent trends favor local excision when technically feasible, although some patients may require an abdominoperineal resection of the rectum, especially for larger tumors.
(C) 2004 Southern Medical Association
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06/01/2004 12:00 AM
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Vancomycin Therapy and the Progression of Methicillin-resistant Staphylococcus aureus Vertebral Osteomyelitis
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colon; Vancomycin therapy is the standard treatment for methicillin-resistant Staphylococcus aureus (MRSA), the most common cause of vertebral osteomyelitis, an increasingly frequent complication of nosocomial bacteremia. We report five recent cases suggesting that, while giving the appearance of success by conventional clinical and laboratory criteria (eg, resolution of fever and leukocytosis), vancomycin monotherapy may in fact be insufficient to prevent or reverse the progression of hematogenous MSRA vertebral osteomyelitis. A review of the literature and possible therapeutic alternatives are also discussed.
(C) 2004 Southern Medical Association
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03/01/2005 12:00 AM
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Neoadjuvant Therapy: An Emerging Concept in Oncology
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Neoadjuvant therapy, an adjunctive therapy given before the main therapy, has become an integral part of modern multidisciplinary cancer management. Organized by the primary organ involved by cancer, this review summarizes the outcomes of neoadjuvant therapy for common malignant solid tumors, based on large, randomized, controlled trials. In locally advanced rectal, laryngeal, and breast cancer, neoadjuvant therapy enables organ preservation; however, it does not improve overall survival when compared with definitive treatment followed by adjuvant therapy. In locally advanced bladder and cervical cancer, patients who undergo neoadjuvant therapy before radical surgery appear to have better survival than those receiving definitive therapy alone; however, it is unclear if the neoadjuvant approach will be superior to definitive therapy followed by adjuvant therapy. To date, the survival benefits of neoadjuvant therapy for resectable non-small cell lung, esophageal, gastric, and prostate cancer remains under investigation.
(C) 2005 Southern Medical Association
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02/01/2005 12:00 AM
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Ischemic Colitis: A Clinical Review
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Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
(C) 2005 Southern Medical Association
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