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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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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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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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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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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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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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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 . One week following surgery the patient transferred to a long-term care facility.
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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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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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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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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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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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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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