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| Stoma Complications |
| Among the common stoma complications are peristomal hernia (bulging of the area around stoma), retracted stoma (sinking of stoma), prolapsed (increase in size of stoma) and cut stoma (a break in the integument of stoma). |
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(source: Southern Medical Journal).
More Information (source: Southern Medical Journal).
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12/31/1969 03:59 PM
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Gastroplasty in Morbid Obesity: Observations in 300 Patients
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colon; Morbid obesity is associated with a number of life-threatening complications. Medical treatment of morbid obesity is rarely successful. Gastric reduction has replaced intestinal bypass as the surgical treatment of choice. Indications for operation are fairly standardized, and complications and results are similar in most large series. In our series of 300 gastroplasties done during the past four years, weight loss compares favorably with that in other reported series. Our hospital complication rate has been low because of short operating time and early ambulation. Postoperative vomiting has been reduced by enlarging the stoma. Revision rate was between 1% and 2% per year. The surgical treatment of morbid obesity requires a great deal of personal contact between surgeon and patient in the preoperative and postoperative periods. Because these patients tend not to comply with the dietary restrictions of the operation, close follow-up care is required.
(C) 1985 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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2. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998;41:1562-1572 An abscess was found to the right of the stoma at the lower end of the incision wound, and this was
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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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Gastric Bypass: Roux-en-Y Gastrojejunostomy From the Lesser Curvature
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We describe a new technique for the surgical treatment of exogenous morbid obesity. The stomach is partitioned from the angle of His toward the lesser curvature, and a Roux-en-Y proximal jejunal limb drains the proximal gastric pouch, which is 25 to 35 ml in capacity. By use of the enteroanastomosis (EEA) or the intraluminal (ILS) stapling instrument for the gastrojejunostomy from the lesser curvature of the stomach, the functional reliability, vascular integrity, and ease of construction of the stoma have been improved. We performed the gastric bypass operation on 300 consecutive patients, 268 women and 32 men, over a two-year period beginning in June 1979. The patients' average admission weight was 126 kg. Diseases associated with obesity were observed in 57% of the patients, and concomitant operations were performed in 29%. The average weight loss at 6, 12, 18, and 24 months was 37.0, 48.5, 51.5, and 52.0 kg, respectively. Early and late complications occurred in 37 patients (12%), requiring 40 reoperations. Two deaths (0.6%) occurred within the 30 months' of observation.
(C) 1983 Southern Medical Association
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12/31/1969 03:59 PM
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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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12/31/1969 03:59 PM
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Seeding of the Percutaneous Endoscopic Gastrostomy Tract from Esophageal Squamous Cell Cancer Presenting as an Acutely Bleeding Malignant Gastric Ulcer: A Novel Clinicoendoscopic Presentation
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Background: While the clinical presentation of cutaneous stomal metastases after percutaneous endoscopic gastrostomy (PEG) placed for pharyngoesophageal malignancy is well described, the clinicoendoscopic findings with gastric stomal metastases is insufficiently characterized. A novel clinicoendoscopic presentation is reported of significant gastrointestinal bleeding caused by an ulcerated gastric stomal metastasis.
Methods: A male patient was admitted for melena with a growing abdominal wall mass at a former PEG stoma. A PEG had been inserted 8 months earlier for esophageal obstruction from squamous cell cancer. Abdominal computed tomography revealed an 8 x 7 x 6 cm mass extending from the skin to the gastric wall. Esophagogastroduodenoscopy revealed an ulcerated gastric mass. Pathologic examination revealed squamous cell carcinoma in both the gastric ulcer margin and the cutaneous mass. The patient was transfused 2 units of packed erythrocytes.
Results: Review of all 44 identified stomal metastases after PEG revealed only 15 cases of pathologically proven gastric involvement, including only five illustrated endoscopic reports. Previously reported clinical manifestations of malignant gastric stomal involvement include an asymptomatic gastric mass, an asymptomatic gastric ulcer, a gastric ulcerated mass with chronic anemia, or gastric perforation from gastric involvement.
Conclusions: The current novel report of significant upper gastrointestinal bleeding from a malignant gastric ulcer at the PEG insertion site, that required blood transfusions, extends the clinicoendoscopic spectrum of peristomal metastases after PEG. Peristomal ulcers occurring in this circumstance should be biopsied at an initial or follow-up EGD, despite the recent gastrointestinal bleeding, to exclude malignancy.
(C) 2008 Southern Medical Association
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12/31/1969 03:59 PM
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Acute Buried Bumper Syndrome
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Buried bumper syndrome (BBS) is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. This unusual phenomenon occurs when the internal bumper of a PEG tube erodes and migrates through the gastric wall and becomes lodged anywhere between the gastric wall and the skin. If not removed and treated appropriately, it can lead to life-threatening complications. It is considered to be a late complication, with most cases occurring from months to years later. We present an unusual case of a very rapid development of BBS, along with a brief review of contributing factors and treatment recommendations.
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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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Novel Endoscopic Triangulation Approach to Percutaneous Transgastric Placement of Jejunal Extension Feeding Tube
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In patients who have surgically-altered upper gastrointestinal anatomy, postoperative endoscopic enteral nutrition options can be limited by issues such as bowel stenosis and/or acute angulation. This report details the use of an endoscopic triangulation method combining per-oral and percutaneous transgastric approaches to overcome an efferent gastrojejunostomy limb stenosis, to successfully place a jejunal extension feeding tube through a newly placed PEG site. This description provides an alternative endoscopically feasible option for successful enteral nutrition access, thus obviating the need for additional operations to place surgical feeding tubes or to commit patients to long-term total parenteral nutrition.
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12/31/1969 03:59 PM
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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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12/31/1969 03:59 PM
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A Short Perspective on the Surgical Restoration of Alaryngeal Speech
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Despite advances in conservative laryngeal surgery and radiotherapy, total laryngectomy still remains the procedure of choice for advanced-stage laryngeal carcinoma around the world. The loss of natural voice is very often traumatic for the total laryngectomy patient, presenting lifelong challenges for communication in a world that relies heavily on verbal communication. Functional rehabilitation of these patients has long been one of the major challenges facing clinicians, but it is only in the last three decades that the emphasis on restoration of function and quality of life has become almost as important as cure and survival. Although voice restoration for alaryngeal speakers can be attained with any of 3 speech options - esophageal speech, electrolarynx and surgical voice restoration (SVR) using a valve the SVR technique has today become the preferred method and 'gold standard.' Successful tracheo-esophageal voice restoration in laryngectomy patients can be very rewarding, and patients are no longer condemned to silence while they await the results of their cancer treatments. They can face the challenges of life with the knowledge that a near-normal quality of life is very much possible.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1 Erythematous, friable, and protuberant 8 × 7 cm mass located at the former site of the PEG stoma in the left upper quadrant about halfway between the umbilicus (lower left) and the left costal margin.
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12/31/1969 03:59 PM
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Table. Pathologicall...
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Table. Pathologically proven stomal metastases of the stomach after PEG performed for pharyngoesophageal cancer
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2 Computed tomography of the abdomen at the level of the midgastric body reveals an 8 × 7 × 6 cm heterogeneous solid mass that contains a central track from the previously removed PEG tube; this track extends from the skin protuberance through the abdominal wall (left rectus abdominus muscle) to the gastric wall.
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12/31/1969 03:59 PM
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Fig. 3
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Fig. 3 Tangential close-up video photograph taken during EGD, performed 2 days after an episode of melena, reveals an acute 1.5 × 1.5 cm wide, round, gastric ulcer with a whitish-yellow fibrinopurulent base at the center of a 4 cm round gastric mass in the midgastric body. Endoscopic evidence of contiguity between the ulcerated gastric mass and the cutaneous (abdominal wall) mass include discrete one-for-one movement of the ulcerated gastric mass with external compression of the cutaneous mass, and transillumination of the cutaneous mass with endoscopic illumination of the ulcerated gastric mass.
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12/31/1969 03:59 PM
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Fig. 4
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Fig. 4 A, Low-power photomicrograph of a percutaneous biopsy of the abdominal wall mass reveals foci of intensely basophilic, poorly differentiated squamous cell cancer invading and disrupting the architecture of the normal eosinophilic squamous cell mucosa throughout the specimen (hematoxylin and eosin, original magnification × 10); B, Medium-power photomicrograph of a large forceps endoscopic biopsy of the gastric ulcer margin reveals poorly differentiated squamous cell cancer on the surface of gastric mucosa (on the right) invading normal gastric columnar cells below (on the left). Malignant epithelium is indicated by nuclear hyperchromia, pleomorphism, and enlargement; by disruption of the normal stratified squamous epithelial architecture; and by invasion of adjacent columnar epithelium (hematoxylin and eosin, original magnification × 40).
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