Complete Colectomy Research Articles

Catabacter hongkongensis Bacteremia with Fatal Septic Shock

To the Editor: Catabacter hongkongensis is a newly described anaerobic agent that is likely an intrinsic component of normal gut flora; it was first reported by Lau et al. in 2007 (1). We report a fatal case of infection caused by C. hongkongensis that was identified by 16S rRNA sequence. A man 52 years of age was admitted to an intensive care unit in France for septic shock. He was a retired service member, smoker, and alcohol drinker. He had a history of hypertension but no previously known gastrointestinal disease. He sought treatment for acute abdominal pain and diarrhea of several hours’ duration. On admission, he had persistent abdominal pain with generalized abdominal distension, arterial hypotension, and hypoxemia but was not febrile. Two sets of anaerobic and aerobic blood cultures were performed at a 1-hour interval, and empiric treatment with amoxicillin/clavulanic acid and gentamicin was started. Biochemical screening showed severe metabolic acidosis, acute renal insufficiency, and systemic inflammatory response syndrome. An abdominal radiograph revealed massive pneumoperitonitis. Laparotomy showed multiple lesions and intestinal perforation at the ascending and first part of the transverse colon, with a large amount of purulent fluid in the peritoneal cavity. A complete colectomy was performed, with rectum closure and end ileostomy. Despite fluid resuscitation and catecholamine infusions, hemodynamic instability worsened rapidly and led to the patient’s death. Microbiological analysis of abdominal fluid revealed the presence of Pseudomonas aeruginosa, Escherichia coli, and Enterococcus spp., but no anaerobic agent. On day 3 postincubation, 1 of the 2 anaerobic blood cultures grew a motile gram-positive bacillus, which grew only in strictly anaerobic conditions. Phenotypic analysis showed catalase production but not indole positivity or nitrate reduction. Standard phenotypic tests were performed with the rapid ID 32A and api20A strips (bioMerieux, Marcy l’Etoile, France). The numeric profiles obtained were 0002000010 and 4030121, respectively. The bacteria produced acid from arabinose, glucose, mannose, and xylose, was negative for glycerol fermentation and leucine arylamidase and positive for rhamnose fermentation. Despite these results, phenotypic tests failed to identify the isolate. Antimicrobial drug susceptibility was determined by disk diffusion method and Etest for MICs. The isolate showed susceptibility to metronidazole (MIC 32 µg/mL) according to Eucast clinical breakpoints (www.eucast.org). No other bacteria were isolated in the blood cultures. Genetic analysis was performed by 16S rRNA gene sequencing of a 1,265-bp fragment by using DG74 and RDRO80 primers (2). The nucleotide sequence obtained was compared with known sequences in GenBank by multiple sequence alignment using the ClustalW program (3). It was 100% identical to C. hongkongensis (GenBank accession no. {type:entrez-nucleotide,attrs:{text:AY574991,term_id:46310217,term_text:AY574991}}AY574991). The first 4 case-patients with C. hongkongensis infection were described by Lau et al. in 2007 (1). Two of these patients lived in Hong Kong and the 2 others in Canada. As in our case, only 1 patient died. Since there was a high degree of phenotypic and genetic difference with other anaerobic agents, the authors proposed a new genus and species and affiliation with a new family, Catabacteriacae. The 2 isolates from Canada differed from the 2 others by being negative for glycerol fermentation and positive for rhamnose fermentation and leucine arylamidase, similar to our case, except for leucine arylamidase, which in our case was negative. In the previously reported cases, C. hongkongensis was susceptible to metronidazole, vancomycin, and kanamycin; variably susceptible to penicillin (MICs 0.5–4.0 µg/mL); and resistant to colistin and cefotaxime (1). Whether C. hongkongensis belongs to the intestinal flora, as do Bifidobacterium, Eggerthella, Eubacterium, and Lactobacillus spp., remains undetermined. Codony et al. recently investigated by real-time PCR the presence of Catabacteriaceae in 29 water samples in the vicinity of Barcelona, Spain. Four samples were positive, demonstrating presence of this organism in the European environment and its probable enteric origin (4). Because our patient sought treatment with severe infection associated with isolation of other pathogenic bacteria, whether blood infection by C. hongkongensis may be responsible for such a fatal outcome is unknown. Nevertheless, we can exclude sample contamination by this anaerobic bacteria for the 2 following reasons. First, anaerobic contaminants are rare in blood cultures and generally involve Propionibacterium acnes. Furthermore, the rapid growth of the present isolate in blood cultures within 3 days suggested a relatively high bacterial load in the blood sample. Our report confirms that C. hongkongensis can be found in blood culture associated with gastrointestinal disease and may reflect intestinal perforation. Identification may be difficult. Isolation of motile gram-positive anaerobic bacillus together with catalase positivity should lead to suspicion of C. hongkongensis in clinical laboratories. Full identification of this pathogen requires 16S sequencing. Environmental reports have demonstrated the presence of this organism in human wastewater in Europe, which suggests that it may be universally present as part of the normal human gastrointestinal flora.

Massive acute colonic pseudo-obstruction successfully managed with conservative therapy in a patient with cerebral palsy

Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a massive dilation of the colon in the absence of mechanical obstruction. Treatment measures may include anticholinergic agents such as neostigmine, colonoscopy, or fluoroscopic decompression, surgical decompression, and partial or complete colectomy. We reviewed the case of a 26-year-old male with cerebral palsy who had a history of chronic intermittent constipation who presented to the emergency department (ED) with signs of impaction despite recurrent fleet enemas and oral polyethylene glycol 3350. The patient was found to have a massive colonic distention of 26 cm likely because of bowel dysmotility, consistent with ACPO. This article includes a discussion of the literature and images that represent clinical examination, x-ray, and computed tomography (CT) findings of this patient, who successfully underwent conservative management only. Emergency department detection of this condition is important, and early intervention may prevent surgical intervention and associated complications.

Influence of colectomy on hydrogen excretion in breath

Hydrogen breath test is the most commonly used method to analyze carbohydrate absorption and diagnose carbohydrate malabsorption. The result of the H(2) breath test is influenced by different factors, which are mostly related to quantitative or qualitative aspects of colonic flora. A scarcely studied variable is the effect of colonic anatomical integrity on H(2) excretion in breath. The present study aims to determine whether loss of colonic integrity reduces H(2) excretion capacity after an oral load of an unabsorbable carbohydrate. An observational study was conducted in three patient groups: controls with preserved colon, patients with partial colectomy, and patients with complete colectomy and ileostomy. H(2) concentration in breath was measured by gas chromatography every 10 min for 3 h after oral lactulose administration. Twenty-two patients with partial colectomy, 18 controls with preserved colon, and seven patients with ileostomy were included. H(2) excretion after lactulose did not differ between patients with partial colectomy and controls (basal excretion = 8.5 vs 4 ppm; delta increase = 50.0 vs 47.5 ppm; area under the curve = 4,480.0 vs 4,710.5 ppm/min). In contrast, H(2) excretion was significantly lower in the ileostomy group. Partial colectomy does not influence the capacity for H(2) excretion after oral unabsorbable carbohydrate administration.

Colectomy Rate Comparison After Treatment of Ulcerative Colitis With Placebo or Infliximab

The efficacy of infliximab for treating patients with ulcerative colitis has been established. The Active Ulcerative Colitis Trial (ACT)-1 and ACT-2 randomized, double-blind, placebo-controlled studies evaluated infliximab induction and maintenance therapy in moderately to severely active ulcerative colitis. Overall, 728 patients received placebo or infliximab (5 or 10 mg/kg) intravenously at weeks 0, 2, and 6, then every 8 weeks through week 46 (ACT-1) or 22 (ACT-2). Colectomy, hospitalization, and surgery/procedure data through 54 weeks after the first infusion were obtained from ACT-1, ACT-2, and associated data sources. In the prespecified analysis, all data were combined to ascertain time to colectomy. Kaplan-Meier product-limit method was used to estimate the cumulative incidence of colectomy, and log-rank test was used to compare the combined infliximab group and placebo. Eighty-seven percent (630 of 728) of patients had complete colectomy follow-up; 13% (98 of 728) of patients had a median follow-up of 6.2 months. The cumulative incidence of colectomy through 54 weeks was 10% for infliximab and 17% for placebo (P = .02), yielding an absolute risk reduction of 7%. Compared with placebo, fewer ulcerative colitis-related hospitalizations and surgeries/procedures per 100 patient-years of treatment occurred with infliximab therapy: 40 vs 20 (P = .003) and 34 vs 21 (P = .03), respectively. Serious adverse events occurring in infliximab-treated patients included serious infections, tuberculosis, histoplasmosis, listeriosis, and malignancy. Patients with moderately to severely active ulcerative colitis treated with infliximab were less likely to undergo colectomy through 54 weeks than those receiving placebo.

Targeted, Evidence-Based Colorectal Cancer Therapies: Shifting the Patient Outcome

Targeted, Evidence-Based Colorectal Cancer Therapies: Shifting the Patient Outcome

Pseudo-obstructions coliques aiguës en médecine interne : circonstances étiologiques et pronostic, à propos d’une étude rétrospective

Purpose. – To analyze the context in which acute colonic pseudo-obstructions occur in a medical practice. Method. – Retrospective study of patients with an acute colonic pseudo-obstruction hospitalized in an internal medicine department between November 1992 and December 1999. Results. – We found 12 patients including eight men (mean age: 80.2 years). All had abdominal pains. Seven patients presented an occlusive syndrome. A septic shock occurred in two subjects. The average diameter of the cecum was 10 cm. Distention involved the whole colon for nine patients, and only the left part for three. Six subjects were affected by a bronchopneumonia, three had a previous history of recent diarrhea, two had colonic diverticulitis, and two others had a diabetic neuropathy. Ogilvie’s syndrome revealed hypothyroidism for one patient. Nine patients were taking one or more medications incriminated in the acute colonic pseudo-obstruction: calcium-channel blockers ( n = 6), neuroleptics ( n = 5), antidepressant agents ( n = 4), dopaminergic drugs ( n = 2) and opiates ( n = 1). Five patients underwent a colonoscopic decompression. Surgical procedures were undertaken for three patients: one underwent a complete colectomy because of numerous perforation. Except for the colectomized patient, the outcome resulted in either recovery ( n = 7), partial improvement ( n = 3), or recurrence ( n = 1). Conclusion. – In a medical environment, acute colonic pseudo-obstruction is a pathology for elderly persons, namely with a masculine predominance and often associated with iatrogenic factors. The outcome is more often than not favorable, but it may result in invasive acts or significant complications at this age.

Surgical treatment of ulcerative colitis

The treatment of ulcerative colitis is primarily a medical problem and fortunately most patients with this disease respond reasonably well to a carefully regulated medical management. In some patients these conservative measures are insufficient to control or arrest the disease, and surgical treatment is indicated and necessary for relief. As the result of recent interest and study of ulcerative colitis there have been many reports dealing with the etiology, diagnosis and medical management of these cases, so that at present the disease is suspected earlier in its course and its presence is proved by proctoscopic examination and the barium enema. There have been fewer reports dealing with the surgical treatment of the intractable cases. It is my purpose in this discussion to present a group of these patients treated at the Lahey Clinic by ileostomy and by partial and complete colectomy and to outline indications for operation and the results

Rectal cancer risk in hereditary nonpolyposis colorectal cancer after abdominal colectomy. International Collaborative Group on HNPCC.

The authors analyzed the incidence of rectal cancer in patients with hereditary nonpolyposis colorectal cancer (HNPCC) after an abdominal colectomy. The treatment of choice for a newly diagnosed patient with HNPCC with colon cancer is an abdominal colectomy. The incidence of rectal cancer after abdominal colectomy in HNPCC is not known. A questionnaire was mailed to all International Collaborative Group on HNPCC members to identify patients in whom rectal cancer developed after total, subtotal or completion colectomy. Statistics were performed using the log-rank test, Kaplan-Meier method, and Cox's proportional hazards model. Rectal cancer developed in 8 (11%) of 71 patients a median of 158 months (range, 38-282 months) from their primary procedure. Of these eight patients, adenomas in the rectal mucosa developed in five at risk either before (4) or synchronous (1) with the diagnosis of rectal cancer. At the time of diagnosis of rectal cancer, six of eight patients were being observed. Age at first procedure and whether the patient was under surveillance were the only significant variables (p < 0.05) in the multivariate analysis in terms of rectal cancer risk. The risk of developing rectal cancer was estimated to be 3% every 3 years after abdominal colectomy for the first 12 years. The risk of rectal cancer in patients with HNPCC after an abdominal colectomy is approximately 12% at 12 years. Age at first surgical procedure and surveillance correlated with rectal cancer risk. Aggressive endoscopic surveillance of the rectum should be performed after abdominal colectomy.

P-ANCA of undefined specificity in ulcerative colitis: correlation to disease activity and therapy.

Sera of 108 patients with chronic inflammatory bowel disease (IBD) and 13 sera from patients with other gastrointestinal diseases were screened for antibodies against neutrophil cytoplasmic antigens (ANCA) by an indirect immunofluorescence test. 37 out of 64 sera (58%) from patients with ulcerative colitis (UC) produced a fine granular and perinuclear ANCA staining pattern ("snowdrift-like" p-ANCA) clearly different from the cytoplasmic ANCA fluorescence (c-ANCA) seen in active Wegener's granulomatosis (WG) and the typical p-ANCA pattern produced by anti-myeloperoxidase (MPO) autoantibodies. Only 1 of 44 sera from patients with Crohn's disease (CD) and none of the control sera showed positive "snowdrift-like" p- ANCA reactions. 31 out of the 37 p-ANCA positive sera (84%) were obtained from patients with high disease activity with and without longterm high dose steroids. p-ANCA titers became negative after longterm steroid therapy and following complete colectomy.

Surgery for constipation.

Over a period of 30 years a total of 27 patients have been subjected to partial or complete colectomy and anastomosis for constipation. Patients fall into four groups: (i) functional constipation; (ii) adult megacolon; (iii) megasigmoid and (iv) persistent Hirschsprung's disease. The first two groups comprised 17 patients with resistant constipation, with or without megacolon or dolichocolon. Seven (41%) of these patients subsequently required operation for acute small-bowel obstruction due to adhesions. In two patients a permanent ileostomy was necessary for persistent rectal inertia after colectomy. The functional results in these first two groups were good. The third and fourth groups had similar presenting features; five had megasigmoid, and in these resection of the sigmoid colon gave good results. The remaining five patients with proven Hirschsprung's disease responded well to a pull-through resection (4) and to colectomy and anastomosis (1).

Rectal electrolyte transport and mucosal permeability in ulcerative colitis and Crohn's disease.

Abstract The inflamed rectal stump of 11 patients who had undergone complete colectomy for proximal inflammatory bowel disease was perfused in situ with isotonic sodium chloride solutions or isotonic mixtures of saline, potassium, and bicarbonate. The results were compared with the findings in 6 healthy subjects. Unidirectional fluxes of sodium and the net fluxes of sodium, chloride, potassium, bicarbonate, and water were determined in both groups, whereas estimations of the diffusional permeability coefficient of urea, fructose, 51 Cr-EDTA (ethylene diaminetetra-acetic acid), 57 Co-vitamin B 12 , and 125 I-PVP (polyvinylpyrrolidone) were made in the patients only. The mean absorptive capacity for sodium, chloride, and water was significantly increased in the group of patients, but the electrolyte transfer in one patient, who was in complete remission, did not seem to be different from that of control subjects. The pattern of electrolyte transport in inflammatory bowel disease was the same as that found in the normal rectum and colon. Thus, net water transport was dependent on net sodium absorption, while the bicarbonate secretion balanced the chloride ions absorbed in excess of sodium. Potassium was secreted into the rectal lumen, even when the luminal concentration exceeded that of blood. The mucosa-to-serosa flux of sodium was significantly reduced, but a decreased sodium flux ratio found in patients with active disease was, however, above all due to an increased serosa-to-mucosa flux of sodium suggesting that the defective absorption might be primarily due to the fact that sodium already "pumped" leaks out into the gut lumen. The concept of increased permeability of the epithelium in active disease is supported by the findings of a relatively constant relationship between the diffusional permeability coefficients of the named uncharged hydrophilic solutes and their respective free diffusion coefficients in water.

The prognosis of chronic ulcerative colitis in children.

THE controversy concerning the treatment for chronic ulcerative colitis has never ended. The question whether surgical or medical management prolongs these patients' lives with greater certainty has never been answered. The problem is particularly difficult in children. Complete colectomy is a formidable procedure, and problems associated with permanent ileostomy are often difficult. There is also the very real hazard that complicating carcinoma may develop, and in addition the survival period from the disease is variable.In 1959 Rosenqvist and his associates1 reported their experience with 150 cases of chronic ulcerative colitis in their pediatric department. They stated that cancer of . . .

Carcinoma of the Colon in Chronic Ulcerative Colitis

Summary 1.A further attempt has been made to demonstrate the fact that the incidence and degree of malignancy that occurs in long standing idiopathic ulcerative colitis is due to some other factor than a carcinomatous change in the inflammatory polypoid type of formation. 2.As soon as intractability has been determined, it would appear that complete colectomy may well reduce the incidence of these very malignant carcinomas.

Modified technique for total colectomy in ulcerative colitis.

THE MODERN concept of the operative treatment of ulcerative colitis is that when surgical intervention is indicated the objective of the surgeon should be complete colectomy and that ileostomy should be considered only as the first step of a two-stage procedure that will finally result in the extirpation of the entire colon including the rectum. The history of the surgery of ulcerative colitis, as exemplified by the gradually increasing scope of the surgical intervention, is a fascinating story of surgical progress. The first surgical procedures aimed at providing a means of irrigation of the diseased colon with antiseptic solution, but the futility of appendicostomy and cecostomy was soon manifest. Ileostomy alone, in spite of its frequent employment as a last-resort measure, had a much longer vogue. Deflecting the fecal current by ileostomy frequently was a lifesaving measure, but complications arising in the diseased colon, such as acute exacerbation of the

Polyps of the large intestine

1. 1. Polyps of the large intestine are frequent. They are usually single but increase in number until in certain patients they become uncountable. 2. 2. Any polyp may develop into carcinoma. The more polyps, the greater tendency for carcinoma to form. 3. 3. All polyps should be removed. 4. 4. When carcinoma of the large intestine or rectum develops, one should redouble efforts to remove all polyps, even at the cost of radical surgery. 5. 5. In polyposis a complete colectomy with proctectomy should be performed. An anal ileostomy may prove superior to the abdominal type of ileostomy.

The surgical treatment of ulcerative colitis.

THE treatment of ulcerative colitis is primarily medical. Experience has shown, however, that at least 25 per cent of patients with ulcerative colitis require surgical intervention,1 , 2 to preserve life, for the relief of chronic invalidism or to treat one of the frequent complications of this disease such as perforation, arthritis or malignant degeneration in the diseased colon.From 1927 to January, 1949, 263 patients with ulcerative colitis were operated on. An ileostomy was carried out on 216 and partial colectomy on 59 patients, and 148 patients had a complete colectomy in addition to ileostomy. The following remarks are based upon . . .

Surgery in Other Countries.

Australian and New Zealand Journal of SurgeryVolume 10, Issue 1 p. 94-97 Surgery in Other Countries. First published: July 1940 https://doi.org/10.1111/j.1445-2197.1940.tb07142.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract THE EARLY STAGES OF RENAL TUBERCULOSIS. REPORT ON A CASE OP COMPLETE COLECTOMY FOR ULCERATIVE COLITIS. Volume10, Issue1July 1940Pages 94-97 RelatedInformation

THE SURGICAL TREATMENT OF ULCERATIVE COLITIS

The treatment of ulcerative colitis is primarily a medical problem and fortunately most patients with this disease respond reasonably well to a carefully regulated medical management. In some patients these conservative measures are insufficient to control or arrest the disease, and surgical treatment is indicated and necessary for relief. As the result of recent interest and study of ulcerative colitis there have been many reports dealing with the etiology, diagnosis and medical management of these cases, so that at present the disease is suspected earlier in its course and its presence is proved by proctoscopic examination and the barium enema. There have been fewer reports dealing with the surgical treatment of the intractable cases. It is my purpose in this discussion to present a group of these patients treated at the Lahey Clinic by ileostomy and by partial and complete colectomy and to outline indications for operation and the results

Complete Colectomy for Adenomatosis

Complete Colectomy for Adenomatosis