Underwent Sigmoid Resection Research Articles

Endoscopic crescentic fold disease of the sigmoid colon: the clinical and histopathological spectrum of a distinctive endoscopic appearance.

In this paper we describe an endoscopic appearance of the sigmoid colon characterised by mucosal swelling, erythema and haemorrhage strictly localised to the crescentic mucosal folds. In a 5-year period these changes were seen in 34 (1.42%) of 2380 colonoscopies and fibreoptic sigmoidoscopies. The majority of patients were middle-aged or elderly. Diverticular disease was present in most (82%) but the abnormalities were confined to the crescentic mucosal folds with sparing of the diverticular orifices. The majority of patients presented with a history of bleeding per anum. Histologically there was a spectrum of changes varying from minor vascular congestion to florid active inflammatory disease with crypt architectural abnormalities mimicking ulcerative colitis, but rectal biopsies were invariably normal. Three patients later progressed to typical distal ulcerative colitis and two other patients presenting to us with endoscopic crescentic fold disease had a previous histologically documented history of distal ulcerative colitis. In three patients the histological features were of mucosal prolapse. About half the patients required some form of therapy to control their symptoms. Steroids and/or sulphasalazine were of value although two patients subsequently underwent sigmoid resection, one to control bleeding and the second for a diverticulosis-associated stricture. Whilst endoscopic crescentic fold disease represents a specific endoscopic appearance the clinical and histological features indicate a wide spectrum of disease.

The Role of Intravenous Fluorescein in the Detection of Colon Ischemia During Aortic Reconstruction

Intravenous fluorescein is an accurate predictor of small bowel viability, but its effectiveness in assessing colon perfusion during aortic surgery has not been evaluated. Over a 10 year period 186 of 3,306 patients undergoing aortic reconstruction received 500 to 1000 mg of intravenous fluorescein intraoperatively to evaluate colon viability. Prior history of colectomy, hypogastric or mesenteric arterial occlusive disease, or ruptured aneurysm placed these patients at risk to develop ischemic colitis. Patients were operated on for aneurysmal disease (n = 94), occlusive disease (n = 66), or a combination of both (n = 26): 171 exhibited uniform normal perfusion patterns under Wood's lamp illumination, while in 11 it was "patchy." None of these patients developed full-thickness ischemic colitis (observed specificity: 100%). Fluorescence of the rectosigmoid was absent in four patients. One of these patients with a ruptured aneurysm underwent immediate sigmoid resection, while three underwent inferior mesenteric artery reimplantation. The fluorescein pattern subsequently normalized in two patients, but one underwent sigmoid resection for an expanding mesenteric hematoma. The second patient recovered without complications. The final patient continued to show a segmental sigmoid defect and postoperatively developed full-thickness injury requiring sigmoidectomy. During the same period 18 other patients developed transmural colon ischemia from 3,120 aortic reconstructions (0.6%), with a mortality rate of 56%. None had received intraoperative fluorescein. Selective use of intravenous fluorescein may reduce the mortality of ischemic colitis following aortic reconstruction.

TREATMENT OF SIGMOID VOLVULUS

Twenty patietns who were admitted for sigmoid volvulus between 1964 and 1987 were analysed. Four of six patients who were treated with non-operative reduction or operative detorision as an initial treatment subsequently underwent resection of the sigmoid colon. Of thirteen patients who underwent sigmoid resection and primary anastomosis, two patients complicated by anastomotic dehiscence, one did by intra-abdominal abscess, and one died. Recent four cases undergone intraoperative irrigation of the colon developed no postoperative complications. All three death cases after operation had gangrenous bowel and arrived the hospital with shock state. One underwent sigmoid resection and anastomosis and two did Hartmenn's operation. Because of the high recurrence rate after reduction and of the low postoperative mortality rate in non-gangrenous cases, sigmoid resection and primary anastomosis is thought to be the treatment of choice in such cases.

The importance of intraluminal anastomotic fecal contact and peritonitis in colonic anastomotic leakages. An experimental study.

An experimental, randomized, prospective study was performed in 64 dogs to evaluate the effect of fecal loading, solely, or in combination with induced peritonitis, on colonic anastomosis. The animals, none of which had bowel preparations, were randomized into four groups. Group I underwent sigmoid resection and standard open end-to-end anastomosis; Group II underwent sigmoid resection and an intracolonic bypass procedure; Group III underwent experimentally induced fecal peritonitis, sigmoid resection, and anastomosis; Group IV underwent induction of fecal peritonitis, sigmoid resection and an intracolonic bypass procedure. Using Fisher's exact test, results indicate a more statistically significant increased leak rate in Group III than in Group II (P = .04), and Group III than in Group IV (P = .03), but no statistically significant anastomotic leak rate between the peritonitis (III and IV) and the nonperitonitis (I and II) groups. A very significant statistical increase in leak rate (P = .002) was observed when comparing the 25 percent leak rate of Groups I and III (anastomosis subjected to fecal contact) with the 0 percent leak rate of Groups II and IV (anastomosis excluded from fecal contact) regardless of the peritonitis. This study suggests that the intraluminal contact of fecal loading at the colonic anastomosis is a more significant factor in anastomotic complications due to dehiscences than peritonitis per se. It follows, therefore, that if feces can be excluded from intraluminal contact with an anastomotic site, an anastomosis can be safely performed even in the presence of treated peritonitis.

Arterial embolism of tumor causing fatal organ infarction.

Although hematogenous metastasis ordinarily involves the embolization of tumor cells singly or in microscopic aggregates, it is distinctly unusual for the emboli to be large enough to result in clinically recognizable infarction.1,2We have recently cared for a patient with widely disseminated adenocarcinoma of the colon characterized by a particular propensity for hematogenous metastases who died of acute myocardial and cerebral infarction secondary to arterial embolism of tumor. We report the case herein with a brief review of the literature. Patient Summary A 72-year-old white widow, when seen by her physician in February 1965, had a history of intermittent rectal bleeding of 18 months' duration. X-ray study with barium enema revealed a sigmoid polyp which proved to be an adenocarcinoma. She underwent sigmoid resection with anastomosis of the descending colon to the rectum. The primary lesion extended only to the muscularis, but a single metastatic lymph node was

Arterial Embolism of Tumor Causing Fatal Organ Infarction

Although hematogenous metastasis ordinarily involves the embolization of tumor cells singly or in microscopic aggregates, it is distinctly unusual for the emboli to be large enough to result in clinically recognizable infarction.^1,2We have recently cared for a patient with widely disseminated adenocarcinoma of the colon characterized by a particular propensity for hematogenous metastases who died of acute myocardial and cerebral infarction secondary to arterial embolism of tumor. We report the case herein with a brief review of the literature. <h3>Patient Summary</h3> A 72-year-old white widow, when seen by her physician in February 1965, had a history of intermittent rectal bleeding of 18 months' duration. X-ray study with barium enema revealed a sigmoid polyp which proved to be an adenocarcinoma. She underwent sigmoid resection with anastomosis of the descending colon to the rectum. The primary lesion extended only to the muscularis, but a single metastatic lymph node was