Segmental colectomy for bleeding diverticular disease guided by the PEEP test

2017 ◽  
Vol 47 (4) ◽  
pp. 355-359
Author(s):  
Vijay Naraynsingh ◽  
Shamir O Cawich ◽  
Dale Hassranah ◽  
Feisal Daniel ◽  
Ravi Maharaj ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Postoperative Morbidity ◽  
Total Colectomy ◽  
Fresh Blood ◽  
Early Completion ◽  
Emergency Operations ◽  
The Third ◽  
Segmental Colectomy ◽  
Successful Control ◽  
Preoperative Localisation

Many patients with massive lower gastrointestinal (GI) haemorrhage from diverticulosis are subjected to total colectomy when preoperative localisation is unavailable. We dissected colectomy specimens and noted that there was limited retrograde reflux in most of these cases. Therefore, we sought to assess the value of a positive endoluminal erythrocyte presence (PEEP) test (presence of fresh blood in the caecum) to direct segmental colectomies in 14 patients who required emergency operations for massive lower GI haemorrhage. Overall, 13 (93%) patients who had segmental colectomy guided by the PEEP test had successful control of bleeding. There was no mortality and a 14% postoperative morbidity after segmental resections guided by the PEEP test. One patient had persistent bleeding and required a completion colectomy on the third postoperative day. We propose that the PEEP test be added to the surgical armamentarium to guide segmental resection in the absence of localisation by conventional means. However, we advocate blind total colectomy if the PEEP test is equivocal and early completion colectomy if there is significant re-bleeding.

scholarly journals Surgical treatment of colonic Crohn’s disease: a national snapshot study

2020 ◽  
Author(s):  
Keyword(s):  
Crohn’S Disease ◽  
Surgical Treatment ◽  
Crohn's Disease ◽  
Hospital Stay ◽  
Subtotal Colectomy ◽  
Postoperative Morbidity ◽  
Elective Surgery ◽  
Length Of Hospital Stay ◽  
High Rate ◽  
Segmental Colectomy

Abstract Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.

scholarly journals Surgical treatment of Chagas megacolon. Critical analysis of outcome in operative methods

2008 ◽  
Vol 23 (suppl 1) ◽  
pp. 83-92 ◽  
Author(s):  
Ricardo Luiz Santos Garcia ◽  
Bruna Meyer R. de Matos ◽  
Omar Féres ◽  
José Joaquim Ribeiro da Rocha
Keyword(s):  
Surgical Treatment ◽  
Critical Analysis ◽  
Total Colectomy ◽  
Intestinal Resection ◽  
University Hospital ◽  
High Morbidity ◽  
Emergency Operations ◽  
Chagasic Megacolon ◽  
Left Hemicolectomy ◽  
The University

PURPOSE: Surgical treatment of chagasic megacolon has suffered innumerable transformations over the years. Poor knowledge of the disease physiopathology is one of the reasons. METHODS: From January 1977 to December 2003, 430 patients were submitted to surgical treatment for chagasic megacolon. Of these procedures, 351 were elective and 79 emergency operations carried out at the University Hospital of Ribeirão Preto. Four elective operations, most frequently used, should be singled out: anterior rectosigmoidectomy (52.71%), left hemicolectomy (18.23%), Duhamel-Haddad operation(15.95%), and total colectomy (5.98%). From the 79 exploratory laparotomies performed on an emergency basis, 53 (67.09%) required intestinal resection. From the 430 patients operated upon, 268 (62.33%) progressed without recurrence of intestinal constipation, and 71 (15.51%) had a recurrence. RESULTS AND DISCUSSION: Based on the data collected, left hemicolectomy had the highest constipation recurrence rate compared to other operating procedures; anterior retosigmoidectomy had less complication episodes and a larger recurrence of intestinal constipation in comparison to the Duhamel-Haddad operation. Emergency operations, mainly for the treatment of volvulus and fecaloma, presented high morbidity and mortality and required extensive intestinal resections, stomas and reoperations.

Predictors of Postoperative Morbidity after Emergency Sigmoid Resection for Diverticular Disease: A Nationwide Study

2016 ◽  
Vol 223 (4) ◽  
pp. e87
Author(s):  
Huriye Hande Aydinli ◽  
Cigdem Benlice ◽  
Gokhan Ozuner ◽  
Maher A. As ◽  
Emre Gorgun
Keyword(s):  
Diverticular Disease ◽  
Postoperative Morbidity ◽  
Sigmoid Resection ◽  
Nationwide Study

scholarly journals Atypical Presentation of Colonic Diverticular Disease

2021 ◽  
Vol 33 (1) ◽  
pp. 94-98
Author(s):  
Refaya Tasnim ◽  
Nawsabah Noor ◽  
Quazi Tarikul Islam
Keyword(s):  
Gastrointestinal Bleeding ◽  
Diverticular Disease ◽  
Lower Gastrointestinal Bleeding ◽  
Common Finding ◽  
Fresh Blood ◽  
Colonic Diverticulosis ◽  
Infectious Colitis ◽  
Colonic Neoplasia ◽  
Life Threatening ◽  
Colonic Diverticular Disease

Hematochezia or passage of fresh blood per rectum is a relatively common finding in medical practice which mostly indicates lower gastrointestinal bleeding. The causes for lower gastrointestinal bleeding include diverticular disease, vascular ectasia, ischemic, inflammatory or infectious colitis, colonic neoplasia, hemorrhoids, anal fissures and small bowel lesions (Crohn’s disease, Vascularectasia, Meckel’s diverticulum).If a patient comes with severe hematochezia, the first and foremost task is to stabilize the patient and then find out the source of bleeding as soon as possible. Elderly patients presenting with severe hematochezia, is most likely due to colorectal malignancy but benign causes like colonic diverticulosis can also present as life threatening bleeding in rare occasions. Here we report a case of 70-years-old male patient presenting with severe painless hematochezia leading to severe anemia due to diverticulosis. Bangladesh J Medicine July 2022; 33(1) : 94-98

RISK FACTOR ANALYSIS OF TYPE COLORECTAL OPERATION AND INTRAABDOMEN CONTAMINATION ON EVENT POST OPERATIVE ADHESION: SYSTEMATIC REVIEW AND METAANALYSIS

2021 ◽  
pp. 75-79
Author(s):  
Afra Amira ◽  
Adi Muradi Muhar ◽  
Asrul Asrul
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Odds Ratio ◽  
Rectal Resection ◽  
Total Colectomy ◽  
Meta Analysis ◽  
Right Hemicolectomy ◽  
Postoperative Adhesions ◽  
Hartmann Procedure ◽  
Segmental Colectomy

BACKGROUND: Colorectal surgery is the highest incidence of adhesion-related problems. The type of surgery might be total coletomy, right hemicolectomy, left hemicolectomy, segmental colectomy, Hartmann procedure, and colostomy. Surgical procedures performed on the colon could be contaminated. The most common contamination is faecal contamination. Various causes of peritoneal irritation result in localized brin production, which results in adhesion to the surfaces in contact. PURPOSE: This study focused on the type of colorectal surgery and intra-abdominal contamination on the incidence of postoperative adhesions. METHOD: Systematic review and meta-analysis. We searched for published journal on types of colorectal surgery and contamination with adhesion events published from 2010-2020 using electronic database : Pubmed, Science Direct and Cochrane. RESULT: Ten journals (8 cohort and 2 case control) were included in the meta-analysis. In the risk factors for colorectal surgery: APR surgery, total colectomy and rectal resection had a signicant risk of postoperative adhesions with a pooled odds ratio of 1.74 (95% CI 1 respectively). ,10-2,78); 2.89 (95% CI 2.44-3.41) and 9.91 (95% CI 8.66-11.35). Intra-abdominal contamination also had a risk of adhesions with a pooled odds ratio of 863.47 (95% CI 177.73-4194.13). CONCLUSION: Types of colorectal surgery : APR, total colectomy, and rectal resection and intra-abdominal contamination had a risk of postoperative adhesions.

scholarly journals Effects of bromopride on abdominal wall healing with induced peritoneal sepsis after segmental colectomy and colonic anastomosis in rats

2011 ◽  
Vol 26 (6) ◽  
pp. 433-437 ◽  
Author(s):  
Marcos Vinícius Melo de Oliveira ◽  
Alexandre Malta Brandão ◽  
Pedro Henrique Alves de Morais ◽  
Naiara Galvão da Silva ◽  
Silvana Marques e Silva ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Saline Solution ◽  
Colonic Anastomosis ◽  
Breaking Strength ◽  
Left Colon ◽  
Control Group ◽  
The Third ◽  
Segmental Colectomy ◽  
Group B ◽  
Harmful Effects

PURPOSE: Evaluate the effects of bromopride on abdominal wall healing of rats with induced peritoneal sepsis after segmental colectomy and colonic anastomosis. METHODS: Forty rats underwent sectioning of the left colon and end-to-end anastomosis and were divided into two groups of 20 animals for the administration of bromopride (bromopride group - B) or saline solution (control group - C). Each group was divided into subgroups of 10 animals each to be killed on the third (GB3 and GC3) or seventh postoperative day (GB7 and GC7). It was analyzed the following characteristics: breaking strength of the abdominal wall's wound; surgical and histopathological features of the abdominal wall; and clinical features of the rats. RESULTS: There was no difference between the groups in relation to the weight of the rats and the breaking strength of the abdominal wall's wound. The GB7 group presented less edema and less quantity of fibrin during histopathological evaluation compared to the GC7 group. CONCLUSION: Bromopride did not have harmful effects on the healing of abdominal wall in rats.

scholarly journals P493 Segmental colectomy vs. extended colectomy for colonic Crohn’s disease: results from 112 consecutive patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S431-S432
Author(s):  
A Frontali ◽  
A Chierici ◽  
X Treton ◽  
L Maggiori ◽  
Y Bouhnik ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Morbidity ◽  
Clinical Recurrence ◽  
Surgical Recurrence ◽  
Age At Surgery ◽  
Significant Difference ◽  
Segmental Colectomy ◽  
Comparative Results

Abstract Background According to recent literature, extended colectomy (EC) and segmental colectomy (SC) are equally effective for colonic Crohn’s disease (CCD), with no differences in terms of postoperative morbidity, incidence of long-term recurrence and definitive stoma, but earlier recurrence is observed in patients with SC. Our objective was to evaluate our comparative results between EC and SC. Methods All consecutive patients undergoing surgery for CCD (EC vs. SC) in our Centre were included and compared and we evaluated postoperative morbidity, long-term clinical and surgical recurrence. Results One hundred and twelve patients (mean age at diagnosis of CD, 31 ± 17 years, mean age at surgery 42 ± 17 years) with CCD underwent EC (n = 45) or SC (n = 67); 62 (55%) patients presenting concomitant small bowel disease, 10 (9%) an extra-intestinal manifestation and 16 (14%) were active smokers. Postoperative morbidity was 8/45 (18%) in case of EC vs. 9/67 (13%) in case of SC (NS). In EC group, 8/8 (100%) complicated patients vs. 16/37 (43%) uncomplicated patients were under anti-TNF before surgery (p = 0.04). This significant difference was not showed in SC group. After a median follow-up of 40 ± 34 months (range 1–130), clinical recurrence incidence was 15/45 (33%) in EC vs. 27/67 (40%) in SC patients (NS) and surgical recurrence was 8/45 (18%) in CE vs. 13/67 (19%) in CS patients (NS). Recurrence of the disease occurred after 19 ± 20 months (range, 1–74) in EC vs. 14 ± 26 months (range, 1–130) in CS patients (p = NS). Conclusion Our study confirms that in case of surgery for CCD, EC and SC are equally safe and feasible but recurrence happens earlier after SC than EC. Additionally, the role of anti-TNF is confirmed for postoperative complications.

scholarly journals Indonesia

2021 ◽  
Vol 21 (46) ◽  
Author(s):  
Keyword(s):  
Global Economy ◽  
Policy Support ◽  
Vaccination Program ◽  
Economic Downturn ◽  
Growth Path ◽  
Early Completion ◽  
The Third ◽  
Upside Risk ◽  
The Impact ◽  
Scarring Effects

Indonesia has responded with a bold and comprehensive policy package to cushion the impact of the COVID-19 pandemic. The economy rebounded in the third quarter of 2020, and the economic recovery is projected to strengthen in 2021 and 2022. Strong policy support and an improving global economy will be the main drivers initially, and greater mobility and confidence will follow with the planned vaccination program in 2021. The uncertainty surrounding the growth outlook is larger than usual. Early completion of a widespread vaccination program is an upside risk, while a protracted pandemic remains a downside risk. The macro-financial fallout of the pandemic and economic downturn could be larger than expected, and credit conditions could be slow to improve. Ongoing reforms aimed at promoting investment are expected to help mitigate the scarring effects from the pandemic and put the economy on a sustained growth path that builds on Indonesia’s favorable demographics.

A New Optimal Control of a Tandem Cold Metal Rolling Process

2010 ◽  
Vol 102-104 ◽  
pp. 441-445
Author(s):  
Yu Rong Nan ◽  
Yong Feng Li
Keyword(s):  
Riccati Equation ◽  
Control Strategy ◽  
Rolling Process ◽  
The Third ◽  
Tandem Cold Rolling ◽  
State Dependent ◽  
Successful Control ◽  
Tandem Cold Mill ◽  
Cold Metal ◽  
Cold Mill

In tandem cold mill, a strip is flattened by stands of rolls to a desired thickness. In the process, there exists thickness disturbance and hardness disturbance, which will affect the export thickness of the strip. In order to solve these problems, control system adopt a new control strategy wherein a state-dependent Riccati equation is utilized. In the third part of this paper, the new technique which uses the state-dependent Riccati equation method for controlling the tandem cold rolling is tested by simulations. The results of these simulations are included in the evaluations which show successful control during the passage of the weld.

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