Is single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage a safe procedure?

Objective. This study was conducted to provide local data regarding the results and post-operative complications after single-stage resection and anastomosis for acute sigmoid volvulus, without intra operative colonic lavage. Study Design: Descriptive Cross Sectional. Setting: DHQ Charsadda. Period: May 2017 to December 2019. Material & Methods: This clinical study was done on 50 patients who presented with the signs and symptoms of acute sigmoid volvulus excluding those with complications of the illness such as gangrene, perforation and peritonitis. Surgery for all patients was carried out under General anaesthesia. All the patients underwent emergency resection and primary anastomosis, without mechanical bowel preparation. Data were collected regarding post operation complication and analysis by using SPSS version 23. Chi square test was used to compare at level of significance <0.005. Results: Median age of patients was 50 years with male to female ratio 5:3. Seven patients presented with wound infection, one dehiscence while zero Anastomotic leakage and zero death postoperative recorded. Conclusion: Single stage resection and primary anastomosis without preoperative colonic lavage for acute sigmoid volvulus is a simpler and short procedure with low mortality and morbidity rates.

The Use оf Intraoperative Colonic Irrigation in Surgical Treatment of Obstructing Cancer of the Left Colon

Purpose. Study of technical options and immediate results of primary anastomoses using intraoperative colonic irrigation in the surgical treatment of left-sided colonic tumor obstruction.Material and methods. Of the 128 patients with left-sided colonic obstruction, 20 patients underwent surgery with intraoperative colonic lavage and the formation of a primary colonic anastomosis. The mean age was 61.7 1.4 years. In 5 patients, the compensated stage of colonic malignant obstruction was detected, in 8 patients - subcompensated, in 7 patients - decompensated. Colon icirrigation was carried out by means of antegrade jet injection of 8 -10 liters of isoosmolar solution of electrolytes and was terminated by the introduction of enterosorbent microsorb-P. In 11 cases left-sided hemicolectomy was performed in patients and in 9 cases - resection of the sigmoid colon with primary anastomosis.Results. After surgical interventions various complications were observed in 7 patients. In 2 patients afailure of anastomosis was revealed, the successful treatment of which did not require repeated surgical procedures. In the postoperative period 1 (5.0%) patient died on the 4th day after surgical intervention from cardiopulmonary insufficiency on the basis of concomitant pathology.Conclusion. In the conditions of specialized surgical hospitals after careful evaluation of operational risk with obstructing cancer of the left colon it is possible to use segmental resections of the colon with the imposition of a primary anastomosis with mandatory use of intraoperative colonic lavage . This tactic helps to increase the effectiveness of surgical interventions and provides early rehabilitation of operated patients.

Colonic lavage in treatment of refractory Clostridium difficile infection: an adaptation of the Pittsburgh protocol

Clostridium difficile infection (CDI) is a common nosocomial sequela in patients treated with antibiotics. Surgical intervention is indicated in fulminant cases. However, the mortality associated with total colectomy and end ileostomy is high. Previous reports have indicated that surgical intervention for severe complicated CDI with formation of a loop ileostomy leading to the diversion of fecal stream followed by colonic lavage can be beneficial in treating severe CDI. This procedure is known as the Pittsburgh protocol and has been reported to decrease the mortality and the need for a total colectomy in patients with severe complicated CDI. In this case, we present a 75-year-old female with refractory CDI. In her treatment, we adapted the Pittsburgh protocol and utilized a 20-French MIC gastrostomy tube to recreate the ileocecal valve and control the colonic lavage without retrograde flow.