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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective analysis was undertaken of the records of 107 patients with Crohn's disease of the colon or with ulcerative colitis who underwent 162 operations under steroid cover. The study revealed no correlation between steroid dosage and postoperative morbidity or mortality. The incidence of wound dehiscence and incisional hernia compared favourably with the reports of other unselected series of similar patients. Contamination did significantly influence results. Septic complications were more frequent when the operative field was contaminated and both delayed wound healing and mortality were related to this sepsis. A ;clean and dirty' technique was effective in controlling contamination during elective bowel division but preoperative bowel perforation and accidental entry into the lumen of the bowel during dissection were potentially avoidable sources of contamination. Primary healing of the perineal wound after proctocolectomy was seldom achieved in contaminated patients where a drain tube was brought out through the main perineal incision. When perineal sinuses or fistulae followed a proctocolectomy, patients with Crohn's disease had a significantly slower rate of healing than did patients with ulcerative colitis. However, there was no difference in the healing of abdominal wounds in relation to the primary pathology. Even abdominal incisions which were used on more than one occasion healed as well as those which were used for the first time. A prophylactic antibiotic regime of either ampicillin or tetracycline offered little protection against postoperative sepsis. The organisms which caused such infections were often insensitive to the two antibiotics.
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PMID:Factors which influenced postoperative complications in patients with ulcerative colitis or Crohn's disease of the colon on corticosteroids. 68 Jun 5

A case of Pyoderma gangrenosum with two different abdominal sites in a female patient suffering from colonic Crohn's disease is presented. Local trauma on the midline scar of an incisional hernia and around the stoma were the possible triggering factors. Despite the major abdominal wall defect and an infected parietal collection, steroid therapy was very effective without the need for surgery.
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PMID:[Peristomal pyoderma gangrenosum after colectomy for Crohn disease. Successful medical treatment]. 144 54

Eighty-four computed tomographic (CT) scans from patients referred for bowel obstruction between January 2, 1988, and December 31, 1989, were retrospectively evaluated. A pair of radiologists without knowledge of patient histories determined the presence or absence of bowel obstruction. Sixty-four patients ultimately proved to have intestinal obstruction, and 20 did not. Diagnosis was established by means of surgery (n = 39), barium studies (n = 17), and clinical course (n = 28). Causes of obstruction included adhesions (n = 37), metastases (n = 6), primary tumor (n = 7), Crohn disease (n = 4), hernia (n = 3), hematoma (n = 2), colonic diverticulitis (n = 2), and other (n = 3). In addition, 83 CT examinations in patients with no history or indication of intestinal obstruction were simultaneously reviewed. The overall sensitivity was 94%, specificity was 96%, and accuracy was 95%. The cause of obstruction was correctly predicted in 47 of 64 cases (73%). Intestinal obstruction was not diagnosed in any of the 83 control patients. CT is most useful in patients with a history of abdominal malignancy and in patients who have not been operated on and who have signs of infection, bowel infarction, or a palpable abdominal mass.
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PMID:Bowel obstruction: evaluation with CT. 206 89

Forty-six patients who underwent colectomy with end ileostomy for ulcerative colitis (n = 33) or Crohn's disease (n = 13) have been reviewed for paraileostomy hernia (PIH) formation 1-16 years after surgery. PIH developed in 13 of these patients (28 per cent) and was not related to the original disease or excessive weight gain. Twenty-eight patients underwent limited computed tomography (CT) scanning of the stomal region. Eight of these had a clinically detectable PIH, which was demonstrated on CT. A further two patients had PIH demonstrated on CT which was not detected by clinical examination. The rate of PIH was similar where the stoma emerged lateral to the rectus abdominis muscle (six out of 16 patients, 37 per cent) to where the stoma emerged through the rectus (four out of 12 patients, 33 per cent). Recurrence following operative repair of PIH was common. PIH occurs more frequently than previously supposed. CT can detect PIH and may be useful in evaluating a patient with stoma-related symptoms for occult PIH formation.
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PMID:Paraileostomy hernia: a clinical and radiological study. 227 17

Fifty-nine patients with an ileostomy were studied who were examined by small bowel enema over a 10-year period. Twenty-two subsequently underwent surgery, nine for recurrent Crohn's disease, seven for obstruction due to adhesions or internal hernia and one for ovarian carcinoma. The remaining five patients with colonic Crohn's disease had panproctocolectomy or closure of the ileostomy. The small bowel enema is a reliable method for investigating the small intestine of patients with an ileostomy.
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PMID:The small bowel enema in the patient with an ileostomy. 318 Jun 54

Indications for ileostomy revision in 49 patients with inflammatory bowel disease operated upon between January 1975 and December 1984 were obstruction (15), retraction (10), parastomal hernia (9), prolapse (8), and fistula (4). Recurrent Crohn's disease was an important factor in the pathogenesis of ileostomy complications particularly obstruction, retraction and fistula. Local revision without laparotomy was successful in seven of eight patients with an ileostomy prolapse, but in only four of eight patients with a retracted stoma. Results of local repair without laparotomy and resiting were successful in five of six patients with a parastomal hernia. Laparotomy was usually necessary in patients with obstruction especially if there was underlying Crohn's disease and in patients with peristomal fistula. Resiting of the stoma after laparotomy was used only if the stoma site was outside the rectus muscle or if the original stoma site was infected.
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PMID:Indications and outcome of reoperation for ileostomy complications in inflammatory bowel disease. 336 Dec 22

The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.
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PMID:Major causes of intestinal obstruction in Libya. 358 Aug 11

A patient with incarcerated Crohn's appendicitis and a spigelian hernia is presented, representing the challenge in diagnosis, incision choice, and choice of definitive surgical procedure. While it is unlikely that the report of such a patient's course will make prospective recognition of this rare entity more likely, a systematic approach to this patient has allowed a satisfactory result with minimal complications.
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PMID:Crohn's appendicitis in an incarcerated spigelian hernia. 375 8

Surgeons operating on patients with an obscure peritonitis should be aware of the diverse etiologies of small intestinal perforation and the general principles of management of each. A series of 16 adult patients with free perforation of the small intestine and spreading peritonitis in the absence of bowel obstruction, incarcerated hernia, or trauma is reviewed. Etiologies were as follows: Crohn's disease, four patients; foreign body ingestion, two patients; jejunal diverticulosis, one patient; lymphoma, two patients; cancer chemotherapy, one patient, amyloidosis, one patient; idiopathic, five patients. Although all patient presented with diffuse peritonitis, the findings of fever and leukocytosis were inconstant. Free air was demonstrated on radiographs in only eight of 16 patients, and the correct preoperative diagnosis was not made except in the four patients with Crohn's disease. Resection and primary anastomosis were utilized successfully in ten patients, the remainder of the patients undergoing oversewing the the perforation. Four patients (25%) died.
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PMID:Free perforation of the small intestine. 712 43

We report our surgical, late complications and functional outcome of 157 consecutive restorative proctocolectomies with an ileoanal J pouch at the Department of Surgery L, Arhus City Hospital. Nine patients had familial adenomatous polyposis, while 148 patients were operated for ulcerative colitis. All patients had a protecting ileostomy. There was no mortality. Surgical complications after J pouch: Six patients were reoperated, five due to intra-abdominal bleeding, one for ileus. There was only one pelvic abscess, and it was drained percutaneously. There were no fistulae, no anastomotic leakage and no early pouch removal. Surgical complications after ileostomy closure: Eight patients were reoperated; two due to wound infections, five for ileus and one due to a wound rupture. Late Complications: Four pouches were removed, due to incontinence, difficult evacuation, chronic pouchitis or Crohn's disease. There were three late pouchovaginal fistulae more than one year after surgery. Five patients had surgery for ileus, one for an intra-abdominal abscess, one for a perianal fistula and eight for incisional hernia. Functional outcome: One year after pouch surgery more than 90% of patients were satisfied with the operation, 2.2% had regretted and 3.6% were in doubt. The functional result was satisfactory in the majority of the patients, but 21.1% had one or more night evacuations and 13.9% had variable degrees of incontinence.
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PMID:[Results of ileoanal reservoir surgery]. 865 Jul 82


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