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Query: UMLS:C0031154 (peritonitis)
 15,372 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare accurately the results of two operative approaches--proximal colostomy with drainage and proximal colostomy with resection or exteriorization--the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration of symptoms, clinical presentation, number of coexistent diseases, type of peritonitis or chronic corticosteroid use. Overall mortality for emergency operation was 12 percent. Mortality was significantly greater (P less than 0.05) among the 31 patients treated by colostomy and drainage (26 percent) than among the 90 patients treated by colostomy and resection or exteriorization (7 percent). Seven of the nine patients who died from persistent sepsis had undergone colostomy and drainage. Four clinical factors were found to be predictive of mortality (P less than 0.05): persistent postoperative sepsis, fecal peritonitis, preoperative hypotension, and prolonged duration of symptoms. These factors identified a subgroup of patients who, because of an increased risk of death, would be likely to benefit from the more complete eradication of the septic focus that is achieved by colostomy and resection.
Dis Colon Rectum 1985 Feb
PMID:Sigmoid diverticulitis with perforation and generalized peritonitis. 397 9

A case of generalized peritonitis, secondary to a perforation of the rectosigmoid colon during barium-enema roentgenography, is presented. The patient required immediate surgical intervention with the prime importance of the treatment being removal of as much of the contaminating materials as possible. This was done successfully with irrigation and wiping, using urokinase solution. Peritoneal lavage with urokinase solution was also carried out in the early postoperative period. Fluid replacement with careful monitoring of fluid and electrolyte balance is essential before, during, and after the surgical procedure. Adequate antibiotic therapy and careful respiratory and nutritional support are also important.
Dis Colon Rectum 1985 May
PMID:Barium peritonitis. Report of a case and review of the literature. 399 52

The intracolonic bypass is a procedure preventing the gastrointestinal secretions and fecal contents from coming into contact with an anastomotic closure site without interrupting the intraluminal continuity of fecal flow from proximal to distal colon. Experimental and clinical data have indicated that the intracolonic bypass can protect such an anastomosis, in the presence of maximal colonic loadings, dehiscences, and fecal peritonitis. This single stage procedure obviates the necessity for construction and subsequent closure of a temporary colostomy in situations where it is currently indicated; the morbidity, mortality, psychologic problems, and economic costs associated with these multiple procedures are avoided. Sufficient experience now has been gained to recommend the intracolonic bypass as a viable alternate to temporary colostomy.
Dis Colon Rectum 1985 Dec
PMID:Temporary colostomy--an outmoded procedure? A report on the intracolonic bypass. 406 47

After colonic resections, peritoneal defects exposed to colonic flora and blood may become the seat of localized peritonitis and cause small-bowel adhesions and obstruction. In the past five years, we have seen 14 patients where one or both of these complications was anticipated for one of the following reasons: presence of an abscess cavity, local infection or accidental tear of the colon. In these patients a rubber sheet was stitched to the edges of the peritoneal defect with absorbable sutures and brought out through the abdominal wall. In all patients the rubber dam functioned as a passive drain and as a barrier between the peritoneal defect and the small bowel. Three weeks later the rubber dam was removed by traction. None of these patients developed small-bowel obstruction and no adverse effects from the rubber sheet were seen. The working mechanism of the rubber dam was investigated in female Wistar rats. After removing the peritoneum between the left kidney and pelvis, the defect was covered with a rubber dam. A capsule with a standard solution of Escherichia coli, Bacteroides fragilis, and autoclaved feces was used to initiate peritonitis under the rubber dam. The rubber proved to act as an efficient drain and barrier. No abscesses or small-bowel adhesions were seen. In the control group, 75 per cent of the animals died from generalized peritonitis or developed an abscess.
Dis Colon Rectum 1984 Nov
PMID:The rubber dam as a means to isolate contaminated peritoneal defects after colonic resection. 649 3

The traditional work-up of patients with lower left quadrant peritonitis often includes the eventual use of barium-enema radiography. Diagnosis is usually delayed until adequate patient stabilization allows diagnostic contrast enemas. Delay of accurate diagnosis may, at times, have serious clinical sequelae. The use of barium enema in acute lower left quadrant peritonitis has both theoretic and actual disadvantages. These include extravasation of barium, with resultant barium cellulitis and peritonitis, precipitation of acute obstruction, and delay in evaluation by endoscopy, sonography, computerized tomography, and angiography. Forty recent cases of lower left quadrant peritonitis were evaluated on admission by water-soluble contrast enema. Water-soluble contrast enemas appear to be safe and accurate and avoid the aforementioned disadvantages of barium.
Dis Colon Rectum 1984 Feb
PMID:The use of water-soluble contrast enemas in the diagnosis of acute lower left quadrant peritonitis. 669 35

The most important cause of morbidity and mortality in colonic resection remains anastomotic leakage and, to this end, temporary stomas, with their own incidence of mortality or morbidity, are often created. Problems associated with both anastomosis and stoma can be prevented with the use of an internal bypass tube. This tube is implanted in the proximal colon above the proposed anastomotic site, then passed distally to the rectal ampulla, following which, the proximal and distal colonic segments are anastomosed. The fecal stream and gastrointestinal secretions are there by prevented from coming in contact with the anastomotic site. The tube is expelled spontaneously after a varying time. The anastomoses in the experimental animals were subjected to maximal stress. Additionally, large dehiscences and induced fecal peritonitis were purposefully created in some animals. Results demonstrated that the intracolonic bypass tube prevents leakage even from gross dehiscences and that these dehiscences progress to complete healing. The experimental study leading to its clinical adaptation is presented.
Dis Colon Rectum 1984 Jun
PMID:Intracolonic bypass by an intraluminal tube. An experimental study. 673 59

Presented is the authors' experience with 182 patients treated primarily by the one-stage primary resection or two-stage resection. (Hartmann operation). One hundred thirty five patients undergoing primary resection had an associated mortality rate of 2.2 per cent. Of 44 patients operated upon using the Hartmann operation for complicated diverticulitis (obstruction, perforation, abscess formation, or fistula formation) the mortality rate was 4.5 per cent. Primary resection in an elective setting is associated with the lowest mortality and morbidity; however, marked inflammation, obstruction and/or peritonitis preclude primary anastomosis. In the urgent setting the staged operation is associated with acceptable morbidity and mortality.
Dis Colon Rectum 1983 Jul
PMID:Surgical management of diverticulitis. The role of the Hartmann procedure. 686 72

From 1968 to 1979, 18 patients underwent emergency abdominal colectomy with ileorectal anastomosis. Indications for operation included massive colonic bleeding (11), obstructing carcinoma (5), toxic megacolon (1), and enterocolitis (1). Five patients died postoperatively (27.8 per cent). Causes of death included sepsis, upper gastrointestinal bleeding, and respiratory failure. All had peritonitis, and five had documented anastomotic leaks. Seven of the surviving patients had significant morbidity from the procedure which included anastomotic leak, small bowel obstruction, wound infection, sepsis, and pulmonary emboli. Only six patients survived without complications. Although others have written about the safety of emergency subtotal colectomy with ileorectal anastomosis, our experience suggests this procedure is associated with excessive morbidity and mortality.
Dis Colon Rectum
PMID:Emergency abdominal colectomy with primary anastomosis. 697 Jun 59

Review of 475 cases of diverticular disease of the colon emphasized needs to stratify patients into clinical categories. Of 223 cases of diverticulosis coli, had significant colonic complaints which received no attention. Of 198 emergency admissions for acute diverticulitis, only 16 required emergency surgery. Resection in the face of serious peritonitis is not advisable. Twenty-seven elective resections gave excellent results. Three subtotal colectomies were successfully done for major bleeding. Final focus was on determination of therapy groups: medical, surgery advisable, and surgery inevitable.
Dis Colon Rectum
PMID:Diverticular disease of the colon: surgical perspectives in the past decade. 697 90

A retrospective review of 1353 cases of acute perforated sigmoid diverticulitis treated surgically demonstrates that those operations that resect or exteriorize the perforated segment at the first operation are associated with a lower operative mortality rate than procedures that fail to remove the perforated segment at the initial operation. These results are true for both diffuse peritonitis and localized abscess.
Dis Colon Rectum 1980 Oct
PMID:Surgical treatment of perforated diverticulitis of the sigmoid colon. 700 5


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