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It is not unusual for surgeons to have to construct a enterostoma during an emergency abdominal operation. The enterostomal complications, often overlooked, can be serious for the patient. There are many factors relating to stoma complications. The purpose of this paper is to determine whether the emergency status of an operation is an independent risk. Over a 19-year period from 1976 to 1995, there were 1758 enterostomas constructed at our institution. Fifty-nine per cent were for emergent situations, defined as any operation performed for peritonitis, obstructions, or massive hemorrhage. The data pertaining to complications was compiled by the enterostomal therapist and prospectively recorded into an institutional database. Complications were characterized as skin problems, parastomal problems (infection, separation), retraction, stenosis, necrosis, prolapse, and herniation. There were 624 (35%) patients with recorded complications. It was not uncommon for a patient to have more than one complication. There were 500 (55%) skin problems, 111 (12%) parastomal problems, 104 (11%) retractions, 33 (4%) stenoses, 112 (12%) necroses, 28 (3%) prolapses, and 19 (3%) enterostomas herniated. Overall, there were 1044 emergently created enterostomas, and we found that 356 (34%) patients had a complication. The most common indications for emergency laparotomies were abdominal gunshot wounds (40%), bowel obstruction (20%), bowel perforation other than by gunshot or stab wound (15%), and diverticulitis (8%). Among the nonemergently created enterostomas (714), there were 268 (37%) with complications (P = 0.015). Our findings suggest that emergently created enterostomas are not at greater risk for complications, except for the ileostomy. Although further analysis of this particular subset must be undertaken, the technical intricacies of an ileostomy, including preoperative marking of the site, might have an important role.
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PMID:Enterostomal complications: are emergently created enterostomas at greater risk? 920 42

We report a case of enteric mucocele formation in a 4-year-old boy after endorectal pull-through correction for Hirschsprung's disease with proximal intestinal neuronal dysplasia. On 17 April 1997, when the patient was 2 years old, a loop ileostomy was performed after an ineffective endorectal pull-through operation involving the right colon. Because of frequent prolapse of the stoma, when the child was two-and-a-half years old an end ileostomy was made by a resection of the distal ileotoma and redundant terminal ileum. When he was 4 years old, he was readmitted because of ileus, peritonitis, and a huge abdominal mass. Complete atresia of the colon at the level of pelvic reflection with proximal enteric mucocele formation was noted at laparotomy. He made an uneventful recovery after resection of the mucocele. This is the first reported case of such a complication after an endorectal pull-through operation. The possible causes and techniques for the prevention of this complication are discussed.
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PMID:Enteric mucocele formation after endorectal pull-through: report of a case. 1096 10

Between 1959 and 1968 in New Delhi, 20 patients with peritonitis or prolapse of the intestines into the vagina after attempted abortion were seen. Only one of these was performed in the Department of Obstetrics. Admission was 1-3 days after the abortion was induced. The mortality rate was 25%, with 4 of the 5 patients dying of peritonitis. The mortality was greatest in the 3 cases of large bowel injury. Details of the clinical treatment are presented.
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PMID:Intestinal injury during induced abortion. 1230 45

Stapled rectal mucosectomy (SRM) became a widely accepted surgical procedure for haemorrhoids. One of the rare complications is severe bleeding. We report the case of a patient who underwent SRM for thirddegree haemorrhoids. In addition, he suffered symptoms of outlet obstruction, although defecography showed no serious disease. One day after SRM, the patient complained of abdominal pain and peritonitis. Computed tomography revealed blood in the abdomen. The patient underwent laparotomy, which revealed a deep enterocele that reached down to the level of the sphincteric muscle. The ventral part of the stapled ring was placed intraperitoneally, and a longitudinal defect of the rectal serosa was observed. The serosa defect was sutured and a diverting sigmoid stoma was carried out. The patient left the hospital 10 days later. We emphasize vigilance for undetected enteroceles in mucosal prolapse syndrome combined with defecation problems.
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PMID:Severe intra-abdominal bleeding following stapled mucosectomy due to enterocele: report of a case. 1505 89

Tension-free vaginal tape (TVT) is considered as the treatment of choice for female stress urinary incontinence. Bowel erosion is a rare complication of TVT that generally occurs a few days after surgery with a clinical picture of peritonitis and/or intestinal obstruction. Herein is reported a case of a bowel erosion with a late clinical manifestation 3 months after hysterectomy and TVT placement for genital prolapse and urinary incontinence. Bowel erosion may complicate TVT operation several months after surgery and should be considered as differential diagnosis in patients presenting with a clinical picture of peritonitis and/or intestinal obstruction.
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PMID:[Bowel perforation as late complication of tension-free vaginal tape]. 1620 4

Creating blow-hole colostomy for decompression could provide a time-saving and efficient surgical procedure for a severely debilitated case with a completely obstructed colorectal cancer. Complications are reported as prolapse, retraction, and paracolostomal abscess. However, complication with an ischemic distal limb has not been reported. We report a case of critical intra-abdominal disease after decompressed colostomy for relieving malignant sigmoid colon obstruction; a potential fatal condition should be alerted. A 76-year-old male visited our emergency department for symptoms related to obstructed sigmoid colon tumor with foul-odor vomitus containing fecal-like materials. An emergent blow-hole colostomy proximal to an obstructed sigmoid lesion was created, and resolution of complete colon obstruction was pursued. Unfortunately, extensive abdominal painful distention with board-like abdomen and sudden onset of high fever with leukocytopenia developed subsequently. Such surgical abdomen rendered a secondary laparotomy with resection of the sigmoid tumor along with an ischemic colon segment located proximally up to the previously created colostomy. Eventually, the patient had an uneventful postoperative hospital stay. In the present article, we have described an emergent condition of sudden onset of distal limb ischemia after blow-hole colostomy and concluded that despite the decompressed colostomy would resolve acute malignant colon obstruction efficiently; impending ischemic bowel may progress with a possible irreversible peritonitis. Any patient, who undergoes a decompressed colostomy without resection of the obstructed lesion, should be monitored with leukocyte count and abdominal condition survey frequently.
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PMID:Delayed ischemic gangrene change of distal limb despite optimal decompressed colostomy constructed in obstructed sigmoid colon cancer: a case report. 1652 Dec 37

A 45-year-old woman developed 3 years after abdominal hysterectomy a prolapse of the left fimbrial end of the uterine tube through a small defect in the vaginal vault with pelvic peritonitis and abscess.
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PMID:[Diagnostic image (330). A woman with lower abdominal pain 3 years after abdominal hysterectomy]. 1763 75

Acute pelvic pain in the female patient can have myriad presentations and, depending on the diagnosis, profound consequences. In the pregnant patient with pelvic pain or bleeding, an ectopic pregnancy must be first excluded. Ultrasound is important in determining the size and location of the ectopic pregnancy, and presence of bleeding, which in turn helps guide treatment decisions. Subchorionic or subplacental bleeds in an intrauterine pregnancy may also present with vaginal bleeding with consequences dependent on gestational age and size of bleed. In the postpartum female suspected to have retained products of conception, sonographic findings may vary from a thickened endometrial stripe to an echogenic mass with associated marked vascularity, often mimicking an arterial-venous malformation. In the nonpregnant patient, early diagnosis and treatment of ovarian torsion can preserve ovarian function. Other causes of peritoneal irritation may also cause acute pelvic pain including a ruptured hemorrhagic cyst or ruptured endometrioma. When pelvic inflammatory disease is suspected, imaging is used to evaluate for serious associated complications including the presence of a tuboovarian abscess or peritonitis. While leiomyomas of the uterus are largely asymptomatic, a leiomyoma that undergoes necrosis, torsion or prolapse through the cervix may be associated with acute severe pain or bleeding. The imaging features of these and other important clinical entities in the female pelvis will be presented.
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PMID:Emergency gynecologic imaging. 1885 41

We report a case of silent bowel perforation by a fractured subduroperitoneal shunt after surgical shunt revision. A 93-year-old bedridden man experienced transanal prolapse of a shunt catheter after defecation. Upon arrival, the patient showed no fever or acute abdominal signs. Abdominal computed tomography (CT) showed an abandoned shunt catheter in the lower abdomen with rectum perforation. The disconnected catheter was successfully removed from the anus by digital rectal maneuver, and no peritonitis or other complication developed afterward. Such broken shunts no longer provide drainage function, and also pose a risk of migrating into the hollow viscera. Therefore, even in the absence of overt peritoneal signs, disconnected catheters should be removed by laparoscopic or minimal surgery to prevent possible development of this unusual complication. Instances of the rare complication are reviewed, and pathogenesis and treatment of the condition are discussed.
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PMID:Disconnected subduroperitoneal shunt catheter induces silent bowel perforation: An unusual complication. 2209 88

Postoperative outcomes of animals that have undergone cesarean delivery have been reported previously; however, in most studies results were influenced by a combination of surgery per se and the preoperative condition of the animal, which was frequently impaired because of the presence of dystocia. To evaluate the effects of the cesarean section itself we conducted a matched cohort study comparing postpartum complications and future reproductive performance of 162 ewes subjected to elective cesarean section and 162 ewes that had an unassisted vaginal delivery. Survival and subsequent growth of their lambs were also compared. Effect of mode of delivery on weight gain was estimated using linear mixed models. Case ewes, which underwent surgery during the period from 1996 through 2004, and control ewes were from the flock at the Animal Production Experimental Centre, Norway. Two ewes (1.2%) that underwent cesarean section died; one developed peritonitis and the other experienced uterine prolapse and did not recover. Postoperatively, four ewes suffered from metritis, three suffered a wound infection, and four a delayed wound healing; all recovered after treatment. One of the ewes that delivered vaginally died 3 days after lambing. The incidences of fetal and postnatal deaths did not differ significantly between the cesarean and the vaginal delivery groups (fetal deaths, 3.5% and 3.1%, and postnatal deaths, 9.9% and 7.1%, respectively). Survival rates and weight gains of the lambs the subsequent months were similar for the two groups. Seventy percent of the ewes that had a cesarean section and 72% of those that had a vaginal delivery were bred the next season; conception rates were 89% and 90%, respectively. However, the ewes subjected to surgery the previous year gave birth to significantly fewer live-born lambs (mean, 1.64) than those that had had a vaginal delivery (1.93). The difference was the result of a reduced litter size and an increased number of fetal deaths in the former group. Birth weights of the live-born lambs the second year did not differ between the groups. In conclusion, severe short-term complications were rare among the ewes that underwent elective cesarean section. Survival and growth of their lambs and their conception rate the subsequent season did not differ from the corresponding outcomes of the ewes that delivered vaginally, but their fertility was reduced in the sense that they gave birth to fewer live-born lambs the following lambing season.
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PMID:Short-term and long-term outcomes of ewes and their offspring after elective cesarean section. 2321 96


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