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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Restorative proctocolectomy is now the treatment of choice for most patients with ulcerative colitis and familial polyposis coli. Temporary defunctioning ileostomy has been advocated during the period of anastomotic healing to prevent pelvic sepsis. However, the ileostomy itself may be a source of significant complications. To examine ileostomy function we reviewed thirty five patients (mean age 34.5 +/- 1.95 years) who underwent restorative proctocolectomy. Thirty four patients had a defunctioning ileostomy established at the time of pouch anal anastomosis. Closure of the ileostomy has been carried out in 33 patients (mean closure time 3.1 +/- 0.29 months). One patient underwent early pouch excision. Thirteen of the 35 patients developed post-operative complications (37%), two directly related to the defunctioning ileostomy. Both occurred following closure of the stoma and required laparotomy. Serious complications associated with defunctioning ileostomy as demonstrated in this study are uncommon (8.5%). Given the potentially disastrous consequences of a pouch-anal anastomotic leak we feel that the relatively low morbidity associated with a defunctioning ileostomy justifies its continued routine usage in the operation of restorative proctocolectomy.
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PMID:The role of the defunctioning ileostomy in restorative proctocolectomy. 133 Sep 73

Portal vein thrombosis is a rare complication of ulcerative colitis and is invariably fatal. This report describes a patient with severe Crohn's disease who underwent elective surgery complicated by an anastomotic disruption with faecal peritonitis. Following emergency laparotomy he developed left hypochondrial pain which was a manifestation of splenomegaly consequent upon portal vein thrombosis. Anticoagulation was successful in preventing further spread of the thrombosis as monitored by colour Doppler ultrasound. Severe active disease, surgery and sepsis have been recognized as predisposing factors for thromboembolic complications in inflammatory bowel disease and this patient was exposed to all three. It is conceivable that portal vein thromboses occur more commonly than suspected and ultrasound scanning could ascertain the prevalence if performed prospectively.
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PMID:Portal vein thrombosis in a complicated case of Crohn's disease. 140 98

Restorative proctocolectomy is now established as the procedure of choice in many patients with ulcerative colitis or familial polyposis coli as well as in some patients with multiple colorectal tumors, ischemia, trauma, or congenital abnormalities. Some patients, however, may have had previous pelvic, abdominal, or perineal surgery, which might be considered a contraindication to restorative proctocolectomy. In a consecutive series of 73 private patients undergoing restorative proctocolectomy under one surgeon, we have reviewed in detail 13 who had had previous "significant" abdominal, pelvic, or anal surgery. Eight patients had previously had surgery for fistula-in-ano or fissure-in-ano, two had had an anal sphincter repair, and three had undergone possibly compromising abdominal or pelvic surgery prior to restorative proctocolectomy. Twelve of the 13 made an uncomplicated recovery from restorative proctocolectomy, although one has since died from carcinomatosis. One patient died after closure of an ileostomy from a combination of enterocutaneous fistula, infection, bleeding, and a perforated duodenal ulcer. One patient developed sepsis, necessitating removal of the pouch, and is classified as a failure. Two of the remaining 11 have had minor long-term functional problems with nocturnal fecal incontinence, and one patient needs to catheterize the pouch to evacuate, but all three patients prefer a pouch to an ileostomy. Restorative proctocolectomy can be performed successfully even after previous pelvic, abdominal, or anal surgery with an acceptable complication rate when compared with pouch surgery in the uncompromised patient.
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PMID:Restorative proctocolectomy in patients after previous intestinal or anal surgery. 161 57

Between 1984 and 1989 21 patients underwent proctocolectomy and were reconstructed with ileal-pouch-anal anastomosis using a J-pouch. 18 patients had ulcerative colitis and 3 adenoma of the colon. In 16 of 21 patients the operation was performed in a three-stage way: (1.) total colectomy; (2.) proctomucosectomy, ileal-pouch-anal anastomosis and protective ileostomy; (3.) ileostomy closure. 5 patients had a two-stage operation (3 patients with adenoma of the colon, 2 patients with low or no steroid medication). Operative mortality was 0%. Complications were seen in 4 of 21 patients after colectomy (sepsis, pelvic abscess in 2 instances, ileus), in 4 of 21 patients after ileal-pouch-anal anastomosis (pouch-vaginal fistula, pelvic abscess, anastomotic stricture, ileus) and in 2 of 19 patients after closure of ileostomy (pouch-vaginal fistula). In 19 of 21 patients the ileostomy is closed. All of these patients are fully continent during the day and only 2 patients are slightly incontinent at night. The average stool evacuation is 4 to 5 during the day and once to twice at night. All patients are very satisfied with the result.
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PMID:[Early and long-term results following ileum-anal pouch anastomosis]. 164 48

Sixty-nine patients were operated upon in a three-stage procedure. Early complications occurred in 29 percent after colectomy-ileostomy, in 25 percent after proctomucosectomy with ileoanal anastomosis and loop ileostomy, and in 9 percent after closure of loop ileostomy. Only three of these were considered serious. Seventy-one percent of the patients were readmitted into the hospital between the three operations or after the last one. Total hospital stay was 49 days (median); the range was 20 to 345 days. Reconstruction of the reservoir was performed in four patients owing to defecation problems, with satisfying functional results in two patients, while two emptied by catheter. There was no postoperative mortality or pelvic sepsis, and no pouches were excised. Ileostomy was re-established in two patients. At histopathologic re-evaluation of colectomy specimens, the diagnosis was changed from ulcerative colitis to Crohn's disease in three patients and to indeterminate colitis in five. Median follow-up was 4.3 years. Continent anal defecation without ileostomy was achieved in 67 patients (97 percent), with 4.1 bowel movements per day and 0.6 per night. Perfect continence was achieved in 55 percent in the daytime and in 43 percent at night. The low rate of reservoir-threatening complications is attributed to the three-stage procedure and the technical details in the surgical procedures.
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PMID:Colectomy-proctomucosectomy with S-pouch: operative procedures, complications, and functional outcome in 69 consecutive patients. 173 82

Between January 1982 and March 1990, 106 patients underwent restorative proctocolectomy in eight separate surgical departments. The indication for operation was ulcerative colitis in 86%, familial adenomatous polyposis in 12% and megacolon in 2%. The age at operation was 33 +/- 2 years (mean +/- sem) (range 15-55 years). There were no perioperative deaths. The principal causes of post-operative morbidity were intra-abdominal sepsis (15%), anastomotic stricture (10%) and intestinal obstruction (8%). Intestinal continuity has been restored in 99 patients. All were grossly continent, but 32% experienced occasional soiling. The mean stool frequency was 5/day and 1/night. The overall failure rate was 6%. Eighty-nine percent of patients were happy with the outcome. We conclude that restorative proctocolectomy is safe and provides acceptable functional results. It should be the operation of choice in most patients with ulcerative colitis or familial adenomatous polyposis.
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PMID:Restorative proctocolectomy: the Irish experience. Irish Association of Coloproctology. 209 88

The first 25 restorative proctocolectomies (RP) performed by one surgeon since 1986 are reviewed. Ulcerative colitis (23) and idiopathic megarectum (2) were the indications for surgery. The initial seven patients had a submucosal proctectomy and transanal hand sewn pouch-anal anastomosis. Eighteen patients had a totally stapled RP. One patient with malignancy died from factors unrelated to surgery. Complications developed in eight patients after pouch-anal anastomosis and in four patients after ileostomy closure. There was one pouch failure due to pelvic sepsis. No pelvic sepsis has occurred following a stapled ileal pouch-anal anastomosis with defunctioning ileostomy. After a mean follow up period of 20.5 months all patients are continent (mean stool frequency = 4/day and 0.5/night). Soiling occurred in three patients who had a transanal hand sewn pouch-anal anastomosis. All patients in the stapled group have satisfactory control. Restorative proctocolectomy produces satisfactory operative and functional results which have improved as our experience has increased.
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PMID:Early results with restorative proctocolectomy. 209 89

One hundred nine men and 71 women with a mean age of 31 years had construction of 164 S, 2 J, and 14 other ileoanal reservoirs. Postoperative gastrointestinal complications included small bowel obstruction in 11 percent and ileus, hemorrhage, and sepsis in 6 percent, 5 percent, and 11 percent, respectively. There was a 13 percent incidence of miscellaneous postoperative complications. Pouch perianal fistulas developed in 5 percent of patients, and pouch vaginal and other pouch fistulas developed in an additional 4 percent. During long-term follow-up, small bowel obstruction developed in 27 percent of patients, and enterolysis or enterectomy was required in 15 percent of patients. One hundred fourteen patients who were followed for a mean length of 5 years after ileostomy closure (range 16 to 88 months) were evaluated for functional outcome. Function improved with time in 63 percent of patients and remained stable in another 33 percent; only 4 percent had long-term deterioration. Ninety-five percent of patients would again choose an ileoanal reservoir over a permanent ileostomy. This long-term assessment shows that although the ileoanal reservoir is a viable option in the management of mucosal ulcerative colitis, it should not be recommended to every patient.
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PMID:The ileoanal reservoir. 215 8

Restorative proctocolectomy is widely regarded as the surgical procedure of choice for patients with ulcerative colitis or familial adenomatous polyposis, the majority being carried out within specialised regional centres. The use of this procedure outside such centres has been investigated by reviewing the results from a District General Hospital (DGH) over the 8 year period 1981-1989. Seventeen patients (11 male and 6 female with a median age of 36 years) underwent total colectomy and ileoanal anastomosis with formation of a pelvic reservoir (TC-IA). Fourteen had ulcerative colitis (UC), 2 familial adenomatous polyposis (FAP) and one a colonic and rectal cancer. Three pouch designs were used ("S" in 7, "J" in 8 and "W" in 2) with no operative or perioperative deaths. Further laparotomy was required in two patients for adhesions and pelvic sepsis. Functional results were assessed in 16 patients at a mean of 5 years after surgery. The median daily stool frequency was 5 (range 2-6). Twelve of the 16 patients defaecate spontaneously, 2 regularly self-catheterized and 2 do so occasionally. None of the patients is incontinent of formed or liquid stool but one has occasional soiling. These results suggest that TC-IA may be satisfactorily performed outside a specialised unit.
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PMID:Restorative proctocolectomy: a procedure for the district general hospital? 215 79

Proctocolectomy with ileal pouch is indicated in patients with diseases of the colon limited to the mucosa. The ileum must not be involved. In order to maintain stool continence, anal sphincter and mucosa must be preserved; however, mucosa of the rectum can be resected. There are three types of pouches possible (S, J, W) with increasing capacity. The distal loop of the ileum must not be longer than 1-2 cm, otherwise the defecation may be inhibited. Between 1977 and 1987 205 patients have been treated by proctocolectomy, most of them for ulcerative colitis of familial polyposis. In 6% the operation was unsuccessful (unknown Crohn's disease, pelvic sepsis or stool incontinence), 27% of the patients suffered from complications when the pouch was constructed or the ileostoma was closed (obstruction, sepsis). The overall mortality was 1%. 2 of 174 patients were incontinent. In all other patients the frequency of defecation was 3-5 per day. Stool continence depends on the shape of the pouch: 75% of the patients with a J-pouch and 93% of the patients with a W-pouch were continent. The overall results were better in patients with familial polyposis than with ulcerative colitis. The latter developed pouchitis in 20%.
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PMID:Restorative proctocolectomy with ileal reservoir: indications and results. 215 58


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