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

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

Nine years experience of anorectal surgery for Crohn-related lesion have been analysed. The series regards only 14 cases with pathology including ragade, abscesses and anocutaneous and retrovaginal fistulas. Treatment was as conservative as possible except for cases in which fistulizations led to sepsis as a result of which some adjustments had to be made and proctectomies in incontinence.
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PMID:[Anorectal lesions in Crohn's disease. Our experience]. 225 Jul 80

The ileal neobladder produces a completely detubularized, low pressure, high capacity reservoir constructed from ileum without any valves. From April 1986 through May 1989, 113 patients underwent this procedure at our institution. Of these patients 99 underwent simultaneous radical cystectomy for bladder cancer and 14 underwent bladder augmentation. The mean postoperative followup was 14.4 months, with a range of 1 to 36 months. There was no perioperative mortality. However, 7 patients died more than 2 months postoperatively: 5 of tumor progression, 1 of pneumonia and severe metabolic acidosis, and 1 of septicemia of unknown cause. Reoperation was necessary in only 13 patients; 10 patients required urethrotomy or dilation of urethral strictures. Day and night continence was preserved in 82.1% of all patients. Stress incontinence, which must be corrected by an artificial sphincter, was found in 4 patients (4.2%) and night-time incontinence that required an external device occurred in 5 (5.3%). Eight patients (8.4%) with mild stress incontinence required no further treatment. Pressure waves exceeding 22 cm. water seldom occurred and then only at maximum capacity. Our experience with this relatively simple system without a nipple is an overwhelming success. The need for reoperation is extraordinarily low and the high reservoir capacity results in continence from the beginning in most patients. The concept is sound and offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
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PMID:The ileal neobladder: experience and results of more than 100 consecutive cases. 230 60

The experience gained with restorative proctocolectomy and ileal reservoir in 60 patients is presented. Fifty-two patients had W reservoirs and the operative technique of the procedure is described in detail. Forty patients had a defunctioning ileostomy and 20 had a single stage procedure. There was no perioperative mortality. The main complications were sepsis (28 per cent), intestinal obstruction (18 per cent) and reservoir ileitis (20 per cent). There was a significant improvement in sepsis rate (from 20 to 4 per cent) and hospital stay (from 31.8 to 15.6 days) with increased experience. The functional results of 48 patients with W reservoirs was assessed. The mean number of evacuations per 24 h (+/- s.d.) was 3.8 +/- 0.2. Sixty-five per cent of patients did not evacuate at all, or rarely, at night and none evacuated more than once at night. Forty-four per cent of patients took antidiarrhoeal agents. Continence was normal in 50 per cent of patients. Minor leakage occurred in 46 per cent of cases, frequent leakage in 4 per cent and incontinence in none. Sexual function in 29 men was normal. Ninety-four per cent of patients considered the results of their operation to be good or excellent.
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PMID:Experience of restorative proctocolectomy with ileal reservoir. 253 30

The aim of this study was to compare the immediate postoperative results and the long-term outcome of ileal pouch-anal anastomosis in 94 patients with familial adenomatous polyposis to those in 758 patients with ulcerative colitis. Two colitis patients died after operation (0.3%), but no polyposis patients died. Overall operative complications appeared in 26% and 29% of polyposis and colitis patients, respectively (NS). Reoperation for intestinal obstruction did not differ between the two groups, but sepsis requiring reoperation was more common in colitis patients (6%) than in polyposis patients (0%, p less than 0.04). At follow-up (mean, 3 years), polyposis patients had fewer daytime stools (4.5 stools per day), less nighttime fecal spotting (26%), and less pouchitis (7%) than colitis patients (5.8 stools per day; spotting, 40%; pouchitis, 22%; p less than 0.002). The conclusion was that polyposis patients tolerated the operation better and had less long-term disability than did colitis patients. The data suggest that postoperative sepsis, daytime stooling frequency, nocturnal incontinence, and pouchitis may be, at least in part, disease related and not surgeon or operation related.
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PMID:Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. 216 96

Between April 1986 and April 1989, each of 108 patients received an ileum neobladder, 94 patients for total bladder substitution after radical cysto-prostatectomy and 14 for augmentation of a fibrotic and contracted bladder following tuberculosis, interstitial cystitis or radiotherapy of the pelvis. The operative technique is standardized, relatively simple and safe, and it prevents upper urinary tract deterioration and reflux. Continence is preserved in more than 80% of all patients by the function of the external urethral sphincter and by the high capacity and the low internal pressure of the intestinal reservoir. Follow-up of more than 3 months postoperatively was possible in 96 patients, the evaluation including micturition behavior at home and a urodynamic investigation. Stress incontinence requiring correction by an artificial sphincter was found in 3 and nocturnal incontinence necessitating some external device in 6 patients. There was no perioperative mortality. Local tumor recurrence and/or metastases occurred in 14 patients; 7 patients died postoperatively, 5 owing to tumor progression, 1 of pneumonia and serve metabolic acidosis, and 1 owing to septicemia of unknown cause. Re-operation was necessary in 13 patients, in 6 because of mechanical ileus or intra-abdominal abscess, in 3 because of stenosis of the uretero-ileal anastomosis, in 1 because of tumor progression, in 1 because of vesico-vaginal fistula, in 1 patient because of incisional hernia, and in 1 because of wound dehiscence. Urethrotomy or dilatation of urethral strictures was necessary in 8 patients. All other early and late complications were rare and could be managed by conservative means.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[3 years' experience with the ileum neobladder--the first 108 patients]. 276 96

Patients with total colonic ulcerative colitis or familial polyposis traditionally require a proctocolectomy. In an effort to preserve the normal pathway for defecation and avoid the nuisance of an abdominal stoma, a continence-preserving procedure involving a pelvic reservoir has been performed at the University of Minnesota Hospitals on 120 patients. The majority were operated on for colonic ulcerative colitis. There were no deaths. The mean hospital stay after restorative proctocolectomy was 10 days and after ileostomy takedown the mean stay was 7 days. Functional results were assessed in 52 patients. Daytime bowel movements averaged 6.4 and night-time movements 1.4. Major daytime incontinence occurred in 6% of the patients, 21% had moderate soiling at night and 70% wore a perineal pad in the evening. Ninety-two percent of the patients expressed satisfaction with the procedure. The most serious complication was pelvic sepsis. It occurred in nine patients, six of whom required subsequent surgery. The Parks S pouch provides a means of maintaining anal continence. This series and others have shown that young, healthy, well-motivated persons will benefit most from a restorative proctocolectomy.
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PMID:Proctocolectomy and ileoanal anastomosis with an S pouch: functional results. 282 15

Of 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical 'pouchitis' occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
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PMID:Clinical and functional results after restorative proctocolectomy. 283 77

Resection and peranal suture is now an accepted technique for low rectal carcinoma; however, long-term results of large numbers are not known. Eighty-four patients who had this procedure at a specialist institution between 1972 and 1985 are reviewed. There was a low operative mortality (2.4 percent), but a high complication rate with pelvic sepsis in 34 (40.5 percent) and anastomotic dehiscence (either partial or complete) in 40 (47.6 percent). The crude five-year survival rate was 56 percent. Isolated local recurrence occurred in seven patients (9.2 percent) and in a further seven patients it was associated with systemic recurrence. The functional results were satisfactory with 92 percent of assessed patients having three or less bowel actions per day. Subsequent incontinence occurred in 8 of the 60 patients assessed and 5 of these needed proximal diversion. For patients in whom the only alternative is abdominoperineal excision of the rectum, these results confirm that there is no disadvantage in terms of potential cure and that the functional results are acceptable.
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PMID:Resection and sutured peranal anastomosis for carcinoma of the rectum. 291 22

Convenience to the hospital staff is certainly not an acceptable reason for the use of a potentially dangerous drainage tube. An indwelling urinary drainage catheter should be used only in patients who need multiple straight urinary catheterizations, develop urinary obstruction or incontinence, or are comatose and require frequent urinary output measurements. An indwelling catheter may also be needed for drainage or stenting during or following genitourinary surgery. Once it has been determined that urinary catheterization is necessary, a closed urinary drainage system catheter must be carefully and aseptically inserted by experienced hospital personnel after careful preparation. The closed drainage system must be meticulously maintained throughout the patient's hospitalization and catheterization. After the catheter is removed, a urinary culture should be performed to identify any postcatheter infection. If there is infection, the patient must be treated with antibiotics. If symptoms of a urinary tract infection, bacteremia, or sepsis ensue, treatment must be rapidly begun with antibiotics as appropriate on the basis of drug sensitivity testing. These techniques will not eliminate bacteriuria associated with urinary drainage catheters. However, they will reduce the incidence, morbidity, and mortality associated with urinary catheterization.
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PMID:Nosocomial urinary tract infections. 305 56


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