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

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

Medical records of 194 patients with ruptured uteri at Mulanje CCAP Hospital in Malawi were studied from January 1974 to December 1982. The mortality rate was 10.3%; this figure was elevated with rupture of an intact uterus, primigravidity, rupture prior to hospital admissions, and being in shock when admitted. Fetal mortality was 70% and strongly correlated with maternal mortality. A stronger relationship was found between fetal mortality and shock, absence of scar, and time of rupture. Fetal mortality was also associated with surgery performed, completeness of rupture, and rupture diagnosis prior to delivery. Hysterectomies were performed in 33.3% of the cases. 3 groups were identified among the cases: unscarred uterus ruptured before admission, scarred uterus ruptured prior to admission, and scarred uterus ruptured in hospital. For the 1st group, factors contributing to the uterus rupture include cephalopelvic disproportion, malpresentation, prolonged labor, and herbal oxytocies. In this group, 57% were para 5. The majority of women in the other 2 groups were para 1-4. Incidences of shock varied between the 3 groups; the unscarred group had 67% with shock while the scarred ruptures had 38% (prior to admissions) and 8% (after hospital admission). An anterior rupture site was the most common site of uterus rupture; the findings are 49% for the 1st group, 81% for the 2nd group, and 90% for the 3rd group. The highest mortality rate (20%) was observed in women with unscarred uterus rupture before admission. Fetal mortality was 95%, 57%, and 27% for the 3 groups respectively. The major causes of death were shock and sepsis. Prolonged hospital stay was attributed to wound infection or vesico-vaginal fistula.
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PMID:Ruptured uterus in Mulanje CCAP Hospital, 1974-1982. 228 75

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

In 144 pull-through-operations performed for anorectal-atresia, following complications were observed: pneumonia 11%, sepsis 8.3%, peritonitis 5%, bowel obstruction 5%, osteomyelitis 1%, retraction of the pulled-through colon 4%, anal stenosis 16%, secondary megacolon 9%, fistula relapse 8%, mucosal prolapse 4%. Recto-urethral, recto-vesical- and recto-vaginal fistula relapses are managed by interposition of the gracile muscle. Anal stenoses and secondary megacolon are prevented by a sufficiently long postoperative bougienage.
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PMID:[Therapy of postoperative complications following abdominoperineal or abdominosacroperineal pull-through surgery in anal atresia]. 343 Dec 99

Vesico-cutaneous fistulas rarely occur in the urinary tract (1.7% of all urinary fistulas). Trauma, neoplasias, inflammation and iatrogenic pathologies are among the principal causes. The external mouth of the fistula is usually found in the hypogastric area, scrotum, perineum and rarely elsewhere. This report describes the case of a 48 year old woman who, after severe trauma suffered bladder laceration, treated only with cystorraphy. Sepsis and gangrene followed involving the pubic area and the right thigh, associated with acute renal and adrenal gland cortex failure. After emergency treatment, the patient was discharged with an indwelling catheter. Ten months later she was referred to our urology clinic because of a suspected bladder-vaginal fistula. The indwelling catheter was removed and the bladder resumed functioning well. Six months later the external mouth of the fistula appeared on the right inner thigh. NMR confirmed the diagnosis of a vesico-cutaneous fistula. Surgery resolved the abnormality.
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PMID:[Vesico-cutaneous fistula of the thigh as a late manifestation]. 802 28

The aim of this study was to prospectively assess the morbidity of creating and closing loop ileostomies in a consecutive series of patients having an ileoanal pouch procedure. Between 1983 and 1991, 203 patients had loop ileostomies created for temporary fecal diversion after an ileoanal pouch procedure. There was one death as a result of liver failure. One patient developed a persistent pouch-vaginal fistula that resulted in pouch excision. The remaining 201 patients had their ileostomies closed at a mean time of 10 weeks after the primary procedure. Only 7% needed surgery to correct ileostomy-related problems. After ileostomy closure, complications were noted in only 2% of patients. Loop ileostomy is easy to create and provides highly effective fecal diversion, which decreases the incidence of and mitigates the serious sequelae of pouch sepsis. Closure is simple, does not require a laparotomy, and is associated with few complications. Our experience with loop ileostomy for temporary fecal diversion after an ileoanal pouch procedure has been favorable. The loop ileostomy may be the stoma of choice for most clinical situations in which temporary fecal diversion is indicated.
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PMID:Loop ileostomy for temporary fecal diversion. 818 41

Between January 1976 and June 1991, 161 women underwent restorative proctocolectomy. Seventeen (10.6 per cent) developed pouch-vaginal fistula. There was no difference in the incidence of inflammatory (15 of 141; 10.6 per cent) and non-inflammatory (two of 20; 10 per cent) disease, the severity of colitis or the number of stages in the operation. In 15 patients the fistula involved the ileoanal anastomosis; in two it had possibly occurred at the dentate line. There was no significant difference in the proportion of hand-sewn (ten of 120; 8.3 per cent) and stapled (seven of 41; 17 per cent) ileoanal anastomosis. Of the 17 women, six had pelvic sepsis in the immediate postoperative period and five had an anastomotic complication. There was no case of Crohn's disease. Three patients developed a pouch-vaginal fistula before closure of the ileostomy. The remaining 14 fistulas occurred a median of 7 (range 1-144) months after closure. Five further patients were referred from elsewhere to give a total of 22 for analysis of treatment and outcome. The fistula developed before ileostomy closure in five patients (group 1) and after closure in 17 (group 2). Following treatment, six fistulas had healed with five patients still undergoing treatment. In group 1, three of the five fistulas healed, whereas in group 2 only three of the 17 healed. Eight patients required excision of the pouch. The prognosis appears to be worse when pouch-vaginal fistula occurs after ileostomy closure. The optimal management is not yet established.
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PMID:Pouch-vaginal fistula. 836 45

The authors report a case of emphysematous cystitis in a 50-year-old woman treated by corticosteroids, occurring 1 month after hysterectomy for locally advanced ovarian cancer. Although the patient presented a vesico-vaginal fistula, the presence of air in the bladder wall and only in the bladder lumen, confirmed the diagnosis of emphysematous cystitis. Despite intensive care and surgery with colostomy and Mikulicz drainage associated with urinary diversion (transparietal bladder catheter on one side and cutaneous ureterostomy on the other side), the patient died on day 10 in a context of sepsis. The circumstances of discovery, the various clinical forms and the radiological features of emphysematous cystitis described in the literature are reviewed together with the modalities of management.
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PMID:[Emphysematous cystitis complicating non-conservative total hysterectomy for ovarian cancer]. 1521 42

A 67-year-old lady presented to the surgical outpatient clinic with a 4 month history of recurrent purulent discharge from her left buttock. Four years and 4 months prior to this she underwent a posterior intravaginal slingoplasty for vaginal prolapse and urinary stress incontinence. An MRI demonstrated a long gluteo-vaginal fistula tract from the posterior wall of the vaginal vault through the left ischiorectal fossa to the skin. An examination under anaesthesia revealed that the fistulous tract was surrounding the intact mesh used for the posterior intravaginal slingoplasty. The mesh was removed, the fistula tract excised and the perineal wound marsupialised. The patient was discharged 5 days later. The wound healed within 4 weeks and she remains sepsis free 2 years on.
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PMID:Gluteo-vaginal fistula: a long-term complication of posterior intravaginal slingplasty. 2267 11

Worldwide, the incidence of obstetric hysterectomy is expected to be on the decline due to improvements in obstetric care. This hospital-based 10-year review (2001-10) was performed to determine its incidence and outcome in Ile-Ife, Nigeria. The trend was determined by comparing the current incidence with that from two previous studies from the same centre. There were 58 obstetric hysterectomies and 15,194 deliveries during the review period, giving a rate of 3.8/1,000 deliveries. A rising trend was observed in the obstetric hysterectomy rate in Ile-Ife over two decades (1990-2010). Uterine rupture was the commonest indication (60%). Postoperative complications such as sepsis, vesico-vaginal fistula and renal failure affected 34.5% of the patients. Maternal and fetal case fatality rates were 18.2% and 43.6%, respectively. The obstetric hysterectomy rate in Ile-Ife is high and the trend is rising. Universal access to skilled birth attendance is advocated to reduce uterine rupture and consequently obstetric hysterectomy.
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PMID:Obstetric hysterectomy: trend and outcome in Ile-Ife, Nigeria. 2391 55


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