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

The records of 93 patients with colocutaneous fistulas associated with diverticulitis treated at the Cleveland Clinic between 1965 and 1983 were reviewed. There were 56 males and 37 females with an age range of 19 to 80 years (median, 57 years). Eighty-eight fistulas followed surgery for diverticulitis while five developed spontaneously. The presence of a diverting stoma in 34 patients did not prevent fistula formation but did decrease morbidity (x2 = 12.75, P less than 0.001). Initial investigations showed a high incidence of recent weight loss (in 40 percent) and hypoalbuminemia (47 percent), although these factors did not influence outcome. Patients with high output (greater than 200 cc/day) fistulas (n = 9) fared significantly worse than those with low outputs. There were 28 patients with fistulas to other organs, 20 involving small bowel. Factors leading to persistence of the fistulas included sepsis (42 cases) and sigmoid colon distal to an intended colorectal anastomosis (38 cases). Ninety-two patients underwent surgery, 80 percent having a one- or two-stage resection and anastomosis. There was one postoperative death and complications occurred in 44 patients (48 percent). Surgery was successful in producing patients without stoma or fistula in 71 cases (77 percent). There were five recurrent fistulas, 14 new fistulas, and 13 patients retained their stomas. A diagnosis of Crohn's disease was made in ten patients who had a high rate of complicated fistulas, recurrent fistulas, and retained stomas. Patients with carcinomas (n = 5) also did poorly, but those on systemic steroids (n = 7) fared no worse than patients not receiving them. This study emphasizes the role of diversion of the fecal stream in reducing the morbidity of colonic fistulas. It is clearly important to carry out a true colorectal anastomosis after resection for diverticulitis, and in patients with unusually complicated clinical courses, the diagnosis of Crohn's disease should be entertained.
Dis Colon Rectum 1987 Feb
PMID:Colocutaneous fistulas complicating diverticulitis. 380 27

Since 1978, 41 patients (12 percent of all restorative operations) have undergone peranal coloanal reconstruction following anterior resection (LAR) for cancers of the midrectum. Twenty-seven patients (66 percent) were men and 14 patients (34 percent) were women (mean, 58.8 years). The mean distance of the primary tumor from the anal verge was 6.7 cm and 50 percent of the primary tumors were considered highly mobile. In 29 patients, a hand-sewn anastomosis was performed between the colon and the dentate line. In the 12 most recent patients, the anastomosis was performed using a circular stapling instrument. A diverting colostomy should be employed in all cases and is closed approximately three months later. There has been no operative mortality. Morbidity included anastomotic separation (two patients), minor anastomotic defects (three patients), pelvic sepsis (two patients), and bacteremia of unknown origin (two patients). Where fecal diversion was employed, there were no instances of anastomotic leak. Two patients with hemorrhage were returned to the operating room. Thirty-seven of the 41 patients underwent curative resections. Thirty-three percent of the patients had Dukes' C lesions. With a median follow-up of 31 months for the curative resections, 73 percent remain free of disease. Sixty-four percent of evaluable patients have either excellent or good anorectal function nine to 12 months after colostomy closure. Of 26 operations performed by one surgeon, 22 patients (85 percent) are currently evaluable. Nineteen (86 percent) of the 22 have normal or near-normal bowel function. Four guidelines for performing a functionally successful operation are presented. Coloanal reconstruction following LAR, were pull-through operations were previously required, is an excellent sphincter-preserving operation. The functional results one year after the operation are gratifying, with the majority of patients leading an active life with normal bowel function.
Dis Colon Rectum 1985 Aug
PMID:Peranal coloanal anastomosis following low anterior resection for rectal carcinoma. 389 52

Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.
Dis Colon Rectum 1985 Nov
PMID:Surgery for diverticulitis in renal failure. 390 14

Of two hundred patients undergoing proctocolectomy with ileal pouch-anal anastomosis, all but nine have had temporary diverting ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus and perforation after she had returned home, and at surgery the pouch was excised. Ileal pouch-anal anastomosis without a temporary diverting ileostomy can be performed safely by surgeons experienced with this procedure in carefully selected patients.
Dis Colon Rectum 1986 Jan
PMID:Ileal pouch-anal anastomosis without temporary, diverting ileostomy. 394 Aug 3

Endoanal mucosal proctectomy with preservation of the anal sphincters has been employed as an alternative to the traditional method of rectal excision in 23 patients with ulcerative colitis or Crohn's disease. Ten patients in whom the anal canal was left open and drained had uneventful postoperative courses. Of the remaining 13 patients in whom the top of the anal remnant was oversewn, four had local pelvic sepsis that resolved in a few weeks' time and one patient had a pelvic hematoma requiring relaparotomy and sphincter muscle excision. Postoperative disturbances in bladder or sexual function did not occur in any of the patients. At the latest follow-up (mean 21 months), all patients were fully satisfied with the result of the operation. On proctoscopic examination, an anal remnant, measuring approximately 3 cm from the anal verge, could be demonstrated. Its upper end had healed with a fibrous scar in 50 percent of the patients, whereas a small area of friable granulation tissue, sometimes with a short sinus tract was still observed in the others. The persistence of such lesions was associated with minor mucous discharge occasionally escaping from the anal canal. Biopsies disclosed regeneration of cylindric and transitional types of epithelium. The fate of these epithelial remnants remains to be seen. Endoanal mucosal proctectomy appears to be an attractive alternative to the conventional technique. It prevents a great deal of morbidity and enhances postoperative rehabilitation.
Dis Colon Rectum 1985 Jan
PMID:Mucosal proctectomy and ileostomy as an alternative to conventional proctectomy. 397 97

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

Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stage en bloc resection of the uterus and colon is the procedure of choice. Hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.
Dis Colon Rectum 1985 May
PMID:Colouterine fistula secondary to diverticulitis. 399 53

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the early, rapid, and radical debridement of all devitalized tissues and prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.
Dis Colon Rectum 1985 Jul
PMID:Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread. 401 14

This report reviews the clinical presentation, operative management, and survival in 120 infants with intestinal atresia and stenosis treated from 1972 to 1984. Duodenal atresia occurred in 39 neonates and duodenal stenosis in 19. Thirty-two infants had severe associated anomalies. Operative management included duodenoduodenostomy in 47 infants, duodenotomy and web excision in four, and duodenojejunostomy in seven. Jejunoileal atresia occurred in 49 infants and stenosis in three. Six infants had cystic fibrosis and nine had gastroschisis. Operative therapy included wide proximal resection and end-to-end anastomosis in 18 infants, minimal resection with antimesenteric tapering enteroplasty and anastomosis in 14 neonates, and resection with temporary enterostomies in 20 infants. Twenty-nine infants (56%) required total parenteral nutrition. Colon atresia occurred in 11 infants and stenosis in one. Initial end-colostomy with subsequent resection and anastomosis was performed in 11 infants while one underwent a primary resection. The survival rate was 91% for duodenal defects, 87% for jejunoileal cases, and 100% for colonic anomalies. Death is currently caused by severe associated anomalies in infants with duodenal atresia and sepsis and total parenteral nutrition-related cholestasis with progressive liver failure in instances of jejunoileal atresia.
 ...
PMID:Intestinal atresia and stenosis: analysis of survival in 120 cases. 404 43

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.
Dis Colon Rectum 1985 Nov
PMID:Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia. 405 2


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