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

Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.
Dis Colon Rectum 1984 Feb
PMID:Surgical aspects of radiation enteritis of the small bowel. 669 36

During the last ten years, 14 patients with proven aortoenteric fistulas were admitted to the Greenville Hospital System, a community system of 1200 beds in four units serving a county of 250,000 residents. The experience obtained is tabulated, and illustrative case reports are used to emphasize the diagnostic and treatment problems inherent in this group of patients. It is obvious that two major manifestations result when intra-abdomial vascular prostheses communicate with some portion of the gastrointestinal tract. The most common manifestation of aortenenteric fistual is massive GI hemorrhage, usually preceded by an earlier, less consequential bleeding episode called a "herald bleed." If the small bowel, other than the duodenum or colon, is involved, then chronic bleeding and sepsis are most characteristic. The problems of diagnosis and management are discussed.
Dis Colon Rectum 1984 Mar
PMID:Aortoenteric fistula: diagnosis and management. 669 40

A randomized controlled trial aimed at comparing the individual efficacy of cephalothin, cefoxitin, and metronidazole in the prevention of postoperative wound infection was performed among 74 colorectal surgical patients. Of 28 patients on cephalothin, seven (25 per cent) developed a postoperative infection, but among 23 patients in each of the other two groups, only one (4 per cent) in each group became infected. These results confirm the primary importance of anaerobes in the causation of postoperative sepsis after colorectal surgery.
Dis Colon Rectum
PMID:Cephalothin, cefoxitin, or metronidazole in elective colonic surgery? A single-blind randomized trial. 675 28

A safe and practical procedure for total colectomy and mucosal proctectomy with ileoanal anastomosis has been developed and performed by us on 11 patients with adenomatosis coli and two patients with ulcerative colitis. The major features of the operative procedure are 1) total removal of the rectal mucosa to just above the dentate line; 2) preservation of anorectal function by a long rectal cuff procedure achieved by rectal mucosal excision from a level just below the sacral promontory, using a rectal internal stent and gauze packing techniques for rectal mucosal stripping, with, in some patients, an ileal reservoir added; and 3) prevention of pelvic sepsis by intraoperative rectal irrigation, rectal cuff drainage, and a temporary defunctioning loop ileostomy. Of six patients with at least three months of follow-up after reconstruction, each has returned to normal life, averaging two to seven semiformed stools each day. A side-to-end ileoanal anastomosis with a low-lying, loop-type ileal reservoir provided the best functional results.
Dis Colon Rectum 1980 Oct
PMID:Total colectomy, mucosal proctectomy, and ileoanal anastomosis. 677 28

Of 227 patients with stage B or C colorectal carcinoma operated for "cure," 132 had a febrile postoperative course. Of the latter, five patients (3.7 per cent) died of sepsis. The five-year actuarial recurrence rate for 227 patients was 53 per cent. When the patients were divided into groups according to stage of disease and postoperative fever, the following was found: Eighty-one low stage patients (B1 + B2) had a 34 per cent five-year actuarial recurrence rate, and 146 high-stage patients (B3 + C4 + C2)-- a 71 per cent rate (P less than 0.0005). Fever occurred postoperatively in 46 per cent of low-stage patients and in 65 per cent of high-stage patients (P = 0.004). In low-stage patients, the five-year actuarial recurrence rate was 3 per cent in the group with an afebrile postoperative course, and 66 per cent in that with fever (P much less than 0.0005). Similarly, in high-stage patients, the recurrence rate was 24 and 93 per cent, respectively in the group with afebrile and febrile postoperative courses (P much less than 0.0005). Preoperative plasma CEA levels seemed to have no bearing upon prognosis, unless above 20 ng/ml. Eighty-two per cent of patients who had serial postoperative plasma CEA measurements and recurrence of cancer had increasing CEA levels. Thus, postoperative fever lasting two or more days was the most unfavorable prognostic factor, highly significant statistically, whereas stage of disease ranked only second in isolating better prognoses among operated patients from those at higher risks of recurrence.
Dis Colon Rectum 1983 Apr
PMID:The strongest prognostic factors in colorectal carcinoma. Surgicopathologic stage of disease and postoperative fever. 683 98

A previously unreported complication of a patient with Crohn's enterocolitis and internal fistulation is presented. The patient presented with meningeal signs in the lumbosacral region, fever, and sepsis. Computerized axial tomography revealed air in the epidural space, and a presumptive diagnosis of rectalepidural fistula was made. Surgical management included a diverting end sigmoid colostomy and presacral drainage.
Dis Colon Rectum 1983 Sep
PMID:Rectalepidural fistula complicating Crohn's enterocolitis. 687 95

From 1968 to 1979, 18 patients underwent emergency abdominal colectomy with ileorectal anastomosis. Indications for operation included massive colonic bleeding (11), obstructing carcinoma (5), toxic megacolon (1), and enterocolitis (1). Five patients died postoperatively (27.8 per cent). Causes of death included sepsis, upper gastrointestinal bleeding, and respiratory failure. All had peritonitis, and five had documented anastomotic leaks. Seven of the surviving patients had significant morbidity from the procedure which included anastomotic leak, small bowel obstruction, wound infection, sepsis, and pulmonary emboli. Only six patients survived without complications. Although others have written about the safety of emergency subtotal colectomy with ileorectal anastomosis, our experience suggests this procedure is associated with excessive morbidity and mortality.
Dis Colon Rectum
PMID:Emergency abdominal colectomy with primary anastomosis. 697 Jun 59

Ninety patients were included in this prospective randomized trial. Each required electric colorectal surgery and was prepared for operation with oral preoperative antibiotic therapy, systemic peroperative therapy, or by a combination of both. The number of each type of septic postoperative complication and their total did not differ between the group treated by oral antibiotics prior to operation and the group treated peroperatively with systemic antibiotic therapy. The total number of septic complications (wall abscesses, fistulas, subdiaphragmatic abscesses, septicemia, peritonitis), however, was significantly less (P less than 0.05) in the group treated by both preoperative oral antibiotics and peroperative systemic antibiotic therapy (3.3 per cent) than in either groups treated only orally preoperatively (30 per cent) or by systemic antibiotic therapy during the operation (23 per cent). The combination of oral antibiotic therapy prior to operation and of systemic peroperative antibiotic therapy, therefore, presents the most effective prophylactic effectiveness.
Dis Colon Rectum
PMID:Comparison between oral and systemic antibiotics and their combined use for the prevention of complications in colorectal surgery. 704 24

The problem of peritonitis after perforation or trauma to the colon continues to be an important one for colon and rectal surgeons. Treatments vary, but mortality and morbidity have always been high. For these reasons, the usefulness of continuous peritoneal lavage as adjuvant therapy in the treatment of peritonitis was examined. Twenty patients with gross peritoneal contamination were treated with continuous postoperative peritoneal irrigation for 17 to 72 hours. No patient died of sepsis or developed an intra-abdominal abscess. Three patients died: two of advanced cancer and one of a pulmonary embolus. Three additional patients developed complications: mild congestive heart failure in two and transient respiratory failure in one.
Dis Colon Rectum 1982 Oct
PMID:Continuous postoperative lavage in the treatment of peritoneal sepsis. 712 62

The combination of blunt pelvic and perineal injuries is relatively uncommon but carries with it a high morbidity and mortality. A colostomy with distal wash-out plays a significant role in the prophylaxis of septic complications, even in the absence of recognizable colorectal trauma. Among 14 patients with this type of injury, there were six deaths (42 per cent). Three patients died initially because of hemorrhage, and three late deaths were due to sepsis. Two of these patients had no colostomy, and one had a diversion without wash-out. The indications for proximal diversion should be broadened to include an expanded view of the perineum, herein presented.
Dis Colon Rectum
PMID:Blunt pelviperineal injuries. An expanded role for the diverting colostomy. 717 47


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