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

The outcome of mucosal proctectomy with ileoanal anastomosis in patients with polyposis coli has not been well studied. A series of 25 patients with polyposis treated at the Mount Sinai Hospital over a period of ten years is reported. The mean age of the patients was 23 years. Early postoperative complications were present in seven patients and consisted of thrombophlebitis (three), pelvic sepsis (three), and retraction of the anastomosis (one). Intestinal obstruction requiring laparotomy occurred in another five patients. Twenty-three patients were followed for a mean of 47 months after closure of the ileostomy. Ninety-one percent are satisfied with the operative results. The mean number of bowel movements per 24 hours is 6.0. All patients are continent, but eight have occasional episodes of rectal seepage at night. Nearly 50 percent require some antidiarrheal medication. New adenomatous polyps have developed just above the dentate line in four patients. Patients with polyposis coli seem to have fewer serious complications requiring excision of the ileoanal anastomosis than patients with ulcerative colitis. They also should have lifelong surveillance of the entire gastrointestinal tract even after total colectomy with ileoanal anastomosis.
Dis Colon Rectum 1987 Jun
PMID:Familial polyposis coli. Results of mucosal proctectomy with ileoanal anastomosis. 359 59

A 20-year-old woman presented with an acute perianal abscess. Tuberculous culture was positive and a chest radiograph demonstrated miliary spread. Tuberculosis still should be considered as an etiologic factor in acute anorectal sepsis.
Dis Colon Rectum 1987 Sep
PMID:Miliary tuberculosis presenting as an acute perianal abscess. Report of a case. 362 77

To evaluate the outcome of surgery for ulcerative colitis in pediatric and adolescent patients, the experience at the Cleveland Clinic Foundation was reviewed retrospectively. Fifty-nine percent of the patients presented with acute toxic colitis and sepsis; 94 percent underwent staged procedures with creation of a temporary or permanent ileostomy. Sepsis was the most frequent postoperative complication (38 percent), and accounted for all three deaths (5 percent). Long-term disability was minimal, and 90 percent of the patients were fully active at the time of follow-up.
Dis Colon Rectum 1987 Oct
PMID:Surgery for ulcerative colitis in the pediatric population. Indications, treatment, and follow-up. 365 87

Forty-four patients presenting with painful outlet constipation had internal rectal intussusception documented by cinedefecography. Rectal reservoir reduction by multiple elastic ligation or staple excision of redundant mucosa effectively improved bowel function and outlet symptoms in the majority of patients. Rectal reduction procedures were performed under intravenous sedation with antibiotic coverage, no postoperative sepsis, and a single case of significant postoperative bleeding. Associated abnormalities on defecography were unaffected.
Dis Colon Rectum 1987 Oct
PMID:Rectal reservoir reduction procedures for internal rectal prolapse. 365 90

Retroperitoneal abscesses may develop insidiously, resulting in delayed diagnosis with significant morbidity and mortality. Subcutaneous emphysema of the thigh may be a late manifestation of this process, and often heralds a poor prognosis because of associated myonecrosis and fulminant sepsis. The presentation and clinical course of such a patient is summarized, and the relevant anatomy of the retroperitoneal spaces that predisposes to this condition is described.
Dis Colon Rectum 1986 Jul
PMID:Retroperitoneal perforation of the appendix presenting as subcutaneous emphysema of the thigh. 372 Apr 59

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group.
Dis Colon Rectum 1986 Nov
PMID:Surgery for large bowel cancer in people aged 75 years and older. 376 88

Rubber band ligation of hemorrhoids has had a low incidence of complications until recently, when five deaths resulted from bacterial septicemia or toxemia. The case presented describes a severe soft-tissue infection following banding successfully treated with antibiotics, surgical debridement, and hyperbaric oxygen.
Dis Colon Rectum 1987 Feb
PMID:An unusual complication of rubber band ligation of hemorrhoids. 380 21

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


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