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

Seven cases of gastrointestinal bleeding originating from peripancreatic blood vessels seen between 1977 and 1982 are presented. The bleeding originated either from true aneurysms, formed when the pancreatic inflammatory processes weaken the walls of peripancreatic blood vessels, from pseudoaneurysms which occurred after vascular leakage into pancreatic pseudocyst, or from veins. Gastrointestinal bleeding occurs when these entities rupture into gastrointestinal viscera. Hemorrhage of this nature must be considered in the clinical setting of patients who have a history of alcoholism, chronic relapsing pancreatitis, and known pseudocysts. Endoscopy, bleeding scans, and barium contrast studies are only occasionally helpful in diagnosis. Selective visceral angiography during acute hemorrhage is often diagnostic and concomitant arterial embolization techniques may offer a temporizing or permanent modality for hemostasis. This technique may be especially useful in the unstable, acutely ill patient with alcoholic hepatitis, sepsis, or an immature pseudocyst who poses a poor operative risk.
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PMID:Major gastrointestinal hemorrhage from peripancreatic blood vessels in pancreatitis. Treatment by embolotherapy. 660 4

A new inherited neuromuscular disease was identified in 4 patients (1 male, 3 females), offspring of consanguineous marriages, belonging to the same kindred. The proband was a 24-year-old female with history of ptosis and ophthalmoplegia since childhood and progressive intestinal pseudo-obstruction for the last 4 years of her life. A sural nerve biopsy showed axonal and demyelinating neuropathy. Muscle biopsies of pectoral and gastrocnemius revealed myopathic alterations with marked variation in muscle fiber size, atrophy of both fiber types and normal mitochondria. An upper gastrointestinal study showed barium in the stomach after 8 h and jejunal diverticula. Tests for absorption of fat, protein, carbohydrate, folic acid and vitamin B12 were normal. Serum levels of vitamin A and lipoproteins were also normal. The patient underwent partial gastrectomy and gastrojejunostomy. Postoperatively, she developed severe pancreatitis, sepsis, peritonitis and expired. Tissue samples from the proband and from her brother, revealed normal mucosa, but degeneration of smooth muscle of the stomach and small intestine. The myenteric plexus and vagus nerves were normal. The biochemical studies of contractile proteins (myosin, actin, tropomyosin) in the fresh and cultured smooth muscle cells of the proband obtained at the time of gastrectomy showed a 50-75% decrease in the synthesis of different contractile proteins. Turnover of contractile proteins and synthesis and turnover of collagen showed normal values. The reduction in synthesis of contractile proteins may account for the weak peristalsis and be a factor in the pathogenesis of the intestinal pseudo-obstruction.
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PMID:Inherited ophthalmoplegia with intestinal pseudo-obstruction. 668 98

Three patients with Boerhaave syndrome were successfully managed with nonoperative treatment. The diagnosis was delayed 5 days in one patient and 10 days in the other two. None of the patients appeared septic. Their conditions had been misdiagnosed as myocardial infarction, pneumonia and pulmonary embolism. Treatment consisted of intravenous hyperalimentation and administration of antacids and antibiotics. Cimetidine was also used in one patient. Two patients were discharged 14 days after diagnosis and the third on the 20th hospital day. Follow-up barium swallows showed complete healing in 2 months in all three patients. Conservative management of spontaneous esophageal perforation is feasible when (1) the perforation is already 5 days old, (2) there are no signs of severe sepsis, (3) esophageal barium study shows a wide-mouthed cavity draining freely back into the esophagus, and (4) the pleural space is not contaminated. When the diagnosis is made promptly, surgical therapy remains the treatment of choice, and patients managed conservatively who show signs of sepsis should be operated on without hesitation. Follow-up esophageal evaluation should be performed to confirm complete healing and to evaluate underlying disease.
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PMID:Boerhaave syndrome. Successful conservative management in three patients with late presentation. 678 84

A satisfactory bowel preparation is essential for adequate double contrast barium enema and colonoscopy. Efficient preparation is also important for reducing the risk of anastomotic dehiscence and sepsis in elective colorectal surgery. Traditional preparation by starvation, purgation and enemas is time consuming, unpleasant for patients, and in our experience results in a satisfactory preparation in only 23% of patients. Elemental diets are inefficient when used for only five days. Whole bowel irrigation with a nasogastric tube enables patients to be in hospital for only one day before operation and provides a satisfactory result in 61% of patients. Whole bowel irrigation is not recommended for stenosing tumours. Irrigation with saline causes sodium and water retention and the use of a balanced electrolyte solution (eg, Ringer's lactate) reduces the risk of these side effects. Oral mannitol has become popular but in our experience results in a satisfactory preparation in only 41% of patients. Mannitol is fermented by E coli to potentially explosive gas mixtures unless oral antimicrobials (neomycin and metronidazole) are used immediately before operation. Polyethylene glycol also causes osmotic catharsis without the risk of explosion. We currently favour nasogastric irrigation with polyethylene glycol and a balanced electrolyte solution, but there is still a place for traditional preparation over five days for patients with stenosing tumours of the left colon.
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PMID:Indications and techniques for bowel preparation in colorectal cancer. 687 84

Six patients with Clostridium septicum sepsis seen at Duke University Medical Center over a two-year period also had other abnormalities, consisting of hematologic disorders in 3 and colon tumors in 3. Three patients died of sepsis; 2 survived following disarticulation of the arm to control gas gangrene, while the sixth patient survived the sepsis but died of metastatic disease. When anaerobic cultures are positive for C. septicum, antibiotics should be given immediately. The high incidence of underlying colon tumor, especially in the cecum, should prompt consideration of a barium-enema examination.
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PMID:Clostridium septicum infection associated with colonic carcinoma and hematologic abnormality. 693 62

During a 20 year period at the Johns Hopkins Medical Institutions, 17 patients were operated on for secondary aortoenteric fistula. The interval from initial operation to the onset of symptoms varied greatly and averaged 2.8 years. Symptoms included not only gastrointestinal bleeding but also sepsis and abdominal or back pain. Associated advanced cardiovascular disease was common. Helpful preoperative diagnostic studies included esophagogastroduodenoscopy, aortography, barium contrast gastrointestinal series and groin sinography. However, a high index of suspicion was the most important element of diagnosis. Overall operative mortality was high (47 percent). All six patients with a graft left in the retroperitoneum had an unsatisfactory result (four instances of recurrent aortoenteric fistula). Successful repair was accomplished only in those patients undergoing graft excision and axillofemoral bypass.
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PMID:Secondary aortoenteric fistula. A 20 year experience. 697 90

Sixteen patients underwent a modification of the Sugiura procedure for bleeding esophageal varices, involving (a) esophageal transection, (b) splenectomy, (c) selective vagotomy, and (d) pyloroplasty. Five patients died, and the remaining 11 had barium studies of the esophagus and stomach which were compared with the preoperative appearance. Esophageal varices disappeared in 7 patients and persisted in 1. No recurrent bleeding or encephalopathy was seen: however, there were a large number of complications, including pleural effusion, ascites, ileus, pneumonia, and renal failure. Hepatic failure, respiratory failure, and sepsis secondary to gastrointestinal leakage also occurred and were fatal in all cases. As the Sugiura procedure is increasingly being employed in the United States, radiologists should be familiar with the spectrum of postoperative radiographic findings in the esophagus and stomach.
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PMID:Radiographic findings in the esophagus following the Sugiura procedure. 697 61

Resection of the rectosigmoid colon with anastomosis below the peritoneal reflection carries appreciable mortality and morbidity rates particularly because of leakage and resulting sepsis, Protecting the anastomosis with a transverse colostomy does not prevent this complication although it does reduce the catastrophic sequelae that often occur. Anastomotic leakage rates have been reported to be as high as 69% and fecal fistula rates as high as 27% following this type of surgery. A pelvic. A pelvic hematoma may act as a culture medium should sepsis occur and may interfere with anastomotic healing. A method of removing accumulated blood and serum from the pelvis following low anterior resection has been employed with the aim of reducing anastomotic leakage, and a 10-year experience has been compiled. Sixty consecutive patients were studied from July 1970 to June 1980. All underwent barium enema examination and/or proctosigmoidoscopy following low anterior resection with concomitant or previous transverse colostomy. There were four subclinical leaks seen at 6 weeks for an incidence of 6.8%. All resolved spontaneously within 6 additional weeks. No fecal fistulas or pelvic abscesses were encountered. Contaminated blood and serum are significant contributing factors to low anterior anastomotic breakdown. By removing such material before it can become infected, this complication can be significantly reduced.
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PMID:Value of pelvic suction-irrigation in reducing morbidity of low anterior resection of the rectum--a ten-year experience. 703 57

Esophageal perforation can be caused by any instrument, device, or foreign body reaching the hypopharynx. Diagnosis remains difficult. If esophageal perforation is suspected, Gastrografin (meglucamine diatrizoate) swallow study, eventually followed by barium swallow study, is the most useful diagnostic test. Absolute rules cannot be made about the selection of nonoperative or surgical treatment. If diagnosed early, cervical or thoracic esophageal perforations can sometimes be treated conservatively if there are no signs of systemic sepsis. Recurrent leakage after surgical closure is not unusual. Local tissue flaps can reinforce the closure, particularly after delayed operation, thereby often avoiding the necessity for a reoperation or an esophageal exclusion.
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PMID:Esophageal perforation. 703 37

Our patient, who was known to have multiple myeloma, presented with weight loss, rectal bleeding, and a barium enema study suggestive of a colitis with a mass lesion. Colonoscopy with biopsy revealed the mass to be large mucosal folds infiltrated with amyloidosis. Amyloidosis has been reported to mimick malignancy, mainly by tumorous deposits in the stomach and less commonly in the small and large bowels. Gastrointestinal surgery in patients with amyloidosis potentially may have undesirable consequences due to failure of anastomotic suture lines and subsequent sepsis (6, 11, 17, 18). The knowledge that amyloidosis may be associated with multiple myeloma and an appreciation of the wide range of gastrointestinal roentgenographic findings in patients with amyloidosis should prompt the clinician to obtain endoscopic and biopsy evaluation of these patients.
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PMID:Amyloidosis masquerading as inflammatory bowel disease with a mass lesion simulating a malignancy. 708 Nov 72


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