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Query: UMLS:C0042961 (volvulus)
 4,305 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.
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PMID:[Hartmann's procedure. A retrospective study of 86 cases]. 144 49

The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy.
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PMID:Minimally invasive colon resection (laparoscopic colectomy). 168 89

Dilated colon is provoked by obstructing lesions, toxic megacolon or colonic pseudoobstruction. The obstructing lesions of the colon are colonic volvulus, inflammatory bowel disease with stenosis or colonic cancer. Toxic megacolon is more often caused by I.B.D. and rarely by infectious diseases. Etiological diagnosis is possible after clinical and radiological evaluation. Colonoscopy is always indicated, except in toxic megacolon. Balloon dilatation of strictures, palliative treatment of colonic carcinoma by Laser procedures, reduction of colonic volvulus and aspiration of colonic pseudoobstruction are the principal indications of therapeutic colonoscopy in the non surgical treatment of dilated colon.
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PMID:[Acute dilatation of the colon]. 179 37

The differential diagnosis of lower gastrointestinal bleeding in children can be reduced markedly simply by taking into account the age of the child. The clinical condition of the patient can further help narrow the diagnostic possibilities. Newborns and infants who are clinically unstable are more likely to have diseases such as necrotizing enterocolitis, volvulus, Hirschprung disease, intussusception, or Meckel diverticulum. A baby who appears healthy should be examined for swallowed blood, allergic colitis, anal fissures, or lymphonodular hyperplasia. An older child of healthy appearance with bleeding is likely to have a juvenile polyp or infectious colitis, but a child who appears sick may have hemolytic uremic syndrome, Henoch-Schoenlein purpura, or inflammatory bowel disease. This information, along with that gleaned from the physical examination, can lead the pediatrician to determine the need for specific tests, such as abdominal radiographs, stool cultures, and an endoscopic evaluation. We have come a long way in our ability to diagnose the causes of lower gastrointestinal bleeding. With the availability of newer radiographic and nuclear medicine modalities and the ability to visualize the colon endoscopically, the need for exploratory laparotomy for diagnosis is rarer. While surgery may still be the therapy of choice, new diagnostic modalities give the surgeon much more preoperative information.
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PMID:Lower gastrointestinal bleeding. 223 71

The expression of gastrointestinal cancer antigen, CA 19-9, and of carcinoma-associated antigen, CA-50, was studied in formalin-fixed and paraffin-embedded tissue from 18 patients with ulcerative colitis, 29 with Crohn's disease in the colon, four with diverticular disease, and eight with sigmoid volvulus. None of the patients with inflammatory bowel disease showed strong dysplasia or had manifest carcinoma. Both antigens were expressed frequently in patients with inflammatory bowel disease. Of the 18 patients with ulcerative colitis, 17 were positive for both CA 19-9 and CA-50, and of the 29 with Crohn's colitis, 21 were positive for CA 19-9 and 22 for CA-50. No distinct differences in antigenic expression were found between Crohn's disease and ulcerative colitis. CA-50 was expressed in normal colonic mucosa from 10 of 12 patients with sigmoid volvulus or diverticular disease, and such mucosa was positive for CA 19-9 in three of the four patients with diverticular disease and in two of the eight patients with sigmoid volvulus. It is concluded that immunodetection of CA-50 or CA 19-9 is of limited value in the differential diagnosis of inflammatory bowel disease. The usefulness of these antigens as markers for precancerous changes in inflammatory bowel disease is also doubtful, since the expression is also frequent in cases of inflammatory lesions, with no obviously increased risk of malignancy.
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PMID:Expression of the carcinoma-associated antigens CA 19-9 and CA-50 in inflammatory bowel disease. 347 29

The most common cause of colonic obstruction is adenocarcinoma, followed by diverticulitis, volvulus, and a variety of miscellaneous causes. Most signs and symptoms, from whatever cause, consist of abdominal pain with distention and the inability to pass flatus or stool. The clinical diagnosis is confirmed by x-ray studies. Plain films of the abdomen in various positions, chest films, and the addition of contrast studies verify the cause of the obstruction in most instances. The differentiation between neoplasm and diverticulitis causing the obstruction can be difficult or impossible at times, and may become apparent only after the obstruction begins to resolve with conservative management, or the cause is discovered at surgery. The history of previous abdominal or pelvic irradiation, surgery, and inflammatory bowel disease often causes difficulty in the differential diagnosis.
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PMID:The diagnosis of colonic obstruction. 711 69

In order to examine the presentation and course of Crohn's disease (CD) versus those of ulcerative colitis (UC) in children < or = 10 years of age, a retrospective review of children < or = 10 years old with inflammatory bowel disease singled out 40 patients and compared their findings with those of 38 children with UC. The mean age at onset was 7.5 years for CD, as compared with 5.9 years for UC. A family history of inflammatory bowel disease was present in 13 patients (32%). Abdominal pain (97%), diarrhea (78%), and weight loss (88%) were the major initial complaints, with growth retardation present in 12 (30%) children. At onset, four children had diffuse small-bowel disease, nine had terminal ileal disease, 15 had ileocolitis, and 12 had colitis; at the end of the study two had diffuse small-bowel disease, four had terminal ileal disease, 25 had ileocolitis, and seven had colitis. Extra-intestinal manifestations increased with duration of disease. Although the number of recurrences did not differ greatly between groups, those with ileocolitis and colitis needed longer steroid therapy and more days in hospital than did those with only small-bowel disease. Operation was required in 42.5% of children with CD, as compared with 5% of those with UC, with six CD children (35%) requiring later reoperation for recurrent disease or fistula and abscess. Two children died from causes unrelated to their disease (gastric volvulus, carcinoma of the breast).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Crohn's disease in children 10 years old and younger: comparison with ulcerative colitis. 857 7

The gastric dilatation-volvulus (GDV) syndrome in the dog is considered to be multifactorial. The medical records of 42 dogs treated for GDV between 1990 and 1994 were reviewed in an effort to evaluate the correlation between GDV and preexisting gastrointestinal disease. Twenty-three cases fit the inclusion criteria of an intestinal biopsy taken at the time of corrective surgery and a complete medical history. The microscopic jejunal changes expected from the acute vascular compromise in these animals were diffuse edema, dilatation of lymphatics with possible lymphangiectasia, mucosal degeneration, diapedesis of neutrophils, and rare hemorrhage. These changes were discounted. Of the 23 biopsies, 14 (61%) were consistent with the presence of an underlying inflammatory disease, and of these 14, 12 (86%) were accompanied by case histories of prior gastrointestinal disturbances. This study raises the possibility of an association between GDV and inflammatory bowel disease.
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PMID:Gastric dilatation-volvulus in the dog with histological evidence of preexisting inflammatory bowel disease: a retrospective study of 23 cases. 878 18

In some emergency situations of colo-rectal pathology, especially those characterized by hemorrhaging, the endoscopy has acquired, with the passing of years, a fundamental role both from the diagnostic and the therapeutic point of view. In no more than 25% of the lower intestinal tract hemorrhages, the clinical picture does have the signs of an emergency. The diverticula, IBD and angiodysplasias are primarily responsible for rendering these characteristics. Even when possible problems concerning an accurate intestinal cleaning can arise, a correct diagnosis is possible at least in seven cases out ten. When the colonoscopy isn't conclusive and the bleeding persists may be recommended the selective arteriography (helpful also in hemorrhages lower than 0.5 ml/min). Also in cases of acute obstructive syndrome the colonoscopy, taking advantage of the direct view of the lesion, can give a correct diagnosis, sometimes supported by the histologic examination. Regarding the operating capacity of the method, the endoscopy can resolve minute and localized bleeding lesions. The Argon or Nd:YAG laser photocoagulation is widely used. Recently BICAP and heater probe methods have been developed, which aveld the problem connected to the HF electrocoagulation. A very efficacious and simple method is that of injecting 1:10.000 adrenalin, 1% polidocanol, absolute ethanol or hypertonic solution around the lesion. The scarred strictures are those more easily and safely treated by pneumatic dilatation or (limited to the rectum-sigmoid) by Savary sounds. In the volvulus or bowel invagination, just by having the endoscope goes up in the lumen, often normal condition settles again. In the Ogilvie's syndrome you can deflate the cecum with an aspirator or more simply by positioning a tube above the hepatic flexure, with 85% success. In the malignant strictures the debulking of tumor mass by laser treatment, sometimes followed by dilatation, may be preparatory to the surgery or purely palliative. Finally the extraction of foreign bodies must be performed, in order to obtain a relaxed anal sphincter, in general anaesthesia or by a previous rigid rectoscope dilatation.
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PMID:[Emergencies in colorectal diseases: role of the endoscopist]. 892 30

The loss of small intestinal mucosal surface area is a relatively common clinical situation seen in both the pediatric and adult population. The most frequent causes include mesenteric ischemia, trauma, inflammatory bowel disease, necrotizing enterocolitis, and volvulus. Following surgical resection, the remnant intestine compensates or adapts to the loss of native bowel by increasing its absorptive surface area and functional capacity. Unfortunately, many patients fail to adapt adequately, and are relegated to lifelong intravenous nutrition. Research into intestinal adaptation following small bowel resection (SBR) has evolved only recently from the gross and microscopic level to the biochemical and genetic level. As understanding of this process has increased, numerous therapeutic strategies to augment adaptation have been proposed. Epidermal growth factor (EGF) is an endogenous peptide that is secreted into the gastrointestinal tract and able to influence gut ontogeny, as well as mucosal healing. Early studies have demonstrated its ability to augment the adaptive process. Focusing on a murine model of massive intestinal loss, the morphological, structural, biochemical, and genetic changes that occur during the intestinal adaptive process will be reviewed. The role of EGF and its receptor as critical mediators of the adaptive process will be discussed. Additionally, the ability of EGF to augment intestinal proliferation and diminish programmed cell death (apoptosis) following SBR will be examined. Enhancing adaptation in a controlled manner may allow patients to transition off parenteral nutrition to enteral feeding and, thereby, normalize their lifestyle.
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PMID:Epidermal growth factor is critical for intestinal adaptation following small bowel resection. 1105 64


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