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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is generally thought that the fibrotic process associated with an "inflammatory" aneurysm abates with operative repair. This paper reports a patient in whom the inflammatory process was accelerated after surgery leading to the development of subacute small bowel obstruction and worsening urinary tract obstruction in the postoperative period. Graft sepsis was suspected but all cultures were negative and his condition deteriorated on broad-spectrum antibiotics. Steroid therapy, however, resulted in a prompt reversal of symptoms, signs and objective evidence of obstruction. The problems of investigation of peri-aneurysmal fibrosis and graft sepsis are discussed. Possible aetiological factors and the relationship between the "inflammatory" aneurysm and idiopathic retroperitoneal fibrosis are considered.
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PMID:The response of peri-aneurysmal fibrosis--the "inflammatory" aneurysm--to surgery and steroid therapy. 235 Dec 23

In 1974 total colectomy and ileoanal straight endorectal pull-through (ERPT) were first used at our institution for the definitive management of total colonic Hirschsprung's disease in infants and children. Early success with this operation encouraged us to use this procedure in children and adults with ulcerative colitis and familial polyposis in 1977. Since 1974 we have performed total colectomy and straight ileoanal ERPT on 100 consecutive patients with ulcerative colitis (79), familial polyposis (19), and total colonic Hirschsprung's disease (10). Patients who have undergone a colectomy and ERPT but have not had their temporary ileostomy closed have been excluded from this report. This group of patients represents the only large series of straight ERPTs available for comparison with the various reservoir modifications that have been reported. All operations were performed under the direction of the author. The mean age at surgery was 20.6 +/- 9.8 years, with a range of 1 to 48 years. Forty-six patients were younger than 18 years at the time of operation. All patients with ulcerative colitis and familial polyposis underwent a temporary loop ileostomy with total abdominal colectomy with ERPT; the 10 infants and children with Hirschsprung's disease underwent the total colectomy and ERPT without a back-up ileostomy. There were two deaths in this series, one from fulminate hepatic failure in the late postoperative period and the other from multiple bowel fistulas and sepsis in a teenager with Crohn's disease, in whom the initial diagnosis was ulcerative colitis. Follow-up has ranged from 3 months to 15 years. There were 13 cases of adhesive bowel obstruction, seven of which required an enterolysis. Pelvic sepsis occurred in three patients, two of whom required operative drainage. Two women developed rectovaginal fistulas, which healed with temporary diversion. Minor wound infections occurred in five patients. There were no anastomotic leaks, nor were any cases of pouchitis encountered. In five patients permanent conversion to a Brooke ileostomy was required. Mean stool frequency 3 years after surgery was 7.7 per 24 hours. Daytime continence was achieved in all patients. Occasional nocturnal soiling occurred in 11.1% of patients at 1 year and was absent by 3 years. Neither age nor diagnosis (ulcerative colitis versus familial polyposis) affected stool frequency.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults. 239 80

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS), a visceral myopathy causing intestinal obstruction in the newborn, is a generally fatal condition, with death being secondary either to sepsis or to malnutrition if long-term intravenous feeding is not provided. A patient with MMIHS is described who has been raised by total parenteral nutrition (TPN) for seven years since her birth. Severe hepatic dysfunction was encountered in early infancy, which gradually cleared after the initiation of milk feeding by mouth, although the milk could not be absorbed because of the high-output jejunostomy. The patient also experienced a bone disease similar to scurvy but caused by copper deficiency at the age of 9 months. The central venous catheter now in situ is the 25th one for the patient. When these catheters were evaluated, the Broviac proved more efficacious than the traditional Silastic for use in long-term TPN. The patient does not yet have normal bowel function and still requires TPN.
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PMID:Successful nutrition management of megacystis-microcolon-intestinal hypoperistalsis syndrome--a case report. 252 Mar 38

A 67-year-old woman with a 6-year history of angina pectoris underwent percutaneous transluminal coronary angioplasty. Just after manipulation of the guiding catheter during a second attempt at angioplasty and aortography, the patient developed intestinal obstruction with peritonitis. Laparotomy was performed, and surgical specimens taken during surgery revealed necrosis and perforation of the small intestine. Microscopical examination proved that this was the result of multiple fresh cholesterol emboli in the arteries. Postoperatively, renal failure and sepsis developed, and the patient died 13 days after surgery. Autopsy revealed multiple cholesterol emboli in arteries of the intestine, spleen, pancreas, liver and kidneys. This case demonstrates that cholesterol embolism can be a serious complication of percutaneous transluminal coronary angioplasty.
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PMID:An autopsy case of cholesterol embolism following percutaneous transluminal coronary angioplasty and aortography. 252 60

We designed a model of intestinal obstruction (IO) to study the histological alterations in the intestinal wall and the mesenteric lymph nodes (MLN). Therefore we used 32 Sprague-Dawley rats and under anesthesia a laparotomy was performed and the distal ileum was ligated with 3-0 silk, producing a complete occlusion. At different interval (24, 48, 72 and 96 hours) the animals were sacrificed by cervical dislocation and were histologically analyzed. At 24 hours post IO, congestion, edema and a inflammatory infiltrate were observed at the level of the lamina propia and the MLN were reactive. At 48 hours the congestion and edema increased and the intestinal mucosa began to fragment, allowing the bacteria to translocate and getting to the lymph nodes in the intestinal wall. The reactivity at the MLN increased. The observation of bacterial translocation in IO widen the scope of the alterations in this pathology, were not only absorption of toxic products and endotoxin occurs in the compromise segment and this phenomenon could explain the incidence of bacteremia and sepsis in the IO patients.
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PMID:[Factors involved in bacterial translocation in an experimental model of intestinal obstruction]. 253 59

The experience gained with restorative proctocolectomy and ileal reservoir in 60 patients is presented. Fifty-two patients had W reservoirs and the operative technique of the procedure is described in detail. Forty patients had a defunctioning ileostomy and 20 had a single stage procedure. There was no perioperative mortality. The main complications were sepsis (28 per cent), intestinal obstruction (18 per cent) and reservoir ileitis (20 per cent). There was a significant improvement in sepsis rate (from 20 to 4 per cent) and hospital stay (from 31.8 to 15.6 days) with increased experience. The functional results of 48 patients with W reservoirs was assessed. The mean number of evacuations per 24 h (+/- s.d.) was 3.8 +/- 0.2. Sixty-five per cent of patients did not evacuate at all, or rarely, at night and none evacuated more than once at night. Forty-four per cent of patients took antidiarrhoeal agents. Continence was normal in 50 per cent of patients. Minor leakage occurred in 46 per cent of cases, frequent leakage in 4 per cent and incontinence in none. Sexual function in 29 men was normal. Ninety-four per cent of patients considered the results of their operation to be good or excellent.
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PMID:Experience of restorative proctocolectomy with ileal reservoir. 253 30

The aim of this study was to compare the immediate postoperative results and the long-term outcome of ileal pouch-anal anastomosis in 94 patients with familial adenomatous polyposis to those in 758 patients with ulcerative colitis. Two colitis patients died after operation (0.3%), but no polyposis patients died. Overall operative complications appeared in 26% and 29% of polyposis and colitis patients, respectively (NS). Reoperation for intestinal obstruction did not differ between the two groups, but sepsis requiring reoperation was more common in colitis patients (6%) than in polyposis patients (0%, p less than 0.04). At follow-up (mean, 3 years), polyposis patients had fewer daytime stools (4.5 stools per day), less nighttime fecal spotting (26%), and less pouchitis (7%) than colitis patients (5.8 stools per day; spotting, 40%; pouchitis, 22%; p less than 0.002). The conclusion was that polyposis patients tolerated the operation better and had less long-term disability than did colitis patients. The data suggest that postoperative sepsis, daytime stooling frequency, nocturnal incontinence, and pouchitis may be, at least in part, disease related and not surgeon or operation related.
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PMID:Ileal pouch-anal anastomosis: comparison of results in familial adenomatous polyposis and chronic ulcerative colitis. 216 96

Thirty-six major abdominal operations were performed on 35 Acquired Immune Deficiency Syndrome (AIDS) patients (33 men, two women). Twenty-two elective operations were indicated for diagnosis of abdominal or retroperitoneal mass (6), incomplete bowel obstruction (5), intra-abdominal infection (4), biliary symptoms (3), thrombocytopenia (3), and toxic megacolon (1). Fourteen emergency operations were for perforated viscus or peritonitis (11), massive gastrointestinal bleeding (2), and cecal volvulus (1). In 5 of 22 (23%) elective operations AIDS was unknown to the treating physicians until diagnosed by the surgical pathology; in contrast, all 14 emergency operations were in patients who had a known diagnosis of AIDS. The operative findings were related to AIDS in 34 of 36 (94%) operations. Cytomegalovirus was the most common pathogen, isolated or identified microscopically in 11 patients (eight emergency and three elective operations). Mycobacterial infections presented as retroperitoneal adenopathy or splenic abscess in six patients. Non-Hodgkins lymphoma was the most common malignancy found, presenting as an abdominal mass (4), bowel obstruction (3), or with gastrointestinal bleeding (2). Kaposi's sarcoma was diagnosed at laparotomy in four patients. The 1-month operative mortality rate for elective operation was 9% (2 of 22) and 46% (6 of 13) in emergencies. Postoperative complications included 1 reoperation for sepsis caused by inadequately resected CMV colitis; 1 pancreatic fistula; 1 wound dehiscence, and 2 minor wound infections.
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PMID:Acquired immune deficiency syndrome (AIDS). Indications for abdominal surgery, pathology, and outcome. 255 44

In 126 consecutive patients operated on for carcinoma of the lower two-thirds of the rectum, a consistent policy of sphincter preservation resulted in 100 (79 per cent) having anterior resection and 22 (17 per cent) abdominoperineal resection. Perioperative complications in the anterior resection group were: death (two patients), clinical leakage (three patients), pulmonary embolism (five patients), pelvic haematoma (one patient), small bowel obstruction (one patient) and wound sepsis (six patients). Of 55 patients who had a potentially curative anterior resection with follow-up of at least 2 years, one developed local recurrence. Five per cent of patients had significant continence problems. Low anterior resection for carcinoma is associated with low perioperative morbidity, satisfactory functional results and acceptable local recurrence rates.
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PMID:Declining indications for abdominoperineal resection. 259 51

1. Widespread visceral and intestinal wall metastases are present in women dying with ovarian cancer. Intestinal wall invasion is commonly found at autopsy and is associated with bowel obstruction. Liver parenchymal replacement by metastases in more extensive than that in the lung, where most metastases have a subpleural location. Multifocality characterizes metastases in both of these organs. 2. Neoplastic lymphatic invasion is common. Lymphatic and blood vascular invasion are associated with an increased incidence of metastases in lymph nodes, small bowel wall, pancreas, lungs, ureter, and liver. 3. The mean survival time from diagnosis to death is less than 2 years. Both increasing neoplastic histological grade and clinical stage at diagnosis are associated with decreased survival time. 4. The most common causes of death are carcinomatosis, infection, or a combination of these processes. Sepsis, pneumonia, or both of these account for most of the fatal infections. 5. Bowel and ureteral obstruction constitute the most common forms of tumor-induced morbidity. The former process tends to be multifocal, involving the small and large intestines, and it is found during the disease course as well as at autopsy. Ureteral involvement is usually associated with hydronephrosis and is bilateral in approximately one fourth of the cases.
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PMID:The pathology and biologic behavior of ovarian cancer. An autopsy review. 265 34


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