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

Of two hundred patients undergoing proctocolectomy with ileal pouch-anal anastomosis, all but nine have had temporary diverting ileostomies. Of these nine patients, eight had successful results. One patient developed abdominal sepsis due to jejunal volvulus and perforation after she had returned home, and at surgery the pouch was excised. Ileal pouch-anal anastomosis without a temporary diverting ileostomy can be performed safely by surgeons experienced with this procedure in carefully selected patients.
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PMID:Ileal pouch-anal anastomosis without temporary, diverting ileostomy. 394 Aug 3

Six infants with short-gut syndrome refractory to medical management underwent isoperistaltic colon interposition (length 11.7 +/- 3.1 cm.). The abdominal catastrophes that required extensive intestinal resection were: volvulus (3), necrotizing enterocolitis (2), and gastroschisis with intestinal atresia (1). No infant had another major congenital anomaly. The average trial of attempted medical therapy prior to colon interposition was 5.5 +/- 3.6 months. There was no perioperative mortality or morbidity associated with the colon interposition. Following the colon interposition, three infants were weaned from total parenteral nutrition (TPN) in 3 +/- 1 months and all survived. In contrast, three infants could not be withdrawn from TPN and they died secondary to complications of TPN (2 from sepsis and 1 from hepatic failure). Long-term survival was associated with a greater length of small bowel remaining after the initial resection (51 +/- 12 cm v 35 +/- 24 cm), colon interposition at a younger age (3 +/- 1 months v 8 +/- 3.5 months), and a shorter duration of medical management prior to colon interposition (2.8 +/- 0.8 months v 6.7 +/- 5.0 months). All survivors are now tolerating a regular diet and having one to four formed stools per day. Normal somatic growth and developmental milestones are being achieved. The follow-up period is from 24 to 84 months. Our experience with the colon interposition in the patient with short gut syndrome has led us to conclude that when a reasonable trial of medical management has failed, a colon interposition is a safe and effective adjuvant to treatment.
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PMID:Colon interposition: an adjuvant operation for short-gut syndrome. 644 Sep 66

Cecal volvulus is a malrotational abnormality of the intestine that causes obstruction. Diagnosis is difficult and, if delayed, the results may be intestinal ischemia, perforation, sepsis, and even death. Cecal ischemia or gangrene cannot always be determined from physical and laboratory findings. Although not always conclusive, contrast radiography may be helpful; however, laparotomy is often required for definitive diagnosis and therapy. If vascular compromise of the cecum is found, right hemicolectomy is the treatment of choice. In the absence of ischemia, decompressive tube cecostomy, simple detorsion, and cecopexy have all been recommended, but the optimal treatment is a matter of controversy.
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PMID:Cecal volvulus: A diagnostic and therapeutic challenge. 710 10

Sepsis secondary to bacterial translocation is common in infants with short bowel syndrome (SBS). Although early feeding is advocated to enhance adaptation in SBS, the effects of feeding on sepsis in SBS patients have not been examined. Twenty-one infants and children (aged 2 months to 3 years) with SBS (< 80 cm small bowel length) from a variety of causes (15 necrotizing enterocolitis, 2 atresia, 2 gastroschisis, 2 volvulus) had follow-up prospectively for septic episodes before and after feedings were initiated, while still receiving total parenteral nutrition. The incidence and number of septic episodes and microbiology (blood cultures) were tabulated and compared with those of 20 patients with similar ages, and diagnoses without SBS. Statistically significant differences among infants with SBS were noted with respect to sepsis incidence (6 of 21 [29%] NPO v 16 of 21 [76%] feeding) number of septic episodes (1.3 +/- .2 NPO v 4.2 +/- .4 feeding), and presence of gram-negative rods causing bacteremia (1 of 6 [17%] NPO v 13 of 16 [81%] feeding) (all: P < .05). There were similar differences between SBS and non-SBS infants. These data show that enteral feeding increases the incidence and number of episodes of sepsis in SBS infants, but not in matched non-SBS patients. The predominance of gram-negative organisms in sepsis in SBS suggests increased gut bacterial translocation in these patients, implying that selective gut decontamination may reduce the episodes of bacteremia.
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PMID:Enteral feeding increases sepsis in infants with short bowel syndrome. 747 38

There exists great variability in the literature as to the percentage of cases of sudden and unexpected infant death in which definable causes can be identified. Review was undertaken of the clinical and family histories, death scene features including parental interviews, and pathological and microbiological features of 361 consecutive cases presenting as sudden and unexpected infant death with minimal preceding symptoms and signs to the Adelaide Children's Hospital over a 10-year period from 1983 to 1992. Three hundred and twenty-nine cases of SIDS were identified. Nine cases (2.5%) were attributed to accidental asphyxia based partly on death scene examination. This left only 23 cases (6.4%), which were due to a variety of other diverse entities including sepsis, volvulus with sepsis, congenital cardiac disease, probable metabolic disorders, heat stroke, and unclassifiable disorders. This relatively low figure lends support to definitions of SIDS that emphasize the importance of death scene investigation and clinical history review prior to postmortem examination.
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PMID:How useful is postmortem examination in sudden infant death syndrome? 780 80

In this retrospective study carried out covering the period, 1978-1991, 62 neonates were seen, diagnosed and treated for intestinal atresia which included: duodenal atresia and stenosis, small bowel atresia and atresia of large bowel. Locations of obstruction were duodenal in 17 patients, jejunal in 25 patients, jejuno-ileal in 5 and colon in two. Duodenal atresia was noted in 9 infants and duodenal stenosis due to annular pancreas, Ladd's bands with malrotation of bowel in 8. Associated anomalies which were observed were anorectal malformations in 2 and malrotation in 2 infants. Birth weights ranged from 1450 gm to 3000 gm. Prematurity was recorded in 11 infants. Diagnosis of intestinal atresia in our patients was made clinically and radiologically. Intestinal atresia in neonates was differentiated from other causes of obstruction such as Meconium Ileus, Hirschsprung's disease, neonatal volvulus, rectal atresia in anorectal malformations. Treatment of infants with intestinal atresia was surgical. Surgical techniques used depended on pathological findings. In 36 patients, complications such as functional obstructions with vomiting and failure to thrive, malabsorption, aspiration, bronchopneumonia, sepsis were observed. Overall mortality rate in our cases was 25 (41.9%) out of 62 patients.
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PMID:Intestinal atresia and stenosis as seen and treated at Kenyatta National Hospital, Nairobi. 818 36

The results of 37 consecutive cases of Hartmann's procedure over a 5-year period (1985-1990) were reviewed. The series consisted of 27 emergency procedures (11 diverticular disease, 13 carcinoma, two trauma and one sigmoid volvulus) and ten elective procedures (nine carcinoma and one peridiverticular abscess). The indications for emergency procedures were obstruction and perforation. All patients presented with faecal peritonitis owing to colonic perforation. The mean (range) age was 79.4 (34-90) years. The postoperative mortality rate was 30 per cent overall (11 of 37), 33 per cent (four of 12) in the diverticulitis group, 23 per cent (five of 22) in the carcinoma group, and 100 per cent in the iatrogenic trauma group. Death was mainly due to sepsis (82 per cent). Postoperative complications were mainly wound infections, which occurred in 43 per cent (16 of 37) cases. In 25 per cent of the surviving patients, re-establishment of continuity was performed in three of 17 (18 per cent) of the carcinoma group and three of seven (43 per cent) of the diverticulitis group. No attempt at restoration of intestinal continuity was made in six cases due to medical risk in two, extensive carcinoma in two and local recurrence with metastatic disease in two. Three patients refused all further intervention. There were no postoperative deaths after the restoration of continuity. This series reflects the severity of the pathology in this high risk group of patients. However, the operation can be life-saving for a selected group of patients and offers good palliation for advanced colorectal tumours.
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PMID:The Hartmann procedure revisited. 823 29

Cholestatic jaundice is the major complication of total parenteral nutrition (TPN) in infants and children. The pathogenesis of this syndrome is poorly understood. The aims of this study were: (1) to define the histologic liver injury in relation to the clinical course of infants on TPN and (2) to determine whether enteral feeding will reverse or halt these changes. We identified 31 infants treated for severe gastrointestinal disease for whom liver histology was available from 1987 to 1991. Clinical records and liver biopsy (23) or autopsy specimens (13) were reviewed. Five patients had biopsies at two subsequent operations. The clinical diagnosis was necrotizing enterocolitis (24), atresia or stenosis (3), midgut volvulus (2), Hirschsprung's disease (1), and sepsis (1). Twenty-one of 31 infants were premature and had a mean birth weight of 1,868 g. Twenty-five of 31 were on TPN and 28 of 31 had received some enteral feeding by the time of the biopsy. Enteral feeding was begun as early as possible in all infants even if continued TPN was necessary for full support. Cholestasis occurred in 71% of premature infants versus 22% of full-term babies. Infants with cholestasis had been on TPN for a longer time (37 days v 18) with a correspondingly shorter period of enteral feeding (17 days v 27). Mean total bilirubin level was 14 in patients with cholestasis and 5 in those without, but the bilirubin level did not correlate with the extent of histological injury and was frequently normal despite marked histological damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total parenteral nutrition-associated cholestasis: clinical and histopathologic correlation. 826 85

Malrotation of the intestinal tract is a product of a well defined aberrant embryology. Because the consequences of malrotation associated with a midgut volvulus may be catastrophic, an understanding of the anatomy, diagnostic criteria, and appropriate therapy for this putative emergency illness is imperative. This report summarizes a recent 18-month experience with this diagnosis and contrasts this experience with that in the published literature. More than half (14/22) of the patients presented during the first month of life, and all had vomiting, which in most cases was bilious. The barium upper gastrointestinal series was the preferred diagnostic study, being both sensitive (18/19, 95%) and accurate (18/21, 86%). In this series two-thirds of the patients presented with volvulus (15/22, 68%) of whom five had ischemic intestine requiring resection. One of these children died of overwhelming sepsis. A Ladd procedure was the preferred treatment, which as defined by us includes evisceration and inspection of the mesenteric root, counterclockwise derotation of a midgut volvulus, lysis of Ladd's bands with straightening of the duodenum along the right abdominal gutter, inversion-ligation appendectomy, and placement of the cecum into the left lower quadrant. A high index of suspicion in the neonate with vomiting, rapid diagnosis, and appropriate operative therapy results in a predictable favorable outcome for children with intestinal malrotation.
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PMID:Malrotation of the intestine. 833 78

While small-bowel transplantation remains an option for the management of short-bowel syndrome (SBS), every effort must be made to optimize the function of the native bowel. This report describes a patient with SBS who dramatically improved after a Bianchi procedure. The patient was born with type IIIb jejunal atresia, complicated by volvulus of the terminal ileum. He was left with 40 cm of small bowel and his ileocecal valve. During the first 20 months of his life, he was always hospitalized except for 3 months. He was on parenteral nutrition (TPN) and suffered multiple episodes of central line sepsis. Massive small-bowel dilatation caused a functional bowel obstruction with bacterial overgrowth, and villous atrophy of the jejunal mucosa was discovered on biopsies done by colonoscopy. In March 1994, we elected to proceed with a Bianchi procedure. Thirty cm of jejunum were divided longitudinally. During the following year, his enteral tolerance steadily improved to the point where TPN could be discontinued. We conclude that pediatric surgeons should not hesitate to use this procedure in the management of SBS.
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PMID:The Bianchi procedure in a patient with jejunal atresia. 949 89


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