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

Patients with anastomoses at the anorectal ring, with or without anastomotic dehiscence, may develop large presacral collections. Such collections often drain poorly through the anastomosis, leading to chronic sepsis. A novel method of widely draining such collections by "marsupialization" into the bowel lumen with use of an endoscopic stapler inserted transanally is described.
Dis Colon Rectum 1999 Feb
PMID:Marsupialization of presacral collections with use of an endoscopic stapler. 1021 6

We present a case of life-threatening retroperitoneal sepsis after injection sclerotherapy for first-degree hemorrhoids.
Dis Colon Rectum 1999 Mar
PMID:Life-threatening retroperitoneal sepsis after hemorrhoid injection sclerotherapy: report of a case. 1022 67

The use of mesh repairs in parastomal hernias has recently been the subject of controversy. We describe a modified Thorlakson technique that incorporates an incomplete circumferential mesh to reinforce the fascial repair. In this preliminary report five cases have been operated on without any serious complications. A comprehensive literature review found that a total of 72 cases have been reported by various authors. Failure rates caused by recurrence or mesh-related sepsis amounted to 8.3 percent. In comparison with results for stoma relocations and nonprosthetic in-situ fascial repairs, mesh repairs have the lowest recurrence rates.
Dis Colon Rectum 1999 Nov
PMID:Parastomal hernia repair: modified thorlakson technique, reinforced by polypropylene mesh. 1056 44

Aim of this study has been to evaluate retrospectively morbidity and mortality of 42 colon substitutions after resection for esophageal cancer. Colon substitution was the intervention of first choice in six patients. In the other patients the stomach was useless, because of previous gastric surgery (n = 14), of gastric involvement by the tumor (n = 21) or technical problem (n = 1). Patients have been separated in 2 groups: from 1969 to 1983 (group A, n = 22), and from 1983 to 1997 (group B, n = 20). Mortality and morbidity (all eventful postoperative course) have been collected for the 30 postoperative days. Total morbidity has been 57% as 77% in group A and 35% in group B (p < 0.05). Cervical and colo-colic leak have been the most common complications. Total mortality has been 14% as 22% in group A and 5% in group B (p < 0.1). In group A 3 patients died from anastomosis leak (intrathoracic or intraabdominal) and 2 from medical complications. In group B 1 patient died from unexplained sepsis. Our results show significative decrease of morbidity and mortality in group B. These results can be compared to those of gastroplasty for cancer or coloplasty for benign disease. In cancer of the esophagus, if stomach can not be used as substitutes, colon substitution is the best alternative, which can be used without increase of mortality and morbidity.
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PMID:[Coloplasty after esophagectomy in cancer. A retrospective study of morbidity and mortality]. 1063 31

Stapled hemorrhoidectomy (mucosectomy) is a new technique that has recently been introduced for the treatment of third-degree and fourth-degree hemorrhoids and rectal mucosal prolapse. We present a case of severe retroperitoneal sepsis complicating stapled hemorrhoidectomy that was successfully treated by conservative means, further surgery therefore being avoided. The literature on the more serious complications associated with stapled hemorrhoidectomy is reviewed.
Dis Colon Rectum 2002 Jun
PMID:Retroperitoneal sepsis complicating stapled hemorrhoidectomy: report of a case and review of the literature. 1207 37

Although mucosal plication for rectal prolapse, known as the Gant-Miwa procedure, is described in some English textbooks, it has been infrequently performed in the West. However, this procedure has been used and developed in conjunction with anal encircling in Japan since the 1960s and is still considered to play a major role in the treatment of rectal prolapse. Certain technical details have been found necessary to ensure the success of the procedure, especially in the technique of anal encircling. For example, the use of Teflon tape and routing relatively deeply and outside the external anal sphincter are necessary. Clinical results show a recurrence rate of 0 to 31 percent with no mortality and almost never any serious complications such as significant bleeding or severe sepsis, which are occasionally encountered in other perineal procedures. Most patients report improved continence after this procedure, and worsening of evacuation is rarely encountered based on our experience. Some physiologic studies have shown improved resting pressure and rectal sensation, which can have a positive influence on the defecatory function. We believe that the Gant-Miwa procedure with anal encircling should be considered as a treatment of choice among perineal procedures for rectal prolapse.
Dis Colon Rectum 2003 Oct
PMID:Mucosal plication (Gant-Miwa procedure) with anal encircling for rectal prolapse--a review of the Japanese experience. 1453 Jun 65

Colon ascendens stent peritonitis (CASP) and cecal ligation and puncture (CLP), two animal models designed to closely mimic the clinical course of intra-abdominal sepsis, were compared. In the past, immunomodulatory therapies developed in animal studies failed to be successful in humans. As a consequence, the established animal sepsis models were criticized. It has been proposed that present models had to be reevaluated, and new, clinically more relevant models should be evolved. CLP procedure was performed puncturing once (CLP[1]) or twice (CLP[2]) the ligated cecum of C57BL/6 mice. In the CASP model, a stent with defined diameter was surgically inserted into the ascending colon. Survival, bacterial load, immunohistochemistry, and serum cytokine levels were analyzed in the groups. Survival after CASP procedure correlated strongly with the stent diameter, whereas the number of punctures in CLP did not significantly change survival rate. Bacterial loads of peritoneal lavage, liver, and lung, as well as serum cytokine levels (tumor necrosis factor, interleukin 1 beta, interleukin 10) steadily increased from 6 to 24 h after the CASP procedure. In contrast, continuously low amounts of bacteria and cytokines were found in CLP mice at any point of time. Twenty-four hours after CLP surgery, the ligated cecum was covered by adhesive small bowel loops, whereas in CASP mice, the intestinal leakage was then still present. The CASP model mimics closely the clinical course of diffuse peritonitis with early and steadily increasing systemic infection and inflammation (systemic inflammatory response syndrome). In contrast, CLP reveals a model of intra-abdominal abscess formation with sustained and minor signs of systemic inflammation.
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PMID:Cecal ligation and puncture versus colon ascendens stent peritonitis: two distinct animal models for polymicrobial sepsis. 1516 78

Anterior sacral meningocele is a rare anomaly most frequently presenting as a presacral mass. Since the first description in 1837, approximately 150 cases have been reported. The case presented is a 37-year-old female in whom an asymptomatic presacral mass was discovered during her first delivery. Because normal delivery was impossible, a cesarean section was performed. A year later, in a regional hospital a "cystic presacral tumor" was treated with biopsy and drainage. Four years later, she developed constipation caused by perineal compression for which she was admitted to our department in which two anterior presacral cysts were excised. The recovery was complicated with meningitis, which was successfully treated with antibiotics. Whenever a presacral mass is found, anterior sacral meningocele has to be a diagnostic consideration. The symptoms are usually related to the compression on rectum, bladder, and sacral nervous plexus. Rectal examination and radiography of the pelvis with the sacral bone showing the "scimitar sign" are the main diagnostic methods. Myelography, computed tomography, and magnetic resonance imaging are the best methods for identifying the precise anatomy of sacral meningocele and for proper planning of the operation. Transvaginal or transrectal aspiration and drainage are not advised, because they may result in a lethal outcome caused by sepsis.
Dis Colon Rectum 2004 Nov
PMID:Anterior sacral meningocele with presacral cysts: report of a case. 1562 92

Clinically significant anastomotic strictures usually only occur with very low colorectal anastomoses below the level of the peritoneal reflection. The reported rate averages 8 percent and has been attributed to tissue ischemia, localized sepsis, anastomotic leak, proximal fecal diversion, radiation injury, inflammatory bowel disease, and recurrent rectal cancer. Most patients will have symptoms of obstipation, frequent small bowel movements, and bloating. Symptomatic strictures are often approached by dilation (balloon or Hegar) or less often repeat resection. Many of these patients have anastomoses that are too low to consider repeat resection. Strictureplasty with linear stapling devices, stricture resection by use of the circular stapling device, and repeat dilations have all been described. Steroid injections into the stricture have been described in strictured esophagogastric anastomoses but have not been commonly used for strictured coloproctostomies. We describe three cases of coloanal stricture following resections that were complicated by postoperative pelvic abcesses, anastomatic leaks, and pelvic fibrosis. Two cases had undergone low coloanal anastomosis that was protected by a loop ileostomy and developed as significant stricture in the early postoperative period. The third case was managed without a protective loop ileostomy. These were initially managed by repeated dilation of the anastomosis. Each episode was followed by rapid recurrence of the stricture. All patients underwent subsequent dilation with injection of 40 mg of triamcinolone acetate (divided dose in four quadrants) into the stricture and subsequent complete resolution of the stricture. Those patients with loop ileostomies had them taken down and all have been followed for up to 12 months without clinical or endoscopic evidence of recurrent stricture.
Dis Colon Rectum 2005 Apr
PMID:The strictured anastomosis: successful treatment by corticosteroid injections--report of three cases and review of the literature. 1574 75

Abdominal sepsis due to secondary fecal peritonitis following anastomosis insufficiency is a rare but life threatening complication of colorectal surgery. The induction of IFN-gamma by IL-12 is believed to play a key role in sepsis as it promotes antibacterial effector mechanisms such as oxidative burst or nitric oxide induction. The impact of gene deficiency for IL-12 (IL-12p40 KO), oxidative burst (p47(phox) KO), or NO induction (iNOS KO) on the outcome of fecal peritonitis was characterized using the murine Colon Ascendens Stent Peritonitis model (CASP). In the IL-12p40 KO model, 3 and 12 h after surgery, serum cytokine levels of IL-1beta, TNF, IL-18, and IL-10 were analyzed. Expression of IL-1beta, IL-10, IP-10, and MIP-1alpha was measured in lung and liver by RNAse Protection Assay. IL-12p40 and iNOS-deficient mice exhibited a significantly higher susceptibility to CASP as compared to the controls, whereas no significant difference was observed in p47(phox) KO mice. Absence of IL-12 resulted in delayed expression of proinflammatory cytokines and chemokines in both the liver and the lung, and was associated with significant reduction of IL-1beta levels in the serum 12 h after CASP. IL-12 and iNOS possess protective functions in fecal murine peritonitis. Surprisingly, no significant contribution of oxidative burst to the immune response was observed. Overall, these findings suggest that IL-12 deficiency causes a profound delay of the immune response after polymicrobial challenge resulting in significantly increased susceptibility in the CASP model.
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PMID:Impact of interleukin-12, oxidative burst, and iNOS on the survival of murine fecal peritonitis. 1575 96


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