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

Sigmoid diverticulitis with perforation and generalized peritonitis is a grave complication of diverticular disease. To compare accurately the results of two operative approaches--proximal colostomy with drainage and proximal colostomy with resection or exteriorization--the authors assessed the clinical and pathologic features of 121 consecutive patients with perforating sigmoid diverticulitis. There were no differences between treatment groups in age, sex, mean duration of symptoms, clinical presentation, number of coexistent diseases, type of peritonitis or chronic corticosteroid use. Overall mortality for emergency operation was 12 percent. Mortality was significantly greater (P less than 0.05) among the 31 patients treated by colostomy and drainage (26 percent) than among the 90 patients treated by colostomy and resection or exteriorization (7 percent). Seven of the nine patients who died from persistent sepsis had undergone colostomy and drainage. Four clinical factors were found to be predictive of mortality (P less than 0.05): persistent postoperative sepsis, fecal peritonitis, preoperative hypotension, and prolonged duration of symptoms. These factors identified a subgroup of patients who, because of an increased risk of death, would be likely to benefit from the more complete eradication of the septic focus that is achieved by colostomy and resection.
Dis Colon Rectum 1985 Feb
PMID:Sigmoid diverticulitis with perforation and generalized peritonitis. 397 9

Colouterine fistula complicating diverticulitis is rare. Our experience with two patients, one with chronic vaginal discharge and the other with acute overwhelming sepsis, emphasizes the wide spectrum of clinical presentations that may accompany this entity. In patients with chronic symptoms, surgery is indicated to forestall further local infectious complications, and a single-stage sigmoid resection without hysterectomy may be adequate. If malignancy cannot be excluded, a single-stage en bloc resection of the uterus and colon is the procedure of choice. Hysterectomy may also be mandatory to extirpate a nidus of acute infection. When severe local inflammation or obstruction mandate urgent operation, a two-stage procedure involving resection and end colostomy, followed by reanastomosis at a later time, is safest and most effective.
Dis Colon Rectum 1985 May
PMID:Colouterine fistula secondary to diverticulitis. 399 53

This is the report of a patient with gangrene of the skin and subcutaneous tissue of the scrotum and base of the penis secondary to diverticulitis of the sigmoid colon. Due to high mortality in such patients, the early, rapid, and radical debridement of all devitalized tissues and prompt recognition of the source of sepsis is of utmost importance. Computed tomography (CT) scanning facilitates delineating the extent of disease. Anatomy of the perineal body and pathways of spread are discussed.
Dis Colon Rectum 1985 Jul
PMID:Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread. 401 14

Sixteen selected patients with rectal procidentia, anal incontinence, or both were treated by the insertion of a Dacron impregnated Silastic sling at the Lahey Clinic between 1981 and 1984. The indications for operation were incontinence in 14 patients, procidentia with incontinence in one patient, and procidentia alone in one patient. No operative deaths occurred. Immediate complications included urinary retention in the three patients and hematoma in one patient. Late complications included infection, requiring removal of the Silastic sling in four patients; however, two of these patients underwent subsequent successful reinsertion of the sling after control of local sepsis. Among patients for whom follow-up data were available, satisfaction with the results of this procedure were excellent in two patients, good in six, fair in two, and poor in one. Sphincter repair with a Silastic sling is a safe, reliable alternative in the treatment of selected patients with anal incontinence or rectal procidentia.
Dis Colon Rectum 1985 Nov
PMID:Sphincter repair with a Silastic sling for anal incontinence and rectal procidentia. 405 2

Colonic necrosis is a rare complication of peripancreatic sepsis following acute pancreatitis. Three patients with colonic necrosis associated with extensive retroperitoneal suppuration are reported. The pathogenesis of this syndrome may be explained by the tendency of pancreatic abscesses to extend widely in the retroperitoneum. Management is discussed, emphasizing the need for an aggressive surgical approach and multiple operations.
Dis Colon Rectum 1985 Dec
PMID:Colonic necrosis in acute pancreatitis. A complication of massive retroperitoneal suppuration. 406 56

In a prospective randomized clinical trial, 103 patients undergoing elective colorectal surgery received either cefoxitin or a combination of metronidazole and gentamicin. Six of 52 patients in the cefoxitin group (11.5 per cent) and six of 48 patients in the metronidazole/gentamicin group (12.5 per cent) developed serious wound infections. Two patients (3.8 per cent) in the cefoxitin group and one patient (2.1 per cent) in the metronidazole/gentamicin group developed deep sepsis. These results suggest that cefoxitin is as effective as the combination of metronidazole and gentamicin for prophylaxis against serious postoperative septic complications.
Dis Colon Rectum 1983 Oct
PMID:A comparison of intravenous cefoxitin and a combination of gentamicin and metronidazole as prophylaxis in colorectal surgery. 634 50

Rectal abscess may result in necrotizing soft-tissue infection including fasciitis, myositis, and extraperitoneal dissection of pus without muscle necrosis. The presentation and therapy of ten patients treated over the past six years are reviewed. Early recognition of rapidly spreading infection was imperative. The mortality rate of 40 per cent correlated with the degree of sepsis present at admission. The high mortality attendant with the complications of rectal abscess emphasizes the need for aggressive therapy, including frequent examinations under anesthesia, wide debridement, systemic triple antibiotic therapy, diverting colostomy, aggressive wound care, and hyperalimentation.
Dis Colon Rectum 1983 Aug
PMID:Necrotizing soft-tissue infection from rectal abscess. 640 68

Forty-four patients with enterocutaneous fistulas treated at the University of Nigeria Teaching Hospital (UNTH) Enugu in five years (1977-81) are reviewed. Most fistulas resulted from complications of surgery (29 per cent) and appendicitis (55 per cent). The commonest locations were in the cecum (48 per cent), ileum (30 per cent), and colon (20 per cent). The outstanding complication was sepsis. Spontaneous closure occurred in 15 patients (34 per cent). Twenty-two patients were treated surgically. There was a high mortality of 18 per cent from septic complications and malnutrition.
Dis Colon Rectum 1984 Aug
PMID:Enterocutaneous fistulas in Enugu, Nigeria. 646 92

The consequences of pelvic sepsis after Ivalon rectopexy are described in four patients. Despite clear evidence of pelvic infection, reoperation was delayed by ineffective conservative measures and morbidity thereby prolonged. In three, the causative organism was Staphylococcus aureus and it is suggested that prophylactic antimicrobial regimens for intestinal organisms alone may be inadequate.
Dis Colon Rectum 1984 Sep
PMID:Management of pelvic sepsis after Ivalon rectopexy. 646 97

We report the results of a prospective audit of the rates of postoperative infection in patients having operations for inflammatory bowel disease. Apart from a single prospective controlled trial, all other groups have been studied sequentially using the original placebo control group for comparison. The rate of abdominal wound sepsis when no antibiotic was used was 37 per cent. This was reduced to 23.3 per cent with 24-hour cover using metronidazole and gentamicin. However, only after prolonged use of metronidazole and gentamicin for five days was there a significant reduction in abdominal wound infections to 13.3 per cent. Prophylaxis, using 24-hour cover with metronidazole combined with five-day therapy with mezlocillin, achieved an abdominal wound infection rate of 15.6 per cent. The most recent group of patients studied have received 24-hour cover with metronidazole and five-day exposure to latamoxef. In the last group the rate of abdominal wound infections was only 13.5 per cent and serious postoperative bleeding was recorded in eight patients (15 per cent) compared with serious bleeding is only three of the remaining 129 patients (2.3 per cent). The only patients in whom streptococcal isolates were eliminated were those receiving metronidazole and mezlocillin. The majority of infections was due to antibiotic-sensitive strains of Escherichia coli, Proteus, and Staphylococcus species.
Dis Colon Rectum 1984 Sep
PMID:Audit of sepsis in operations for inflammatory bowel disease. 646 1


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