Ogilvie's syndrome treatment. (1/7)

INTRODUCTION: Ogilvie's Syndrome (OS) is a rare condition caused by parasympathetic dysfunction of large bowel characterized by acute and massive colon distension without mechanical obstruction. Rarely this disease has to be treated by the surgeon but operations may be indicated in case of medical treatment failure. METHODS: A retrospective analysis was carried out at the Emergency Surgery DPT of St Orsola-Malpighi University Hospital Bologna Italy. From 1995 to 2002 11 patients were treated for severe OS: they were 8 males and 3 females and the mean age was 68 yrs. All these subjects had large bowel distension with caecum diameter more than 8 cm without any evidence of mechanical obstruction. RESULTS: In 4 patients (36%) OS was caused by trauma or surgical procedures whereas in 7 cases (64%) was produced by other conditions. Only in 3 cases (27%) conservative treatment was successful; the remaining 8 patients were submitted to surgical therapy. 6 patients were submitted to decompressive caecostomy and in 2 cases a subtotal colectomy was done. Mortality was 36%. DISCUSSION AND CONCLUSIONS: Surgical treatment of OS is indicated when there is a conservative treatment failure. The high mortality is related to diagnostic and therapeutic delays, advanced age and comorbidities.  (+info)

Alleviating debilitating, chronic constipation with colostomy after appendicostomy: a case study. (2/7)

Severe chronic constipation is a debilitating condition. Patients not only experience infrequent bowel movements, but also are often frustrated by the sensation of incomplete evacuation; pain; straining; daily use of enemas; and continual concerns regarding diet, fluids, and medications. Diagnostic tests are performed to rule out organic causes of the condition. Common treatment options consist of dietary fiber supplementation, dietary instruction, adequate fluid intake, enemas, and laxatives; additional noninvasive management includes biofeedback training and botulinum toxin type A injections. Surgery is rarely recommended, although a select group of patients may benefit from antegrade continence enema procedure. A female patient presented with a history of long-standing constipation. When antegrade continence enema offered no improvement and other treatment measures failed, she underwent successful laparoscopic-assisted sigmoid resection and end colostomy. This approach may provide options for patients in similar circumstances.  (+info)

Anterograde colonic stent placement via a cecostomy tube site. (3/7)

Colonic stents have been used as a method of relieving colonic obstruction since 1991. They are classically inserted in a retrograde fashion via the rectum and are deployed under a combination of endoscopic and fluoroscopic guidance. A unique case is presented where the colonic stent was passed in an anterograde fashion through a recently created cecostomy tube site as a method of palliation to relieve an obstructing hepatic flexure tumour.  (+info)

Colonic pseudo-obstruction. (4/7)

Colonic pseudo-obstruction is often confused with mechanical intestinal obstruction. It occurs when there is an autonomic imbalance resulting in sympathetic over-activity affecting some part of the colon. The patient is often elderly with numerous comorbidities. Once mechanical obstruction is excluded by contrast enema, the patient should be treated conservatively with nasogastric and flatus tubes for at least 48 hours, and precipitating factors should be treated. When pseudo-obstruction does not settle with waitful watching, prokinetic agents and/or colonoscopic decompression can be tried. When there is a risk of impending perforation of the caecum from massive colonic dilatation and colonic ischaemia, it should be dealt with by caecostomy or hemicolectomy. In spite of available medical and surgical interventions, the outcome remains poor.  (+info)

Stomal adenocarcinoma in Crohn's disease. (5/7)

Malignant change occurring at the site of a stoma in two patients with proved Crohn's disease is described. Patients with ulcerative colitis have an increased risk of colonic malignancy and Crohn's disease is also associated with both small and large bowel carcinoma. Most previous reports of stomal carcinoma have been associated with ulcerative colitis although Crohn's disease seems to carry a greater risk of associated small bowel carcinomas. This is the first report of stomal carcinoma complicating Crohn's disease. Epithelial dysplasia is associated with gastrointestinal carcinomas in both ulcerative colitis and Crohn's disease and a dysplasia-carcinoma sequence has been suggested as the origin of these tumours. In both our patients with stomal adenocarcinoma, dysplasia was identified in adjacent tissues, which suggests a similar mechanism. Malignant change should be suspected if epithelial dysplasia is discovered in a biopsy specimen from the mucosa of an ileostomy in Crohn's disease, and this risk is increased if the dysplasia is of a high grade.  (+info)

Cecal infusion of nutrients improves nutritional status of rats. (6/7)

The role of colonic fermentation in providing energy was investigated in rats with small bowel transection (T) or 80% resection (SBR). Rats were randomized to receive for 12 d either saline (S) or the enteral solution (E) through a cecostomy to meet 30% of energy requirement; the rest (70%) was provided by parenteral nutrition. Although SBR-S rats lost weight significantly compared with d 1 of the study, SBR-E rats gained. Significantly greater carcass wet weight and fat were found in SBR-E and T-E rats compared with SBR-S and T-S rats. SBR-E and T-E rats had significantly greater colonic mucosal dry weight and protein compared with SBR-S and T-S rats. Cecal short-chain fatty acid (SCFA) contents were also significantly higher in SBR-E and T-E rats compared with SBR-S and T-S rats. There was no significant effect of surgery (T vs. SBR) on any of the variables studied. These results suggest that the products of fermentation of an enteral solution infused through a cecostomy contribute substantially to energy requirement, maintenance of body composition and nutritional status of rats.  (+info)

Effects of germinated barley foodstuff in preventing diarrhea and forming normal feces in ceco-colectomized rats. (7/7)

Germinated barley foodstuff (GBF) derived from the aleurone and scutellum fractions of germinated barley was rich in glutamine and low-lignified hemicellulose. The diarrhea caused by ceco-colectomy could be prevented by feeding GBF to rats. GBF could also increase the protein content and sucrase activity of small intestinal mucosa in this model. This diarrhea-preventive effect of GBF would be based on the water-holding capacity and bulging force under alkaline conditions, e.g. in the small intestine.  (+info)