Faecal composition after surgery for Hirschsprung's disease.
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Diarrhoea and perianal excoriation occur frequently after the endorectal pull-through operation for Hirschsprung's disease. A new method of faecal analysis was performed on 3-day stool collections in 17 postoperative Hirschsprung patients and in 14 normal children, in order to define the faecal abnormality and to establish the cause of perianal excoriation in these patients. Loose stools in postoperative patients were deficient in dry solid content and contained an excess of extractable faecal water. This also had a raised electrolyte concentration, particularly with respect to sodium. Total daily output of faecal water was normal. Formed stools from postoperative patients were also deficient in drysolids but had a normal extractable water content. Excess extractable faecal water, the main abnormality of loose stools in these patients, is the result of abnormal water absorption from the distal colon. Perianal excoriation in these patients is most closely associated with the concentration of sodium in faecal water. (+info)
Chronic intestinal pseudo-obstruction: treatment and long term follow up of 44 patients.
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AIMS: To document the long term course of chronic idiopathic intestinal pseudo-obstruction syndrome (CIIPS) in children with defined enteric neuromuscular disease, and the place and type of surgery used in their management; in addition, to identify prognostic factors. METHODS: Children with CIIPS were investigated and treated prospectively. RESULTS: Twenty four children presented congenitally, eight during the 1st year of life, and 10 later. Twenty two had myopathy and 16 neuropathy (11 familial). Malrotation was present in 16 patients, 10 had short small intestine, six had non-hypertrophic pyloric stenosis, and 16 had urinary tract involvement. Thirty two patients needed long term parenteral nutrition (TPN): for less than six months in 19 and for more than six months in 13, 10 of whom are TPN dependent; 14 are now enteral feeding. Prokinetic treatment improved six of 22. Intestinal decompression stomas were used in 36, colostomy relieved symptoms in five of 11, and ileostomy in 16 of 31. A poor outcome (death (14) or TPN dependence (10)) was seen with malrotation (13 of 16), short small bowel (eight of nine), urinary tract involvement (12 of 16), and myopathic histology (15 of 22). CONCLUSIONS: In CIIPS drugs are not helpful but decompression stomas are. Outcome was poor in 24 of 44 children (15 muscle disorder, 10 nerve disease). (+info)
Systemic lupus erythematosus with a giant rectal ulcer and perforation.
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A 41-year-old man with systemic lupus erythematosus (SLE) who developed pelvic inflammation due to perforation of a giant rectal ulcer is described. The patient presented with persistent diarrhea, abdominal pain and fever without development of disease activity of SLE. Endoscopic and radiological examinations revealed a perforated giant ulcer on the posterior wall at the rectum below the peritoneal evagination. The ulcerated area was decreased after a colostomy was performed at the transverse colon to preserve anal function. The patient is currently being monitored on an outpatient basis. It should be noted that life-threatening complications such as perforated ulcer of the intestinal tract could occur without SLE disease activity. (+info)
Sacral chordoma--a case report.
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Chordoma, a rare malignant tumour of early adulthood, rarely presents in children. We report such a case of rare malignant tumour which was diagnosed in the first decade of life. (+info)
Closure of colostomy.
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We analyzed the records of 77 cases of loop colostomy closure in Vietnam War Casualties. All records were complete from the date of injury to discharge following colostomy closure. Simple of the loop colostomy was performed in 44 patients and resection of the stoma and reanastomosis of bowel segments was performed in 33 patients. Average operating time for simple closure of the loop was 70 minutes compared to 115 minutes for resection and anastomosis. Nasogastric suction was used less frequently and for a shorter time with simple loop closure. The total postoperative complication rate was 9% with simple loop closure as compared to 24% for resection and anastomosis. Simple closure of the loop described in this report is technically easier and as safe as resection of the stoma and reanastomosis. (+info)
Effect of elective abdominal surgery on human colon protein synthesis in situ.
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OBJECTIVE: To determine the effect of elective abdominal surgery on the rate of human colon fractional protein synthesis in situ. SUMMARY BACKGROUND DATA: Efficient intestinal protein synthesis plays an important role in the physiology and pathophysiology of the intestinal tract, allowing preservation of gut integrity and thereby preventing bacterial or endotoxin translocation. Because of species differences, animal studies have only limited applicability to human intestinal protein metabolism, and because of methodologic restrictions, no studies on colon protein synthesis in situ are available in humans. METHODS: The authors used advanced mass spectrometry techniques (capillary gas chromatography and combustion isotope ratio mass spectrometry) to determine directly the incorporation rate of 1-[13C]-leucine into colon mucosal protein in control subjects and nonseptic postoperative patients. All subjects had a colostomy, which allowed easy access to the colon mucosa, and consecutive sampling from the same tissue was performed during continuous isotope infusion (0.16 micromol/kg per minute). RESULTS: Control subjects demonstrated a colon protein fractional synthetic rate of 0.74 +/- 0.09% per hour. In postsurgical patients, colon protein synthesis was significantly higher and the tissue free leucine enrichment was significantly lower, compatible with an increased colon proteolytic rate. CONCLUSIONS: Elective abdominal surgery followed by an uncomplicated postoperative course is associated with a stimulation of colon protein synthesis and possibly also of protein degradation. The postoperative rate of colon protein synthesis is, compared with other tissues, among the highest measured thus far in humans. (+info)
Importance of the fecal stream on the induction of colon tumors by azoxymethane in rats.
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The effect of the fecal stream on intestinal carcinogenesis with azoxymethane was studied in male rats. Colostomies were performed approximately 2 cm distal to the cecum in 50 Sprague-Dawley rats to produce a 20-cm segment of nonfunctional large bowel; an additional 50 animals were left intact. Each of these groups was divided equally and was fed a normal diet or a diet containing 2% cholestyramine by weight. All animals were given azoxymethan s.c. At the end of 7 months all rats were sacrificed. The animals with colostomies developed significantly fewer tumors in the defunctionalized bowel than did intact animals in the same bowel segment. Cholestyramine appeared to increase the tumor yield in the large bowel of the intact animals but had no effect on the number of tumors in the defunctionalized bowel. Further, the intact animals on both dietary regimens developed a greater number of large tumors in the distal 20 cm of bowel. The results show that the fecal stream alters the carcinogenic activity of azoxymethane in the large bowel of the rat. It also appears that the carcinogen can reach its target tissue by a route other than the fecal stream. (+info)
Gastrocolic and gastrojejunocolic fistulae: report of twelve cases and review of the literature.
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Seven gastrocolic and five gastrojejunocolic fistulae were recorded at Charity Hospital between 1940 and 1970. Such fistulae occurred in males more often than females. In this series, as in others, the most common cause was gastric surgery for peptic ulcer disease. Pain, diarrhea, and weight loss were clinical findings in half the patients; anemia, leukocytosis, electrolyte disturbances and hypoalbuminemia were common laboratory findings. A fistula was demonstrated radiologically in nine of the twelve patients, management of these patients included no operation (3); two-stage procedure (2); and one-stage procedure (7); with a recent trend toward the one-stage procedure. A case report of a fistula resulting from postoperative complications of perforative appendicitis in which a successful combination of hyperalimentation and diverting colostomy was used is presented. (+info)