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Bowel Resection (bowel + resection)
Kinds of Bowel Resection Selected AbstractsBowel resection for severe endometriosis: An Australian series of 177 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Graeme J. Dennerstein No abstract is available for this article. [source] Bowel resection for severe endometriosis: An Australian series of 177 casesAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Hannah J. WILLS Background: Colorectal resection for severe endometriosis has been increasingly described in the literature over the last 20 years. Aims: To describe the experiences of three gynaecological surgeons who perform radical surgery for colorectal endometriosis. Methods: The records of three surgeons were reviewed. Relevant information was extracted and complied into a database. Results: One hundred and seventy-seven women were identified as having undergone surgery between February 1997 and October 2007. The primary reason for presentation was pain in the majority of women (79%). Eighty-one segmental resections were performed, 71 disc excisions, ten appendicectomies and multiple procedures in ten women. The majority of procedures (81.4%) were performed laparoscopically. Histology confirmed the presence of disease in 98.3% of cases. A further 124 procedures to remove other sites of endometriosis were conducted, along with an additional 44 procedures not primarily for endometriosis. A total of 16 unintended events occurred. Conclusions: Our study adds to the growing body of literature describing colorectal resection for severe endometriosis. Overall, the surgery appeared to be well tolerated, demonstrating the role for this surgery. [source] CXCL12 Is a constitutive and inflammatory chemokine in the intestinal immune systemINFLAMMATORY BOWEL DISEASES, Issue 4 2010Iris Dotan MD Abstract Background: Inflammatory bowel disease (IBD) is characterized by increased lymphocytic infiltrate to the lamina propria (LP) and upregulation of inflammatory chemokines and receptors. CXCL12 is a constitutive chemokine involved in lung, brain, and joint inflammation. We hypothesized that CXCL12 and its receptor, CXCR4, would have a constitutive and inflammatory role in the gut. Methods: Intestinal epithelial cells (IECs) and T lymphocytes were isolated from intestinal mucosa of IBD and control patients undergoing bowel resection. Autologous T cells were isolated from peripheral blood (PB). CXCL12 and CXCR4 expression by IECs was assessed by polymerase chain reaction and immunohistochemistry, lymphocyte phenotype by flow cytometry, and migration by Transwells. Results: IECs expressed CXCL12 and expression was increased and more diffuse in IBD compared to normal crypts (ulcerative colitis [UC] > Crohn's disease [CD], inflamed > noninflamed). CXCR4 was expressed by IECs, LP T cells (LPTs), and PB T cells (PBTs), and CXCR4+ cells were increased in IBD LP in situ. PBTs and LPTs from all patients had a high and comparable migration toward CXCL12 (P < 0.0001 and P < 0.05 vs. medium, respectively). Migration toward IBD-IEC-derived supernatant was significantly higher compared to normal. Antibodies against CXCR4 and CXCL12 blocked migration. Conclusions: CXCL12 is expressed by normal IECs and upregulated and differentially distributed in IBD IECs. CXCR4 is expressed by IECs and LPTs, and CXCR4+ cells are significantly increased in IBD LP. CXCL12 is chemotactic for both PBTs and LPTs. Thus, CXCL12 and CXCR4 have a constitutive and inflammatory role in the intestinal mucosa and their selective therapeutic manipulation may be considered in IBD management. (Inflamm Bowel Dis 2009;) [source] Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2008Fabiana Castiglione MD Abstract Background: Postsurgical recurrence (PSR) is very common in patients with Crohn's disease (CD) and previous surgery. Endoscopy is crucial for the diagnosis of PSR, also showing high prognostic value. Bowel sonography (BS) with or without oral contrast enhancement (OCBS) is accurate for CD diagnosis but its role in PSR detection and grading is poorly investigated. The aim was to evaluate the diagnostic accuracy of BS and OCBS for PSR compared to the endoscopical Rutgeerts's grading system. Methods: We prospectively performed endoscopy, BS, and OCBS in 40 CD patients with previous bowel resection to provide evidence of possible PSR. Endoscopy, BS, and OCBS were executed 1 year after surgery, with PSR diagnosis and grading made in accordance with Rutgeerts. BS and OCBS were considered suggestive for PSR in the presence of bowel wall thickness (BWT) >3 mm. OCBS was performed after ingestion of 750 mL of polyethylene glycol (PEG). Also, a receiver operating characteristic (ROC) curve was constructed in order to define the best cutoff of BWT to discriminate mild from severe PSR (grade 0,2 versus 3,4 of Rutgeerts) for both BS and OCBS. Results: In all, 22 out of the 40 CD showed an endoscopic evidence of PSR (55%). A severe PSR was present in 14 patients (64%). Sensitivity, specificity, and positive and negative predictive values were 77%, 94%, 93%, and 80% for BS, and 82%, 94%, 93%, and 84% for OCBS. On the ROC curve a BWT >5 mm showed sensitivity, specificity, and positive and negative predictive values of 93%, 96%, 88%, and 97% for the diagnosis of severe PSR at BS, while a BWT >4 mm was the best cutoff differentiating the mild from the severe CD recurrence for OCBS, with a sensitivity, specificity, and positive and negative predictive values of 86%, 96%, 97%, and 79%, respectively. Conclusions: Both BS and OCBS show good sensitivity and high specificity for the diagnosis of PSR in CD, with a BWT >5 mm for BS and BWT >4 mm for OCBS strongly indicative of severe endoscopic PSR. Accordingly, these techniques could replace endoscopy for the diagnosis and grading of PSR in many cases. (Inflamm Bowel Dis 2008) [source] Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patientsINFLAMMATORY BOWEL DISEASES, Issue 8 2008Geoffrey C. Nguyen MD Abstract Background Inflammatory bowel disease (IBD) patients are at increased risk of protein-calorie malnutrition. We sought to determine the prevalence of clinically diagnosable malnutrition among those hospitalized for IBD throughout the United States and whether this malnutrition influenced health outcomes. Methods We queried the Nationwide Inpatient Sample between 1998 and 2004 to identify admissions for Crohn's disease (CD) or ulcerative colitis (UC) and a representative sample of non-IBD discharges. We assessed the prevalence and predictors of malnutrition and its association with in-hospital mortality and resource utilization. Results The prevalence of malnutrition was greater in CD and UC patients than in non-IBD patients (6.1% and 7.2% versus 1.8%, P < 0.0001). The adjusted odds ratio for malnutrition among IBD admissions compared with non-IBD admissions was 5.57 [95% confidence interval (CI): 5.29,5.86]. More IBD discharges than non-IBD discharges with malnutrition received parenteral nutrition (26% versus 6%, P < 0.0001). There was increased likelihood of malnutrition among those with fistulizing CD (OR 1.65; 95% CI: 1.50,1.82) and among those who had undergone bowel resection (OR 1.37; 95% CI: 1.27,1.48). Malnutrition was associated with increased in-hospital mortality 3.49 (95% CI: 2.89,4.23), length of stay (11.9 days versus 5.8 days, P < 0.00001), and total charges ($45,188 versus $20,295, P < 0.0001). Conclusions Clinically apparent malnutrition is more frequent among IBD admissions than among non-IBD admissions. Its association with greater mortality and resource utilization may reflect more severe underlying disease that can lead to both malnutrition and worse outcomes. Nonetheless, diagnosable malnutrition may serve as a clinical marker of poor IBD prognosis in hospitalized patients. (Inflamm Bowel Dis 2008) [source] Medical therapy for Crohn's disease stricturesINFLAMMATORY BOWEL DISEASES, Issue 1 2004Gert Van Assche MD Abstract Intestinal fibrostenosis is a frequent and debilitating complication of Crohn's disease (CD), not only resulting in small bowel obstruction, but eventually in repeated bowel resection and short bowel syndrome. Over one third of patients with CD have a clear stenosing disease phenotype, often in the absence of luminal inflammatory symptoms. Intestinal fibrosis is a consequence of chronic transmural inflammation in CD. As in other organs and tissues, phenotypic transformation and activation of resident mesenchymal cells, such as fibroblasts and smooth muscle cells, underlie fibrogenesis in the gut. The molecular mechanisms and growth factors involved in this process have not been identified. However, it is clear that inflammatory mediators may have effects on mesenchymal cells in the submucosa and the muscle layers that are profoundly different from their action on leukocytes or epithelial cells. Transforming growth factor-beta (TGF-,), for instance, has profound anti-inflammatory activity in the mucosa and probably serves to keep physiologic inflammation at bay, but at the same time it appears to be driving the process of fibrosis in the deeper layers of the gut. Tumor necrosis factor, on the other hand, has antifibrotic bioactivity and pharmacologic inhibition of this cytokine carries a theoretical risk of enhanced stricture formation. Endoscopic management of intestinal strictures with balloon dilation is an accepted strategy to prevent or postpone repeated surgery, but careful patient selection is of paramount importance to ensure favorable long-term outcomes. Specific medical therapy aimed at preventing or reversing intestinal fibrosis is not yet available, but candidate molecules are emerging from research in the liver and in other organs. [source] Clinical significance of granuloma in Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 3 2002Dr. Nizar N. Ramzan Abstract Crohn's disease (CD) is diagnosed from information obtained clinically, pathologically, and radiologically. One important pathologic finding is a granuloma, which is helpful when a positive diagnosis of CD will affect treatment. Whether the presence of a granuloma has any clinical implication is not clear. We conducted a retrospective study to determine whether a granuloma found on a biopsy sample is associated with disease severity, fistulizing or perianal disease, frequent relapses, and extraintestinal manifestations. Eighty-two patients were identified who had a biopsy or bowel resection for CD between 1990 and 1994 at a tertiary referral center; 21 (25.6%) had a granuloma. This group was compared with a group of 61 patients without a granuloma. Forty-five percent were male (n = 37), mean age at diagnosis was 42.6 years (median, 39.5 years), mean disease duration at presentation was 8.8 years (median, 4.8 years), and mean follow-up duration was 2 years (range, 1 day to 10.2 years). No significant differences were demonstrated between the two groups by the Fisher exact test with regard to fistulizing or perianal disease, oral aphthous ulcers, disease severity, axial or peripheral arthralgia, episcleritis, anterior uveitis, erythema nodosum, or pyoderma gangrenosum. [source] The transversus abdominis plane block: a valuable option for postoperative analgesia?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010A topical review The transversus abdominis plane (TAP) block is a newly described peripheral block involving the nerves of the anterior abdominal wall. The block has been developed for post-operative pain control after gynaecologic and abdominal surgery. The initial technique described the lumbar triangle of Petit as the landmark used to access the TAP in order to facilitate the deposition of local anaesthetic solution in the neurovascular plane. Other techniques include ultrasound-guided access to the neurovascular plane via the mid-axillary line between the iliac crest and the costal margin, and a subcostal access termed the ,oblique subcostal' access. A systematic search of the literature identified a total of seven randomized clinical trials investigating the effect of TAP block on post-operative pain, including a total of 364 patients, of whom 180 received TAP blockade. The surgical procedures included large bowel resection with a midline abdominal incision, caesarean delivery via the Pfannenstiel incision, abdominal hysterectomy via a transverse lower abdominal wall incision, open appendectomy and laparoscopic cholecystectomy. Overall, the results are encouraging and most studies have demonstrated clinically significant reductions of post-operative opioid requirements and pain, as well as some effects on opioid-related side effects (sedation and post-operative nausea and vomiting). Further studies are warranted to support the findings of the primary published trials and to establish general recommendations for the use of a TAP block. [source] Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforationJOURNAL OF DIGESTIVE DISEASES, Issue 4 2007Nikolaos S SALEMIS BACKGROUND: Peritoneal mesothelioma is a rare disease associated with poor prognosis. Acute abdomen as the first presentation is an extremely rare occurrence. We report an exceptional case of a patient who was found to have a jejunal perforation due to infiltration of peritoneal mesothelioma. METHODS: A 62-year-old man was admitted with clinical signs of peritonitis. Computerized tomographic scans showed a mass distal to the ligament of Treitz, thickening of the mesentery and a small amount of ascites. RESULTS: Emergency laparotomy revealed a perforated tumor 15 cm distal to the ligament of Treitz and diffuse peritoneal disease. Segmental small bowel resection and suboptimal cytoreduction were performed. Histopathology and immunohistochemistry showed infiltration of malignant mesothelioma. During the postoperative period pleural mesothelioma was also diagnosed. Despite adjuvant chemotherapy, the patient died of disseminated progressive disease 7 months after surgery. CONCLUSIONS: Peritoneal mesothelioma is a rare malignancy with grim prognosis. Small bowel involvement is a poor prognostic indicator. Our case of a small bowel perforation due to direct infiltration by peritoneal mesothelioma appears to be the first reported in the English literature. [source] New growth factor therapies aimed at improving intestinal adaptation in short bowel syndromeJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2006Prue M Pereira Abstract Short bowel syndrome (SBS) is used to describe a condition of malabsorption and malnutrition resulting from the loss of absorptive area following massive small bowel resection. The key to improved clinical outcome after massive small bowel resection is the ability of the residual bowel to adapt. Although still in experimental stages, a major goal in the management of SBS may be the augmented use of growth factors to promote increased adaptation. A number of growth factors have been implicated in promoting the adaptation process. The best-described growth factors are reviewed: glucagon-like peptide-2 (GLP-2), epidermal growth factor (EGF), and growth hormone (GH). This article reviews the ability of recombinant GLP-2, EGF and GH to modulate structural and functional aspects of intestinal adaptation following small bowel resection. Although these growth factors have shown promise, small sample size, inconsistent measurement parameters and uncontrolled study designs have hampered the acquisition of strong data advocating the use of growth factor treatment for SBS. Multicenter trials using well-defined outcome measures to assess clinical efficacy are needed to direct the clinical indications, timing and duration of therapy and assess potential risks associated with growth factor therapies. [source] Influence of diet complexity on intestinal adaptation following massive small bowel resection in a preclinical modelJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2002Julie E Bines Abstract Aims: To investigate the effect of dietary complexity on intestinal adaptation using a preclinical model. Methods: Four-week-old piglets underwent a 75% proximal small bowel resection or transection operation (control). Post-operatively, animals received either pig chow (n = 15), polymeric formula (n = 9), polymeric formula plus fiber (n = 6), or elemental formula (n = 7). Results: The weight gain of all groups was reduced compared with controls that were fed the same diet. Animals that had a resection, which were fed elemental formula, had significantly reduced weight gain compared with the other groups (4.7 4.2 vs 30.7 7.1 kg chow and 11.5 1.3 kg polymeric formula). Villus height was increased in the jejunum, ileum and terminal ileum of resected animals compared with controls in animals fed with pig chow, polymeric formula and elemental formula. The animals that had a resection had a significant reduction in the transepithelial conductance (10.4 5.5 vs 25.4 6.5 mS/cm2) and 51Chromium-EDTA flux (2.8 1.9 vs 4.8 4.9 µL/h per cm2) compared with the controls. Conclusions: A complex diet was found to be superior to an elemental diet in terms of the morphological and functional features of adaptation following massive small bowel resection. © 2002 Blackwell Publishing Asia Pty Ltd [source] Acute mesenteric venous thrombosis due to protein S deficiency in a pregnant womanJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009p Atakan Al Abstract Acute mesenteric venous thrombosis is a rare and potentially fatal disease, which often occurs in medically compromised elderly patients. Isolated mesenteric venous thrombosis may be encountered in young women who have underlying hypercoagulable disease. We report a case of mesenteric venous thrombosis in a young pregnant woman in whom protein S deficiency was diagnosed at a later stage. The patient underwent extensive bowel resection. On follow-up she had developed an obstruction on the intestinal anastomosis. The anastomosis was revised, but the patient died of intervening complications 3 months after the operation. Early management of acute mesenteric venous thrombosis relies on early diagnosis, which requires a high index of suspicion. The condition must be considered during evaluation of persistent abdominal pain in pregnant women with hypercoagulable disorder. [source] Clinicoradiological score for predicting the risk of strangulated small bowel obstructionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2010F. Schwenter Background: Intestinal ischaemia as a result of small bowel obstruction (SBO) requires prompt recognition and early intervention. A clinicoradiological score was sought to predict the risk of ischaemia in patients with SBO. Methods: A clinico-radiological protocol for the assessment of patients presenting with SBO was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would predict ischaemia requiring resection. Results: Of 233 consecutive patients with SBO, 138 required laparotomy of whom 45 underwent intestinal resection. In multivariable analysis, six variables correlated with small bowel resection and were given one point each towards the clinical score: history of pain lasting 4 days or more, guarding, C-reactive protein level at least 75 mg/l, leucocyte count 10 × 109/l or greater, free intraperitoneal fluid volume at least 500 ml on computed tomography (CT) and reduction of CT small bowel wall contrast enhancement. The risk of intestinal ischaemia was 6 per cent in patients with a score of 1 or less, whereas 21 of 29 patients with a score of 3 or more underwent small bowel resection. A positive score of 3 or more had a sensitivity of 67·7 per cent and specificity 90·8 per cent; the area under the receiver operating characteristic curve was 0·87 (95 per cent confidence interval 0·79 to 0·95). Conclusion: By combining clinical, laboratory and radiological parameters, the clinical score allowed early identification of strangulated SBO. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Factors influencing management and comparison of outcomes in paediatric intussusceptionsACTA PAEDIATRICA, Issue 8 2007A K Saxena Abstract Aim: This study aims to compare management strategy and outcomes of paediatric ileocolic intussusceptions (ICI) versus small-bowel intussusceptions (SBI). Methods: Hospital charts of patients with intussusceptions between January 1999 and June 2006 were reviewed retrospectively. Results: A total of 135 patients with the diagnosis of intussusceptions were found in the database. In 111 patients the diagnosis was confirmed using ultrasound. The median age of the patients was 2.25 years (range 9 weeks,10 years). ICI were documented in 83 patients (74.8%) and SBI in 28 (25.2%). Spontaneous reductions were observed in 11 of 83 (13.3%) ICI and 18 of 28 (64.3%) SBI. Pneumatic reductions were attempted and were successful in 61 of 67 (91%) ICI and 6 of 7 (85.7%) SBI. Surgery was performed in 11 of 83 (13.3%) ICI and 4 of 28 (14.3%) SBI; with 2 of 83 (2.4%) ICI and 3 of 28 (10.7%) SBI patients requiring bowel resections. The median age of patients requiring surgery was 9 months in ICI and 6 years in SBI. Conclusion: There are differences in ICI and SBI with regard to spontaneous reductions, and bowel resection, and age with regard to surgery and bowel resection. The treatment efficacy depends on time of presentation, intussusception type, pathologic lead points, ultrasound/colour Doppler interpretation and expertise in reduction techniques. [source] Postoperative mesenteric pseudoaneurysm in a patient undergoing bowel resection for Crohn's diseaseCOLORECTAL DISEASE, Issue 3 2010H. M. Salinas No abstract is available for this article. [source] Postoperative arrhythmias in colorectal surgical patients: incidence and clinical correlatesCOLORECTAL DISEASE, Issue 3 2006S. R. Walsh Abstract Objective, To determine the incidence and clinical correlates of postoperative cardiac arrhythmias in patients undergoing elective large bowel resection. Methods, Fifty-one consecutive patients undergoing elective open colorectal resection were recruited for this prospective observational study. Participating patients underwent daily three-lead electrocardiograms postoperatively. Data regarding potential risk factors for arrhythmias were recorded. Post-operative complications were recorded. Results, Thirteen (26%) patients developed a postoperative arrhythmia, most commonly atrial fibrillation. Significant univariate correlates with postoperative arrhythmias were: age (P < 0.01), hypertension (P < 0.01), pre-operative serum potassium levels (P < 0.01), postoperative pulmonary oedema (P = 0.03), postoperative serum potassium (P = 0.03) and sodium (P < 0.01). Arrhythmia patients were more likely to have other complications (P = 0.02). Thirty-one percent of arrhythmia patients had underlying sepsis compared with 18% of controls (P = 0.38). Conclusion, Arrhythmias are common following elective large bowel resection. They occur in older patients and are associated with the development of other complications. [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] Factors influencing management and comparison of outcomes in paediatric intussusceptionsACTA PAEDIATRICA, Issue 8 2007A K Saxena Abstract Aim: This study aims to compare management strategy and outcomes of paediatric ileocolic intussusceptions (ICI) versus small-bowel intussusceptions (SBI). Methods: Hospital charts of patients with intussusceptions between January 1999 and June 2006 were reviewed retrospectively. Results: A total of 135 patients with the diagnosis of intussusceptions were found in the database. In 111 patients the diagnosis was confirmed using ultrasound. The median age of the patients was 2.25 years (range 9 weeks,10 years). ICI were documented in 83 patients (74.8%) and SBI in 28 (25.2%). Spontaneous reductions were observed in 11 of 83 (13.3%) ICI and 18 of 28 (64.3%) SBI. Pneumatic reductions were attempted and were successful in 61 of 67 (91%) ICI and 6 of 7 (85.7%) SBI. Surgery was performed in 11 of 83 (13.3%) ICI and 4 of 28 (14.3%) SBI; with 2 of 83 (2.4%) ICI and 3 of 28 (10.7%) SBI patients requiring bowel resections. The median age of patients requiring surgery was 9 months in ICI and 6 years in SBI. Conclusion: There are differences in ICI and SBI with regard to spontaneous reductions, and bowel resection, and age with regard to surgery and bowel resection. The treatment efficacy depends on time of presentation, intussusception type, pathologic lead points, ultrasound/colour Doppler interpretation and expertise in reduction techniques. [source] | ||||||||||||||||||||||