Home About us Contact
|
Home About us Contact | ||
|
|
||
Intestinal Resection (intestinal + resection)
Selected AbstractsEnd-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative studyEQUINE VETERINARY JOURNAL, Issue 4 2005D. I. RENDLE Summary Reasons for performing study: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. Hypothesis: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). Methods: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to-end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. Results: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. Conclusion: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. Potential relevance: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers. [source] Management and prevention of postoperative Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 10 2009Miguel Regueiro MD Abstract Postoperative Crohn's disease (CD) recurrence is a common occurrence after intestinal resection. Currently, the optimal management of patients who have undergone surgical resection is unknown and treatment remains subjective. Clinicians in conjunction with patients must balance the risks of recurrence against the potential risks associated with treatment. For those at very low risk of recurrence, no therapy may be needed; however, for patients at moderate risk immunomodulators should be considered. For those at highest risk of recurrence, biologic therapy, specifically antitumor necrosis factor agents, have emerged as appropriate treatment. Any postoperative management strategy should include a colonoscopy 6,12 months after surgery to identify recurrence. This review discusses current evidence for various pharmacologic approaches in the prevention of postoperative recurrence and provides guidance for clarifying patient risk. (Inflamm Bowel Dis 2009) [source] Could immunosuppressive drugs reduce recurrence rate after second resection for crohn disease?INFLAMMATORY BOWEL DISEASES, Issue 5 2004Arnaud Alves MD Abstract Background: The aim of this study was to assess the possible benefit of postoperative immunosuppressive drugs administration (ie, azathioprine, 6-mercaptopurine, or methotrexate) on long-term surgical recurrence rate after second anastomotic ileocolonic resection. Methods: From 1984 to 2000, 26 patients with CD underwent second resection for ileocolonic anastomotic recurrence. There were 14 women and 12 men (mean age ± SD: 34 ± 9 years). Two groups of patients were compared according to the postoperative treatment: immunosuppressive (IS) drugs group was composed of 14 patients, and control group was composed of 12 patients receiving either salicylates (n = 5) or no treatment (n = 7). Results: Clinical recurrence rate at 3 years was significantly lower in the IS group than in the control group (3/12, 25% vs 6/10, 60%; P < 0.05). Although not significant, after a mean follow-up of 80 ± 46 months (extr. 17,178 months) after the second resection, clinical recurrence rate at follow-up was also lower in IS group (6/14, 43%) than in control group (9/12, 75%). The mean delay of recurrence was similar in both groups (27 ± 13 months vs 28 ± 21; NS). A third intestinal resection was performed less frequently in the IS group than in control group (2/14, 17% vs 7/12, 58%; P < 0.02). Conclusions: In patients treated with IS drugs, the rate of postoperative recurrence after second ileocolonic CD resection is lower than in untreated patients. Our results suggest that IS drugs should be evaluated prospectively for prevention of second postoperative CD recurrence. [source] Growth after intestinal resection for Crohn's disease in children, adolescents, and young adultsINFLAMMATORY BOWEL DISEASES, Issue 4 2000Timothy A. Sentongo Abstract Objective: Growth before and after intestinal resection for Crohn's disease (CD) was examined in a group of children, adolescents, and young adults. Methods: Retrospective chart review of patients who had intestinal resections as clinical management of complications of CD between 1985 and 1996. Pre- and postoperative measurements of weight and height were reviewed. Z-scores were computed for weight-forage (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Two tailed t tests were used to compare postoperative growth patterns. Significance was defined as p < 0.05. Results: Twenty-five subjects (8 females, mean age 16.2 ± 2.8 years with one operation, and 3 males, mean age 15.7 years with multiple operations) were identified. There were significant improvements in the postoperative growth patterns of subjects who had one operation: HAZ (-1.28 ± 1.45 versus ,0.98 ± 1.37, p = 0.041), WAZ (-1.35 ± 1.02 versus ,0.74 ± 0.93, p = 0.0006) and WHZ (-0.64 ± 0.95 versus ,0.23 ± 0.81, p = 0.036). Furthermore, the magnitude of postoperative weight gain directly correlated with the age at CD diagnosis, R2 = 0.16, p = 0.046. Trends towards improved postoperative WAZ (-0.83 versus ,0.49) and HAZ (-0.47 versus ,0.27) were also observed in the three subjects who had multiple operations. Conclusion: The pattern of weight and height growth was improved after intestinal resection for CD. Nonetheless, close monitoring of postoperative growth is necessary especially in children diagnosed with CD at a young age. [source] Intussusception: Trends in clinical presentation and managementJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2006FRANCES A JUSTICE Abstract Background:, The association of a rotavirus vaccine and intussusception has renewed interest in understanding the incidence, clinical presentation and outcome of intussusception. Methods:, A retrospective chart review of all patients diagnosed with intussusception at Royal Children's Hospital, Melbourne over a 6.5-year period (1 January 1995,30 June 2001) was conducted using patients identified by a medical record database (ICD-9-CM code 560.0 1993,1997; ICD-10-CM code 56.1 1998,2001). Patient profile, clinical presentation, diagnosis methods, treatment and outcome were analyzed and compared to data previously reported on children with intussusception at the same hospital during 1962,1968. Results:, The hospitalization rate for primary idiopathic intussusception increased marginally from 0.19 to 0.27 per 1000 live births during the period 1962,1968 to 1995,2001. Most patients (80%) were <12 months of age (median age 7 months, range 2,72 months). The combination of abdominal pain, lethargy and vomiting was reported in 78% of infants. Air enema confirmed the diagnosis of intussusception in 186 of 191 cases (97%) and air reduction was successful in most cases (82%). Factors associated with increased risk of intestinal resection included abdominal distension (32%), bowel obstruction on abdominal X-ray (27%) and hypovolemic shock (40%). No mortality was observed in the present study. Conclusions:, Over the past 40 years at Royal Children's Hospital, Melbourne the hospitalization rate due to primary idiopathic intussusception has marginally increased from 0.19 to 0.27 per 1000 live births. Diagnosis and treatment using air enema has been highly successful, resulting in a reduction in patients requiring surgery and reduced hospital stays. [source] Evaluation of intestinal mucosal function by measuring expired 14CO2 after oral administration of 14C-putrescineJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2001Akira Sasaki Abstract Background: Diamine oxidase (DAO) is the enzyme that degrades putrescine, the key main product of polyamine metabolism, and reflects enterocytic maturity of absorption because diamine oxidase activity is highest in the small intestine. We have already shown that expired 14CO2 after oral administration of 14C-putrescine correlated with intestinal DAO activity. However, the influence of food composition and the mucosal adaptation after intestinal resection have not been elucidated. Methods: Male Wistar rats were fed normal chow or an elemental diet (ED) for 2 weeks. Resected rats underwent 50% jejunectomy or 50% ilectomy. Expired 14CO2 levels, following oral administration of 14C-putrescine were measured in all rats, and compared with the intestinal DAO activity and other mucosal parameters. Results: In the ED group, the 14CO2 levels reached a peak earlier, and values were 2.9-fold higher than in the group fed with normal chow. Mucosal alkaline phosphatase (ALP) and DAO activity in the ED group were also higher than in the group fed normal chow, although the mucosal wet weight was significantly lower in the ED group. In the resection groups, all expired 14CO2 values increased during measurement. The peak 14CO2 values in the jejunectomy group shifted earlier in the postoperative period. The mucosal DAO activity in both the resection groups was higher than it was in the control group at the fifth and 10th postoperative day. However, there were no differences among the three groups at the 15th postoperative day. Conclusions: Our studies suggested that expired 14CO2 after oral administration of 14C-putrescine correlates with mucosal DAO activity, and that it also reflects intestinal function. [source] Emergency case admissions at a large animal tertiary university referral hospital during a 12-month periodJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2008Brett A. Dolente VMD, DACVIM Abstract Objective: To collate and describe emergency admissions to a large animal tertiary university referral hospital during a 12-month period. Design: Prospective clinical study. Setting: Large animal tertiary university referral hospital. Animals: Large animal emergency patient admissions. Interventions: None. Measurements and main results: Information obtained from the medical record included the presenting complaint, clinical problem, admission time, duration of clinical signs before presentation, diagnostic procedures performed, therapies administered, and therapeutic procedures performed during the first 24 hours following admission, and survival to discharge. The most common category listed for the presenting complaint and clinical problem categories was gastrointestinal. Most emergency cases were admitted during the evening and in late spring, summer, and early fall. Most cases had a duration of clinical signs before presentation of >2 hours and ,8 hours (27%) or >8 hours and ,24 hours (29%). The most common diagnostic procedures performed during the first 24 hours were palpation per rectum, ultrasonographic examination, radiographs, and abdominocentesis. Antimicrobials, fluids, and nonsteroidal anti-inflammatory drugs were the most common therapies administered. Approximately 25% of cases required surgery. An exploratory celiotomy was performed in approximately 15% of cases. Enterotomy, intestinal resection and anastomosis, cesarean section, or joint or sheath lavage was each performed in <5% of cases. Overall survival to discharge was 74%. Conclusions: Large animal emergency clinicians are required to have knowledge on a wide range of diseases and should be proficient at performing numerous procedures on an emergency basis. Gastrointestinal disease is the most common type of emergency and the diagnostic and therapeutic procedures performed during the first 24 hours following admission are a reflection of this type of case. Only 25% of cases required surgery. Additional research in the form of a multicenter study and surveying both private and university practitioners needs to be performed to further define the necessary skills for an ,ideal' large animal emergency clinician. [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] Growth after intestinal resection for Crohn's disease in children, adolescents, and young adultsINFLAMMATORY BOWEL DISEASES, Issue 4 2000Timothy A. Sentongo Abstract Objective: Growth before and after intestinal resection for Crohn's disease (CD) was examined in a group of children, adolescents, and young adults. Methods: Retrospective chart review of patients who had intestinal resections as clinical management of complications of CD between 1985 and 1996. Pre- and postoperative measurements of weight and height were reviewed. Z-scores were computed for weight-forage (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Two tailed t tests were used to compare postoperative growth patterns. Significance was defined as p < 0.05. Results: Twenty-five subjects (8 females, mean age 16.2 ± 2.8 years with one operation, and 3 males, mean age 15.7 years with multiple operations) were identified. There were significant improvements in the postoperative growth patterns of subjects who had one operation: HAZ (-1.28 ± 1.45 versus ,0.98 ± 1.37, p = 0.041), WAZ (-1.35 ± 1.02 versus ,0.74 ± 0.93, p = 0.0006) and WHZ (-0.64 ± 0.95 versus ,0.23 ± 0.81, p = 0.036). Furthermore, the magnitude of postoperative weight gain directly correlated with the age at CD diagnosis, R2 = 0.16, p = 0.046. Trends towards improved postoperative WAZ (-0.83 versus ,0.49) and HAZ (-0.47 versus ,0.27) were also observed in the three subjects who had multiple operations. Conclusion: The pattern of weight and height growth was improved after intestinal resection for CD. Nonetheless, close monitoring of postoperative growth is necessary especially in children diagnosed with CD at a young age. [source] Clinical outcome of newly diagnosed Crohn's disease: a comparative, retrospective study before and after infliximab availabilityALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 2 2010E. DOMÈNECH Summary Background, Infliximab (IFX) could change the course of Crohn's disease (CD) by reducing steroid use, surgery or prompting earlier introduction of immunomodulators (IMM). Aim, To evaluate the impact of IFX availability on the course of early CD. Methods, Two cohorts of newly diagnosed CD patients were identified: The first cohort included patients diagnosed from January 1994 to December 1997 and the second from January 2000 to December 2003. All patients were diagnosed, treated and followed up in the same centre until December 1999 (first cohort) or December 2005 (second cohort). Development of disease-related complications, steroid, IMM or IFX requirements and intestinal resections during follow-up were registered. Results, A total of 328 patients were included (146 first cohort, 182 second cohort). A similar proportion of patients in both cohorts received steroids, but steroid exposure resulted significantly more intense in the first cohort (P = 0.001). In the second cohort, 14% of patients received IFX. Thiopurines were used more (P = 0.001) and earlier (P = 0.012) in the second cohort. No differences in surgical requirements or the development of disease-related complications were found. Conclusions, Following a step-up therapeutic algorithm, IFX availability did not reduce surgical requirements or the development of disease-related complications. Aliment Pharmacol Ther,31, 233,239 [source] Food-induced antisecretory factor activity is correlated with small bowel length in patients with intestinal resectionsAPMIS, Issue 10 2003STEFAN LANGE Specially processed cereals (SPC) can increase antisecretory factor (AF) activity in humans with an intact intestine. The aim of the present study was to investigate whether AF synthesis could be induced in patients who had been subjected to intestinal resections. Eight patients with varying extents of intestinal resections due to Crohn's disease and six healthy controls participated. All subjects received 54 g SPC daily for 2 weeks. Plasma AF activity was determined before, during and after the treatment period. Baseline diet and medications were kept unchanged. The patients registered the daily number of bowel movements. The SPC diet increased AF activity in all controls. In the patients there was a significant correlation between the length of the remaining small intestine and AF induction (r=0.94, p<0.01) and only those patients with a remaining small intestine of about 3 m reached AF values comparable to those in healthy subjects. It is concluded that small bowel length is related to the ability of humans to induce AF activity by dietary means. [source] | ||||||||||