ABSTRACT
Objective To explore the principles and methods of surgcal treatment for acute neoplastic colorectal obstruction.Methods The clinical data of 103 patients diagnosed as acute neoplastic colorectal obstruction were analyzed retrospectively.Results In this group,80 cases underwent emergency surgical treatment,(among) which,25 cases of carcinoma of right colon underwent primary resection and anastomosis;in 45 cases of carcinoma of left colon,primary resection and anastomosis was performed in 37 cases;and emergent(operations) were performed in 10 cases of rectal cancer.23 cases received non-emergency surgery.(Anastomotic) fistula occurred in 3 patients,pulmonary infection in 2 patients,pelvic cavity infection in 1(patient),1 patient died and the rest recovered well and were discharged.Conclusions The initial treatment for acute neoplastic colorectal obstruction should be non-surgcal treatment for 1~3d to make non-emergency surgical treatment more possible.If indications are properly selected,primary tumor resection and anastomosis is safe.For patients with severe contamination of abdominal cavity and bowel perforation, primary tumor(resection) should be performed if possible.
ABSTRACT
Objective To summarize our experience in the diagnosis and treatment of right hemicolon carcinoma combined with acute appendicitis.Methods A respective analysis of clinical data of 51 cases of right colon cancer complicated with acute appendicitis and confirmed by surgical operation and pathology was made.Results In 2400 cases of right colon cancer,51 cases(2.1%)complicated with appendicitis.There were medical complications in 39 cases(76.5%).The diagnosis before operation was made in 13 cases(25.5%),and diagnosis of colon cancer was missed in 38 cases(74.5%).Colon adenocarcinoma was found in 40 cases,mucous adenocarcinoma 7 cases(13.7%),undifferentiated carcinoma 4 cases(7.8%);and Dukes B,C,D stages were in 2 cases(3.9%),29 cases(56.9%)and 20 cases(39.2%)respectively.The simple appendicitis,suppurative appendicitis,gangrenous appendicitis and phlegnomous appendicitis was found in 28 cases(54.9%),11 cases(21.6%),8 cases(15.7%)and 4 cases(7.8%)respectively.3-5-year survival was 95.2%,40.0%,respectively.Conclusions Occurrence rate of right colon cancer combined with appendicitis is low,but misdiagnosis rate is high,and 5-year survival rate is low.Middle and old age patients with appendicitis and accompanied with emaciation,anemia,digestive symptoms and right lower abdominal mass should have appropriate examination to avoid missing the diagnosis of right colon cancer.
ABSTRACT
Objective To analyze the outcome of patients with acute obstruction of left colorectal cancer treated by modified antegrade colonic lavage with primary tumor resection and anastomosis.Methods From April 2002 to April 2007,112 patients with acute obstruction of left colorectal cancer underwent surgery.During the operation the left colon was exteriorized and placed into a sterilized plastic bag to protect the surgical field from contamination,then a catheter was inserted via the appendix,and after antegrade colonic lavage,primary resection and anastomosis was performed.Results Tumor resection and primary anastomosis was successfully done in the 112 cases.Postoperatively,1 case had anastomotic leak which healed after reoperation with proximal colostomy,and one patient died.Conclusions Modified antegrade colonic lavage is a simple procedure,the bowel can be rapidly decompressed with essentially no contamination,and has a high level of bowel cleansing.It is possible to safely perform primary resection and anastomosis for left colon cancer after the modified antegrade lavage.