ABSTRACT
Cholecystocolonic fistula with associated idiopathic megabowel (megacolon and megarectum) is a rare presentation as acute large bowel obstruction. Frequently presenting with chronic constipation, acute bowel obstruction is rarely encountered in the presence of concomitant cholecystocolonic fistula. This presents diagnostic and management difficulties with no consensus on appropriate surgical approach. This case highlights the outcomes following emergency total colectomy and subtotal cholecystectomy as a single-stage procedure for a 68-year-old man presenting with cholecystocolonic fistula secondary to idiopathic megabowel as acute large bowel obstruction.
Subject(s)
Biliary Fistula/etiology , Gallbladder Diseases/etiology , Intestinal Fistula/etiology , Intestinal Obstruction/etiology , Megacolon/complications , Rectal Diseases/complications , Aged , Biliary Fistula/diagnosis , Biliary Fistula/surgery , Cholecystectomy , Colectomy , Colon/diagnostic imaging , Colon/surgery , Gallbladder/diagnostic imaging , Gallbladder/surgery , Gallbladder Diseases/diagnosis , Gallbladder Diseases/surgery , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/surgery , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Male , Megacolon/diagnosis , Megacolon/surgery , Rectal Diseases/diagnosis , Rectal Diseases/surgery , Rectum/diagnostic imaging , Rectum/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Based on the hypothesis that consistent hyperglycemia can result in insulin resistance, we explored the induction of non-insulin dependent diabetes mellitus (NIDDM) using diet of high glycemic/low fat index and compared the effects on the physiology and histology of the rats. The rats were divided into 3 groups. DM was induced in the first group by single intraperitoneal injection of 150mg/kg alloxan monohydrate and in the second group by feeding the rats with diet of high glycemic index/low fat for 8 weeks. The pathophysiology and histopathology of DM were studied. Hyperglycemia was recorded in the alloxan and food-induced groups respectively. Both groups were also positive for glycosuria, which confirmed the induction of DM. Concentrations of plasma potassium, calcium, protein and urea were higher (p<0.05) in the alloxan-induced than the food-induced diabetic rats, whereas food-induced rats recorded higher hematological indices than the alloxan-induced group. Coronary risk indices were higher in food-induced diabetic rats than the alloxan-induced, while activities of antioxidant enzymes were significantly higher (p<0.05) in alloxan-induced diabetic rats than the food-induced rats. Marked degenerations of the Islets of Langerhans was observed in pancreas of alloxan-induced diabetic rats, whereas, histological examination of the pancreas of food-induced and control rats revealed no visible lesion. Liver and kidney of all food and alloxan-induced diabetic rats showed marked degeneration of the hepatocytes and the glomeruli respectively. This study presents a rat model of type II diabetes mellitus using food of high glycemic/low fat index with its consequent ionoregulatory disruptions, acute anemia, hyperlipidemia, nephropathy and hepatopathy.