ABSTRACT
Between June 1, 1990 and December 31, 1996, 58 consecutive patients with unprepared colons were urgently explored for nontraumatic disease with intent to proceed with primary left-sided colonic anastomosis. Unprotected anastomoses were not attempted in 15 patients. The causes of exclusion included preoperative and intraoperative shock in three patients, and three patients were on long-term high-dose steroids, four had gross fecal contamination of the peritoneal cavity, four had large pelvic abscesses, and one had ischemic colitis. All 43 patients undergoing anastomosis without protective colostomy had stapled anastomoses. Indications included complicated diverticular disease in 32 cases. There were nine cases of obstruction from colorectal carcinoma and one obstruction due to sigmoid volvulus. There was one case of perforation from pseudomembranous enterocolitis. The most common complications were: atelectasis in nine cases, wound infection in two cases, and prolonged ileus in two cases. Pelvic abscess occurred in one case. There was one wound dehiscence. There was one anastomotic dehiscence, and there was no mortality. Operative time averaged 85 minutes and hospital length of stay 9.7 days. Primary anastomosis of the unprepared left colon is safe in most urgent and emergent situations, thus avoiding the significant morbidity and cost of colostomy closure.
Subject(s)
Anastomosis, Surgical , Colon/surgery , Colonic Diseases/surgery , Abdominal Abscess/complications , Acute Disease , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Colitis, Ischemic/complications , Colonic Neoplasms/surgery , Contraindications , Diverticulitis, Colonic/surgery , Enterocolitis, Pseudomembranous/surgery , Feces , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Intestinal Obstruction/surgery , Intestinal Perforation/surgery , Intraoperative Complications , Length of Stay , Male , Middle Aged , Pelvis , Peritoneum/pathology , Prednisolone/administration & dosage , Prednisolone/therapeutic use , Pulmonary Atelectasis/etiology , Rectal Neoplasms/surgery , Shock/complications , Sigmoid Diseases/surgery , Surgical Stapling/adverse effects , Surgical Stapling/methods , Surgical Wound Dehiscence/etiology , Surgical Wound Infection/etiology , Time FactorsABSTRACT
The primary care physician must be able to recognize potentially life threatening or permanently disabling oncologic complications that may be prevented or reversed by foresight or prompt action. The physician must be able to assist the patient in treatment decisions and recognize those situations in which palliation is possible. Accurate diagnosis and treatment of oncologic emergencies and paraneoplastic syndromes may both improve the quality of life and increase the length of survival in the patient with cancer.
Subject(s)
Emergencies , Neoplasms/therapy , Paraneoplastic Syndromes/therapy , Cardiac Tamponade/therapy , Fever/etiology , Fever/therapy , Fractures, Spontaneous/therapy , Humans , Hypercalcemia/therapy , Intracranial Pressure , Neoplasms/complications , Neutropenia/etiology , Spinal Cord Compression/therapy , Superior Vena Cava Syndrome/therapyABSTRACT
Public health programs to prevent disease and promote health are constrained by legal doctrines that protect individuals from intrusive regulation of their health-influencing behaviors. This paper outlines the parameters of acceptable interventions in the context of antismoking legislation and motorcycle helmet safety laws. The authors discuss recent court decisions challenging the constitutionality of these laws and identify criteria the courts apply in reviewing governmental attempts to protect the public from disease or trauma.
