Indium-111 oxine-labeled autologous leukocyte scans in the management of colorectal diseases.

The accuracy and usefulness of indium-111 oxine-labeled autologous leukocyte scans in the management of infectious complications of colon and rectal surgery and of inflammatory diseases of the colon have been studied by review of the records of all patients undergoing such scans at Morristown Memorial Hospital during the first six months such scans were performed there. A total of 20 scans was performed on 18 patients. Twelve scans were performed on 11 patients being treated for diseases of the colon and rectum. Of these 12 scans, one was normal, four demonstrated intra-abdominal abscesses, three demonstrated wound infections (two abdominal, one perineal), one was positive for granulomatous colitis, one for pseudomembranous colitis, one for chronic diverticulitis, and one for enterocutaneous fistula. One allergic reaction to the labeled leukocytes occurred. Comparisons with other corroborative localizing diagnostic tests were made. Subsequent treatment was reviewed. Analysis of these cases indicates that the majority of all scans were performed to evaluate complications of colorectal surgery or inflammatory diseases of the colon and that these scans were highly accurate. In all instances where appropriate, delineation of a lesion in the colorectal cases was followed by corrective treatment.

The surgeon, the surgery, the patient, and the disease: factors complicating colonic surgery.

A review of 231 cases of colonic operations performed during the year 1971 by, or under the supervision of, 32 attending surgeons in an 850 bed private community medical center was undertaken. The overall mortality rate was 5.6% while a 35.5% overall complication rate was also noted. Factors significantly associated with increased overall complication rate were: emergency operations, preoperative anemia (hemoglobin less than 10 gm%), preoperative hypoalbuminemia (serum albumin less than 3 gm%), preoperative obstruction, malignant lesions of the colon and ulcerative colitis, prolonged operation, operations requireing a large quantity of packed cell transfusion, coexisting hepatic disease and operations performed by surgical attending staff under 50 years of age in this institution. Each of these factors is discussed individually. Several factors that were expected to be associated with increased complication rate failed to show significant statistical correlation in this series. These are: age of the patient, coexisting diseases other than hepatic disease, absence of prophylactic parenteral antibiotics, preoperative perforations and operations involving resection of the colon. Hypotheses are offered to explain a number of unexpected poor correlations.