ABSTRACT
Acute colonic pseudo-obstruction, Ogilvie's syndrome, most often appears as a complication of other clinical conditions. It is characterized by massive colonic dilation in the absence of a mechanical cause. Therapy for this condition has traditionally been colonoscopic decompression via a flexible colonoscope. We performed a retrospective study to assess the efficacy of Cystografin enema for colonic decompression in Ogilvie's syndrome. We present a series of 18 patients who developed Ogilvie's syndrome while hospitalized for trauma (n = 10), burn (n = 1), gastrointestinal surgery (n = 4), and hip replacement (n = 3). The mean pre-enema cecal size was 13 cm (range 10 to 15 cm). The mean postenema cecal size was 8.5 cm (range 6 to 15 cm). Fifteen of the 18 patients underwent Cystografin enema as the primary mode of decompression. Three had undergone prior colonoscopy, which had failed. One of the 18 patients required repeat enema for inadequate decompression after the first enema and one underwent colonoscopy for recurrence. Two patients underwent operative intervention after the enema. There were no complications related to the enema. In all patients we were able to rule out a mechanical cause of large bowel obstruction. We believe the safety, efficacy, and ease of this procedure make Cystografin enema optimal first-line treatment for acute colonic pseudo-obstruction.
Subject(s)
Colonic Pseudo-Obstruction/therapy , Enema , Acute Disease , Adult , Aged , Colonic Pseudo-Obstruction/diagnostic imaging , Contrast Media , Diatrizoate Meglumine , Female , Humans , Male , Middle Aged , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
Our institution performed an orthotopic heart transplantation in a patient with Marfan's syndrome. The immediate postoperative course was complicated with ultimate discharge; however, this patient died within 1 year as a result of an aortic dissection. On the basis of our experience, we surveyed all heart transplant centers listed with the North American Transplant Coordinator Organization for other patients with Marfan's syndrome who had been referred for transplantation. Nearly one third of responding centers evaluated a total of 30 patients with Marfan's syndrome. Of these, only 13 were formally listed for a donor organ and 11 underwent heart transplantation with an operative mortality of 9.1% (n = 1). Posttransplantation morbidity was significant and includes a 40% (n = 4) incidence of thoracic aorta dissection (one fatal) in operative survivors. There were three other non-dissection-related late deaths for an overall survival of 54.4% after a mean follow-up of 33.0 months. In this shared experience, it appears that the known vascular complications of Marfan's syndrome may diminish the anticipated results after heart transplantation. The reluctance to place these patients on heart transplant donor waiting lists can be justified.
Subject(s)
Heart Transplantation , Marfan Syndrome/surgery , Adult , Aortic Dissection/etiology , Aortic Aneurysm, Thoracic/etiology , Attitude of Health Personnel , Blood Vessel Prosthesis , Cause of Death , Fatal Outcome , Female , Follow-Up Studies , Heart Transplantation/adverse effects , Hemorrhage/etiology , Humans , Incidence , Male , Marfan Syndrome/complications , Middle Aged , Polyethylene Terephthalates , Referral and Consultation , Survival Rate , Tissue Donors , Waiting ListsABSTRACT
We describe an alternative method for the treatment of an entrapped stone basket. When efforts to remove an engaged stone through the intramural ureter met with marked resistance, the basket with the stone within it was advanced into the renal pelvis. Extracorporeal shock wave lithotripsy then was used to pulverize the stone, allowing successful removal of the basket.
