ABSTRACT
UNLABELLED: Toxic colitis is a severe disease that may be caused by several inflammatory and/or infectious diseases. Ulcerative colitis is one of the most frequent causes of toxic colitis in the United States. Toxic megacolon complicating Clostridium difficile colitis is a rare occurrence with significant morbidity and mortality. CASE REPORT: A 52-year-old male presented with rectal bleeding and tenesmus. He had been treated for amebiasis with metronidazole, and had improved. Two weeks later, symptoms recurred, and he was referred to our hospital. A sigmoidoscopy and biopsies demonstrated mucosal ulcerative colitis. He underwent treatment with systemic prednisone, mesalamine, and hydrocortisone enemas with adequate response. He was asymptomatic for 2 months, but later presented with a tender abdomen and rectal bleeding. Plain abdominal and thorax films showed colonic distention and free intraperitoneal air. Emergency laparotomy was performed, and an inflamed and distended colon, with free inflammatory liquid in the peritoneum, was found. A total abdominal colectomy with temporary ileostomy and Hartmann's pouch was performed. The histopathology analysis demonstrated a Clostridium difficile pseudomembranous colitis. CONCLUSION: The presence of toxic megacolon due to Clostridium difficile in patients with ulcerative colitis is a rare complication that may be suspected in patients with initial relapse who are on antibiotics.
Subject(s)
Colitis, Ulcerative/etiology , Enterocolitis, Pseudomembranous/etiology , Abdominal Pain/etiology , Anti-Inflammatory Agents/therapeutic use , Colectomy , Colitis, Ulcerative/drug therapy , Colitis, Ulcerative/pathology , Diagnosis, Differential , Enterocolitis, Pseudomembranous/drug therapy , Enterocolitis, Pseudomembranous/surgery , Gastrointestinal Hemorrhage/etiology , Humans , Ileostomy , Male , Middle Aged , Steroids , Treatment OutcomeABSTRACT
BACKGROUND: Total proctocolectomy with ileal pouch-anal anastomosis (TPCIAA) is the procedure of choice for patients with Ulcerative Colitis and Familial Adenomatous Polyposis. The frequency of presentation of both diseases is low in Mexico, therefore the experience with the surgical procedure is limited. OBJECTIVE: To analyze the operative morbidity and mortality and long-term functional results in a series of patients operated upon with the TPCIAA in a referral center in Mexico. MATERIAL AND METHODS: Retrospective analysis of 44 consecutive patients operated upon from 1987 through 1997. The operation included resection of the anal transitional zone, handsewn anastomosis of a "J" pouch, and diverting ileostomy in all cases. Operative morbidity and mortality, and long-term functional results and complications were determined. RESULTS: Mean age was 33 +/- 15 years. There were 52% women and 48% men. Diagnoses were ulcerative colitis in 59% and familial polyposis in 36%. Global morbidity was 39%, and mortality 2%. With a mean follow-up of 24 months, mean number of bowel movements was 4, 10% of patients had diurnal spotting, 30% nocturnal spotting, and no patient had gross incontinence. Three patients presented pouchitis with adequate response to antibiotics. Two patients presented long-term pouch fistulas that did not require pouch excision. CONCLUSIONS: The TPCIAA is a feasible operation with acceptable rates of morbidity and mortality and satisfactory functional results.
Subject(s)
Proctocolectomy, Restorative , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Proctocolectomy, Restorative/adverse effects , Retrospective StudiesABSTRACT
INTRODUCTION: Surgical treatment for anorectal fistula may be difficult because of the risk of recurrence, prolonged healing or anal incontinence following the operation. OBJECTIVE: To analyze the experience with the surgical management of ano-rectal fistula during a period of 17 years. PATIENTS AND METHODS: The medical records of 105 patients with anorectal fistulas were reviewed retrospectively, with analysis of demographic and clinical data, operative treatment, and results. RESULTS: There were 73% men and 27% women. Mean age was 45 years. 86% had an underlying chronic disease, most frequently diabetes mellitus (21%) and obesity (14%). No anatomic classification of the fistulous tract was done in 86% of cases, and inter-sphincteric tracts were the most frequent type in the classified cases. In 90% of cases, treatment was fistulectomy. Complications occurred in 13% of cases, mainly delayed healing (6.5%). Recurrent disease was documented in 11 cases (10%), and the majority were treated with a new fistulectomy. There were no cases with anal incontinence following the operation. CONCLUSIONS: The necessity of performing the anatomic classification of ano-rectal fistula should be emphasized. Fistulectomy was the most frequent surgical procedure.
