ABSTRACT
At the Prince Henry Hospital between 1970 and 1987, 8 cases of colonic volvulus were diagnosed in spinal cord injured (SCI) patients. This represents an incidence of 2.6% of SCI patients being treated at the hospital. The aetiology of volvulus is multifactorial and in these patients may be related to: neurological deficit; constipation as a result of immobility; and medications used for controlling muscle spasm, bladder and bowel function. Symptoms and signs are modified by the neurological deficit and awareness of the altered presentation will prevent delay and missed diagnoses. The effect of spinal cord injury and drugs on colonic motility needs further evaluation.
Subject(s)
Colonic Diseases/etiology , Intestinal Obstruction/etiology , Spinal Cord Injuries/complications , Aged , Cecal Diseases/diagnostic imaging , Cecal Diseases/etiology , Cecal Diseases/surgery , Colonic Diseases/diagnostic imaging , Colonic Diseases/surgery , Female , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/surgery , Male , Middle Aged , Radiography , Sigmoid Diseases/diagnostic imaging , Sigmoid Diseases/etiology , Sigmoid Diseases/surgeryABSTRACT
This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the infra-mesocolic approach for drainage is emphasized.
Subject(s)
Abscess/surgery , Pancreatic Diseases/surgery , Abscess/complications , Abscess/etiology , Adult , Aged , Constriction, Pathologic , Drainage , Female , Hemorrhage/etiology , Humans , Male , Middle Aged , Pancreatic Diseases/complications , Pancreatic Diseases/etiology , Pancreatitis/complications , Rupture, SpontaneousABSTRACT
The results of operative pancreatography in 32 patients with pancreatitis are reported. The main pancreatic duct was successfully and adequately demonstrated in 30 patients: in 29 by cannulation of the major ampulla, and in one by direct needle puncture of the duct. No films were obtained in one patient, and in another only the accessory duct could be demonstrated. There was thus a high rate of technical success, but the frequency of gross abnormalities of the major pancreatic duct was low, except in those patients with traumatic pancreatitis. These results are relevant to the assessment of the value of endoscopic retrograde cholangiopancreatography in pancreatic disease.
