ABSTRACT
The article analyzed the structure, incidence rate and results of surgical treatment of paracolostomal complications in 69 patients out of 134 (aged from 23 to 77 years old). The patients were divided into 2 groups according to the variant of terminal colostomy. The single-barrel colostomy was formed by classical (intraperitoneal) method using «proboscis¼ design in 58 patients (43,3%) of the first group. Various complications were developed in the area of colostomy in 42 (72,4%) patients. The single-barrel flat colostomy was applied at the skin level using the method modified by the authors in 76 (56,7%) patients of the second group. The authors designed the method of controlled intra- and postoperative decompression and lavage of the colon by a new model of aspiration-irrigation device in order to unload the colon through colostomy. There were noted complications in the area of colostomy in 27 (35,5%) cases. The developed rational method of terminal colostomy formation, upgrading the ways of intra- and postoperative decompression and lavage of the colon facilitated to decrease of the rate of postcolostomy complications more than two times (from 72,4 to 35,5%). The author's method led to optimization of immediate and long-term results of surgical treatment.
Subject(s)
Colon , Colonic Neoplasms , Colostomy/adverse effects , Adult , Aged , Colon/diagnostic imaging , Colon/pathology , Colonic Neoplasms/complications , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Colostomy/methods , Decompression, Surgical/adverse effects , Decompression, Surgical/methods , Female , Humans , Ileus/diagnosis , Ileus/etiology , Ileus/therapy , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Male , Middle Aged , Outcome and Process Assessment, Health Care , Postoperative Complications/diagnosis , Postoperative Complications/therapySubject(s)
Colorectal Neoplasms , Decompression, Surgical , Intestinal Obstruction , Postoperative Complications , Self Expandable Metallic Stents/adverse effects , Colorectal Neoplasms/complications , Colorectal Neoplasms/pathology , Decompression, Surgical/adverse effects , Decompression, Surgical/instrumentation , Decompression, Surgical/methods , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Neoplasm Staging , Postoperative Complications/classification , Postoperative Complications/etiology , Postoperative Complications/prevention & controlABSTRACT
The article presents a retrospective analysis of the results of surgical treatment of postoperative intraabdominal complications in 42 patients with colon cancer complicated by bowel obstruction and perforation of the tumor. The pyoinflammatory processes such as peritonitis and abscesses of abdominal cavity took a leading place in the structure of postoperative complications according to the authors. Method of "closed" decompression and intraluminal irrigation of the large intestine without wide opening of organ lumen was developed and applied into practice as perioperative prophylaxis of pyoinflammatory processes. These measures allowed reducing the rate of postoperative intraabdominal complications from 19.2 to 7.7%.
Subject(s)
Abdominal Abscess , Colectomy , Colonic Neoplasms , Decompression, Surgical/methods , Intestinal Obstruction , Intestinal Perforation , Peritonitis , Postoperative Complications , Abdominal Abscess/diagnosis , Abdominal Abscess/etiology , Abdominal Abscess/prevention & control , Azerbaijan , Colectomy/adverse effects , Colectomy/methods , Colon/pathology , Colon/surgery , Colonic Neoplasms/complications , Colonic Neoplasms/pathology , Female , Humans , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Male , Middle Aged , Neoplasm Staging , Outcome and Process Assessment, Health Care , Peritonitis/diagnosis , Peritonitis/etiology , Peritonitis/prevention & control , Postoperative Complications/diagnosis , Postoperative Complications/prevention & control , Reoperation/methods , Therapeutic Irrigation/methodsABSTRACT
The results of treatment of scrotum gangrene (Fournier's disease) in 25 patients aged from 34 to 82 years are presented in the article. The diseases of colorectal zone were nosological reasons of Fournier's disease in 13 patients, the diseases of urogenital tract - in 10 cases. Development of Fournier's disease was associated with closed trauma in 1 patient, and 1 case was associated with gunshot wound of perineum and scrotum. Slowly progressing forms of the disease were detected in 14 patients, fulminant and rapidly progressing variants - in 11 patients. Diabetes mellitus of different severity were identified in 6 patients. Clinical picture and laboratory data evidenced about systemic infection in all patients. Non-clostridial anaerobic microbes were the main exciters of pio-necrotic process (92%). 6 patients died. Mortality was about 24%. Toxic shock was the reason of death in 1 patient, progressing endotoxemia - in 3 cases, pulmonary embolism - in 2 cases. The authors consider that early diagnosis and active tactics of radical treatment of pio-necrotic hearth in combination with programmed (phased) remedial necrectomy are effective methods for improvement of treatment results. Also such ways as complex system of local wound treatment, focused and multicomponent therapy of systemic and metabolic disorders of homeostasis are very important in complex treatment of patients.
Subject(s)
Debridement , Fournier Gangrene , Genitalia, Male , Postoperative Complications/rehabilitation , Systemic Inflammatory Response Syndrome/etiology , Urologic Surgical Procedures, Male , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Combined Modality Therapy , Debridement/adverse effects , Debridement/methods , Early Diagnosis , Fournier Gangrene/diagnosis , Fournier Gangrene/etiology , Fournier Gangrene/mortality , Fournier Gangrene/physiopathology , Fournier Gangrene/surgery , Genitalia, Male/pathology , Genitalia, Male/surgery , Humans , Male , Middle Aged , Necrosis , Peptide Hydrolases/therapeutic use , Plastic Surgery Procedures/methods , Retrospective Studies , Survival Analysis , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome , Urologic Surgical Procedures, Male/adverse effects , Urologic Surgical Procedures, Male/methodsSubject(s)
Colon , Colonic Neoplasms , Digestive System Surgical Procedures , Laparoscopy , Colon/pathology , Colon/surgery , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Digestive System Surgical Procedures/adverse effects , Digestive System Surgical Procedures/methods , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Outcome Assessment, Health Care , Postoperative Period , Video-Assisted Surgery/methodsSubject(s)
Colectomy , Colon, Transverse , Colonic Neoplasms , Intestinal Obstruction , Colectomy/adverse effects , Colectomy/methods , Colon, Transverse/pathology , Colon, Transverse/surgery , Colonic Neoplasms/pathology , Colonic Neoplasms/surgery , Colonoscopy/methods , Colostomy/methods , Decompression, Surgical/methods , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Perioperative PeriodABSTRACT
29 patients, aged 18-63 years, with diaphragm ruptures and severe polytraumatic injuries were treated. 26 patients had laparotomy, the rest 2 were thoracotomyzed for the surgical treatment. The rupture of the diaphragm was diagnosed during surgery in 8 (27,6%) patients, who were initially operated on cause of massive bleeding. In 16 (55,2%) cases there were no signs of bleeding, though patients showed clinical picture of abdominal contents' dislocation to the pleural cavity. Rupture of the diaphragm was misdiagnosed during the first operation and caused the second laparotomy in 4 (13,8%) patients. Rupture was left-sided in 28 patients, right-sided in 1 case. Postoperative lethality was 13,8% (4 patients).
