RESUMO
A method is described for achieving proper distal margins in low-lying rectal lesions after initial resection indicates that these may be inadequate. The roticulator is kept on the distal rectal stump until the specimen has been examined. If additional margins are required, a second roticulator is placed distal to the first so that an intervening amount of tissue can be safely resected for adequate margins.
Assuntos
Neoplasias Retais/cirurgia , Reto/cirurgia , Grampeadores Cirúrgicos , Anastomose Cirúrgica , Humanos , Neoplasias Retais/patologia , Reto/patologiaRESUMO
Massive hemorrhage from the colon is always a problem. When that bleeding occurs in a defunctionalized colonic mucous fistula, the surgeon can approach the bleeding site from both ends simultaneously. Two methods of controlling hemorrhage from a mucous fistula with the assistance of Foley catheter tamponade are presented.
Assuntos
Doenças do Colo/prevenção & controle , Hemorragia Gastrointestinal/prevenção & controle , Técnicas Hemostáticas , Fístula Intestinal/complicações , Cateterismo Urinário/instrumentação , Doenças do Colo/etiologia , Hemorragia Gastrointestinal/etiologia , Técnicas Hemostáticas/instrumentação , Humanos , Mucosa IntestinalRESUMO
Seven hundred consecutive patients with multiple areas of injury requiring surgical repair outside of the abdomen were subjected to laparotomy. Five hundred sixty-one patients had intra-abdominal injury: 139 patients were found to have no intraperitoneal damage. The morbidity in the 139 patients with negative findings at laparotomy was 2%. In patients with multiple areas of trauma, the abdomen is almost always suspect. The proliferation of diagnostic tools to detect intraperitoneal damage have, in some ways, helped physicians decide as to laparotomy. However, when multiple injuries are present, particularly of the central nervous system, classical findings of peritoneal damage are difficult to elicit. A diagnostic laparotomy does not add significantly to the overall morbidity or mortality, and in 25% of the patients in whom intraperitoneal pathology was not strongly suspected, damage requiring surgery was found. We think there is still a place for diagnostic laparotomy in patients with multiple trauma.
Assuntos
Traumatismos Abdominais/diagnóstico , Laparotomia , HumanosRESUMO
A retrospective study of women in the child-bearing age with inflammatory disease of the bowel seems to suggest that these women become pregnant as often as other women in the general population. In this small study it was 100 per cent. The incidence of subjective difficulty with conception is likewise small. Patients with Crohn's disease appear to feel better in pregnancy with regard to their intestinal problems, while more than 60 per cent of the patients with ulcerative colitis appear to do poorly. The live-birth rates for both conditions in our series were approximately 80 per cent. An unusual complication in two of our patients with Crohn's disease was a postpartum, postepisiotomy rectovaginal fistula. This may indicate a possible danger of episiotomy in patients who have Crohn's disease.
