RESUMO
The double stapling technique has become an established reconstruction method for patients undergoing low anterior resection. We have used a modification of the conventional technique in which the lower rectal segment is closed with a linear stapler (TA-55) and the anastomosis is performed by using the circular EEA(CEEA) instrument across the linear staple line of the double stapling technique. The aim of this study was to evaluate the prophylactic effect of a loop ileostomy preventing anastomotic leakage. Stapled colorectal anastomosis and stapled coloanal anastomosis in 60 patients forms the basis for the report. The sixty patients were treated by using the double stapling technique either with or without a loop ileostomy. This review presents the advantages and disadvantages of a loop ileostomy for coloanal anastomosis. Postoperative anastomotic leakage in the double stapling technique group occurred in 5 (10.6%)cases of the total 31 cases while in the double stapling technique with loop ileostomy group, it allowed 1(3.4%) of the total 29 cases. This study suggests that the double stapling technique with a loop ileostomy is more effective than the double stapling technique without a loop ileostomy in preventing anastomotic leakage. The addition of a loop ileostomy to protect the low anastomosis might also be expected to influence anastomotic healing.
Assuntos
Humanos , Fístula Anastomótica , Ileostomia , Neoplasias RetaisRESUMO
Tuberculosis of the breast is a rare disease. Its diagnosis is difficult because clinical and radiological appearances are not specific and because isolation of the tubercle bacillus from the lesion is seldom possible. This disease is more common in women between 20 to 40 years of age, but is rare in male, elderly patients and prepubertal women. Difinite diagnosis rests on bacterilogical proof and histopathological findings -formation of a granuloma and usually caseous necrosis with or without demonstrable acid-fast bacilli. Treatment of the disease requires a combination of surgery and antitubercular drugs. We experienced 10 cases of tuberculosis of the breast and report with on them along a literature review.
Assuntos
Idoso , Feminino , Humanos , Masculino , Antituberculosos , Bacillus , Mama , Diagnóstico , Granuloma , Necrose , Doenças Raras , TuberculoseRESUMO
The records of 70 patients who underwent curative operation for traumatized patients with either blunt or penetrating colorectal wounds, treated between january, 1987 and december, 1996 were retrospectively reviewed. A majority of the injuries were about to blunt injuries 50 cases(71.4%) from traffic accident 41 cases(58.6%), falling down 2 cases(2.9%). Injuries occured most commonly at the transverse colon and rectum in 22 case followed by sigmoid colon in 17 case. Associated intraabdominal injuries were frequent 51 cases(72.9%). Among the associated intra abdominal injury, small bowel was the most frequent site in 21 cases(30%) followed by spleen in 7 cases(10%), pancreas in 4 cases(5.7%) and major vessel in 4 case(5.7%). By operative procedure, primary closure of colon and rectum were 14 cases(20%), resection and anastomosis was 12 case(17.1%), primary closure with proximal diversion or end colostomy were 29 cases(41.4%). The complication rate was 59 case(84.2%) and the major complications were as follows wound infection 18 cases(30.5%), intraabdominal abscess 8 case(13.5%), pulmonary complication 7 cases(11.8%), enterocutaneous fistula 4 case(6.7%). Overall mortality were 11 case(15.7%) and mostly blunt and severe multiple trauma cases. The cause of death were MOF, sepsis and hypovolemia. This review covers the past 10 years acculmulation of colorectal injury management, morbidity and mortality.
Assuntos
Humanos , Traumatismos Abdominais , Abscesso , Acidentes de Trânsito , Causas de Morte , Colo , Colo Sigmoide , Colo Transverso , Colostomia , Hipovolemia , Fístula Intestinal , Mortalidade , Traumatismo Múltiplo , Pâncreas , Reto , Estudos Retrospectivos , Sepse , Baço , Procedimentos Cirúrgicos Operatórios , Infecção dos Ferimentos , Ferimentos e Lesões , Ferimentos não PenetrantesRESUMO
Rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum and irradiation injury. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal stricture that were not amenable to conventional methods of dilation but were succesfully managed by transanal electroresection using endoscopic transurethral electroreectoscope.
Assuntos
Constrição Patológica , Dilatação , RetoRESUMO
This is a retrospective clinical analysis of the usefulness of loop ileostomy for the prevention of anastomotic leakage in patients with low rectal cancer when the low anterior resection or coloanal anastomosis is performed. We reviewed 54 cases of low rectal cancer from January 1994 to May 1996 at Department of Surgery, Wonju College of Medicine, Yonsei University. In 54 cases of low rectal cancer, 28 cases were ileostomy group and 17 cases were no stoma group. There were no differences in clinical characteristics such as age and sex distribution. Most patients were classified into stage B or C by modified Astler-Coiler classification but 2 cases of stage D that simultaneous liver resection was performed were in no stoma group. Tumor locations from the anal verge were 6.8 and 10.3 cm by mean in ileostomy and no stomp group, respectively(P<0.05). Heights of anastomosis were 3.7 and 6.8 cm by mean from the anal verge in ileostomy and no stoma group, respectively(P<0.05). Double stapling technique was used for anastomosis in most patients but hand-sewn technique was also carried out in 1 case in ileostomy group. The most common postoperative minor complication was wound infection in both groups. Anastomotic leakage rate was higher in no stoma group(4 of 17, 23.5%) than that of ileostomy group (1 of 28, 3.6%) but statistical comparison could not be confirmed(P=0.00). But interestingly, such complications as stoma perforation, stoma prolapse and parastomal hernia were developed in ileostomy group and that all complications should be corrected by ileostomy repair. As forementioned above, we had concluded that ileostomy could protect anastomosis site but above mentioned complications associated with building the stoma should be also prevented by careful surgical technique.
Assuntos
Humanos , Fístula Anastomótica , Classificação , Hérnia , Ileostomia , Fígado , Prolapso , Neoplasias Retais , Estudos Retrospectivos , Distribuição por Sexo , Infecção dos FerimentosRESUMO
Adenocarcinoma of the bladder is a rare tumor. It's incidence figures in the ranges of 0.5 to 2.0 percent of all epithelial bladder neoplasms. Adenocarcinoma of the bladder occurs more frequently in areas which schistosomiasis is endemic and is the most common malignant tumor arising in the exstrophic bladder or urachus. Primary adenocarcinoma of the bladder must be carefully differentiated from the adenocarcinomas that originate within the urachus, prostate, seminal vesicle, breast, gastrointestinal tract or other organs. This report describes a 43 years old male who was diagnosed as an infiltrative adenocarcinoma of the bladder by the preoperative evaluation and transurethral resection of bladder and was confirmed by the pathologic examination following pelvic exenteration as the primary adenocarcinoma or the bladder extended to the prostate and rectum and was followed by chemotherapy without evidence of metastasis.
Assuntos
Adulto , Humanos , Masculino , Adenocarcinoma , Mama , Tratamento Farmacológico , Trato Gastrointestinal , Incidência , Metástase Neoplásica , Exenteração Pélvica , Próstata , Reto , Esquistossomose , Glândulas Seminais , Úraco , Neoplasias da Bexiga Urinária , Bexiga UrináriaRESUMO
A case of retrograde intussusception (acute type) of efferent limb into Braun side-to-side jejuno-jejunal anastomosis is presented. Intussusception, though infrequent, is well recognized complication after gastric surgery. Patient was 50 year old man who was admitted with epigastric pain and abdominal mass for 6 hours. Patient had a history of total gastrectomy 2 years before admission due to stage II gastric cancer. Seven hours after admission, hematemesis developed. Emergency fiberopticgastroscopy revealed type 4 jejunogastric intussusception. Segmental resection with end-to-end reanastomosis was performed.
