1/19. Epiploic appendagitis: a new diagnosis for the emergency physician. Two case reports and a review.Two cases of epiploic appendagitis are presented. One was mistaken for acute appendicitis, the other for acute diverticulitis. In both cases, the correct diagnosis was made in the operating suite. With the aid of contemporary imaging modalities, however, the diagnosis of epiploic appendagitis need no longer hinge on the pathologic specimen but may be established by the emergency physician. As this disorder recently has been demonstrated to be predominantly self-limited, laparotomy no longer is considered necessary. Conservative management has been shown to be safe. The anatomy, pathophysiology, clinical presentation, radiologic evaluation, and emergency management of epiploic appendagitis are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/19. fecal impaction causing megarectum-producing colorectal catastrophes. A report of two cases.PURPOSE: Massive fecal impaction leading to surgical catastrophes has rarely been reported. We present 2 such patients to remind physicians that neglected accumulation of fecal matter in the rectum may lead to ischemia and perforation of the colon and rectum. methods: Report of 2 patients and a medline search of the literature. RESULTS: In the 1st case massive fecal impaction produced an abdominal compartment syndrome and rectal necrosis. In the 2nd patient fecal impaction resulted in colonic obstruction and ischemia. In both, an operation was life-saving. CONCLUSION: Neglected fecal impaction may lead to a megarectum causing an abdominal compartment syndrome and colorectal obstruction, perforation or necrosis. Measures to prevent fecal impaction are of paramount importance and prompt manual disimpaction before the above complications develop is mandatory. Appropriate operative treatment may be life-saving.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
3/19. Iatrogenic lesions of the colon and rectum.Our ability to document a number of examples of iatrogenic lesions of the colon and rectum in three general hospitals confirms the multiplicity of these lesions as presented in the literature. It appears that the careful surgeon and his associates would well heed the old admonition known as Murphy's law, that "Anything that can go wrong will go wrong." In the daily practice of the general surgeon and proctologist, it is apparent that gentleness in approaching any anal-rectal examination for either diagnostic or therapeutic purposes is mandatory. The insertion of any foreign object, be it an examining finger, a thermometer, enema tip, or proctoscope, may subject the patient to an inadvertent injury of significant proportion. The dangers inherent in the evaluation and treatment of patients with recognized disease processes is significantly greater than that associated with routine and screening examinations. morbidity and mortality have been shown to be associated with the barium enema as well as with the barium enema as well as with some of the newer radiologic procedures such as mesenteric angiography. The use of tap water for enemas has produced morbidity both from thermal injuries and from electrolyte depletion. Antibiotics and chemotherapeutic drugs frequently result in colon and rectal disease, and therapeutic procedures directed at organs adjacent to the colon and rectum have resulted in a number of iatrogenic lesions. This reviews confirms reports of others that iatrogenic lesions of the colon and rectum are not solely due to the physician's inexperience, as significant numbers of these lesions were the result of the diagnostic or therapeutic efforts of men of considerable experience and skill. Advanced age of the patient and diseases leading to changes in the character of the bowel wall frequently were factors in the production of these lesions. A poorly prepared bowel has led to increased morbidity and mortality associated with iatrogenic perforations. The early recognition of these lesions and prompt medical and surgical management diminishes both the morbidity and mortality associated with such injuries.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
4/19. Colorectal endometriosis: aggressive surgical management and practical considerations in a patient with advanced disease.The aim of this study was to evaluate the results of bowel resection in a patient with obstructive colorectal endometriosis. The presentation will acquaint the physician with the signs and symptoms, evaluation, and surgical treatment of colorectal endometriosis. We emphasize that our findings strongly support an aggressive surgical approach with resection for all visible cases of colorectal endometriosis in women with advanced disease.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
5/19. Retroperitoneal perforation of the colon caused by colonic tuberculosis: report of a case.We present a 25-year-old, hiv-negative patient from kosovo, with no significant past medical history, who was admitted to a local hospital for nonspecific upper abdominal discomfort. He was transferred to us after a retroperitoneal mass with contact to the right colonic flexure had been found during workup. colonoscopy demonstrated an edemateous area with a central fistula in the right flexure, and histology showed caseous necrosis. Although neither bacteriology nor histology could detect any germs, gastrointestinal tuberculosis seemed to be very probable. laparotomy with a segmental resection of the colon was performed to remove the fistula-bearing segment, and histologic examination of the resected specimen confirmed the intraoperative suspect of a retroperitoneal colonic perforation. Again, all cultures from the specimen were negative for tuberculosis, but polymerase chain reaction of a regional lymph node revealed acid-fast bacilli of the mycobacterium tuberculosis/bovis species. Although the patient had no other sites of tuberculosis infection like pulmonary or urinary, he received adjuvant standard tuberculosis treatment for six months. At control examination one year after the operation, the patient was free of recurrence and in very good general condition. We report this extremely rare presentation of gastrointestinal tuberculosis to sensitize physicians to tuberculosis again, because incidence rates are increasing and this disease will certainly play a more important role in the future.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
6/19. Simultaneous gastropleural and gastrocolic fistulae in a quadriplegic male.A 56-year-old, quadriplegic man presented to a physician's office with a large, left pleural effusion. He subsequently was found to have a gastropleural and gastrocolic fistula. These two very rare complications of benign peptic ulcer disease are discussed with special reference to patients with profoundly altered sensation.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
7/19. colonoscopy in clinical practice.colonoscopy is a relatively new and important diagnostic modality for evaluation colonic disease. In order to assess its value in the community hospital, all colonoscopies done by me (250 examinations in two hospitals) were reviewed. colonoscopy was sometimes easy and sometimes long and tedious. It was difficult to reach the cecum consistently, but success improved with experience. Many neoplasma not seen on barium enema were found, including three carcinomas. Twenty-seven polyps were removed with the aid of the colonoscopic snare. No complications occurred. colonoscopy should probably be restricted to those physicians who have a large enough case load and who can spend enough time learning the procedure to develop expertise.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
8/19. Retained surgical sponge after laparotomy. Unusual presentation.Erosion of a retained surgical sponge into the intestine is an unusual occurrence and may make its appearance months or years later. The demonstration of a distended bowel by the barium-impregnated mass with multiple polypoidal filling defects in a patient who has undergone previous laparotomy should lead the physician to suspect a retained surgical sponge. Surgical intervention is rewarding.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
9/19. ileus of the colon with cecal dilatation and perforation.Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
10/19. subcutaneous emphysema of the lower extremity of gastrointestinal origin.Two cases of subcutaneous emphysema of the left lower extremity secondary to perforations of the rectum ,nd sigmoid colon are presented. Although this is an extremely rare syndrome, the true incidence is probably higher, as some cases will be misdiagnosed as gas gangrene unless careful clinical and postmortem examinations are performed. Only rapid recognition of the probable origin of the gas, coupled with aggressive, definitive therapy, can prevent the usually fatal course of this condition. In the absence of trauma to the chest or infection in a previously normal leg, subcutaneous emphysema of a limb should alert the physician to the possibility of a gastrointestinal perforation as a source of the gas. Perforations of the gastrointestinal tract into the subcutaneous tissue can occur anywhere from the neck to the lower extremities.- - - - - - - - - - ranking = 0.2keywords = physician (Clic here for more details about this article) |
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