The management of malignant left colon obstruction remains a difficult problem. Conventional surgical treatment is muti-staged and each stage carries its own morbidity and mortality. The purpose of this study is to identify the feasibility and safety of one stage operation in patients presenting with acute obstruction of the left colon. From January 1991 to June 1996, 29 patients received one stage resection for acutely obstructed carcinoma of the left colon at Soonchunhyang University Chunan Hospital. Subtotal colectomies were performed in 9 patients(31.0%), left hemicolectomies in 6(20.7%), low anterior resection in 6(20.7%), sigmoid colectomy in 4(13.8%), anterior resection in 4 patients(13.8%). Subtotal colectomy was performed in patients with massively distended colon of dubious viability and to contain ischemic lesions at proximal colon. Total operative mortality was 6.9%: 5% in the immediate resection with anastomosis group, 11.1% in subtotal colectomy group. Complications included wound infection(4), fecal incontinence(2), intestinal obstruction(2), anastomotic leakage(1), upper G-I bleeding(1), postoperative bleeding(1), pulmonary complication(1). Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in patients with acute malignant obstruction of the left colon.
Chungcheongnam-do ; Colectomy ; Colon* ; Colon, Sigmoid ; Humans ; Mortality ; Wounds and Injuries

OBJECTIVE: To report the defecation patterns of brain-injured patients and evaluate the relationship between functional ability and colon transit time (CTT) in stroke patients. METHOD: A total of 55 brain-injured patients were recruited. Patient interviews and medical records review of pattern of brain injury, anatomical site of lesion, bowel habits, constipation score, and Bristol scale were conducted. We divided the patients into constipation (n=29) and non-constipation (n=26) groups according to Rome II criteria for constipation. The CTTs of total and segmental colon were assessed using radio-opaque markers Kolomark(R) and functional ability was evaluated using the functional independence measure (FIM). RESULTS: Constipation scores in constipation and non-constipation groups were 7.32+/-3.63 and 5.04+/-2.46, respectively, and the difference was statistically significant. The CTTs of the total colon in both groups were 46.6+/-18.7 and 32.3+/-23.5 h, respectively. The CTTs of total, right, and left colon were significantly delayed in the constipation group (p<0.05). No significant correlation was found between anatomical location of brain injury and constipation score or total CTT. Only the CTT of the left colon was delayed in the patient group with pontine lesions (p<0.05). CONCLUSION: The constipation group had significantly elevated constipation scores and lower Bristol stool form scale, with prolonged CTTs of total, right, and left colon. In classification by site of brain injury, we did not find significantly different constipation scores, Bristol stool form scale, or CTTs between the groups with pontine and suprapontine injury.
Brain Injuries ; Colon ; Constipation ; Defecation ; Humans ; Medical Records ; Rome ; Stroke

The incidence of colon injury is low but is associated with adverse outcome if managed inadequately.Colostomy and secondary closure has been the traditional management, which is associated with more pain to the patient and a waste of medical resource. Recent studies indicate that physiologic disturbances after trauma is the main risk factor of anastomotic leak , therefore primary repair or resection and anastomosis is feasible if physiological status of the patient is stable as calibrated by New Injury Severity Score and ASA score. For patients with open abdomen or temporary closure,colonic resection can also be performed at definitive abdominal closure in select cases.
Abdominal Injuries ; complications ; Anastomotic Leak ; Colon ; injuries ; Colonic Diseases ; complications ; surgery ; Colostomy ; Humans ; Wound Healing

Humans ; Accidents, Traffic ; Colon, Sigmoid ; Forensic Medicine ; Autopsy ; Abdominal Injuries ; Thoracic Injuries ; Rupture

Colon, Ascending ; injuries ; Foreign Bodies ; complications ; Humans ; Intestinal Perforation ; diagnosis ; etiology ; surgery ; Male ; Middle Aged ; Seafood

OBJECTIVE: To evaluate the usefulness of plain abdominal radiography as an evaluation method for bowel dysfunction in patients with spinal cord injury (SCI). METHODS: Forty-four patients with SCI were recruited. Patients were interviewed about their clinical symptoms, and the constipation score and Bristol stool form scale were assessed. The colon transit time (CTT) was measured by using radio-opaque markers (Kolomark). The degree of stool retention and the presence of megacolon or megarectum were evaluated using plain abdominal radiographs. We examined the relationship between clinical aspects and CTT and plain abdominal radiography. RESULTS: The constipation scores ranged from 1 to 13, and the average was 4.19+/-3.11, and the Bristol stool form scale ranged from 1 to 6, with an average of 4.13+/-1.45. CTTs were 19.3+/-16.17, 19.3+/-13.45, 15.32+/-13.15, and 52.42+/-19.14 in the right, left, rectosigmoid, and total colon. Starreveld scores were 3.4+/-0.7, 1.8+/-0.86, 2.83+/-0.82, 2.14+/-1, and 10.19+/-2.45 in the ascending, transverse, descending, rectosigmoid, and total colon. Leech scores were 3.28+/-0.7, 2.8+/-0.8, 2.35+/-0.85, and 8.45+/-1.83 in the right, left, rectosigmoid, and total colon. The number of patients with megacolon and megarectum was 14 (31.8%) and 11 (25%). There were statistically significant correlations between the total CTT and constipation score (p<0.05), and Starreveld and Leech scores (p<0.05). Significant correlations were observed between each segmental CTT and the segmental stool retention score (p<0.05). CONCLUSION: Plain abdominal radiography is useful as a convenient and simple method of evaluation of bowel dysfunction in patients with SCI.
Colon ; Constipation ; Humans ; Megacolon ; Neurogenic Bowel ; Radiography, Abdominal ; Retention (Psychology) ; Spinal Cord ; Spinal Cord Injuries

Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed.
Abdominal Injuries ; Anastomotic Leak ; Colon ; Colorectal Surgery ; Colostomy ; Drainage ; Humans ; Stress, Psychological ; Wounds, Nonpenetrating ; Wounds, Penetrating

We experienced a case of unusual complication following esophageal reconstruction. In 1969, accidentally the patient swallowed lye and was developed benign esophageal stricture one year later. In 1972, esophageal reconstruction with right colon was done but pus was drained out of the abdominal wound. After then wound disruption and healing were repeated. In 1996, stenosis of colonic graft was found and resection of stenotic area and end to end anastomosis was done. We concluded that it was developed inflammatory change of graft by intraoperative infection.
Abscess* ; Colon ; Constriction, Pathologic* ; Esophageal Stenosis ; Humans ; Lye ; Postoperative Complications ; Suppuration ; Transplants ; Wounds and Injuries

Although the obstruction of the right colon is usually handled by primary anastomosis following resection, fear of the increased incidence of septic complication, especially anastomotic leakage with sepsis has turned surgeons away from doing anastomosis in the face of acute obstruction of the left colon. However, from recent reports, enough experiences have been accumulated to show that primary anastomosis is associated with minimum morbidity and mortality in the acute obstruction of the left colon. We experienced 54 cases of colon cancer obstruction at Holy Family Hospital from January 1988 to December 1997. Twenty six cases of them were right colon cancers, 24 cases were left colon cancers and 4 cases were rectal cancers. We reviewed these three groups for evaluation of the safety of one-stage resection and anastomosis of left colon cancer obstruction. The postoperative complication rate was 18% in right colon obstruction versus 38% in left colon obstruction. The most common complication was wound infection(43%). In using of primary resection and anastomosis, complication of right colon revealed 15% and left colon was 29%. But in a method of primary resection and anastomosis with decompression, complication of right colon was 17% and left colon was 13%. Especially on the left colon, primary resection and anastomosis with decompression revealed lower complication(13%) than that without decompression(67%). The mortality of colon cancer obstruction was 2% but this was a patient who had a poor general condition and took a primary resection and anastomosis without decompression. In cases of left colon cancer obstruction primary resection and anastomosis with decompression of left colon cancer obstruction can be a safe operation method with low morbidity and mortality.
Anastomotic Leak ; Colon* ; Colonic Neoplasms* ; Decompression ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Rectal Neoplasms ; Sepsis ; Wounds and Injuries

PURPOSE: Burn wound infection, sepsis and organ failure have been major causes of death in massive burn patient. Because it is difficult to fundamentally prevent bacterial colonization by medical treatment, the need of surgical intervention is advocated by many authors. Therefore the effects of early excision and optimal time were studied. METHODS: Twenty four patients with thermal injuries, on whom early excision of eschar was performed, between June and Aug. 2003, were studied. Fascial excision over third and fourth degree burns and tangential excision over indeterminate areas were performed. Superficial and deep layers of eschar was separated and cultivated, and bacterial colony counts performed. The patients were divided into two groups: a colony count equal or greater than 10(5)/g (group A) and less than 10(5)/g (group B), and studied. The plasma endotoxin levels were assayed and compared. RESULTS: Sepsis occurred at a higher rate when the bacterial colony counts were equal or greater than 10(5)/g at the wound site. Bacterial colonization appears to be greatly increased on the 4th in of escharectomy in superficial layers, and on the 5th in deep layers, in old aged or young child patients tends to occur earlier and with greater severity. The microorganism isolated in all patients was Pseudomonas aeruginosa. There was no statistical difference in the plasma endotoxin levels between groups A and B. CONCLUSION: It is suggested that all massive burn injuries would be better treated with early excision, within 3 days after burns, especially in old aged or young child patients.
Burns* ; Cause of Death ; Child ; Colon ; Humans ; Plasma ; Pseudomonas aeruginosa ; Sepsis ; Wound Infection ; Wounds and Injuries