PURPOSE: This study was performed to assess the complications and discomfort of patients with or without a nasogastric tube who underwent elective colorectal surgery and to evaluate the efficacy of the routine practice of employing a nasogastric tube after elective colorectal surgery. METHODS: This study involved a prospective, randomized trial of 100 patients undergoing elective colorectal surgery from February to July 2004. The patients were classified as the nasogastric tube inserted group (NG (+), n=50) and non-inserted group (NG (-), n=50). The inclusion criteria were elective colorectal surgery, age under 70 years and no previous abdominal surgery history. The exclusion criteria were an emergent operation, an overt preoperative bowel obstruction and extensive operations such as pouch surgery and multivisceral resection. RESULTS: The mean age of the subjects was 55 (24~70) years old. There was no difference in terms of age, gender, pathological diagnosis and surgical procedures between the NG (-) and NG (+) groups. A sore throat and nausea was more prevalent in the NG (+) group (P=0.000, P=0.046). The gas passage time was shorter in the NG (-) group than in the NG (+) group (P=0.028). The other variables, such as vomiting, postoperative ileus, postoperative fever, posto-perative atelectasis, postoperative leakage, intraoperativedecompression, stool passage time and the length of the hospital stay revealed no difference between the groups. CONCLUSION: Nasogastric intubation is an uncomfortable procedure for patients and offers no benefit in preventing postoperatve complications. The routine use of a nasogastric tube is not necessary in elective colorectal surgery.
Colorectal Surgery* ; Diagnosis ; Fever ; Humans ; Ileus ; Intubation, Gastrointestinal* ; Length of Stay ; Nausea ; Pharyngitis ; Postoperative Nausea and Vomiting ; Prospective Studies* ; Pulmonary Atelectasis

Torsion of the gallbladder is a uncommon disease. Since Wendel reported the first case of torsion of the gallbladder in 1898, approximately 400 or more cases have been reported on. A mobile gallbladder with abnormal anatomical fixation to the liver is required for this torsion. Twisting of the mobile gallbladder on its pedicle creates occlusion of the blood supply or bile flow to the organ, and gangrene and necrosis finally occurs. Prompt surgery is required for this condition. Unless cholecystectomy is performed, this condition could cause severe postoperative complications or death to the patient. Torsion of the gallbladder has been known to occur frequently in thin, elderly females. Because of its medical rarity, diagnosis of torsion prior to operative exploration is extremely difficult and the diagnosis is generally maded by laparotomy. We report here on a case of torsion of the gallbladder. The patient was an 82 years old female who complained of severe epigastric pain, nausea, and vomiting. Ultrasonography and computed tomography were performed and these modalities demonstrated a distended gallbladder with wall thickening; the gallbladder didn't contain stones. Explorative laparotomy and cholecystectomy was then performed. We found that the necrotized gallbladder was twisted around its pedicle. We report here on a case of gallbladder torsion and we discuss the clinical features and diagnostic methods for this malady.
Aged ; Aged, 80 and over ; Bile ; Cholecystectomy ; Diagnosis ; Female ; Gallbladder* ; Gangrene ; Humans ; Laparotomy ; Liver ; Nausea ; Necrosis ; Postoperative Complications ; Ultrasonography ; Vomiting

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of remote cerebellar hemorrhage (RCH), which was a complication after posterior decompression and lumbar interbody fusion (PILF). SUMMARY OF LITERATURE REVIEW: Remote cerebellar hemorrhage (RCH) after spinal surgery is a rare complication, and its cause is known to be due to a loss of cerebral spinal fluid (CSF) through the dural tear. Most of the literature has disclosed that early diagnosis and treatment of RCH is very important in the patient with suspicious symptoms. MATERIALS AND METHODS: A 57-year-old woman had posterior lumbar decompression and interbody fusion for the severe spinal stenosis at L4-5. During surgery, an accidental dural tear with CSF leakage occurred. The torn dura was sutured. Postoperatively, she developed nausea and a severe headache. Hypotension developed at postoperative 2 hours. A brain CT showed RCH. The patient was conservatively managed with clamping of the wound drainage. RESULTS: The nausea and severe headache were controlled and normal blood pressure could be maintained without dopamine therapy at postoperative day 2. The patient was discharged without any neurological deficit, and her consciousness was clear at postoperative 2 weeks. CONCLUSIONS: Persistent postoperative nausea, headache, and hypotension after repair of the torn dura may suggest that the treating surgeons pay careful attention due to the possibility of RCH, even though the amount of CSF leakage is small.
Blood Pressure ; Brain ; Consciousness ; Constriction ; Decompression* ; Dopamine ; Drainage ; Early Diagnosis ; Female ; Headache ; Hemorrhage* ; Humans ; Hypotension ; Lumbar Vertebrae ; Middle Aged ; Nausea ; Postoperative Nausea and Vomiting ; Spinal Stenosis ; Wounds and Injuries

BACKGROUND: Patients undergoing ambulatory surgery under general anesthesia experience considerable levels of postoperative nausea and vomiting (N/V) after their discharge. However, those complications have not been thoroughly investigated in hand surgery patients yet. We investigated factors associated with postoperative N/V in patients undergoing an ambulatory hand surgery under general anesthesia and determined whether patients' satisfaction with this setting is associated with postoperative N/V levels. METHODS: We prospectively evaluated 200 consecutive patients who underwent ambulatory hand surgeries under general anesthesia to assess their postoperative N/V visual analogue scale (VAS) levels during the first 24 hours after surgery and their satisfaction with an ambulatory surgery setting. Potential predictors of postoperative N/V were; age, sex, body mass index, smoking behavior, a history of postoperative N/V after previous anesthesia or motion sickness, preoperative anxiety level and the duration time of anesthesia. We conducted multivariate analyses to identify factors associated with postoperative N/V levels. We also conducted multivariate logistic regression analyses to determine whether the N/V levels are associated with the patients' satisfaction with this setting. Here, potential predictors for satisfaction were sex, age, postoperative pain and N/V. RESULTS: Postoperative N/V were associated with a non-smoking history, a history of motion sickness and a high level of preoperative anxiety. Twenty-two patients (11%) were dissatisfied with the ambulatory setting and this dissatisfaction was independently associated with moderate (VAS 4-7) and high (VAS 8-10) levels of postoperative N/V and with a high level (VAS 8-10) of postoperative pain. CONCLUSIONS: Although most of the patients were satisfied with the ambulatory surgery setting, moderate to high levels of N/V were associated with dissatisfaction of patients with this setting, suggesting a need for better identifying and managing those patients at risk. The information regarding risk factors for N/V could help in preoperative patient consultation regarding an ambulatory hand surgery under general anesthesia.
Adolescent ; Adult ; Aged ; *Ambulatory Surgical Procedures ; Anesthesia, General ; Female ; Hand/*surgery ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Postoperative Nausea and Vomiting/*diagnosis ; Young Adult

BACKGROUND: Afferent loop syndrome is an uncommon complication of a gastric resection in which intestinal continuity has been restored by using a gastrojejunostomy. It may cause symptoms at any time from the first postoperative day to many years after the gastrectomy, although most symptoms are manifestated during the second postoperative week. Due to difference in the degree and the permanence of the obstruction, the symptoms and the courses of patients with afferent loop syndrome may be acute or chronic. METHODS: We performed a retrospective clinical analysis of 29 patients who had been treated with operations from January 1982 to December 1996 at the Department of Surgery, Catholic University Medical Center. RESULTS: Afferent loop syndrome occurred in 29 cases (0.46%) of gastric surgery involving 1882 peptic-ulcer cases and 4390 stomach cancer cases. The original conditions requiring gastric surgery were gastric ulcers (8/752, 1.06%), duodenal ulcers (10/1130, 0.88%), and stomach cancer (11/4390, 0.25%). This syndrome occurred more frequently for a truncal vagotomy and a Billroth II type antrectomy (1.76%) than for other surgical procedures. The etiologic factors of afferent loop syndrome were an adhesive band (41.4%), volvulus (24.1%), retroanastomotic internal herniation (20.7%), and stomal stenosis (13.8%). The time interval from the first operation to the onset of symptoms was less than two weeks in 58.6% of the patient. Epigastric pain was the most common symptom (93.1%), followed by nausea and/or vomiting (51.7%), tachycardia (41.3%), and fever (27.5%). The diagnostic procedure mainly performed was an upper gastrointestinal series (69%). Hyperamylasemia was noted in 17 patients (65%). Theoperations performed included a bypass jejunojejunostomy in 17 patients (58.6%), a Roux-en-Y enterostomy in 6 patients (20.7%), a tube duodenostomy in 2 patients (6.9%), a bypass jejunostomy with tube duodenostomy in 2 patients, and a pancreaticoduodenectomy in 2 patients. The postoperative complications were wound infections (34.5%), pleural effusion (13.8%), enterocutaneous fistulas (17.2%), and subphrenic abscesses (13.8%). The operative mortality rate (within 2 months) was 13.8%. CONCLUSIONS: If afferent loop syndrome is suspected, it may be demonstrated by using an upper gastrointestinal contrast study. Endoscopy should be performed in all patients in whom the diagnosis of afferent loop obstruction is suspected. It's main value is to rule out other causes for the patient's complaints, especially in alkaline reflux gastritis. Once the diagnosis is made, surgical correction is indicated. The most satisfactory measure to prevent afferent loop syndrome is to avoid a long afferent loop. If a Billroth I or a Roux-en-Y pattern gastrointestinal anastomosis is difficult, this complication is best avoided by using a short afferent loop and by fashioning the anastomosis to prevent an obstruction at the stoma.
Academic Medical Centers ; Adhesives ; Afferent Loop Syndrome* ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenostomy ; Endoscopy ; Enterostomy ; Fever ; Gastrectomy ; Gastric Bypass ; Gastritis ; Gastroenterostomy ; Humans ; Hyperamylasemia ; Intestinal Fistula ; Intestinal Volvulus ; Jejunostomy ; Mortality ; Nausea ; Pancreaticoduodenectomy ; Pleural Effusion ; Postoperative Complications ; Retrospective Studies* ; Stomach Neoplasms ; Stomach Ulcer ; Subphrenic Abscess ; Tachycardia ; Vagotomy, Truncal ; Vomiting ; Wound Infection

Acute necrotizing pancreatitis often progresses into infection, sepsis, multiorgan failure and then, mortality and morbidity which are very high. From January 1988 to December 1996, 14 patients with surgically proved acute necrotizing pancreatitis at the Department of Surgery, Catholic University were analysed. 1) The patients consisted of 12 men and 2 women ranging in age from 27 to 74 years. 2) The ethiological factors included excessive alcohol abuse in 8 patients, biliary tract disease in 2 patients and unknown in 4 patients. 3) In clinical findings, the majority of the patients complained of sudden severe upper abdominal pain, nausea and vomiting, tachycardia, and abdominal distension. 4) Serum amylase level did not increase in 50% although the necrosis was severe, but aspartate transaminase increased in 13 cases. The lactic dehydrogenase and C-reactive protein increased in all tested cases. 5) In regards to diagnostic methods, computerized tomography was highly effective in getting early diagnosis and in finding the complications. 6) Early necrosectomy and drainage procedure was safe and effective. 7) Postoperative complications included pulmonary complications in 3 patients, pancreas fistula in 2, pancreas pseudocyst in 2, acute renal failure in 2, Diabetes mellitus in 2, gastrointestinal bleeding 1, and subphrenic abscess in 1 case. 8) Mortality rate was 36 %. In conclusion, computerized tomography may be used for early detection of acute necrotizing pancreatitis;. Aspartate transaminase, Lactate dehydrogenase and C-reactive protein may be good diagnostic and prognostic indicators upon admission. Necrosectomy and drainage should be chosen as the best surgical treatment in acute necrotizing pancreatitis patients.
Abdominal Pain ; Acute Kidney Injury ; Alcoholism ; Amylases ; Aspartate Aminotransferases ; Biliary Tract Diseases ; C-Reactive Protein ; Diabetes Mellitus ; Drainage ; Early Diagnosis ; Female ; Fistula ; Hemorrhage ; Humans ; L-Lactate Dehydrogenase ; Male ; Mortality ; Nausea ; Necrosis ; Oxidoreductases ; Pancreas ; Pancreatitis, Acute Necrotizing* ; Postoperative Complications ; Sepsis ; Subphrenic Abscess ; Tachycardia ; Vomiting

PURPOSE: Acute appendicitis is the most frequently encountering extrauterine surgical condition in pregnancy. Prompt diagnosis of acute appendicitis in pregnancy is not easy on the basis of clinlical findings, which may be obscured or altered by the presence of a gravid uterus. In most of cases, prompt diagnosis and early surgical intervention could result in optimal maternal and fetal outcomes. MATERIAL AND METHODS: We performed retrospective analysis of 20 cases, which were operated under the diagnosis of acute appendicitis in pregnancy from 1990 to 1995 at the department of surgery, Soonchunhyang University Hospital. RESULTS: 1) The incidence of the acute appendicitis in pregnancy was one per 742 deliveries and the diagnostic accuracy was 85%. 2) The majority of patiens was in the 3rd decade of age (76.5%). 3) Gestational stages at onset of symptom were first trimester in 6 patients (35.3%) and second trimester (52.9%) in most patients. 4) The majority of patients(82.4%) spent less than 24 hours preoperatively. 5) The symptoms in order of frequency were; abdominal pain (100%), nausea (70.5%), vomiting (41.1%), fever (23.5%), chill (11.8%), constipation (11.8%), diarrhea (5.9%). The maximal tenderness was noted on McBurney's point (29.4%) and above McBurney's point (58.8%) in most of patient. 6) The leukocyte counts were mostly in the range of 10,000 to 15,000 mm3 (47.1%) and 15,000 to 20,000 mm3 (35.3%). 7) Several types of incisions were employed: a McBurney incision was used in 8 cases (47.1%), a transverse incision in 8 cases (47.1%), and a low midline incision in 1 case (5.8%). A general anesthesia was done in 6 patients (35.3%), a spinal anesthesia done in 8 patients (47.1%), and an epidural anesthesia done in 3 patients (17.6%). A drain was placed intraabdominally in 2 cases. 8) Among 17 cases, three were reported as focal appendicitis (17.6%), ten as suppurative one (58.8%), one as ganagrenous one (5.9%) and three as perforated one (17.6%). 9) The postoperative complications included 1 wound infection and 4 artificial abortions. There was no maternal death, preterm labor, or spontaneous abortion. CONCLUSION: Despite of diagnostic obstacles due to pregnancy, acute appendicitis can be diagnosed without major difficulty. High index of suspicion is required during diagnostic procedures and prompt surgical intervention improves maternal and fetal outcomes...EABS:
Abdominal Pain ; Abortion, Spontaneous ; Anesthesia, Epidural ; Anesthesia, General ; Anesthesia, Spinal ; Appendicitis* ; Constipation ; Diagnosis ; Diarrhea ; Female ; Fever ; Humans ; Incidence ; Leukocyte Count ; Maternal Death ; Nausea ; Obstetric Labor, Premature ; Postoperative Complications ; Pregnancy Trimester, First ; Pregnancy Trimester, Second ; Pregnancy* ; Retrospective Studies ; Uterus ; Vomiting ; Wound Infection