Management of rectal stump leak following emergency Hartmann’s procedure

We report on the management of three cases of rectal stump leak and sepsis following urgent Hartmann’s procedure for perforated sigmoid diverticulitis or large bowel obstruction. Two patients had significant risk factors for poor tissue healing. All patients developed features of sepsis and computer tomography scans demonstrated rectal stump leak with adjacent collections. All patients required reoperation for drainage and washout of abscess. An intraperitoneal catheter system was introduced together with drains in order to continue on the ward until tract was formed. There was no mortality and minimal morbidity. The key to management of rectal stump leak is the early and aggressive drainage of the associated collection and continued irrigation of the stump.ResumoRelatamos o tratamento de três casos de vazamento de coto retal e sepse após o procedimento de urgente de Hartmann para diverticulite sigmoide perfurada ou obstrução do intestino grosso. Dois pacientes apresentaram fatores de risco significativos para uma má cicatrização tecidual. Todos os pacientes desenvolveram características de sepse e tomografia computadorizada demonstraram vazamento de coto retal com coleções adjacentes. Todos os pacientes necessitaram de reoperação para drenagem e lavagem do abscesso. Um sistema de cateter intraperitoneal foi introduzido junto com os drenos para continuar na enfermaria até a forma&c...
Source: Journal of Coloproctology - Category: Gastroenterology Source Type: research

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Condition:   Diverticulitis Colon Intervention:   Procedure: colon resection, stoma Sponsors:   Uppsala University;   Centrallasarettet Västerås;   Mora Hospital, Landstinget Dalarna;   Uppsala University Hospital;   University Hospital, Linkoeping;   Danderyd Hospital;   Sahlgrenska University Hospital, Sweden;   Stockholm South General Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
AbstractPurpose of ReviewSmall bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel ’s diverticula are covered elsewhere in this volume.Recent FindingsCT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention rema...
Source: Current Gastroenterology Reports - Category: Gastroenterology Source Type: research
CASE SUMMARY: A 62-year-old previously healthy man presented with left lower quadrant pain and fever. Physical examination showed left lower quadrant peritonitis. Computed tomography scan showed a pelvic abscess with extraluminal air (Fig. 1). Intravenous antibiotics were started, and CT-guided percutaneous drainage was performed. The drain was removed 1 week after discharge. One week later, he presented with dysuria and pneumaturia and was started on antibiotics. Colonoscopy confirmed diverticulosis with no other mucosal abnormalities. He underwent a successful laparoscopic sigmoidectomy with colovesical fistula takedown.
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Resident’s Corner Source Type: research
Conclusions: The finding of advanced colonic neoplasia in follow-up colonoscopy after an acute episode of CT-proven diverticulitis is equivalent to, or less than, that of the population colorectal cancer screening program. Routine colonoscopy is not necessary unless there are other concerning symptoms/CT findings.
Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques - Category: Surgery Tags: Original Articles Source Type: research
We present a case of a 62 ‐year‐old lady with a provisional diagnosis of acute cholecystitis, which turned out to be duodenal diverticulitis, who did not respond to conservative management and was successfully managed surgically.
Source: Surgical Practice - Category: Surgery Authors: Tags: CASE REPORT Source Type: research
CONCLUSIONS: Our results indicated showed that the supplement with the probiotic mix of Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201 in combination with the standard antibiotic therapy for AUD reduced abdominal pain and inflammation significantly more than antibiotic treatment used alone. These findings could be due to the anti-inflammatory activity of the probiotic mix. Larger studies are needed to validate its use in the clinical practice. PMID: 31696504 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Authors: Abdalla AO, Narala SB, Abdallah MA, Doshi R, Gullapalli N Abstract Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections. It contributes to significant morbidity and mortality among hospitalized patients in the United States. Prior studies suggest worse outcomes of CDI in patients with diverticulitis and increased risk for recurrent CDI. We conducted this study to evaluate the outcomes of CDI in patients with diverticular disease from a nationwide data sample (2012-2015).Methods: The National Inpatient Sample (NIS) database between January 2012 and ...
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
CASE SUMMARY: A healthy 65-year-old woman presents to the emergency department with a 12-hour history of sudden-onset severe lower abdominal pain. This is her first episode. She reports nausea, vomiting, and anorexia. Her last colonoscopy was at age 60, and was normal, except for diverticulosis of the sigmoid colon. Physical examination is significant for fever, tachycardia, and generalized abdominal pain with rebound tenderness. Pertinent laboratory findings include a leukocytosis and metabolic acidosis. A CT scan is obtained and is consistent with freely perforated diverticulitis, including a thickened sigmoid colon, f...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Resident’s Corner Source Type: research
Natalia Kubicki, Stephen Kavic, Hugo JR BonattiJournal of Minimal Access Surgery 2019 15(4):342-344Splenectomy together with colectomy is most commonly performed as a result of iatrogenic injury and not as an additional elective procedure. A 50-year-old African American female presented with recurrent episodes of diverticulitis. She had mediastinal, and porta hepatis lymphadenopathy and subcutaneous nodules, but multiple biopsies were unable to establish the diagnosis. On computed tomography scan, innumerable hypodense splenic lesions were noted. The patient underwent combined laparoscopic sigmoid colectomy and splenectomy...
Source: Journal of Minimal Access Surgery - Category: Surgery Authors: Source Type: research
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Source: Surgical Practice - Category: Surgery Authors: Tags: Case Report Source Type: research
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