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Mesenteric Arterial Disease
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
What would you do after this?“I would put some warm packs around the bowel and return the viscera into the abdomen, waiting for 15–20 minutes. After this I would ask the general surgeon to have a look at the bowel, and we would make a decision on the need for bowel resection.”
Quality Indicators in Endometriosis Surgery
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Caryl M. Thomas, Richard J. Penketh
Due to service provision constraints, routine postoperative follow-up consultations can prove difficult. Follow-up is recommended if further investigations are required, if treatment has failed or to plan future management. Telephone follow-up consultations are both convenient and improve the patients' access to services and serve as a useful alternative to face-to-face consultations (46). Patients who have undergone complex operative work may also benefit from follow-up, for example, following a bowel resection. Postoperative assessment of the patient's health and functional status following treatment is useful in this scenario and should be fed back to the MDT. Automated follow-up by email with requests to complete symptom questionnaires has been tried but follow-up rates are poor (30).
An Updated Overview of the Medical Management of Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Lila S. Nolan, Martin Goree, Misty Good
Reintroduction of feeds following surgical resection may be challenging, as extensive bowel resection may subsequently compromise the efficiency of nutrient and fluid absorption. Surgical resection of the bowel for NEC places the infant at risk for delayed recovery and poor growth. Infants with extensive intestinal resection are predisposed to short bowel syndrome, which provides an increased risk of requiring prolonged recovery. These infants must be vigilantly evaluated for nutritional malabsorption necessitating long-term parenteral therapy and intestinal rehabilitation to optimize long-term outcomes.
Consideration of quality of life in the treatment decision-making for patients with advanced gastroenteropancreatic neuroendocrine tumors
Published in Expert Review of Anticancer Therapy, 2023
Boris G. Naraev, Josh Mailman, Thorvardur R. Halfdanarson, Heloisa P. Soares, Erik S. Mittra, Julie Hallet
NET-related diarrhea is one of the most common and impactful symptoms affecting patient QoL [24,62]. There are several symptomatic treatments depending on the underlying pathophysiology: carcinoid syndrome, steatorrhea, short GI transit time, or excessive bile acids. For diarrhea due to carcinoid syndrome, SSA therapy is beneficial [72]. However, some patients with serotonin-producing tumors experience diarrhea that is inadequately controlled by SSAs. In these patients, telotristat ethyl should be considered as add-on therapy based on results from TELESTAR. Patients with poorly controlled diarrhea due to carcinoid syndrome may also benefit from RLT. Chronic SSA use may cause pancreatic insufficiency and steatorrhea [62,73], which can be addressed with pancreatic enzyme therapy and dietary adjustments. Additionally, patients with NETs who have undergone small bowel resection can develop diarrhea resulting from shortened GI transit time or decreased bile acid resorption [74]. Diarrhea resulting from short GI transit time can be improved with dietary adjustments, adjustment of fluid consumption, and certain medications. Bile acid sequestrants can address bile acid malabsorption. More generally, nutritional assessments and dietary modifications have the potential to improve patient symptoms (including but not limited to diarrhea) and QoL [75].
Vitamin D levels in IBD: a randomised trial of weight-based versus fixed dose vitamin D supplementation
Published in Scandinavian Journal of Gastroenterology, 2020
Vladimir Kojecky, Jan Matous, Bohuslav Kianicka, Petr Dite, Zdena Zadorova, Jan Kubovy, Martina Hlostova, Michal Uher
Effective substitution in IBD patients may be influenced by certain disease specific factors. Terminal ileal resection has been linked to poor vitD absorption. Farraye et al. studied the dynamics of 25OHD levels following oral vitD administration in patients with both ileal form of CD or ileal resection. 25OHD concentration had no relationship to a particular resected bowel segment [20]. The resorption was proportionate to the length of the bowel resection. Nevertheless, small bowel resections of up to 100 cm (i.e. significantly more than a standard ileo-caecal resection), had no real impact on the efficacy of oral substitution. Other associations such as age and the disease duration did reach statistical significance, however, their contribution to overall variability was minimal.
Specific small bowel injuries due to prolapse through vaginal introitus after transvaginal instrumental gravid uterus perforation: a review
Published in Journal of Obstetrics and Gynaecology, 2019
Goran Augustin, Davor Mijatovic, Bozidar Zupancic, Dragan Soldo, Mario Kordic
The transvaginal instrumental uterine perforation for the termination of pregnancy can result in several degrees of small bowel obstruction. With a small bowel prolapse through the vaginal introitus, a simple obstruction is never present and rarely as a small bowel strangulation. The majority present as a mesenteric stripping or as a degloving injury. Both forms result in an irreversible bowel ischaemia; the latter being the result of the application of extreme, intentional pulling forces. The condition with all of its forms is evident clinically and sufficient for the indication of the urgent operation. A small bowel resection is always necessary. The best operative approach is the transvaginal resection of prolapsed bowel with the linear stapler on both ends; the transabdominal retraction of both small bowel ends and creation of the small bowel continuity, transabdominally. The suturing of uterine perforation or a hysterectomy depend on the degree of uterine damage and patients’ desire for future pregnancies. The maternal survival (if the underreporting of lethal outcomes is not taken into account) is excellent in all subgroups due to: 1) early presentation and intervention, 2) young, healthy women without significant comorbidities, and 3) the absence of peritonitis and profound haemorrhagic shock.