Malignant Neoplasms of the Colon
Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens in Neoplasms of the Colon, Rectum, and Anus, 2007
Jestin et al. (481) identified risk factors in emergency surgery for colonic carcinoma in a large population of 3259 patients; 806 had an emergency and 2453 an elective procedure. Patients who had emergency surgery had more advanced carcinomas and a lower survival rate than those who had an elective procedure (5-year survival rate 29.8% vs. 52.4%). There was a stage-specific difference in survival with poorer survival both for patients with stage I and II carcinomas and for those with stage III carcinomas after emergency compared with elective surgery. Emergency surgery was associated with a longer hospital stay (mean 18 days vs. 10 days) and higher costs (relative cost 1.5) compared with elective surgery. The duration of hospital stay was the strongest determinant of cost.
Sacrococcygeal teratoma
Prem Puri in Newborn Surgery, 2017
The infant is nursed in a prone position for several days postoperatively. The urinary catheter can be removed as soon as the baby’s condition is stable, and the infant can be extubated as soon as his/her respiratory condition allows. The infant can usually be fed as soon as he/she is extubated. The Vaseline pack is usually removed on the first postoperative day by pulling on the 2-0 silk suture left attached to the distal end. Any drain can usually be removed within the first few days of the procedure. A recent paper reported an unusual rare complication of a postoperative epidural hematoma that resulted in a cauda equina syndrome.96 The patient presented 17 days after a late (11 months of age) resection of an SCT with a distended bladder, loss of rectal tone, and significant weakness of the lower limbs. After emergency surgery, the patient eventually made a full recovery.
Wound infections and dehiscence
Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan in Take Charge! General Surgery and Urology, 2020
Operative factors (look at operation notes): Was the procedure performed electively or as an emergency? Patients undergoing emergency surgery are usually unwell and recovery is more likely to be complicated, despite a normal pre-operative nutritional state.Was the wound clean or contaminated? A contaminated wound is at greater risk of post-operative wound infection.How long was the surgery? Surgery longer than 7 hours increases the risk of wound infection.Were they given antibiotic prophylaxis?How was the wound closed? Were there difficulties achieving closure (high tension)? Was it closed in layers? What type of suture (or clip) was used?
Colonic stents for malignant bowel obstruction: current status and future prospects
Published in Expert Review of Medical Devices, 2019
Vittorio Maria Ormando, Rossella Palma, Alessandro Fugazza, Alessandro Repici
In a prospective multicenter study by Saito et al. [65] evaluating the safety and feasibility of SEMS placement as BTS, a total of 518 consecutive patients were enrolled. Technical and clinical success rates were 98 and 92%, respectively. Emergency surgery was performed in eight patients for the treatment of complications. Major complications, including perforation, occurred in 1.6%, persistent colonic obstruction occurred in 1.0 %, and stent migration occurred in 1.3% patients. The median time from SEMS to surgery was 16 days. The primary anastomosis rate was 92%. The rate of anastomotic leakage was 4%, and the overall stoma creation rate was 10%. The median duration of hospitalization following surgery was 12 days. Overall postoperative morbidity and mortality rates were 16 and 0.7%, respectively.
Up-to-date surgery for ulcerative colitis in the era of biologics
Published in Expert Opinion on Biological Therapy, 2020
Takayuki Yamamoto, Michele Carvello, Amy Lee Lightner, Antonino Spinelli, Paulo Gustavo Kotze
The ability to predict clinical outcomes of medical rescue therapy is currently limited and several clinical parameters such as temperature, heart rate, abdominal pain, stool frequency, blood in the stool and colonic dilatation are essential to make a management decision. Preoperative optimization of the patients is indispensable to improve surgical outcomes and needs to be considered whenever feasible (Table 1). Nutritional risk screening is recommended to correct malnutrition prior to surgery. Preoperative anemia, fluid depletion and electrolyte disorders need to be corrected whenever possible. Thromboembolism prophylaxis prior to surgery is well supported by evidence [28]. Although the most common reason for surgery is failure of medical therapy, emergency surgery can be required for intestinal perforation, toxic megacolon and refractory hemorrhage. A three-stage approach is advisable for patients with ASUC; first stage, subtotal colectomy and ileostomy with the rectum left in situ; second stage, ileal pouch–anal anastomosis with defunctioning ileostomy (3–6 months after primary surgery); third stage, closure of ileostomy [29].
An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Rima Nakrani, Ho-Man Yeung, Matan Arnon, Alexandra Selby, Christine Burgert-Lon, Bhishak Kamat
Primary colorectal DLBCL is a rare entity and effective frontline treatment of this condition (i.e., chemoradiotherapy or upfront surgery) has always remained a topic of controversy. Patients with complications, such as perforation, obstruction, or hemorrhage necessitate emergency surgery. Otherwise, clinical and tumor features should be taken into account in non-emergent cases [13]. Some investigators believe that surgery may provide better prognostication, enhance survival outcomes, and reduce the likelihood of future complications. Other authors believe that chemotherapy is adequate to achieve disease control [14]. However, localized disease (Stage I and II) fares better with surgical resection followed by R-CHOP chemotherapy, whereas unresectable disease (Stage III and IV) typically requires a full six cycles of R-CHOP chemotherapy followed by radiation for bulky disease [5]. Nevertheless, as with the treatment of all conditions, the risk and benefits must be weighted along with other factors including age, performance status, clinical condition and comorbidities, and patient/family preferences. In our case, the patient had advanced age, poor nutrition, poor performance status, and advanced stage IV disease. The patient and his oncologist elected for chemoradiation with reduced dosage and close outpatient monitoring for potential complications.
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