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Pathophysiological analysis and strategy for stercoral perforation of the colon

Open Journal of Gastroenterology 2012年第2期2卷 45-50页

作者： Koichi Sato Hiroshi Maekawa Mutsumi Sakurada Hajime Orita Tomoaki Ito Yoshihiro Komatsu Fumiko Hirata Ryo Wada Department of Pathology Juntendo Shizuoka Hospital Juntendo University School of Medicine Department of Surgery Juntendo Shizuoka Hospital Juntendo University School of Medicine

Perpose: In order to establish the pathophysiological features and strategy for stercoral perforation of the colon, we herein analyze a series of stercoral perforation of the colon. Method: Ten patients were diagnosed with stercoral perforation. Clinical features, primary diseases, triggers, causative bacteria in ascites, postoperative complications, pathological features, severity of the disease, and effect of direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) were investigated. Results: Nine patients had a long history of serious and chronic constipation and 7 patients had hypertension. Causative bacteria in ascites during the operation were most commonly Escherichia coli. There were a lot of severe postoperative complications such as sepsis, disseminated intravascular coagulation, and acute lung injury. With regard to the microscopic findings of the perforation site, the intestinal wall showed severe nonspecific inflammatory changes, including an increase of mono-nuclear cells in the lamina propria. There were 4 hospital deaths, so the mortality rate was 40%. APACHE- II and SOFA score were high postoperation and 24 hours after the operation. PMX-DHP was performed in 8 cases of severe conditions of stercoral perforation of the colon. Because the catecholamine index improved within 24 hours, four of 8 cases were rescued. Conclusion: Most of the patients with stercoral perforation of the colon had severe postoperative complications. The severity of the disease was extremely high, therefore, early diagnosis based on pathophy-siological features and comprehensive therapies including PMX-DHP were necessary for strategy of treating stercoral perforation of the colon.

关键词： stercoral Perforation of the Colon APACHE-II Score SOFA Score Polymyxin B Immobilized Fiber (PMX-DHP)

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Three Cases of Severe stercoral Colitis

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Open Journal of Emergency Medicine 2018年第4期6卷 82-87页

作者： Kashio Toyoda Keiichi Yokoyama Tomohide Matsushima Naoki Hashimoto Yasuhide Kitazawa Department of Emergency and Critical Care Medicine Faculty of Medicine Kindai University Osaka Japan

stercoral colitis is the inflammation of the colonic wall caused by fecal impaction. When a patient with a history of chronic constipation visits the Emergency Center with diffuse abdominal pain, sepsis and or rectal bleeding, clinicians should consider the possibility of stercoral colorectal perforation. An accurate diagnosis on a computed tomography (CT) scan (for fecal impaction, intra-abdominal feces, intraperitoneal free air, stranding of the peri-colonic fat in the segment, presence of extraluminal bubbles of gas) may facilitate early surgical intervention and improve the patient’s prognosis based on our clinical experience dealing with three patients who had stercoral colitis.

关键词： stercoral Colitis CT and Hartman’s Operation

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Laparoscopic treatment of complicated colonic diverticular disease:A review

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World Journal of Gastrointestinal Surgery 2016年第2期8卷 134-142页

作者： Ronald Daher Elie Barouki Elie Chouillard Department of Digestive and Minimally Invasive Surgery Poissy/Saint-Germain-en-Laye Medical Center Department of General and Minimally Invasive Surgery Poissy/Saint-Germain Medical Center

Up to 10% of acute colonic diverticulitis may necessitate a surgical intervention. Although associated with high morbidity and mortality rates,Hartmann's procedure(HP) has been considered for many years to be the gold standard for the treatment of generalized peritonitis. To reduce the burden of surgery in these situations and as driven by the accumulated experience in colorectal and minimally-invasive surgery,laparoscopy has been increasingly adopted in the management of abdominal emergencies. Multiple case series and retrospective comparative studies confirmed that with experienced hands,the laparoscopic approach provided better outcomes than the open surgery. This technique applies to all interventions related to complicated diverticular disease,such as HP,sigmoid resection with primary anastomosis(RPA) and reversal of HP. The laparoscopic approach also provided new therapeutic possibilities with the emergence of the laparoscopic lavage drainage(LLD),particularly interesting in the context of purulent peritonitis of diverticular origin. At this stage,however,most of our knowledge in these fields relies on studies of low-level evidence. More than ever,well-built large randomized controlled trials are necessary to answer present interrogations such as the exact place of LLD or the most appropriate sigmoid resection procedure(laparoscopic HP or RPA),as well as to confirm the advantages of laparoscopy in chronic complications of diverticulitis or HP reversal.

关键词： Diverticulitis Laparoscopy Emergent Lavage Drainage Peritonitis Purulent stercoral Complicated Perforation

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