Diseases of the colon and rectum
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Comparative Study
Use of epidural anesthesia and spontaneous ventilation during transabdominal colon and rectal procedures in selected high-risk patient groups.
Patients with cardiopulmonary compromise who require transabdominal colon and rectal procedures are at increased risk for postoperative cardiac and pulmonary complications and prolonged hospital stays. Because epidural anesthesia has been shown to minimize reductions in functional residual capacity and consequently improve pulmonary function, we sought to determine its impact on patients undergoing colon and rectal procedures who were at high risk for postoperative cardiopulmonary morbidity. ⋯ Use of epidural anesthesia with spontaneous ventilation in elective transabdominal colon and rectal procedures may decrease the incidence of pulmonary complications and length of postoperative hospital stay in a select group of high-risk patients.
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Gunshot wounds to the buttocks may cause significant intra-abdominal injuries. Policies of aggressive abdominal exploration or extensive diagnostic testing have been suggested to avoid delays in treatment and consequent morbidity. Our group has recently suggested that clinical examination is a safe and reliable tool for triaging patients with anterior and posterior abdominal gunshot wounds. ⋯ Clinical examination is a safe method for selecting patients with gunshot wounds to the buttocks for nonoperative treatment.