Diseases of the colon and rectum
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Review
Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position.
Acute compartment syndrome in patients undergoing prolonged colorectal procedures is uncommon but can have catastrophic consequences for the patient with the development of metabolic acidosis, myoglobinuric renal failure, Volkmann's contracture, limb loss, and death. The potential to produce long-term disability in a patient has important medicolegal implications, particularly if the complication is avoidable. Why only some patients develop acute compartment syndrome is not fully understood. The purpose of this study was to highlight current knowledge and suggested prevention strategies. ⋯ Acute compartment syndrome is uncommon but cases have been reported after prolonged pelvic procedures in the lithotomy position and it is a preventable condition. More research is required to set clear guidelines on patient positioning during surgery.
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The study was designed to identify the risk factors associated with anastomotic leakage after an intraperitoneal large-bowel anastomosis in patients with colorectal malignancy. ⋯ Intraperitoneal anastomosis after large-bowel resection is associated with a low leakage rate. Emergency surgery and a high American Society of Anesthesiologists grade are independent factors associated with an increased incidence of leakage. A temporary diverting stoma to protect the primary anastomosis or even avoidance of anastomosis could be considered for patients with the two risk factors present.
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The role of colonoscopy in the prevention of colorectal cancer has been accepted, not only by the medical community but by the federal government as well. This study sought to document the current role of colonoscopy in the practices of colorectal surgeons. ⋯ Colonoscopy plays a major role in the practices of colorectal surgeons across the world, accounting for approximately one-quarter of clinical time and total charges. Based on the expectation that this trend will continue, The American Society of Colon and Rectal Surgeons needs to aggressively support its members not only in the technical aspects of colonoscopy but also in the practice management issues.
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Seed bezoars in the rectum have been considered an uncommon cause of fecal impaction in adults. Although there have been several reports on sunflower seed bezoars, seed bezoars from the fruit of the prickly pear cactus and watermelon have received little notice. This study was designed to determine the frequency of fecal impaction by seed bezoars in the rectum and their clinical characteristics in adults. ⋯ Seed bezoars found in the rectum were the most common cause of fecal impaction requiring hospitalization, probably to the result of the eating habits in the Middle East. The consumption of seeds with shell fragments or fruits containing many seeds (such as the prickly pear) should be accompanied by the awareness that large quantities may cause fecal impaction.
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Randomized Controlled Trial Comparative Study
Randomized clinical trial of botulinum toxin plus glyceryl trinitrate vs. botulinum toxin alone for medically resistant chronic anal fissure: overall poor healing rates.
This study was designed to assess whether addition of glyceryl trinitrate to botulinum toxin improves the healing rate of glyceryl trinitrate-resistant fissures over that achieved with botulinum toxin alone. ⋯ There is some evidence to suggest that combining glyceryl trinitrate with botulinum toxin is superior to the use of botulinum toxin alone for glyceryl trinitrate-resistant anal fissure. The poor healing rate may reflect the fact that many of the patients did not have significant anal spasm at trial entry.