Diseases of the colon and rectum
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Two children were admitted for clinical and radiologic signs of small-bowel obstruction. Examination revealed an abdominal mass that was suspected of being a mass of intussusception. Bowel obstruction caused by Ascaris lumbricoides was found at surgery. The laboratory, radiologic, and surgical findings are presented with a short review of the literature with emphasis on diagnosis, incidence, complications, and treatment.
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Colectomy (total or subtotal) is not the operation of choice for elective colonic cancer unless the patient is under 50 years of age, is undergoing curative resection, and has associated adenomatous polyps. Routine colectomy is not supported when a partial obstruction prevents preparation of the colon and interferes with proximal colonic examination. Colectomy (especially subtotal) is acceptable for the acutely obstructed colon but it is technically demanding and requires experience in patient selection.
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Case Reports
Pneumatic perforation of the colon during colonoscopy. Is the hypermobile right colon a risk factor?
Perforation of the colon by pneumatic injury during colonoscopy is a rare complication. Intraoperative observations of a patient who developed massive cecal distention, pneumatosis coli and severe pneumoperitoneum during colonoscopy suggest that an isolated, air-trapping colonic segment is a factor in the mechanism of such injury. The possibility that a poorly fixed, hypermobile cecum and right colon predispose to such injury by air insufflation during colonoscopy is discussed.
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Accidental anorectal injuries are becoming less common. This case, where impalement of the anorectal region by the shaft of a stool occurred to a junior surgeon at work, illustrates a previously unrecognized menace.
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Well-contained abdominal abscesses developed in two renal transplant patients ten years and six months, respectively, after transplantation. Investigations including gastrointestinal series and CT scan demonstrated cystic collections within the abdominal cavity. ⋯ In both patients deroofing the abscess and, in one patient, defunctioning colostomy were performed. Both patients did well in the postoperative period.