Preoperative percutaneous drainage of diverticular abscesses

Article Abstract:

Diverticulitis of the colon is inflammation caused by penetration of fecal matter through the thinned wall of pouchlike sacs in the walls of the intestine. Acute diverticulitis that involves large abscesses located in the pelvic area usually requires emergency surgical drainage to control the infection. The surgery is generally a two-part procedure. The first operation diverts fecal material to a temporary colostomy (an artificial opening through which the feces pass into a bag), either with or without excision of the diseased colon. At a later time, the patient returns to the hospital for surgical closure of the colostomy. The use of computed tomography (CT) has permitted accurate identification of diverticular abscesses in the colon. The use of CT- or ultrasound-guided percutaneous catheter drainage of diverticular abscesses is described; this drainage appears useful preoperatively because it eliminates the need for the colostomy and the second operation. There were 19 patients (average age of 64 years) followed for an average of 17.4 months. All patients had acute diverticulitis of the sigmoid colon with large abscesses which would have required multiple-stage surgery. In 17 patients CT guidance was used, and in two patients ultrasound guidance was used. No complications related to catheter placement developed, and 15 patients required drainage for less than three weeks. The infection resolved rapidly; beyond the third day only two patients (11 percent) had fever or high white blood cell counts. Three patients developed fistula to the colon with drainage of fecal material. Two patients refused surgery, and 14 patients (74 percent) completed the treatment with a single operation, which was sigmoid colectomy (removal of the sigmoid colon). It is concluded that preoperative catheter drainage eliminates the need for a two-stage operation in about 75 percent of patients with large abscesses from diverticulitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Intestines, Abscess drainage, Diverticulitis, Diverticular disease

---

Factors influencing the treatment of intra-abdominal abscesses

Article Abstract:

If the abdominal cavity becomes contaminated, the body responds by containing the infection and forming an intra-abdominal abscess. However, if this abscess is not drained, the patient will die. Abscesses within the abdominal cavity are traditionally drained surgically; this procedure improves survival, but still has a high mortality. With advances in computed tomography (CT) and ultrasonography these abscesses can be identified and located more accurately. More recently, abscesses have been drained percutaneously (through the skin) using small catheters placed with the guidance of CT and ultrasound. An analysis was undertaken of the outcome of treatment of 48 patients with intra-abdominal abscesses. In this group, there were 68 abscesses, and 68 procedures for drainage were performed. The average patient age was 48 years. The causes of the abscesses were postoperative abscess (28 patients), appendix (7), pancreatic (7), intestinal (3), and other (3). Abscesses were classified as simple or complex. Initial treatment was surgery for 30 patients and percutaneous drainage for 18 patients. This initial treatment was successful in 61 percent of the percutaneous group (11 of 18) and 53 percent of the operated group (16 of 30). The more complex abscesses were treated successfully more often by operation (10 of 22 patients) than by percutaneous drainage (1 of 6). Thus patients with complex abscesses usually required surgery, and the mortality was higher for complex abscess patients. The patients who had percutaneous drainage were older and more often had simple abscesses. It is suggested that percutaneous treatment be used if the abscess is accessible, and is a simple abscess. Complex or inaccessible abscesses should be treated surgically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Abdomen, Radiology, Interventional, Interventional radiography, Abdominal abscess

---

Contributions of the Zollinger-Ellison syndrome

Article Abstract:

Zollinger-Ellison syndrome is characterized by pancreatic endocrine tumor and severe peptic ulcer disease. The study of this condition and the exaggerated responses produced by the tumor has led to an increase in our understanding of the normal mechanism of gastrointestinal hormones. The contributions of Zollinger-Ellison syndrome are outlined. When this syndrome was identified in 1955, there was only one known pancreatic endocrine tumor; since then many others have been identified. The markedly increased secretion of acid characteristic of Zollinger-Ellison syndrome was useful in identification of Zollinger-Ellison patients; this contributed to identification of other subsets of patients with duodenal ulcer. The ability to assay gastrin (a stomach hormone), which is the definitive method of diagnosing the syndrome, has increased understanding of other conditions such as pernicious anemia and antral G-cell stomach hyperplasia. The association of the syndrome with hyperparathyroidism led to the first stimulation tests to detect occult gastrinomas. Patients with advanced metastatic liver cancer were noted to have extremely elevated gastrin levels; this supported the concept of serum indicators for metastatic cancer. Knowledge and understanding of the hormone-hormone interrelationship is one of the most important contributions of Zollinger-Ellison syndrome. Other areas of increased understanding include interrelated adenomas; new medical treatment for peptic ulcer disease and development of effective antiulcer drugs; the existence of lymph node involvement that is not metastatic; and the origins of pancreatic endocrine tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Endocrine gland diseases, Endocrine diseases, Pancreatic tumors, Zollinger-Ellison syndrome

Similar abstracts:

• Abstracts: A randomized trial of nonoperative treatment for perforated peptic ulcer. Treatment of peptic ulcers caused by Helicobacter pylori
• Abstracts: Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer. Quantitative fluorescence polymerase chain reaction for the rapid prenatal detection of common aneuploidies and fetal sex
• Abstracts: DNA discoverer James Watson now dreams of curing genetic diseases. A few words of advice from a woman of letters - Ann Landers
• Abstracts: Superficial microwave-induced hyperthermia in the treatment of chest wall recurrences in breast cancer. Hyperthermia alone in the treatment of recurrences of malignant tumors: experience with 60 lesions
• Abstracts: Perioperative morbidity and mortality of gynecologic brachytherapy. The patterns of care outcome study for cancer of the uterine cervix: results of the Second National Practice Survey

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.