Comparison of three bowel preparation for sigmoidoscopy

The efficacy of three lower bowel preparations in 96 patients undergoing rigid sigmiodoscopy was studied. The maximal length of insertion and clarity of view were assessed in each group and compared to patients without bowel preparation. Blood per rectum and diarrhoea were the main indications for sigmoidoscopy. The maximal insertion of the instrument was similar for all groups and the rectosigmoid junction was examined in the majority. The clarity of view was good in 71 percent of patients receiving Fleet enema, 68 percent of those receiving Dulcolax micro-enema, 36 percent in the Dulcolax suppository and 16 percent in the group without bowel preparation. There were no adverse effects or complications arising from bowel preparation or sigmoidoscopy. Bowel preparation significantly improves the number of satisfactory sigmoidoscopic examinations, and the use of simple disposable enemas is safe and effective. (AU)

Benign colovesical fistulae

Two successfully treated cases of benign colovesical fistula are presented. The condition should be suspected whenever patients with colorectal disease develop urinary symptoms. Fllexible colonoscopy and lateral abdominal X-ray should be the initial investigations; but barium enema, cystoscopy and, rarely, CT scan may be necessary to confirm the presence of a colovesical fistula. Patients should be managed conservatively during the acute phase, and then be treated definitively by a single-stage bowel resection. Simple closure or resection and closure is used for the bladder defect. (AU)

Colo-mucosal proctectomy with ileo-anal anastomosis: the Jamaican experience

A total colectomy and a mucosal proctectomy with ileo-anal anastomosis (c-mp-iaa) effectively removes all debilitating, potentially malignant colonic mucosa. Preservation of the anorectal sphincter predictably results in good to excellent anal continence with a low mortality and acceptable morbidity. Since 1983 at the University Hospital of the West Indies (U.H.W.I.), Jamaica, five (5) patients have undergone c-mp-iaa for colonic mucosal disease. All have good to excellent anal continence with an average of 2-6 continent, formed stools per day. There were no operative deaths. The five (5) cases are described and a plea is made for the earlier use of this definitive surgical procedure where indicated. (AU)

Colonoscopy in Jamaica: a 12-year experience

Four hundred and nine colonoscopic examinations were performed in 335 patients over a 12-year period in Jamaica. The main indications were suspected polyps (34 percent), rectal bleeding (22 percent), and suspected carcinoma (11 percent). Total colonoscopy was performed in 33 percent of cases. The ascending colon and hepatic flexure were examined in a further 25 percent, and the transverse colon in another 21 percent. Endoscopic examination of the suspected abnormal area was possible in all cases. In 142 examinations, no abnormality was detected, reflecting a false positive Barium enema in some. Polyps were found in 135 examinations, diverticula in 69 and carcinoma in 13. There were no complications. Colonoscopy was more sensitive and specific than Barium enema. The barium enema findings were incorrect in 91 of 224 examinations (41 percent). Colonoscopy is a safe and accurate procedure which enables improved patient management (AU)

Intussusception in infancy and childhood

Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of Spain, over a 12 year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87 percent) and there was a predominance in the Negro child (62 percent). Male to female ratio was 1.2:1 . A high misdiagnosis rate (55 percent) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4 percent) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment. (AU)

Splenic flexure volvulus

Splenic flexure volvulus is rare, only 22 cases having been reported. Though these usually present with chronic intermittent clinical features we recently encountered a case presenting as acute intestinal obstruction which, on plain abdominal x-rays, had classical features of this condition.(AU)

Ileo-colic volvulus

Three cases of volvulus of the right colon are presented, and the current literature is reviewed. Prompt diagnosis based on clinical suspicion and plain abdominal radiographs can be made. Urgent operative treatment is mandatory. If gangrene has already occurred or if the volvulus cannot be untwisted, primary resection or a Mikulicz procedure should be performed depending on the patient's condition after applying soft clamps to the bowel proximally and distally. In non-gangrene cases, simple detortion is inadequate. Right hemicolectomy may be performed in the fitter patients but caecopexy of the peritoneal flap type has been shown to be promising, and appears to be as effective and perhaps safer in less experienced hands. (AU)

Volvulus of the colon

Volvulus of the colon is a closed loop obstruction resulting from an axial rotation of the colon on its mesentry. It is one of the common causes for obstruction in Northern Iran, East Africa, Eastern Europe and India. It is probably related to the high roughage diet consumed in these communities. These diets are similar to the Jamaican diet. This retrospective study was undertaken to determine the frequency of this type of acute abdominal emergency seen at the University Hospital of the West Indies, (UHWI), Kingston, Jamaica. Colonic volvulus accounted for 8-9 percent of all intestinal obstruction seen at the UHWI between 1971-1976. All types of volvulus were seen with sigmoid volvulus being the most commonly encountered. A high incidence of compound volvulus was also noted. The high roughage diet is suggested as an etiological factor since it is similar to the diet in other countries where the incidence of volvulus is high. Colonic volvulus is an acute surgical emergency requiring prompt diagnosis and urgent treatment. (Summary)