The suspended ileal loop for difficult Hartmann's reversal.

BACKGROUND: Hartmann's reversal can be complicated by the presence of dense adhesions in the upper part of the abdominal cavity, difficulties in freeing the splenic flexure with the risk of splenic tears, a lack of sufficient colonic length, the risk of ureteral lesion, or the risk of lesions of the vascular arcade. METHODS: We propose a technique which consists of interposing an adapted segment of ileal loop between the end of the proximal colon and the rectum to restore intestinal continuity. RESULTS: Two patients had Hartmann procedure, the first for a Hinchey stage 4 perforated diverticulitis and the second for a colorectal fistula due to ischemia of the proximal colonic segment. Hartmann's reversal was expected to be difficult, so a suspended ileal loop was used. The outcomes were uneventful, and functional results were satisfactory. CONCLUSIONS: A suspended ileal loop could be used as a salvage procedure in some cases of potentially difficult Hartmann's reversal.

Spondylodiscitis on recto-rachidian fistula after non-restored sigmoid resection.

After non-restored sigmoid resection and terminal colostomy, the rectal stump can reopen, thereby occasioning a number of problems. We are reporting the case of a 79-year-old female patient who presented with spondylodiscitis due to a recto-rachidian fistula on a rectal stump subsequent to non-restored sigmoid resection. This case sheds light on a rare rectal stump complication. Initial treatment consisting in rectal drainage via transanal route did not suffice; rectal stump resection with omentoplasty was necessary.

Early and long-term results after completion pneumonectomy.

From January 1, 1978 to December 31, 1992, 37 patients underwent a completion pneumonectomy after a previous lobectomy (36 men and 1 woman; mean age, 60 years; range, 41 to 77 years). These account for 4.8% of 758 pneumonectomies. The purpose of the present study was to evaluate the operative results of completion pneumonectomy and long-term survival in patients with bronchogenic cancer. The initial lung resection had been performed for primary bronchogenic cancer in 23, metastatic thyroid adenocarcinoma in 1, and benign diseases in 13 (tuberculosis in 11, aspergilloma in 1, and bronchiectasis in 1). Completion pneumonectomy was required for bronchogenic cancer in 32 (15 stage I, 6 stage II, 11 stage III). One patient had relapsing metastatic thyroid carcinoma, 2 had bronchiectasis, and 2 had a venous infarction after lobectomy. Four patients (10.8%) died perioperatively of the following causes: 1 fatal intraoperative bleeding, 1 fatal postoperative bleeding, 1 pneumonia, and 1 malignant hypercalcemia. Median operative blood loss was 1,000 mL, and 19 patients experienced bleeding exceeding 1,000 mL (51%). Six patients had intraoperative vascular injury. Nonfatal surgical complications occurred in 9 patients (24%), including 5 clotted hemothoraces, 3 empyemas, and 1 bronchopleural fistula. Four patients had medical complications (2 pulmonary edemas, 1 sinus tachycardia, and 1 unexplained fever). Twenty-three had an uneventful straightforward recovery (62%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Local recurrence after surgery for cancer of the rectum]. / Récidives loco-régionales après cancer du rectum opéré.

Local tumor recurrence rates after curative rectal cancer surgery are reportedly high and herald a poor diagnosis. Extramural recurrence is most common and is due to the failure to remove all of the tumor during the initial operation. In the rarer anastomotic recurrence, the implantation of exfoliated malignant cells is possible, but histochemical changes in the mucosa surrounding a tumor may be considered as an alternative cause of local recurrence. Local recurrence rates did not improve when the distal margins were extended over 2 cm, but microscopic lateral tumor extension appears to be the major determinant of recurrence. Early diagnosis is based on frequent CEA assays, history, physical examination, endoscopy, endoluminal ultrasound and pelvic CT scan. Aggressive treatment involving a combination of field irradiation, surgical debulking and intra-operative radiation can result in local control and long-term survival in 10 to 25% of patients.

[Proctocolectomy with ileo-anal anastomosis performed with mechanical suture without mucosectomy and without protective ileostomy]. / Coloproctectomie avec anastomose iléo-anale effectuée par suture mécanique sans mucosectomie et sans iléostomie de protection.

Abdominal proctocolectomy with formation of an ileal reservoir anastomosed onto the anal canal using a stapler device is described. This technique avoids also stripping the mucosa from the anal canal which is time consuming and often difficult and incomplete. The avoidance of a temporary ileostomy did not lead to an increase in post operative complications. Seventeen patients have undergone this procedure for ulcerative colitis and the advantages and disadvantages of it are discussed.

[Surgical widening of strictures in the small intestine in Crohn disease]. / Les plasties d'élargissement dans la maladie de Crohn du grêle.

Twenty-two stricture plasties were performed in five patients with multiple stenosis of the small intestine due to Crohn's disease. Immediate post-operative results were satisfactory but progressive degradation followed. These findings are similar to those reported in the literature on this technique which does not give better results than other methods since none have an effect on the clinical course of the disease. The only advantage is to decrease the amount of intestinal mutilation.