ABSTRACT
A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).
Subject(s)
Defecation , Proctocolectomy, Restorative , Rectum/diagnostic imaging , Humans , Italy , Postoperative Complications/diagnostic imaging , Postoperative Complications/physiopathology , Proctocolectomy, Restorative/adverse effects , Proctocolectomy, Restorative/methods , Rectum/physiopathology , Tomography, X-Ray Computed , UltrasonographyABSTRACT
Twenty two patients obstructive jaundice were investigated by combined fine needle percutaneous cholangiography and hypotonic duodenography. The association of the two techniques enables prompt localization of the site of obstruction and definition of the nature of the lesion. It proves to be of particular use in the differential diagnosis of carcinoma of the head of the pancreas, carcinoma of the distal choledochus and carcinoma of the socalled choledochoduodenal junction.