[Perineal clamping of the everted rectum in conservative coloproctectomy. Experimental and clinical results]. / L'agrafage périnéal du rectum éversé dans la coloproctectomie conservatrice. Résultats expérimentaux et cliniques.

Technical alternatives in conservative proctocolectomy are presently investigated to improve the safety and the functional results of the operation. Abdominal transection of the rectum is not always satisfactory in this procedure. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal via a perineal access; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premier EEA instrument through the staple line of the previously transected anorectal junction. This technique has been evaluated in dogs (N = 10): colo-anal anastomosis was easy, quick, and safe to perform. Clinical, radiological and gross results have confirmed the quality of these circular stapled anastomoses through an inverting linear suture of the anorectal junction. Clinical experience is actually based on 7 patients operated since January 1989 (proctocolitis: 3, polyposis: 4). The value of the technique was confirmed with ileostomy closure at 3 months for the 7 patients and good functional results. This method has several advantages: 1) to retain all of the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.

[Conservative coloproctectomy: the advantages of a circular trans-suture staple anastomosis after linear stapling of the everted rectum. Preliminary results]. / Coloproctectomie conservatrice: avantages d'une anastomose circulaire agrafée trans-suturaire, après agrafage linéaire du rectum retourné. Résultats préliminaires.

Technical alternatives in conservative proctocolectomy are presently investigated to improve the functional results of the operation. To avoid 2 difficult steps in the procedure, mucosectomy and transanal manual suturing, is of interest to retain the entire and canal and to reduce anal stretching duration. A new technique of stapled anastomosis is described: after full mobilization and eversion of the rectum, this latter is closed using a linear stapler and cut immediately above the anal canal; a 18 cm long J pouch is constructed and the anastomosis is stapled using the new premium EEA instrument*. Clinical experience begun in 1989 january, concerns 6 patients (2 U.C., 4 polyposis): at this time, 5 of these had their ileostomy closed, functional results being under evaluation. This method allows 1) to retain all the anal canal, 2) to avoid prolonged anal dilatation, 3) to perform a rapid and safe stapled anastomosis.

[Retroplacental hematoma with incomplete symptoms]. / Les hématomes rétroplacentaires à symptomatologie incomplète.

In a series of 28 cases of retroplacental haematoma, 12 presented an incomplete clinical syndrome (absence de shock--absence of contracture--presence of foetal heart sounds), usually with an association of back pain and vaginal bleeding. These apparently minor forms can be diagnosed on the basis of the vascular context, their development at the 3rd trimester of pregnancy and by the inevitable repercussions on the foetus. They differ from the typical forms by the lower frequency and severity of this foetal distress, provided these atypical and incomplete symptoms have been correctly interpreted allowing early appropriate intervention. One of the elements of an improved overall prognosis for retroplacental haematomas consists of more effective detection of incomplete, and therefore misleading, forms, which have a high incidence (42.8% of all retroplacental haematomas in our series).

[Ogilvie's syndrome following cesarean section. Apropos of a case]. / Syndrome d'Ogilvie après césarienne. A propos d'un cas.

The authors report a case of post-caesarian acute idiopathic dilatation of the colon (Ogilvie's syndrome), which is a rare syndrome, particularly after caesarian section, which poses difficult diagnostic problems. The most serious complication consists of perforation of the caecum. The pathogenesis of this syndrome is still hypothetical. Early treatment essentially consists of inserting a Faucher tube via colonoscopy beyond the splenic flexure. In the case of a pre-perforation syndrome, a right transverse colostomy needs to be performed. Actual perforation of the caecum requires a major operation with a poor prognosis.