Colonic resection

Some surgeons advocate direct application to the wound of or irrigation of the wound with either antibiotics or povidone-iodine during colon resection. Solutions containing povidone-iodine should almost never be placed in the peritoneal cavity, because they are likely to be absorbed and subsequently to cause toxic effects. 

Irving AD, Scrimegour D Mechanical bowel preparation for colonic resection and anasta-moses. Br J Surg 1987 74 580-581. 

Murray JJ, Schoetz DJ, Coller JA, Roberts PL, Viedenheimer MC Intraoperative colonic lavage and primary anastomosis in nonelective colon resection. Dis Colon Rectum 1991 34 527-531. 

H. Bernstein, H. Holubec, J. A. Warneke, H. Garewal, D. L. Earnest, C. M. Payne, D. J. Roe, H. Cui, E. L. Jacobson and C. Bernstein, Patchy field defects of apoptosis resistance and dedifferentiation in flat mucosa of colon resections from colon cancer patients, Ann. Surg. Oncol., 2002, 9(5), 505. 

Bertone, A.L., Ralston, S.L. and Stashak, T.S. (1989b) Fibre digestion and voluntary intake in horses after adaptation to extensive large colon resection. American Journal of Veterinary Research 50, 1628-1632. 

An 80-year-old woman had a colonic resection for Duke s C stage adenocarcinoma and was then given fluorouracil 400 mg/m /day and folinic acid 200 mg/m /day for 5 days every 4 weeks. She later developed metastases and a second course of chemotherapy included irinotecan (180 mg/m ), fluorouracil 400 mg/m, followed by a continuous infusion of 2400 mg/m over 2 days, folinic acid 200 mg/m, ondansetron, and atropine. During the first course of chemotherapy she developed urticaria following the administration of ondansetron and folinic acid. The ondansetron was withdrawn and replaced by metoclopramide and prednisone. During the next course, just after the administration of folinic acid, metoclopramide, and prednisone, she had more urticaria and profound hjrpotension and required intravenous adrena-hne. Folinic acid was withdrawn and subsequent courses were uneventful... 

Joyce, a psychologist. Ovarian cancer, stage 3, diagnosed in 2004 at age fifty-eight. (Treatment surgery, hysterectomy, splenectomy, and colon resection. Chemo carboplatin, paclitaxel, cisplatin, gemcitabine, topotecan, doxorubicin.)... 

Most of the work with Tc-99m labeled RBC scintigraphy has been carried out for detection of lower GIH with the rationale to avert blind bowel or colonic resection. However, investigators still disagree on the usefulness of radionudide methods to detect and localize bowd bleeding, guide surgery or screen patients for arteriography [72-77]. 

A significant percentage of adverse events are associated with a surgical procedure. For instance, in the Utah Colorado Medical Practice Study, the annual incidence rate of adverse events amongst hospitalized patients who received an operation was 3%, of which half were preventable. Some operations, such as extremity bypass graft, abdominal aortic aneurysm repair and colon resection, were at particularly high risk of preventable adverse events (Thomas et al, 2000b Thomas and Brennan, 2001). 

In this patient population with history of colitis and possible prior segmental colonic resections, fistulas and strictures often develop at the anastomosis and make passage of the colonoscopy device impossible. Scarring of the mesentery may also cause rigidity and may lead to failed colonoscopies. Historically, patients would then go on to double contrast barium enema for complete evaluation of the colon. 

Fig. 13.19a,b. Inflammatory stenosis at the anastomosis after colonic resection Mild wall thickening with stenosis and pericolic fat stranding arrow). Virtual colonoscopy shows luminal narrowing (arrow) and a diverticula... 

A 79-year-old man underwent colonic resection for bowel obstruction. He had a history of Parkinson s disease and associated dementia, hypertension, type-2 diabetes and occasional constipation. His current medications included carbidopa-levodopa extended release, lisinopril, furosemide, isophane insulin and polyethylene glycol (as needed for constipation). He was treated with metoclopramide (10 mg i.v., every 6 h) for stimulating gastric motility. After receiving the first three doses of metoclopramide, the patient developed mental deterioration until he became xmre-sponsive, and could not be aroused. An electroencephalogram displayed a pattern of diffuse slowing of the background rhythm, which was consistent with acute metabolic encephalopathy. Metoclopramide was discontinued, and... 

Once the diagnosis of nosocomial pneumonia has been established, several important factors must be considered before a rational empirical antimicrobial regimen can be chosen. These include severity of illness and comorbid conditions of the patient, prior antibiotic use, early versus late onset of infection, results of the sputum Gram s stain, and the resident flora profile of the institution, particularly in the intensive care unit (Table 1). Empirical antimicrobial therapy for nosocomial pneumonia in a ventilated patient with renal failure in whom multiple intra-abdominal abscesses develop following colon resection is very different from the patient who aspirates following an otherwise uncomplicated cholecystectomy. 

Fig. 13.3a,b. A 67 year old woman admitted to the intensive care unit for peritonitis after colon resection, demonstrated gas distension on chest X-ray. a Upper GI series showed a markedly distended stomach (arrows) with no sign of outlet obstruction and the duodenum rapidly filled with contrast material, b The degree of gastric dilatation is shown on CT images. Gastric function became normal during general improvement of the patient... 

Cryotherapy and radiofrequency treatment can ablate metastases in 50%-90% of cases and are relatively safe compared to hepatic resection. With respect to overall survival, there has been no randomised comparison to show that either cryotherapy or radiofrequency treatment alter longterm survival compared with chemotherapy alone. However, this may be related to the fact that most patients being referred for ablation are considered unsuitable for hepatic resection. The ideal patient for ablative therapy would be one who, several years after a curative colonic resection for an early-stage well-differentiated cancer develops a small metastasis in the middle of a lobe of the liver (Primrose 2002). Such a patient is, however, also ideally suited to surgical treatment and for such a patient the longterm results of surgery are good. Interventional... 

Cady B, Monson DO, SwintonNW (1970) Survival of patients after colonic resection for carcinoma with simultaneous liver metastases. Surg Gynecol Obstet 131 697-700 Chopra S, Dodd GD, Chanin MP, et al (2003) Radiofrequency ablation of hepatic tumors adjacent to the gallbladder feasibility and safety. AJR Am J Roentgenol 183 697-701... 

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