1,721,029 research outputs found
Pelvic floor dysfunction in inflammatory bowel disease
No full textAdvances in tailored medical therapy and introduction of biologic agents for inflammatory bowel disease (IBD) treatment have ensured long-term disease remission. Some patients, however, still report defecatory symptoms. Patients present with a wide spectrum of conditions - anal incontinence, obstructed defecation and pelvic pain among the most frequent - that have a great impact on their quality of life. Due to IBD diagnosis, little relevance is attributed to this type of symptoms and their epidemiologic distribution is unknown. Pathogenetic hypotheses are currently under investigation. Routine diagnostic workflow and therapeutic options in pelvic floor service are often underused. The evaluation of these disorders starts with an endoscopy to rule out ongoing disease; the following diagnostic workflow is the same as in patients without IBD. For fecal incontinence and obstructed defecation, simple conservative therapy with dietary modifications and appropriate fluid intake is effective in most cases. In non-responding patients, anorectal physiology tests and imaging are required to select patients for pelvic floor muscle training and biofeedback. These treatments have been proven effective in IBD patients. Some new minimally invasive alternative strategies are available for IBD patients, as sacral nerve and posterior tibial nerve stimulation; for other ones (e.g., bulking agent implantation) IBD still remains an exclusion criterion. In order to preserve anatomical areas that could be useful for future reconstructive techniques, surgical options to cure pelvic floor dysfunction are indicated only in a small group of IBD patients, due to the high risk of failure in wound healing and to the possible side effects of surgery, which can lead to anal incontinence or to a possible proctectomy. A particular issue among defecatory symptoms in patients with IBD is paradoxical puborectalis contraction after restorative proctocolectomy: if this disorder is properly diagnosed, a conservative treatment is indicated, thus avoiding unnecessary laparotomy for small bowel occlusion. Pelvic pain management, coordinated by a specialist with expertise in pelvic floor disorders, includes many options, which vary from oral or local therapies to pelvic floor rehabilitation and sacral nerve stimulation. Surgical procedures often have unsatisfactory outcomes. Diagnosis and investigation of anorectal functional disorders in patients with IBD is important in order to implement better-suited diagnostic and therapeutic strategies, so as to avoid unnecessary and potentially detrimental medical and surgical therapies, with the final aim of improving patients' quality of life
Gallstone ileus after biliointestinal bypass: report of two cases
No full textINTRODUCTION: Gallstone ileus is an uncommon disease and accounts for 1-4 % of all cases of mechanical intestinal obstruction. The physiopathology is related to the presence of a bilioenteric fistula.
METHOD: We report two cases of gallstone ileus in patients operated on biliointestinal bypass for morbid obesity. The anastomosis of the gallbladder to the proximal end of the bypassed jejunum allowed the transit of gallstones in the excluded ileum and its impaction in anti-reflux valvular system.
RESULTS: Preoperative exams were unable to solve the diagnostic query, and the diagnosis was achieved only at laparotomy. One-stage combined enterolithotomy and cholecystectomy were performed.
CONCLUSION: The two patients had an uneventful recovery. To our knowledge, this is the first report of gallstone ileus after biliointestinal bypas
The use of biological mesh (permacol) to repair a contamined wall defect related to evisceration and multiple entero-atmospheric fistulae
No full textdieci anni di bypass biliointestinale per il trattamento chirurgico malassorbitivo dell'obesità grave
No full textVengono presentati i risultati dell'esperienza decennale degli autori con il bypass biliointestinale per la cura chirurgica dell'obesità grave
[2 cases of choledochal calculosis associated with juxtapapillary diverticulum in patients with gastric resection: submesocolon approach]
No full textAlthough laparoscopy and endoscopy have reduced the need for laparotomies in biliary tract surgery, open surgery is sometimes still needed. One case in particular is when previous operations have significantly distorted normal upper abdomen anatomy. We chose an inframesocolic entrance to the posterior peritoneum in two patients with bile duct stones, juxtapapillary duodenal diverticulum and a history of cholecystectomy and partial gastric resectioning. The duodenum was reached at the junction between the second and third section by entering the posterior peritoneum through the inferior sheet of the mesocolon, a relatively avascular area. The diverticulum was incised, the sphincter and papilla operation was performed and the bile duct stones removed. The diverticulum was then resected. Our conclusion is that in certain cases, an inframesocolic entrance can significantly reduce technical difficulties involved in re-operating through dense adhesions, minimize surgical time and blood loss and, when operating through the open diverticulum, spare an unnecessary duodenotomy
Chirurgia bariatrica malassorbitiva reversibile e miniinvasiva : il bypass bilio-intestinale
No full textThe use of biological mesh to repair one large, contaminated abdominal wall defect due to neoplastic invasion. Report of a case
No full textWe hereby report a case of use of biological mesh to repair one large, contaminated abdominal wall defect due to a sigmoid tumour presented as an abscess infiltrating the abdominal wall. Our patient was a 48-year-old woman. Her medical history was negative for any previous disease or surgical procedure. Because of the abscence of neoplastic secondarism an en-bloc resection of the interested sigmoid colon and of the infiltrated abdominal wall was performed, thus resulting a large wall defect in the left inguinal region. In order to close the wall defect a biological porcine collagen mesh was used. In our case we used a Permacol mesh made of porcine acellular dermal collagen. Reconstruction of complicated abdominal wall defects is a challenging surgical problem and primary repair is often difficult to achieve without excessive tension in the abdominal wall. The use of a syntethic mesh in this patient could have been inappropriate due to the possibility of creating adhesions with intra-abdominal viscera and fistula formation. We chose to use a biological mesh because of its safer properties in case of infected, inflamed or infiltrated surgical fields, as demonstrated in the literatur
Dysplasia and cancer complicated IBD: single center retrospective study and surgeon’s point of view
No full text
- …
