AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) unde...AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.展开更多
background We previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations(ARM)and recommended this technique because of its cosmetic excellence.W...background We previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations(ARM)and recommended this technique because of its cosmetic excellence.We herein report the postoperative complications of umbilical stomas(US)compared with traditional abdominal stomas(AS).Methods From our institutional prospective database,we analyzed the patients with ARMs who underwent stoma creation at Kansai Medical University Hospital from January 1995 to November 2016.The surgical technique used to create the US had been performed since 2004.results US and AS were made for 12 and 27 patients with ARMs,respectively.The postoperative complication rates in patients who underwent US and AS had no significant difference(17%and 11%,p=0.6).The complications comprised a wound infection(one case of US),ileus(one case each of US and AS),mucosal prolapse(one case of AS),and depression(one case of AS).No emergency surgery was required for these complications.Conclusion For patients with ARMs,the umbilicus appears to be a safe alternative site for temporary loop colostomy.展开更多
文摘AIM: To study the significance of scoring systems assessing severity and prognostic factors in patients with colonic perforation. METHODS: A total of 26 patients (9 men, 17 women; mean age 72.7 ± 11.6 years) underwent emergency operation for colorectal perforation in our institution between 1993 and 2005. Several clinical factors were measured preoperatively and 24 h postoperatively. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), Mannheim peritonitis index (MPI) and peritonitis index of Altona (PIA Ⅱ) scores were calculated preoperatively. RESULTS: Overall postoperative mortality rate was 23.1% (6 patients). Compared with survivors, non- survivors displayed low blood pressure, low serum protein and high serum creatinine preoperatively, and low blood pressure, low white blood cell count, low pH, low PaO2/FiO2, and high serum creatinine postoperatively. APACHE Ⅱ score was significantly lower in survivors than in non-survivors (10.4 ± 3.84 vs 19.3 ± 2.87, P = 0.00003). Non-survivors tended to display high MPI score and low PIA Ⅱ score, but no signif icant difference was identif ied. CONCLUSION: Pre- and postoperative blood pressure and serum creatinine level appear related to prognosis of colonic perforation. APACHE Ⅱ score is most associated with prognosis and scores ≥ 20 are associated with signif icantly increased mortality rate.
基金This study was supported by the research fund of the Department of Surgery of Kansai Medical University.
文摘background We previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations(ARM)and recommended this technique because of its cosmetic excellence.We herein report the postoperative complications of umbilical stomas(US)compared with traditional abdominal stomas(AS).Methods From our institutional prospective database,we analyzed the patients with ARMs who underwent stoma creation at Kansai Medical University Hospital from January 1995 to November 2016.The surgical technique used to create the US had been performed since 2004.results US and AS were made for 12 and 27 patients with ARMs,respectively.The postoperative complication rates in patients who underwent US and AS had no significant difference(17%and 11%,p=0.6).The complications comprised a wound infection(one case of US),ileus(one case each of US and AS),mucosal prolapse(one case of AS),and depression(one case of AS).No emergency surgery was required for these complications.Conclusion For patients with ARMs,the umbilicus appears to be a safe alternative site for temporary loop colostomy.
