Intraoperative colonic lavage in emergency surgical treatment of left-sided colonic obstruction

PURPOSE: The study contained herein was undertaken to verify if immediate resection with anastomosis with on-site lavage in emergency treatment of left colon obstruction is a safe alternative to the multistage procedure, to look for solutions to practical problems outlined by previous authors, and to check the hospital stay. METHOD: Between 1991 and 1995, all patients (61) admitted with left colon obstruction were treated with intraoperative colonic lavage and primary anastomosis. Personal development of Dudley's technique is reported. Complications and mortality are pointed out. Later, endoscopy was performed to check the status of all survivors. RESULT: Low mortality (2 percent) and major complications rates (3 percent) and short hospital stay (11 days, except for patients with major complications) are reported in our series. CONCLUSION: One-stage surgery with intraoperative lavage is a safe procedure. Patients have a better quality of life (no stoma occurred) with an effective cost-savings.Presented in part at the meeting of the European Congress of Surgery, Athens, Greece, June 4 to 7, 1997.     

An uncomplicated and safe way to perform on-table colonic lavage

Abstract When surgery is performed in patients with acute or sub-acute left-colonic obstruction, the method of antegrade on-table colonic lavage is well established. In this short note, a modification of the original procedure is presented that makes it even more uncomplicated.     

Effectiveness of oolong tea and simethicone solution for lens cleansing during colonoscopy: A double-blinded randomized study

Background and aims:water is an imperfect agent for lens cleansing during endoscopy due to its incompetence to clean hydrophobic dirt, whereas amphiphilic surfactants have the potential to overcome the limitation of water. The trial was aimed to evaluate the cleansing effectiveness of 2 typical surfactants (simethicone solution and oolong tea) for colonoscopic lens.Methods:Oolong tea (O-), low concentration simethicone solution (S1-), high concentration simethicone solution (S2-) and distilled water (D-) were used as washing solutions for colonoscopic lens. Study I: The tip of the colonoscope was immersed in lard oil in order to simulate the blur, and photographs were taken toward a standard colonoscopy image in-vitro pre- and post- each cleansing procedure. The blurred areas of each image were quantified and compared. Study II: 395 consecutive patients who were due to colonoscopy examination were enrolled and randomized into O-, S2-, D-group. The volume of washing solution used and cleansing level during the examination procedure, adenoma and polyp detected per colonoscopy, insertion time and withdraw time were analyzed.Results:Study I: There were no differences in 4 groups for the blurred areas on images before lens cleansing. The blurred areas after lens cleansing were significantly smaller in 3 groups (O- 8.47 ± 20.91 vs S1- 13.06 ± 10.71 vs S2- 6.76 ± 8.49 vs D- 38.24 ± 29.69, P < .05) than water. The decline range of blurred areas after lens cleansing in oolong tea, low concentration simethicone solution, high concentration simethicone solution groups were significantly higher than that in distilled water group (O- 87.35 ± 20.81 vs S1- 78.12 ± 19.24 vs S2- 89.57 ± 8.50 vs D- 53.39 ± 28.45, P < .05). Study II: The volume of washing solution used in S2-group was significantly smaller than that in O-group and D-group. The cleansing level of the colonoscopic lens of O-group was significantly superior than that of S2-group and D-group.Conclusions:The in-vitro test showed oolong tea and simethicone solution can effectively cleans the colonoscopic lens. The clinical trial demonstrated that oolong tea instead of water is effective to provide better visualization during colonoscopy.Registration: Chictr.org.cn No: ChiCTR1900025606.     

Comparison of oral lavage methods for preoperative colonic cleansing

Polyethylene glycol electrolyte lavage solution was compared with a 10 percent mannitol solution for preoperative colonic cleansing. Eighty patients were prepared randomly with one of these solutions on the afternoon prior to surgery. Colonic cleansing was better with polyethylene glycol electrolyte lavage (90 percent optimal cleansingvs. 75 percent). Analysis of hematologic, biochemical, and weight changes before and after the bowel preparation, demonstrated a mild subclinical dehydration with the use of mannitol. Evaluation of patient tolerance demonstrated more nausea, cramps, and abdominal pain with mannitol. Other symptoms were similar with both preparations. Colonic hydrogen gas was sampled during surgery, and two patients in the mannitol group had combustible levels. This study confirms that both 10 percent mannitol and polyethylene glycol electrolyte lavage are safe, effective methods of preoperative bowel cleansing. Better cleansing, patient tolerance, and lower hydrogen gas level make polyethylene glycol electrolyte lavage the preferred method. Poster presentation at the metting of the American Society of Colon and Rectal Surgeons, Houston, Texas, May 11 to 14, 1986. The opinions expressed are those of the authors and do not reflect the opinions of the United States Air Force, the Department of Defense or the Cleveland Clinic Foundation.     

Asymptomatic colonic anisakiasis identified during colonoscopy

A 66‐year‐old‐man had received colonoscopy periodically as a follow up since endoscopic polypectomy of the colon in February 1997. In March 2001, periodic colonoscopy revealed a worm penetrating the mucosa of the sigmoid colon. This worm was caught with biopsy forceps, and it was identified parasitologically as an Anisakis simplex larva (Anisakis larva type I). However, the patient had no complaint before or after the examination. The patient ingested lavage solution, including polyethylene glycol for the preparation of colonoscopy. Therefore, Anisakis larvae might be flushed quickly to the distal colon by an oral colon‐wash without penetration of worms into the gastric or intestinal mucosa. In the present paper, we report on asymptomatic colonic anisakiasis treated successfully by endoscopic removal of the worm. In some cases, penetration of the worm causes cramp of the colon or immediate mucosal huge edematous change and results in intestinal obstruction. Colonoscopic removal of the worm would be most effective and safe if possible.     

Whole-gut lavage for surgery

During the last few years, new forms of bowel preparation before surgery and operative endoscopy have been introduced as whole gut irrigation with saline or mannitol solutions. The use of 10 to 20 per cent mannitol solution is, however, likely to alter the composition and quantity of the colonic gases (methane and hydrogen) and to produce explosive mixtures. Some cases of fatal explosions occurring during endoscopic electroresection have been reported. The authors examine the whole gut lavage methods and report a case of colonic explosion during a left hemicolectomy on a patient prepared with 20 per cent mannitol solution.     

The effect of simethicone on colonic visibility after night-prior colonic lavage. A double-blind randomized study

We prospectively studied 26 patients receiving simethicone (n = 14) or placebo (n = 12) in Colyte (Edlaw Preparations. Inc., Farmingdale, NY, U.S.A.) to determine if the addition of simethicone could improve visibility when administered the night before colonoscopy. Two parameters of visibility were assessed: amount of bubbles and degree of haziness. The effectiveness of a night-prior administration of Colyte to clean the colon of feculent debris was also examined. Patients receiving simethicone had significantly less bubbles (p less than 0.02), but haziness was not improved (p = 0.9). The presence of feculent debris that interfered with the colonoscopic examination was similar in both groups: simethicone 5 of 14 or 35% and placebo 7 of 12 or 58%. Eighty percent (four of five) of patients with feculent debris in the rectosigmoid colon had diverticulosis, and 50% (four of eight) patients with diverticulosis had feculent debris in the rectosigmoid. These data indicate that (a) the combination of simethicone plus Colyte administered the night before colonoscopy improves visibility by diminishing bubbles; (b) this dosage of simethicone is not effective in diminishing haziness when administered the night before colonoscopy; and (c) patients with diverticulosis are likely to have feculent debris in the rectosigmoid colon, and a precolonoscopy enema may be helpful when the diagnosis is known.     

远端导管方法与普通方法支气管肺泡灌洗的对比研究

目的 比较远端导管与经负压吸引进行普通支气管肺泡灌洗这两种方法对支气管肺泡灌洗的回吸收量、操作过程及并发症的影响.方法 选择2008年5月至12月在我院呼吸内科需要进行支气管肺泡灌洗检查的住院或门诊患者,随机分为两组,普通支气管肺泡灌洗组56例,远端导管支气管肺泡灌洗组66例,观察同吸收量,操作失败率和合并症的发生.结果 远端导管支气管肺泡灌洗组的同吸收率超出普通支气管肺泡灌洗组5.55%,操作失败率低于普通支气管肺泡灌洗组9.19%,合并症发生率低于普通支气管肺泡灌洗组7.41%.结论 基于上述结果,我们推荐应用导管支气管肺泡灌洗来取代普通支气管肺泡灌洗.     

Factors predicting successful outcome following neostigmine therapy in acute colonic pseudo-obstruction: a prospective study

AIM: To evaluate predictors of neostigmine response in patients with acute colonic pseudo-obstruction. METHODS: Twenty-seven patients with acute colonic pseudo-obstruction were enrolled in the study. All patients had received initial conservative management such as nil orally, nasogastric suction, rectal tube placement and correction of electrolyte imbalance for the first 24 h. Those who did not resolve with conservative management received 2 mg neostigmine intravenously. The same dose was repeated after 24 h in patients who did not response to the first dose (initial non-responders), or in those patients who relapsed after an initial response (initial responders). All non-responders to neostigmine underwent colonoscopic decompression followed by 2 mg neostigmine infusion for 30 min. A sustained response was defined as the resolution of symptoms and colonic dilatation on a plain radiograph. RESULTS: The study enrolled 27 patients; 18 were male (67%), and the median age was 60 years (range 18-78 years). Eight (30%) patients had spontaneous resolution. Initial response with neostigmine was observed in 16 (84%) patients, of which 10 (63%) had a sustained response. Nine patients (three initial non-responders and six initial responders) had received a second dose of neostigmine. A sustained response was seen only in five initial responders. Four patients who did not respond to neostigmine underwent colonoscopic decompression followed by neostigmine infusion and had a sustained response. Neostigmine responders were more likely to be postoperative patients (11 of 15 (73%) vs one of four (25%), P = 0.07), less likely to have electrolyte imbalance and to be on antimotility agents (three of 15 (20%) vs four of four (100%), P = 0.009 and two of 15 (13%) vs four of four (100%), P = 0.003). CONCLUSIONS: Electrolyte imbalance and usage of anti-motility agents are factors associated with a poor response, while postoperative patients showing good response to neostigmine therapy.     

Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center,prospective, single blinded,randomized controlled trial

Background and Aim

To investigate the efficacy and safety of premedication with simethicone/Pronase during esophagogastroduodenoscopy (EGD) with sedation.

Methods

Six hundred and ten patients were randomly allocated to two groups based on type of premedication given. Premedication used in the control group was 10 mL lidocaine hydrochloride mucilage (LHM, N = 314) and premedication used in the intervention group was 80 mL simethicone/Pronase solution plus 10 mL lidocaine hydrochloride mucilage (SP/LHM, N = 296). EGD was done under sedation. Visibility scores, number of mucosal areas that needed cleansing, water consumption for cleansing, time taken for examination, diminutive lesions, pathological diagnosis, patients’ gag reflex and oxygenation (pulse oximetry) were recorded.

Results

SP/LHM has significantly lower total visibility score than LHM (7.978 ± 1.526 vs 6.348 ± 1.097, P < 0.01). During the procedure, number of intragastric areas that needed cleansing and amount of water consumed were significantly less in the SP/LHM than in the LHM group (P < 0.01). In SP/LHM (P = 0.01), endoscopy procedure duration was significantly longer. Although there was no significant difference in rate of detection of diminutive lesions between LHM and SP/LHM, the endoscopist carried out more biopsies in SP/LHM. This led to a higher rate of diagnosis of atrophic gastritis (P = 0.014) and intestinal metaplasia (P = 0.024). There was no significant difference in gag reflex (P = 0.604) and oxygenation during the endoscopy procedure for either group of patients.

Conclusion

Routine use of premedication with simethicone/Pronase should be recommended during EGD with sedation.     

支气管肺泡灌洗在肺部疾病诊治中的应用

支气管肺泡灌洗是一种操作简便、安全的技术.随着医学科学的发展,其操作技术越来越规范,在临床中的应用越来越广泛,在肺部疾病的诊断和治疗中发挥了重要作用.     

A Case with Multiple Colonic Ulcers Simulating Churg-Strauss Syndrome

Abstract: Churg-Strauss syndrome (CSS), a relatively rare disorder which is associated with serious complications, has a highly variable course and several possible manifestations. We present the case of a 35-year-old woman with a history of bronchial asthma, admitted for evaluation of lower abdominal pain and melena, whose clinical course had certain features in common with CSS. On admission, the white blood cell count was 45,300/mm³ with 65% eosinophils, and the serum immunoglobulin E (5,300 u/ml) level was remarkably elevated. At colonoscopy, there were shallow ulcers, irregular in shape, throughout the large intestine. Abdominal pain and melena were relieved by oral administration of prednisolone. Most previously reported cases have not been recognized as having colonic involvement until surgery or autopsy. In only a few reports of CSS and related disorders were colonoscopic examination findings described.