Physiologic aspects of continence after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis.

We examined the physiology of continence in 12 patients at least four months after colectomy, mucosal proctectomy, and endorectal ileo-anal anastomosis for ulcerative colitis and familial polyposis. The mean fecal output (+/-SEM) was 598 +/- 60 gm, passed as 12 +/- 4 movements/24 hr, of which 4 +/- 1 were passed at night. The patients were generally continent during the day and could distinguish gas from stool, but 11 of 12 leaked stools at night.

Primary nonlymphoreticular malignant neoplasms of the spleen.

Primary sarcomas of the spleen are exceedingly uncommon neoplasms, approximately 90 substantiated cases having been reported. We report on six cases of primary splenic angiosarcoma and three cases of primary malignant fibrous histiocytoma of the spleen which have been seen at the Mayo Clinic during the last 51 years. In one of the cases of splenic angiosarcoma, the lesion was manifested by spontaneous rupture and hemoperitoneum; interestingly, two cases of splenic malignant fibrous histiocytoma were of the inflammatory type and showed corresponding clinical features of a systemic nature.

Postoperative screening of patients with carcinoma of the colon.

A prospective evaluation of 149 patients with Dukes' B2 or C colorectal carcinoma, including periodic history, physical examination, chest radiograph, liver function tests, complete blood count, carcinoembryonic antigen (CEA) radioimmunoassay, barium enema, and endoscopic studies, has been underway since 1976. Thirty-four patients have had recurrence. This study suggests that the history of CEA are the most sensitive noninvasive methods with which to detect recurrent tumors but are unlikely to indicate recurrence at a therapeutically advantageous stage.

Cholecystectomy and carcinoma of the colon.

After cholecystectomy the concentration of secondary bile acids in the bile increases. These bile acids have been incriminated in the pathogenesis of carcinoma of the colon. Hence the hypothesis that cholecystectomy predisposes to the development of carcinoma of the colon.

Factors affecting revision rate after continent ileostomy.

Our aim was to determine factors that may predispose to malfunction of a continent ileostomy. Among 299 patients who underwent continent ileostomy and were followed up for at least one year, the need for revision of the ileostomy was compared by sex, age, type of initial operation, and type of revision. Revision was required less often in females, younger patients, and patients undergoing proctocolectomy and continent ileostomy.

Role of gastroenterostomy in patients with unresectable carcinoma of the pancreas.

A group of 107 patients with unresectable carcinoma of the pancreas who underwent simultaneous biliary bypass and gastroenterostomy were compared with a group of 107 matched patients who underwent biliary bypass only. Hospital mortality was identical. A longer hospital stay was evident after concomitant gastroenterostomy and was related to problems with delayed gastric emptying.

Elective cholecystectomy. The role of biliary bacteriology and administration of antibiotics.

One hundred patients who underwent elective cholecystectomy were studied prospectively to define the accuracy of an intraoperative Gram's stain procedure in discovering the presence of bactibilia, the apparent necessity for prophylactic use of antibiotics, and the resulting septic complication rate. Antibiotics were used for prophylaxis in 48 patients and were withheld from 52. Intraoperative Gram's stain procedure and culture were used in all cases.

Cholecystostomy for noninflammatory disease.

Cholecystostomy in patients with noninflammatory disease of the biliary tract has rarely been evaluated. Our experience with 124 patients suggests that, in addition to being helpful in inflammatory conditions, cholecystostomy is helpful in performing cholangiography, in removing stones and in decompressing an otherwise obstructed biliary tree. The mortality associated with this procedure is minimal, and the morbidity is 4.

Improving survival in adenocarcinoma of the duodenum.

The records of 104 patients with primary adenocarcinoma of the duodenum were reviewed. All patients were followed up to the date of this report, 91 for at least 5 years. Melena was an ominous preoperative finding.

Indwelling ileostomy valve device.

Complications after construction of a continent ileostomy may require reoperation to restore continence. Although most patients accept another operation, a few refuse further operative intervention. In such patients we have employed an indwelling ileostomy valve device.

Randomized prospective evaluation of the EEA stapler for colorectal anastomoses.

A randomized, prospective study should be done to evaluate any new procedure or instrument. Our experience with the end-to-end anastomosis (EEA) stapler suggests that an anastomosis can be created in a shorter time than is required for the traditional hand-sewn technique. This difference is even greater when the anastomosis is technically difficult and located deep within the pelvis.

Emergency abdominal colectomy with primary anastomosis.

From 1968 to 1979, 18 patients underwent emergency abdominal colectomy with ileorectal anastomosis. Indications for operation included massive colonic bleeding (11), obstructing carcinoma (5), toxic megacolon (1), and enterocolitis (1). Five patients died postoperatively (27.

Jejunogastric intussusception.

Jejunogastric intussusception is a rare complication after gastric surgery. Only 16 documented cases have been reported at the Mayo Clinic, Rochester, Minn, during the past 72 years. Jejunogastric intussusception is a difficult condition to diagnose clinically.

Catheter-related complications in patients receiving home parenteral nutrition.

Twenty-seven patients (22 adults, five adolescents, and one child) were treated with home parenteral nutrition (HPN) for 662 patient-months. A Broviac Silastic right atrial catheter which is tunnelled subcutaneously down the anterior chest wall served as a venous access. Thirty-four catheters were used in 27 patients, and the mean catheter life spans to date for adults and adolescents have been 21 and 14 months, respectively.

Surgical management of inflammatory bowel disease.

Indications for operation in patients with inflammatory bowel disease are now standardized as a result of the vast surgicaL experience that has been accumulated during the past 40 years. The surgical indications in Crohn's disease and chronic ulcerative colitis vary minimally with the anatomic distribution of either disease, and can be recognized easily in a particular patient. Consequently, decision or judgment regarding the need for operation is rarely difficult.

Adult Hirschsprung's disease: results of surgical treatment at Mayo Clinic.

Fifty adult patients with Hirschsprung's disease were operated on at the Mayo Clinic between 1950 and 1978. Six different operations were used. Of the three patients treated by the Soave endorectal pull-through procedure, two suffered anastomotic leaks and required diverting colostomies; all three had excellent long-term results, however.

Improved results with continent ileostomy.

The objective of this study was to determine if recent technical modifications have improved our results with continent ileostomy (Kock pouch). The modifications were that the valve of the pouch was made at least 5 cm in length and was anchored with specially placed, nonabsorbable sutures or staples. The pouch was drained continuously for the first four postoperative weeks, after which it was only gradually allowed to expand.

Rectal preservation in nonspecific inflammatory disease of the colon.

Sixty-three patients with chronic ulcerative colitis and 80 patients with Crohn's disease underwent abdominal colectomy and primary ileorectal or ileosigmoid anastoimosis and were followed up for between five and 17 years. No patient developed carcinoma of the rectal stump. The interval proctectomy rate was similar in both groups (24 and 29%, respectively), the rate being influenced by age in the group with chronic ulcerative colitis.

Carcinoma of the colon and rectum complicating chronic ulcerative colitis.

Patients with pancolonic chronic ulcerative colitis are at increased risk to develop carcinoma of the colon. Controversy continues, however, as to whether this carcinoma is more "virulent" than "type ordinaire" carcinoma of the colon and as to the best way to manage these patients. This study reviews the characteristics and survival of 70 patients with cancer of the colon superimposed on chronic ulcerative colitis.

Malignant melanoma of the anorectum.

Melanoma is a virulent tumor that can be widely disseminated and is generally incurable even when the primary growth is small. Review of the cases of 34 patients with primary melanoma of the anorectum, with follow-up ranging from two to five years, suggests that improvement in survival depends on acute surgical awareness and aggressive surgical intervention.

Proximal gastric vagotomy. Initial experience.

Proximal gastric vagotomy was performed in 223 patients with chronic duodenal ulceration between 1973 and 1977. The follow-up ranged from 6 to 78 months with a mean of 39 months. There was no operative mortality.