Muscle fragment welding for control of massive presacral bleeding during rectal mobilization: a review of eight cases.

Introduction: Although massive presacral bleeding during rectal mobilization is uncommon, it can rapidly destabilize a patient. Traditional attempts at control include tamponade with pelvic packing and application of sacral thumbtacks. The aim of this review is to describe the anatomic basis of injury and summarize our experience with this challenging problem, with emphasis on the simple, readily available, effective technique of rectus abdominis muscle fragment welding.

Loop ileostomy: a reliable method of diversion.

Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure.

Prospective assessment of biofeedback for the treatment of paradoxical puborectalis contraction.

Eighteen patients with chronic constipation were diagnosed as having paradoxical puborectalis contraction (PPC) as the cause for their constipation. The diagnosis of PPC was made after office evaluation, colonic transit study, manometry, cinedefecography, and electromyography (EMG). These 18 patients had a mean duration of symptoms of 26.

Does metoclopramide reduce the length of ileus after colorectal surgery? A prospective randomized trial.

Between August 1988 and September 1989, 100 consecutive patients who underwent elective abdominal colorectal surgical procedures were prospectively randomized to receive or not to receive metoclopramide. Metoclopramide was intravenously administered every 8 hours from the completion of surgery until a solid food diet was able to be tolerated. Seven patients were not included in the final tabulations because of one death, one small bowel obstruction requiring laparotomy, one anastomotic leak requiring laparotomy, and four protocol violations.