Exteriorized colon anastomosis for unprepared bowel: An alternative to routine colostomy

Influence of continuous nursing on surgical site wound infection and postoperative complication for colorectal cancer patients with stoma: A meta-analysis

We systematically evaluated the effect of continuous nursing on surgical site wound infections and postoperative complications in colorectal cancer (CRC) patients with stomas. Computerised searches of Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases were conducted to collect clinical studies on CRC patients receiving continuous nursing interventions after colorectal stoma surgery; the search period was from the establishment of each database to August 2023. Two researchers independently screened the literature, extracted the data and completed a literature quality assessment. The meta-analysis was performed using Stata 17.0 and included 20 studies with 1759 patients. The meta-analysis showed that continuous nursing significantly lowered the rates of surgical site wound infection (risk ratio [RR] = 0.24, 95% confidence interval [CI]: 0.14-0.43, p < 0.001) and postoperative complications (RR = 0.30, 95% CI: 0.23-0.39, p < 0.001) for CRC stoma patients compared with the control group. Therefore, continuous nursing intervention should be promoted for use in clinical care.

Successful management of jejunojejunal anastomosis dehiscence by extra-abdominal exteriorization and bandaging in a cat with septic peritonitis

Duodenal and jejunal resections were performed in a cat with septic peritonitis due to small intestinal perforations by a linear foreign body. Three days later jejunal resection and anastomosis were repeated due to dehiscence of the anastomosis site. This segment of intestine was exteriorized through the body wall and managed with bandages for 5 days before it was surgically replaced into the abdomen. The cat made a full recovery.

Externalized Ileocolic Anastomosis: Case Report

A 6-year-old, spayed female Labrador retriever was presented 48 hours after an intestinal resection and anastomosis for management of a small intestinal foreign body. Abdominal ultrasound confirmed the presence of peritoneal effusion. Cytology of fluid collected by abdominocentesis revealed a large number of degenerate neutrophils with intracellular cocci. A diagnosis of septic peritonitis was made, presumably because of dehiscence of the anastomosis. Upon repeat exploratory celiotomy, the intestinal anastomosis (located 4 cm orad to the cecum) was found to be leaking intestinal contents into the abdomen. The distal ileum, cecum, and proximal colon were resected. An end-to-end, ileocolic anastomosis was performed and subsequently exteriorized into the subcutaneous space via a paramedian incision through the abdominal wall. The anastomosis was inspected daily for 4 days before it was returned to the abdomen and the subcutaneous defect was closed. Serial cytology of the peritoneal fluid, which was performed during this 4-day postoperative period, confirmed progressive resolution of peritonitis. The dog was discharged from the hospital 2 days following return of the anastomosis into the abdomen. Externalized intestinal anastomosis is used with good success in human medicine for repair of colonic injuries. In this case, externalization of the anastomosis permitted healing of the intestinal anastomosis in an environment isolated from the detrimental effects created by septic peritonitis. In addition, direct visualization of the anastomosis allowed assessment of healing. To our knowledge, this procedure has not been previously reported in companion animals.

A pilot study on the role of T-tube in typhoid ileal perforation in children

BACKGROUND

Ileostomy is usually performed for patients of typhoid intestinal perforation with poor general condition, but it is associated with significant morbidity. We have used the T-tube in such patients as an alternative to ileostomy.

METHODS

This is a prospective evaluation of a cohort of children with proven typhoid intestinal perforation. Patients with multiple perforations and poor general condition were managed with a T-tube inserted into the bowel lumen after closing all distal perforations (group 3). They were compared with patients who had primary closure of perforation (group 1) or bowel resection (group 2) to determine the efficacy of the use of T-tube.

RESULTS

The total number of patients for groups 1, 2, and 3 was 51, 4, and 12 (n = 67). The mean number of perforations for the three groups was 1, 3.5 +/- 0.58, and 4.25 +/- 0.97. The operation time for the three groups was 37.29 +/- 3.24, 59.25 +/- 3.09, and 59.17 +/- 4.17 minutes, respectively. The T-tube was removed after 13.17 days. The mean duration of fistula at T-tube site to heal was 8.58 +/- 2.11 days. The overall follow-up period was 10.94 +/- 1.15 months and none of the patients with T-tube placement had features of intestinal obstruction.

CONCLUSIONS

In children with multiple typhoid intestinal perforations and poor general condition, the use of T-tube may be an effective management option.