Biomedical subjects
Publications and source records attributed to A Garbini.
Solitary perforated diverticulum of the right colon is a very uncommon acute disease in emergency surgery, and usually a preoperative diagnosis of acute appendicitis is performed. Five cases of solitary perforated diverticulum of the right colon are presented. Preoperative diagnostic difficulties as well as surgical procedures are discussed.
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Hydroelectrolytic changes, the time of action and complications induced by oral administration of 10 per cent mannitol solution in the colonic preparation for X-ray examination were examined. Twenty-six patients were examined using two different solution volumes: one liter in 15 patients and two liters in 11 patients. No significant biochemical changes were noted. X-ray study of the colon revealed an insufficient evacuation in 3.8 per cent, sufficient in 7.6 per cent, and good in 88.6 per cent of cases. In 6 per cent nausea and vomiting occurred, in 11.7 per cent abdominal distention, and in 7.6 per cent hypotension. This approach was well tolerated, particularly when one liter of the solution was used.
The daily urinary output was calculated on the basis of creatininuria, starting from an accepted formula that evaluates ClCr, employing the subject's height and creatininemia. Results are satisfactory. The new formula estimates the daily urinary volume on the basis of the mean of the three creatininuria values of the day.
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Four additional cases of Ogilvie's syndrome (acute colonic pseudo-obstruction), representing the first cases described in Italy, are reported. The medical literature concerning the subject is also thoroughly reviewed. Ogilvie's syndrome is an acute massive dilatation of the large bowel without organic obstruction of the distal colon. Three hundred and fifty-one cases have been described in the literature to date. Eighty-eight per cent of the cases were associated with various extracolonic affections (metabolic and organ dysfunctions, postoperative and posttraumatic states, etc.). Twelve per cent of cases were not associated with known disorders and were defined as idiopathic. The pathophysiology of the syndrome is still unknown. Ogilvie, who first described the syndrome in 1948, suggested an imbalance between the sympathetic and parasympathetic innervation of the colon: this neurogenic hypothesis has been shared by other authors, although explanations may differ slightly. The clinical and radiologic picture closely resembles mechanical obstruction of the large bowel. The most marked dilatation usually takes place in the right colon and cecum: if the distended cecum reaches a diameter larger than 9 to 12 cm, perforation is likely to occur; if perforation occurs, the mortality rate increases from 25 to 31 per cent to about 43 to 46 per cent. If conservative management fails to control the dilatation and cecal rupture is impending or suspected emergency surgery is indicated, the surgical procedure of choice is dictated by the general conditions of the patient as well as by the intestinal findings: operation may consist of cecostomy, colostomy, or right hemicolectomy or simply emptying the bowel.
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.
Fifteen cases of generalized post-operative peritonitis (GPP) are reported. Twelve patients underwent surgical treatment with mortality rate of 25%; three patients did not undergo surgery with mortality rate of 66,6%. Diagnostic, prognostic and therapeutic aspects of this severe post-operative complication are considered to underline the importance of a precocius diagnosis and a timely reanimatory and surgical treatment for a favourable prognosis.
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