Surgical management of sigmoidovesical and sigmoido-uterine fistula complicating diverticultis.
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Glucagon given intravenously to 20 patients with acute diverticulitis was followed by symptomatic relief within an average of 12 hours and obviated the need for therapy with analgesics or other antispasmodics. In a similar group of patients receiving conventional treatment symptoms persisted for an average of 96 hours. The administration of glucagon had no apparent effect on abdominal symptoms which mimicked those of diverticulitis but were caused by other conditions. There was no clinically apparent difference in effectiveness between continuous infusion and intermittent injection of glucagon.
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UNLABELLED: During embryogenesis, abnormal adhesion of the peritoneal folds induces a congenital band which can cause small bowel obstruction. PATIENTS AND METHODS: From 1987 to 2001, 16 adult patients underwent surgery for small bowel obstruction due to a congenital band. There were 8 men and 8 women with a mean age of 59 years (range 23-90). None presented previous abdominal surgery. RESULTS: Six patients presented acute abdominal pain the month before hospitalization. Among the 16 patients, 9 were operated at admission, and 7 after initial surveillance. Suspected diagnosis before operation was small bowel obstruction in 8 cases (with a diagnosis of congenital band in 3); perforated duodenal ulcer (n = 2); appendicitis (n = 2); mesenteric infarction (n = 1); diverticultis (n = 1); cholecystitis (n = 1); and strangulated hernia (n = 1). During operation performed through laparotomy or laparoscopy, a congenital band was noted in 100% of the cases, associated with intestinal necrosis in 5. One patient died postoperatively. CONCLUSION: Because small bowel obstruction by congenital band is a rare condition, it represents a frequent problem of diagnosis. In this situation, the possibility of intestinal necrosis expose the patient to a possible fatal outcome.
Two cases of diverticultis of the right colon are described which received surgical treatment. These lesions often simulate acute appendicitis and thus represent a intraoperative surprise Differential diagnosis using a neoblastic mass is often impossible. The paper stresses the importance of surgical treatment which in general terms is the same as the treatment of the diverticular mass of the left colon. In cases where it is difficult to decide between a phlogostic and neoblastic pathology, it is advised that a right hemicolectomy should be performed in line with criteria for oncological requirements.
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