Ostomy or intestinal anastomosis in cases of peritonitis
Keywords:
Ostomy, Intestinal anastomosis, Acute abdomen, PeritonitisAbstract
Twenty-six patients showing peritonitis due to nontraumatic acute abdomen were submitted to ostomy. Mean age was 51 years (range 25-83), being 13 males and 13 females. Bowel obstruction (BO) was the most frequent cause of peritonitis (11 cases), followed by intestinal perforation (IP) (8 cases), acute mesenteric infarction (AMI) (5 cases), and acute abdomen of inflammatory / infectious origin (AAIO) (2 cases). Brook's ileostomy was performed on 65% of the patients. Jejunostomy was performed only in 4 patients, leading to a bad evolution. Overall mortality was 54%. Primary ostomy or anastomosis in cases of peritonitis constitute a highly controversial theme. Indications and problems involving the intestinal exteriorization in emergency surgery urgency are herein discussed.
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References
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LUND, F.N. - The value of enterostomy in selected cases of peritonits. JAMA. 41:74, 1993.
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SCHROCK, T. R.; DEVENCY, C.W. & DUNPHY, J.E. - Factors contributing to leakage of colonic anastomosis. Ann Surg. 177:513, 1973.
YAMAKAWA, T.; PATTIN, C.S.; SOBEL, S. & MARGENSTERN, L. - Healing of colonic anastomosis following resections for experimental diverticulitis. Arch Surg. 103: 17, 1971.
DUNPHY, J.E - The cat gut. Am J Surg. 119: 1, 1974.
GENZINI. T.; D'ALBUQUERQUE, L.A.C.; MIRANDA, M.P.; SCAFURI, A.G. & SILVA. A.O. - Intestinal anastomosis. Rev Paul Med. 110: 183,1992.
GONÇALVES, A.J. - A utilização das ileostomies na cirurgia de urgência. Dissertação de Mestrado Faculdade de Ciências Médicas da Santa Casa de São Paulo, 1985.
GONÇALVES, A.J. & RASSLAN, S. - Ileostomias: uma alternativa na cirurgia de urgência. In Rasslan, S. - Aspectos "críticos" do doente cirúrgico. São Paulo, Robe Ed. 1988. p. 247.
HAWLEY, P.R.; PAGEFAULK, W. & HUNT, T.K. - Collagenase activity in the gastrintestinal tract. Br J Surg. 57:896, 1970.
IRVIN, T.T. - Collagen metabolism in infected colonic anastomosis. Surg Gynecol Obstet. 143:220, 1976.
KHOURY, G.A. & WAXMAN. B.P. - Large bowel anastomosis. The healing process and sutured anastomosis. A review. Br J Surg. 70:1983.
LUND, F.N. - The value of enterostomy in selected cases of peritonits. JAMA. 41:74, 1993.
NIINIKOSKI, J. & GRILIS HUNT, T.K. - Respiratory gas tensions and collagen in infected wounds. Ann Surg. 175:588, 1972.
RASSLAN, S.; KLUG, W.A.; MANDIA NETO. J.; FAVA. J.; SAAD JR, R. & GONÇALVES, A..J. - Tuberculose intestinal complicada. Rev Assoc Med Brasil. 30:39, 1984.
RASSLAN, S.; MANDIA NETO, J. & FAVA, J. - Fístulas intestinais após ressecções extensas de delgado. GED. 4:17, 1985.
RAVO, B. - Colorrectal anastomotic healing and intracolonic bypass procedure. Surg Clin North Am. 68: 1267, 1988.
SCHROCK, T. R.; DEVENCY, C.W. & DUNPHY, J.E. - Factors contributing to leakage of colonic anastomosis. Ann Surg. 177:513, 1973.
YAMAKAWA, T.; PATTIN, C.S.; SOBEL, S. & MARGENSTERN, L. - Healing of colonic anastomosis following resections for experimental diverticulitis. Arch Surg. 103: 17, 1971.
