Multiple successful emergent peristomal bowel resections under regional anesthesia in a patient with colonic pseudo-obstruction and severe chronic obstructive pulmonary disease

Prolapse occurs at a rate of 8 to 75 per cent and risk factors include obesity, a large abdominal defect, conditions increasing abdominal wall pressure, and a redundant loop of bowel proximal to the stoma.2 Prolapse can often be treated nonoperatively, but reversal or resection must be considered if...

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Bibliographic Details
Published in:The American surgeon 2013-01, Vol.79 (1), p.E47-48
Main Authors: Yheulon, Christopher G, Gagliano, Ronald A
Format: Article
Language:English
Subjects:
Abdomen
Aged
Anesthesia
Anesthesia, Epidural
Cecostomy
Cecum - pathology
Cecum - surgery
Chronic obstructive pulmonary disease
Colonic Pseudo-Obstruction - complications
Colonic Pseudo-Obstruction - diagnosis
Colonic Pseudo-Obstruction - surgery
Fatal Outcome
Humans
Ileal Diseases - complications
Ileal Diseases - diagnosis
Ileal Diseases - surgery
Ileostomy
Ileum - pathology
Ileum - surgery
Intestinal Obstruction - complications
Intestinal Obstruction - diagnosis
Intestinal Obstruction - surgery
Male
Medical treatment
Mortality
Ostomy
Pulmonary Disease, Chronic Obstructive - complications
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Summary:Prolapse occurs at a rate of 8 to 75 per cent and risk factors include obesity, a large abdominal defect, conditions increasing abdominal wall pressure, and a redundant loop of bowel proximal to the stoma.2 Prolapse can often be treated nonoperatively, but reversal or resection must be considered if ischemia or obstruction is present.2 The rate of parastomal hernias ranges from 0 to 48 per cent.2 Risk factors include obesity, malnutrition, steroid therapy, sepsis, chronic cough, and emergent surgery.2 Hernias are usually asymptomatic, and although rare, obstruction, strangulation, and perforation are serious complications. Options for surgical repair are primary fascial repair, relocation of the stoma, and fascial repair with the addition of prosthetic material. 2 Recurrence rates for each method of repair are 46 to 100 per cent, 0 to 76 per cent, and 7 to 33 per cent, respectively.2 Regional anesthesia blocks a constellation of stress responses to surgery including adverse metabolic, inflammatory, and immunologic processes.3 Systematic analyses demonstrate a significant reduction in perioperative cardiovascular events, postoperative pulmonary complications, and mortality.3 However, these benefits are almost exclusively limited to high-risk patients undergoing high-risk procedures.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481307900126