Skip to main content
SpringerLink
Log in

Inflammatory Bowel Disease

  • Chapter
Problems in General Surgery

  • 145 Accesses

Abstract

A 73-year-old man presents to the emergency room with an 8-hr history of progressive lower abdominal pain. His temperature is 38.1°C, and his abdomen is diffusely tender, with peritoneal signs present in both lower quadrants. A white blood cell count is 9800 cells/mm3, and four views of the abdomen disclose only ileus. After volume resuscitation and antibiotic treatment, he undergoes celiotomy. An inflammatory mass of the sigmoid colon is noted, with a small perforation partially sealed off by the omentum. Several hundred cc of turbid fluid are present in the pelvis. Treatment should consist of:

  1. A.

    Sigmoid resection and primary anastomosis.

  2. B.

    Sigmoid resection, end sigmoid colostomy, and oversewing of rectum.

  3. C.

    Transverse colostomy.

  4. D.

    Transverse colostomy and drainage of the mass.

  5. E.

    Transverse colostomy, drainage of the mass, and postoperative peritoneal lavage.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Smiley, D.F.: Perforated sigmoid diverticulitis with spreading peritonitis. Am. J. Surg. 111: 431, 1966.

    Article  PubMed  CAS  Google Scholar 

  2. Asch, M.J., Markowitz, A.M.: Diverticulitis coli: A surgical appraisal. Surgery 62: 239, 1967.

    Google Scholar 

  3. Colcock, B.P.: Diverticular disease: Proven surgical management. Clin. Gastroenterol. 4: 99, 1975.

    PubMed  CAS  Google Scholar 

  4. Miller, D.W., Wichern, W.A.: Perforated sigmoid diverticulitis: Appriasal of primary versus delayed resection. Am. J. Surg. 121: 536, 1971.

    Article  PubMed  Google Scholar 

  5. Rodkey, G.V., Welch, C.E.: Surgical management of colonic diverticulitis with free perforation or abscess formation. Am. J. Surg. 117: 265, 1969.

    Article  PubMed  CAS  Google Scholar 

  6. Byrne, J.J., Garick, E.I.: Surgical treatment of diverticulitis. Am. J. Surg. 121: 379, 1971.

    Article  PubMed  CAS  Google Scholar 

  7. Madden, J.L.: Primary resection and anastomosis in the treatment of perforated lesions of the colon. Am. Surg. 31: 781, 1965.

    PubMed  CAS  Google Scholar 

  8. Small, W.P., Smith, A.N.: Fistula and conditions associated with diverticular disease of the colon. Clin. Gastroenterol. 4: 171, 1975.

    PubMed  CAS  Google Scholar 

  9. Colcock, B.P., Stahmann, F.D.: Fistulas complicating diverticular disease of the sigmoid colon. Ann. Surg. 175: 838, 1972.

    Article  PubMed  CAS  Google Scholar 

  10. Carpenter, W.S., Allaben, R.D., Kambouris, A.A.: Fistulas complicating diverticulitis of the colon. Surg. Gynecol. Obstet. 134: 625, 1972.

    PubMed  CAS  Google Scholar 

  11. Patient Management Problem #4, SESAP III. American College of Surgeons Surgical Education and Self Assessment Program III Syllabus. Chicago, Illinois, 1979, pp 28–37, 163–166.

    Google Scholar 

  12. Byrne, J.J., Garick, E.I.: Surgical treatment of diverticulitis. Am. J. Surg. 121: 379, 1971.

    Article  PubMed  CAS  Google Scholar 

  13. Bradley, E.L., Isaacs, J.: Appendiceal abscess revisited. Arch. Surg. 113: 130, 1978.

    Article  PubMed  Google Scholar 

  14. Stone, H.H., Sanders, S.L., Martin, J.D.: Perforated appendicitis in children. Surgery 69: 673, 1971.

    PubMed  CAS  Google Scholar 

  15. McPherson, A.G., Kinmonth, J.B.: Acute appendicitis and the appendix mass. Br. J. Surg. 32: 365, 1945.

    Article  Google Scholar 

  16. Thomas, D.R.: Conservative management of the appendix mass. Surgery 73: 677, 1973.

    PubMed  CAS  Google Scholar 

  17. Kirsner, J.B.: The local and systemic complications of inflammatory bowel disease. J.A.M.A. 242: 1177, 1979.

    Article  PubMed  CAS  Google Scholar 

  18. Beeken, W.L.: Absorptive defects in young children with regional enteritis. Pediatrics 52: 69, 1973.

    PubMed  CAS  Google Scholar 

  19. Block, G.E., Moossa, A.R., Simonowitz, D.: The operative treatment of Crohn’s disease in childhood. Surg. Gynecol. Obstet. 144: 713, 1977.

    PubMed  CAS  Google Scholar 

  20. Homan, W.P., Tang, C., Thorbjarnarson, B.: Anal lesions complicating Crohn disease. Arch. Surg. 111: 1333, 1976.

    Article  PubMed  CAS  Google Scholar 

  21. Hoffman, J.P., Taft, D.A., Wheelis, R.F., Walker, J.H.: Adenocarcinoma and regional enteritis of the small intestine. Arch. Surg. 112: 606, 1977.

    Article  PubMed  CAS  Google Scholar 

  22. Greenstein, A.J., Sachar, D., Pucillo, A., Kreel, I., Geller, S., Janowitz, H.D., Aufses, A.: Cancer in Crohn’s disease after diversionary surgery. Am. J. Surg. 135: 86, 1978.

    Article  PubMed  CAS  Google Scholar 

  23. Menguy, R.: Surgical Management of free perforation of the samll intestine complicating regional enteritis. Ann. Surg. 175: 178, 1972.

    Article  PubMed  CAS  Google Scholar 

  24. Wall, A.J.: The use of glucocorticoids in intestinal disease. Med. Clin. North Am. 57: 1241, 1973.

    PubMed  CAS  Google Scholar 

  25. Farmer, R.G.: The protean manifestations of Crohn’s disease. Postgrad. Med. 57: 129, 1975.

    PubMed  CAS  Google Scholar 

  26. Gump, F.E., Sakellariadis, P., Wolff, M., Broell, J.R.: Clinical pathological investigation of regional enteritis as a guide to prognosis. Ann. Surg. 176: 233, 1972.

    Article  PubMed  CAS  Google Scholar 

  27. Rosenberg, J.L., Levin, B., Wall, A.J., Kirsner, J.B.: A controlled trial of azathioprine in Crohn’s disease. Am. J. Dig. Dis. 20: 721, 1975.

    Article  PubMed  CAS  Google Scholar 

  28. Klein, M., Binder, H.J., Mitchell, M, Aaronson, R., Spiro, H.: Treatment of Crohn’s disease with azathioprine: A controlled evaluation. Gastroenterology 66: 916, 1974.

    PubMed  CAS  Google Scholar 

  29. Homan, W.P., Dineen, P. Comparison of the results of resection, bypass, and bypass with exclusion for ileocecal Crohn’s disease. Ann. Surg. 187: 530, 1978.

    Article  PubMed  CAS  Google Scholar 

  30. Folley, J.H.: Ulcerative proctitis. N. Engl. J. Med. 282: 1362, 1970.

    Article  PubMed  CAS  Google Scholar 

  31. Nugent, F.W., Veidenheimer, M.C., Zuberi, S., Garabedian, M.M., Parikh, N.K.: Clinical course of ulcerative proctosigmoiditis. Digestive Diseases 15: 321, 1970.

    Article  CAS  Google Scholar 

  32. Scott, H.W., Sawyers, J.L., Gobbel, W.G., Graves, H.A., Shull, H.J.: Surgical management of toxic dilitation of the colon inulculerative colitis. Ann. Surg. 179: 647, 1974.

    Article  PubMed  Google Scholar 

  33. Neschis, M., Siegelman, S S, Parker, J.G.: Diagnosis and management of megacolon of ulcerative colitis. Gastroenterology 55: 251, 1968.

    PubMed  CAS  Google Scholar 

  34. VanHeerden, J.A., Mcllrath, D.C., Adson, M.A.: The surgical aspects of chronic mucosal inflammatory bowel disease (chronic ulcerative colitis). Ann. Surg. 187: 536, 1978.

    Article  CAS  Google Scholar 

  35. Binder, S.C., Miller, H.H., Deterling, R.A.: Emergency and urgent operations for ulcerative colitis. Arch. Surg. 110: 284, 1975.

    Article  PubMed  CAS  Google Scholar 

  36. Foley, W.J., Coon, W.W., Bonfield, R.E.: Toxic megacolon in acute fulminate ulcerative colitis. Am. J. Surg. 120: 769, 1970.

    Article  PubMed  CAS  Google Scholar 

  37. Turnball, R.B., Hawk, W.A., Weakley, F.L.: Surgical treatment of toxic megacolon: Ileostomy and colostomy to prepare patients for colectomy. Am. J. Surg. 122: 325, 1971.

    Article  Google Scholar 

  38. Binder, S.C., Miller, H.H., Deterling, R.A.: Fate of the retained rectum after subtotal colectomy for inflammatory disease of the colon. Am. J. Surg. 131: 201, 1976.

    Article  PubMed  CAS  Google Scholar 

  39. Tompkins, R.K., Weinstein, M.H., Foroozan, P., Marx, F.W., Barker, W.F.: Reappraisal of rectum-retaining operations for ulcerative and granulomatous colitis. Am. J.Surg. 125: 159, 1973.

    Article  PubMed  CAS  Google Scholar 

  40. Korelitz, B.I.; Present, D.H., Alpert, L.I., Marshak, R.H., and Janowitz, H.D.: Recurrent regional ileitis after ileostomy and colectomy for granulomatous colitis. N. Engl. J. Med. 287: 110, 1972.

    Article  PubMed  CAS  Google Scholar 

  41. Goligher, J.C.: The outcome of excisional operations for primary and recurrent Crohn’s disease of the large intestine. Surg. Gynecol. Obstet. 148: 1, 1979.

    PubMed  CAS  Google Scholar 

  42. Lockhart-Mummery, H.E.: Crohn’s disease, of the large bowel. Br. J. Surg. 59: 823, 1972.

    Article  PubMed  CAS  Google Scholar 

  43. Brooke, M.M.: Epidemiology of amebiasis in the U.S. J.A.M.A. 188: 519, 1964.

    Article  PubMed  CAS  Google Scholar 

  44. Ittman, F.E., El-Hashimi, W.K., Pittman, J.C.: Studies of human amebiasis. Gastroenterology 65: 581, 1975.

    Google Scholar 

  45. Tucker, P.C., Webster, P.D., Kilpatrick, Z.M.: Amebic colitis mistaken for inflammatory bowel disease. Arch. Intern. Med. 135: 681, 1975.

    Article  PubMed  CAS  Google Scholar 

  46. Giacchino, J.L., Pickleman, J.R., Bartizal, J.F., Banich, F.E.: The therapeutic dilemma of acute amebic and ulcerative colitis. Surg. Gynecol. Obstet. 146: 599, 1978.

    PubMed  CAS  Google Scholar 

  47. Williams, L.F., Wittenberg, J.: Ischemic colitis: A useful clinical diagnosis, but is it ischemic? Ann. Surg. 182: 439, 1975.

    Article  PubMed  Google Scholar 

  48. Hagihara, P.F., Parker, J.C., Griffen, W.O.: Spontaneous ischemic colitis. Dis. Colon Rectum 20: 236, 1977.

    Article  PubMed  CAS  Google Scholar 

  49. Davis, J.E.: Reversible vascular occlusion of the colon. Ann. Surg. 171: 789, 1970.

    Article  PubMed  CAS  Google Scholar 

  50. Roswit, B.: Complications of radiation therapy: The alimentary tract. Semin. Roentgenol. 9: 51, 1974.

    Article  PubMed  CAS  Google Scholar 

  51. DeCosse, J.J., Rhodes, R.S., Wentz, W.B., Reagan, J.W., Dworken, H.J. Holden, W.D.: The natural history and management of radiation induced injury of the gastrointestinal tract. Ann. Surg. 170: 369, 1969.

    Article  PubMed  CAS  Google Scholar 

  52. MacMahon, C.E., Rowe, J.W.: Rectal reaction following radiation therapy of cervical carcinoma: Particular reference to subsequent occurrence of rectal carcinoma. Ann. Surg. 173: 264, 1971.

    Article  PubMed  CAS  Google Scholar 

  53. Russell, J.C., Welch, J.P.: Operative management of radiation injuries of the intestinal tract. Am. J. Surg. 137: 433, 1979.

    Article  PubMed  CAS  Google Scholar 

  54. Smith, J.S., Milford, H.E.: Management of colitis caused by irradiation. Surg. Gynecol. Obstet. 142: 569, 1976.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Loyola University Stritch School of Medicine, Maywood, Illinois, USA

    Jack Pickleman M.D.

Authors
  1. Jack Pickleman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 1982 Springer Science+Business Media New York

About this chapter

Cite this chapter

Pickleman, J. (1982). Inflammatory Bowel Disease. In: Problems in General Surgery. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1755-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-1755-6_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4757-1757-0

  • Online ISBN: 978-1-4757-1755-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation