References: Laxative
AJR Am J Roentgenol. 1988 Oct;151(4):705-8.
Colonic cleansing for radiographic detection of neoplasia: efficacy of the magnesium citrate-castor oil-cleansing enema regimen.
Gelfand DW, Chen YM, Ott DJ.
Department of Radiology, Bowman Gray School of Medicine, Winston-Salem, NC 27103.
To optimize detection of colonic polyps, we instituted a cleansing regimen of dietary restriction, hydration, magnesium citrate, castor oil, and a cleansing enema. We then conducted a review of serially performed barium enemas to determine the percentage of patients with clean colons in a mixed population of 500 inpatients and outpatients in whom this regimen had been used. The same regimen also was used before single- and double-contrast barium enemas were performed in 139 patients with 234 polyps, and radiologic-endoscopic correlation was used to determine the percentage of polypoid neoplasms detected. The review indicated that a clean colon had been achieved in 97% of the 500 cases. In an additional 1.4% of patients, fecal residue was limited to small amounts in the cecum or ascending colon. In only two cases (0.4%) did fecal material prevent an examination that was suitable for detection of large polypoid or circumferential lesions. The single- and double-contrast barium enemas detected 80% and 91%, respectively, of polypoid lesions of all sizes. Single-contrast examinations detected 94% of polyps 10 mm or larger and 72% of polyps 5-9 mm. Double-contrast studies detected 96% of polyps 10 mm or larger and 88% of those 5-9 mm. The results of this study indicate that with this regimen, fecal residue does not significantly interfere with the detection of colonic polyps via barium enema examination.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3262270&dopt=Abstract constipation laxative colon cleansing
Gastroenterology. 1988 Dec;95(6):1569-74.
Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge.
Jensen DM, Machicado GA.
UCLA Center for the Health Sciences, Wadsworth Veterans Administration Medical Center.
The purpose of this study was to prospectively evaluate (a) the diagnosis and treatment of 80 consecutive patients with severe, ongoing hematochezia from unknown source and (b) the effectiveness and safety of urgent colonoscopy after oral purge. Fifty-two men and 28 women (mean age, 64.5 yr) received a mean of 6.5 U of blood and had negative anoscopy, rigid sigmoidoscopy, and nasogastric tube aspiration before our evaluation. Because of ongoing severe hematochezia in the intensive care unit, urgent diagnosis and treatment was recommended by the attending physicians and surgeons. Emergency panendoscopy was performed before purge. Urgent colonoscopy was performed in the intensive care unit after patients received oral purge and their gut was cleared of blood, clots, and stool. The final diagnosis in these patients was 74% colonic lesions (30% angiomata, 17% diverticulosis, 11% polyps or cancer, 9% focal ulcers, 7% other), 11% upper gastrointestinal lesions, and 9% presumed small bowel lesions. No lesion site was identified in 6%. Clinically significant fluid retention (medically controlled) occurred in 4% of patients after purge. Sixty-four percent of patients had intervention for control of bleeding: 39% had therapeutic endoscopy, 24% surgery, and 1% therapeutic angiography. For 22 patients who also had emergency visceral angiography, the diagnostic yield was 14% and the complication rate was 9%. Our conclusions for patients with severe ongoing hematochezia from an unknown site were as follows. (a) Oral purge was effective and safe for cleansing the colon of stool, clots, and blood. Sulfate purge appeared to be safer than saline purge. (b) Before urgent colonoscopy and purge, emergency panendoscopy was indicated to exclude an upper gastrointestinal ble
Dis Colon Rectum. 1999 Dec;42(12):1609-12.
Enema-induced perforation of the rectum in chronically constipated patients.
Paran H, Butnaru G, Neufeld D, Magen A, Freund U.
Department of Surgery A, Meir Hospital, Kfar-Sava, Israel.
INTRODUCTION: The use of retrograde irrigation enemas is common in the treatment of chronic constipation, especially in the elderly. Perforation of the rectum and sigmoid colon caused by cleansing enemas, used by chronically constipated patients, has not been previously described. METHODS: We reviewed all patients with colorectal perforations caused by irrigation enemas admitted to our service in the three-year period between January 1995 and December 1997. RESULTS: Thirteen patients were treated by our surgical service because of perforations of the rectum and sigmoid colon related to a previous retrograde irrigation enema. Ten of these patients came from nursing homes, and the other three lived at home. The relevant information relating the enema administration to the patient's condition was given in only two of the ten patients referred to the emergency room by the institution's nursing or medical staff. In the other eight the information was vague and sometimes misleading. The diagnosis of colorectal perforation was made by history, plain abdominal x-rays, and CT scan with or without meglumine diatrizoate enemas. Ten patients survived, regardless of age, previous diseases, or operative findings. In all of them, diagnosis was made within 36 hours from the perforation. The three deaths occurred in patients in whom the diagnosis was made late. CONCLUSIONS: Awareness of the possible injury from enemas administered to chronically constipated patients should be stressed. A high degree of suspicion by the attending physician is extremely important, because prompt diagnosis and early surgical treatment carries a relatively good prognosis.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10613482&dopt=Abstract constipation laxative colon cleansing
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