References: Laxative
Radiology. 1977 Oct;125(1):255-7.
Colonic polyp detection: role of roentgenography and colonoscopy.
Amberg JR, Berk RN, Burhenne HJ, Clemett AR, Dodds WJ, Friedland GW, Goldberg HI, Goldstein HM, Laufer I, Lawson TL, Margulis AR, Marshak RH, Miller RE, Short WF, Stewart ET, Youker JE, Zboralske FF.
In order to determine the relative yields of colonoscopic and radiologic examinations of the colon, the following guidelines are suggested: (a) prospective data collection; (b) a standard, effective colon cleansing regimen; (c) colonoscopic and radiologic examiners of comparable expertise; (d) examiners should be unaware of each other's findings; (e) a suitable method for demonstrating false-negative findings and for resolving conflicting findings between the two examinations; and (f) indexing of the study findings as to lesion size, lesion location, quality of colon cleansing, and examiner's level of confidence. The two examinations should be used as complementary diagnostic procedures.
Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=897181&dopt=Abstract constipation laxative colon cleansing
AJR Am J Roentgenol. 1997 Jan;168(1):199-205.
Treatment of colonic obstruction with expandable metal stents: radiologic features.
Canon CL, Baron TH, Morgan DE, Dean PA, Koehler RE.
Department of Radiology, University of Alabama Hospital, Birmingham 35233-6830, USA.
OBJECTIVE: The purpose of this prospective study was to evaluate the efficacy of expandable metal stents for colonic decompression in patients presenting with acute malignant obstruction and to describe the associated radiographic findings. SUBJECTS AND METHODS: Using both fluoroscopic and endoscopic guidance, we placed expandable metal stents within the colons of 13 patients presenting with acute malignant obstruction. Stents were placed in four patients to permit a standard bowel cleansing before surgical resection with primary anastomosis. In the other nine patients, stents were placed for palliation of nonresectable tumors, obviating colostomy. Outcomes and complications were analyzed. The radiologic aspects of procedural planning, stent placement, assessment after placement, and detection of complications were evaluated. RESULTS: Of the four surgical candidates who were successfully resected with primary anastomosis, two received incomplete bowel cleansing because of stent migration with recurrent obstruction. Eight of the nine patients who had stents placed for palliation of nonresectable tumors had relief of acute obstruction. Complications in this group included two perforations, one that required immediate colostomy and one that was self-limited and conservatively treated. Two other patients of the eight developed early stent obstruction, requiring colostomy in one. The other patient who had a stent placed for palliation of a nonresectable tumor declined further treatment. Contrast-enhanced enema examination proved useful in assessing the suitability of lesions for stent decompression, directing the choice of stent type and the most appropriate position for the patient during the stent placement. Immediately after stent place
Minerva Chir. 1998 Dec;53(12):1059-67.
[Perforated diverticular disease of the left colon. Proposed single-stage left colectomy protected by a three-way lavage and active aspiration tube (di Gullino) positioned inside or below the anastomosis. Experience in 65 cases]
[Article in Italian]
Gullino D, Giordano O, Lijoi C, Masella M, De Carlo A.
Divisione di Chirurgia Generale, USL n. 17, Regione Piemonte, Ospedale SS. Annunziata, Savigliano, Cuneo.
BACKGROUND: The incidence of perforative diverticulitis of the left colon is steadily increasing. Today the decision is generally taken to perform two-stage surgery: segmentary resection without (Hartmann's operation) or with anastomosis, but protected by a colostomy ("limited intervention"). This study aimed to examine standard colectomy performed in a single operation ("ideal intervention"). METHODS: Left colectomy with primary ligature of the lower mesenteric artery and vein at the source and outlet, en bloc removal of the colon-mesocolon and immediate transverse colorectal anastomosis. Anastomosis protected by the omentum which is also used to peritonise the retroperitoneum and to wrap around the anastomosis, and anastomosis also protected by the author's three-way lavage and active aspiration tube in either a trans- or subanastomosis and transanal position. Urgency is essential for this single-stage operation, together with massive dose antibiotic treatment limited to the pre- and postoperative stages, but above all peritoneal cleansing using accurate, methodical, repeated and abundant lavage with 8-10-20 or more litres, but only used 500 ml at a time. Of these 65 cases, 40 (62%) were purulent localised peritonitis and 25 (38%) were generalised (14 purulent, 4 fecaloid and 7 fecal). 8 cases (12.3%) underwent surgery in three stages and 16 (24.6%) underwent sigmoidectomy in one or two stages ("limited intervention"), 41 cases (63%) (1985-95, when Gullino's three-way tube became available) underwent standard
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