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References: Laxative







Minerva Chir. 1999 Jan-Feb;54(1-2):37-47.
[The single-stage surgery of colorectal neoplastic occlusion. The experience of 133 cases]

[Article in Italian]

Gullino D, Giordano O, Ghione S, Masella M, De Carlo A, Lijoi C.

Divisione di Chirurgia Generale, USL n. 17, Regione Piemonte, Ospedale SS. Annunziata, Savigliano, Cuneo.

BACKGROUND AND AIM: 133 cases of occluded colorectal neoplasms (14% of the entire series): 30 (23%) of the right colon, 103 (77%) of the left colon-rectum; 69 males (52%) and 64 females (48%); mean age 67.5 years old, range 33-91 years. pTNM: stage II, 28 cases (21%); stage III: 43 cases (32%); stage IV, 62 cases (47%). The aim of this study was to resolve the occlusive symptoms and to treat the neoplasm in a single operation. METHODS: In the 62 cases at stage IV, surgery was solely palliative: 49 (79%) derivations, 13 (21%) entero-enterostomies and 36 (58%) preternatural anus; 11 (18%) standard hemicolectomies, extended in two cases to hepatic resection, and 2 (3%) Hartmann's operations. In the 71 cases at stages II and III, surgery took the form of standard colic exeresis with primary ligature of the colonic vessels at source and at the outlet; 15 (21%) right colectomies, 50 (70%) left colectomies, extended in 6 cases (8%) to abdomino-perineal amputation; 6 segmentary colectomies, 3 (4%) of the transverse colon and 3 (4%) Hartmann's operations. The following aspects are essential in this single-stage surgery: urgency; massive dose antibiotic treatment limited to the pre- and perioperative stages; peritoneal cleansing using accurate, methodical, repeated and abundant lavage; perioperative colonic preparation using direct colotomic perioperative lavage or using a trans-buccoenteric access (using Grosz-Dennis tube); the peritonisation of the retroperitoneum with the omentum and the protection of the anastomosis using omental wrapping and active lavage and, for colorectal anastomosis, even using the 3-way tube, lavage and active aspiration, in a transanal trans- or sub




Radiology. 2002 Apr;223(1):248-54.
MR colonography with barium-based fecal tagging: initial clinical experience.

Lauenstein TC, Goehde SC, Ruehm SG, Holtmann G, Debatin JF.

Department of Diagnostic Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.

PURPOSE: To assess a strategy for fecal tagging with barium sulfate as an inexpensive tagging agent in conjunction with magnetic resonance (MR) colonography in patients suspected of having colorectal lesions. MATERIALS AND METHODS: Twenty-four patients suspected of having colonic lesions because of rectal bleeding, positive fecal occult blood test results, or altered bowel habits underwent MR colonography and subsequent conventional colonoscopy. A 200-mL dose of a barium sulfate-containing contrast agent was ingested with each of four low-fiber meals, beginning 36 hours before the examination. For MR colonography, the colon was filled with tap water. Gadobenate dimeglumine was injected intravenously. Images were acquired 75 seconds after gadobenate dimeglumine administration by using only a T1-weighted three-dimensional gradient-echo sequence. Images were reviewed by two radiologists blinded to conventional colonoscopic data. By using colonoscopy as the reference standard, sensitivity and specificity of MR colonography were determined for detecting colorectal masses. RESULTS: On the basis of MR colonography, 15 polyps of 5-20 mm and 10 carcinomas were detected and later confirmed with conventional colonoscopy. Conventional colonoscopy depicted three additional lesions less than 8 mm in diameter. Thus, sensitivity of MR colonography was 89.3% (25 of 28) for lesions and 91.7% (22 of 24) for patients. CONCLUSION: Barium-tagged MR colonography obviates bowel cleansing and depicts all lesions exceeding 8 mm in diameter.

Laxative online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11930074&dopt=Abstract constipation laxative colon cleansing




AJR Am J Roentgenol. 2002 May;178(5):1109-16.
Quality of virtual colonoscopy in patients who have undergone radiation therapy or surgery: how successful are we?

Gollub MJ, Ginsberg MS, Cooper C, Thaler HT.

Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.

OBJECTIVE: In patients who have a history of abdominopelvic radiation, surgery, or both, conventional colonoscopy may fail to examine the entire colon. The purpose of this study is to assess whether high-quality virtual colonoscopy can be achieved in this patient population. MATERIALS AND METHODS: After colonic cleansing, 61 patients (16 men and 45 women; mean age, 64 years; age range, 27-81 years) underwent 63 virtual colonoscopy examinations after using either single- or multidetector CT (slice thickness, 3.75-5.0 mm; table speed, 1.7-11.25 cm/sec; pitch, 1.5-3.0; and overlapped reconstructions, 1.95-2.5 cm) in supine and prone positions after IV administration of 1 mg of glucagon and rectal air insufflation. Conventional two-dimensional axial images were analyzed on a PACS (picture archiving and communication system) workstation. Two radiologists, who were unaware of patient history, independently evaluated the colonic distention on a 4-point scale (4 = optimal distention) and fluid retention on a 3-point scale (3 = no fluid) for all segments of the colon in patients who were imaged in both the supine and prone positions. Segmental and total average colon scores were calculated. RESULTS: Forty-one patients (65%; 43 examinations, 67%) underwent prior surgery, radiation, or both (surgery, n = 29; radiation, n = 3; both, n = 11). The average overall colonic distention and fluid retention for this group was 3.13 and 2.38, respectively, versus 3.24 and 2.3 in the control group (p = not significant). CONCLUSION: High-quality examinations were achieved in patients who had previously undergone radiation, surgery, or both with no clinically significant difference in distention or fluid retention



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