AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from Janua...AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively. RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery. CONCLUSION: Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequenttreatment. The prognosis is bad and the mortality rate after surgery is high.展开更多
AIM： To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease,METHODS： 307 patients （118...AIM： To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease,METHODS： 307 patients （118 males, 189 females, age range： 40-80 years） were enrolled in the study and randomly assigned to： Rifaximin （400 mg bid for 7 d every month） plus dietary fiber supplementation （at least 20 gr/d） or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms＇ questionnaire were performed every two months. RESULTS： Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group （6.4±2.8 and 6.2 ± 2.6 at enrollment, P = NS, 1.0 ±0.7 and 2.4±1.7 after 24 mo, P 〈 0.001, respectively）. Probability of symptom reduction was higher and complication frequency lower （Kaplan-Meyer method） in the Rifaximin group （P 〈 0.0001 and 0.028, respectively）.CONCLUSION： In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of RJfaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation.Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients,confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.展开更多
文摘AIM: To investigate the etiology, diagnosis and treatment of spontaneous perforation of the colon. METHODS: The clinical data of 10 cases of spontaneous perforation of the colon, observed at Fuding hospital from January 2004 to December 2007, were analyzed retrospectively. RESULTS: The mean age at onset was 65 years (range from 45 to 73). Seven patients had a history of chronic constipation. All patients complained of sudden lower abdominal pain. The perforation occurred after coloclysis and administration of senna leaves in two patients. Nine patients had signs of peritoneal irritation. Seven cases underwent abdominal paracentesis, which was diagnostic in six. Only one case was definitely diagnosed prior to surgery. One patient underwent neoplasty of the colon, another a partial resection of colon, six a neoplasty of the colon plus sigmoid colostomy, and two underwent Hartmann surgery. All perforation sites were opposite to the mesenteric edge. The perforation sites were located on descending colon in one case, sigmoid colon in three cases, and rectosigmoid colon in six cases. In five patients, surgical pathological examination was consistent with the microscopical changes of colonic perforation caused by feces. Three patients died after surgery. CONCLUSION: Spontaneous perforation of the colon most commonly occurs among the elderly with chronic constipation. Abdominal paracentesis is helpful for the diagnosis. The perforation site is located opposite to the mesenteric edge. Sigmoid colon and rectosigmoid colon are the most frequent locations. Neoplasty of the colon and sigmoid colostomy are the most frequenttreatment. The prognosis is bad and the mortality rate after surgery is high.
文摘AIM： To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease,METHODS： 307 patients （118 males, 189 females, age range： 40-80 years） were enrolled in the study and randomly assigned to： Rifaximin （400 mg bid for 7 d every month） plus dietary fiber supplementation （at least 20 gr/d） or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms＇ questionnaire were performed every two months. RESULTS： Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group （6.4±2.8 and 6.2 ± 2.6 at enrollment, P = NS, 1.0 ±0.7 and 2.4±1.7 after 24 mo, P 〈 0.001, respectively）. Probability of symptom reduction was higher and complication frequency lower （Kaplan-Meyer method） in the Rifaximin group （P 〈 0.0001 and 0.028, respectively）.CONCLUSION： In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of RJfaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation.Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients,confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.
