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Emergent ileocecectomy for infection and inflammation
R Sarkar1, R S Bennion, P J Schmit
1Department of Surgery, Olive View-UCLA Medical Center, Sylmar 91342, USA.
The American Surgeon
|October 10, 1997
Summary
Emergency ileocecal resection for ileocecal conditions is safe and effective, with primary anastomosis leading to good outcomes. This approach avoids the need for ileostomy in most patients undergoing surgery for inflammatory diseases.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- The efficacy of right colectomy for inflammatory conditions and intra-abdominal sepsis is debated.
- Ileocecal resection is a critical intervention for various ileocecal pathologies.
Purpose of the Study:
- To evaluate the outcomes of emergency ileocecal resection for infectious and inflammatory causes.
- To assess the safety and efficacy of primary anastomosis in these cases.
Main Methods:
- Retrospective analysis of 83 patients undergoing emergency ileocecal resection over 7 years.
- Review of preoperative diagnoses, CT scan utility, intraoperative findings, and postoperative outcomes.
- Analysis of complication rates based on preoperative conditions like abscess and perforation.
Main Results:
- Preoperative diagnosis accuracy was 54%, not improved by CT scans (59%).
- Common diagnoses included appendicitis (39%), diverticulitis (23%), cancer (14%), and Crohn's disease (8%).
- Primary ileocolic anastomosis was successful in 89% of patients, with no mortality and a low complication rate (18%). Free perforation increased complications to 31%.
Conclusions:
- Emergency ileocecal resection with primary anastomosis is a safe and effective treatment for ileocecal infectious and inflammatory diseases.
- This approach minimizes the need for ileostomy and subsequent operations.
- While abscess presence did not increase complications, free perforation was associated with higher morbidity.