Mark Killingback

Management of Perforative Diverticulitis

Perforative diverticulitis often requires emergency surgical intervention. The principles of surgical management, such as whether the perforation communicates between the lumen of the colon and the peritoneal cavity or whether a mesenteric or pericolic abscess is present, are explained. The surgical options relative to such disorders as phlegmonous masses, acute diverticulitis with peritonitis, and nonperforated diverticulitis are thoroughly explicated.

Irradiation injuries of the large intestine

A series of 15 patients suffering from irradiation injuries to the large bowel is reviewed. Ten patients required surgical intervention, initially a diverting stoma in eight; intestinal continuity was re-established in three patients. Loop ileostomy may be preferable to loop tranverse colostomy for fecal diversion, as the former is easier for the patient to manage, and ensures that there is no interference with blood supply to the colon should an abdomino-anal pull-through procedure be indicated later to restore continuity. As only three of the patients developed recurrent carcinoma, the initial operation for irradiation injury to the large bowel should be carefully planned so that the patient is not ultimately cured of carcinoma but left with a permanent stoma.

Triple Primary?Carcinomata of Rectum, Breast, and Transverse Colon Associated with Dermatomyositis

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Acute diverticulitis: Progress report, Australasian survey (1967-1969)

SummaryIt is important to point out that this series of 144 cases of acute diverticulitis is a prospective study, with each case documented in great detail; therefore, the study provides a good basis for the evaluation of treatment. No definite conclusions can be reached at the present time, but it can be stated that 64 patients were treated by quite simple means (i.e., drainage alone or drainage combined with closure of a perforation) and only two of the 64 died. Other methods of treatment, such as colostomy or emergency resection, have yet to prove more effective than these more simple procedures in the management of acute diverticulitis. The important thing, obviously, is to save the patient’s life. The question whether more extensive surgery during this emergency period would prevent future symptoms and complications will require further careful follow up of the patients in the survey.

Pilonidal sinuses of the anal canal: Report of a case

SummaryThe many reported cases of pilonidal sinuses arising outside the sacral area have been collected, and reference is made to nine unreported cases seen in the practices of the other 15 surgeons at Sydney Hospital. It is concluded that such pilonidal sinuses are not rare. In addition to these cases, a case is presented as an example of a pilonidal sinus arising in the anus and anal canal.

Prophylactic administration of low-dose heparin in colorectal surgery.

SummaryA retrospective study of 192 patients operated on by three members of the Edward Wilson Colon and Rectum Unit, Sydney Hospital, was carried out. All operations performed involved dissection within the pelvis. Prophylactic administration of low-dose heparin was used for 71 of these patients. The incidences of clinical thromboembolic disease were 7 per cent in both the group receiving heparin and the other group. In slightly more than half of the patients, pulmonary emboli occurred in the absence of peripheral deep venous thrombosis. It is suggested that the source of these emboli was thrombosis arising in the pelvic veins.