Raul Ramos

Virulent diverticular disease in young obese men

Recent treatment of young patients (aged 40 years or less) with complicated diverticulitis prompted us to review our experience. During a 9-year period ending in December 1990, 61 of 238 patients treated for acute diverticulitis were 40 years of age or younger. The younger patients were primarily obese Hispanic males in whom the correct diagnosis was frequently missed. Younger patients more frequently required an operation on an urgent basis for complications of diverticulitis during the initial hospitalization. The most common indication for operation in young patients was perforation compared with recurrent disease for the older age group. The younger group had a sevenfold incidence of enteric fistulas complicating their acute episode of diverticulitis. Our data suggest that diverticular disease in young patients is more common and more likely to require early surgical intervention than previously noted. In addition, obesity may represent an important etiologic factor in the development of diverticular disease.

Invasive necrotizing infection secondary to anorectal abscess

During a six-year period, six patients were treated for invasive necrotizing infection secondary to anorectal abscess. The delay in definitive diagnosis and treatment ranged from three to 14 days. All patients had significant concomitant diseases. The number of operative procedures for each patient ranged from one to nine. Antibiotics, as well as nutritional supplementation by the parenteral or enteral route, were used on all patients. Each patient had three or more complications attributable to this infection. Hospital stay ranged from 30 to 76 days. All patients survived. Factors contributing to the development of this condition are delay in diagnosis, inadequate and inappropriate treatment, and concomitant disease. Factors associated with a satisfactory outcome are examination under general or conduction anesthesia by an experienced examiner, prompt and definitive operative therapy (including drainage and removal of all necrotic tissue), antibiotics, frequent reexamination under general anesthesia, nutritional support, and close attention to concomitant disease.

A simple technique for construction of a J-Pouch

A technique for construction of an ileal pouch is described.

Dissection and Resection Facilitated Laparoscopic Right Hemicolectomy

Laparoscopically facilitated right colectomies for benign or malignant disease can minimize the incision size and the trauma to the patient. A suitable patient is a one who after a comprehensive preoperative evaluation appears to have a lesion not involving neighboring organs, not invading the abdominal parietes, and not associated with interintestinal fistulas or abscesses. A careful history, a thorough physical examination, barium contrast studies, and enhanced computed tomography in selected patients should provide the surgeon with enough information to decide whether a patient is a suitable candidate for laparoscopic surgery.

Effects of patient age and previous operations on completeness of sigmoidoscopy

* Received for publication I)ecember 6, I972. instrument. Examinations were performed during July 1971. The ages of the patients, their histories of previous pelvic surgery, and whether sigmoidoscopy was complete or incomplete were recorded. We have defined incomplete sigmoidoscopy as passage o[ the scope to less than 20 cm above the anal verge. 2 The 141 patients were divided into four groups: Group I included 57 patients who had not previously had abdominal surgery; Group II included 63 patients who had previously had hysterectomy (total abdominal, vaginal, and subtotal); Group III included 11 patients who had previously had cesarean section, tubal ligation, or uterine suspension, or some combination of these;