Rupert B. Turnbull

Total fecal diversion by the temporary skin-level loop transverse colostomy

SummaryThe temporary skin-level loop transverse colostomy has been described. Proof of its ability to divert the fecal stream totally is illustrated by complete diversion in 25 patients ingesting a postcolostomy barium meal. There was no postoperative complication.

Occult invasive cancer in polypoid adenomas of the colon and rectum

ConclusionsOne thousand three hundred and forty-five patients with polypoid adenomas of the colon and rectum, that appeared to be benign both clinically and by morphologic characteristics, were treated by simple transcolonic excision or by biopsy and coagulation. A review of 1,500 specimens removed from these patients revealed that 180 (13. per cent) patients had some type of cancer which was discovered on histologic examination of the polyp. Of these, 37 (2.7 percent) had foci of invasive cancer. A clinical study to determine the effectiveness of local treatment was carried out in the invasin group. One patient (aged 77 years) we known to have local recurrence of cancer in the rectum three years after inadequacy treatment, but no patient had metastases within four to 14 years.Adequate local treatment seems to satisfactory for benign-appearing polypod adenomas even though they may contact foci of invasive cancer.

Carcinoma in rectal polyp; follow-up observations on 27 patients.

Radical surgery has often been carried out when cancer in rectal polyp is found or implied in the pathologists report. A plea is made for a careful consideration of the histologic characteristics of the lesion before the decision for radical or conservative surgery. From the complete histologic picture, an individualized plan of therapy can be established; experience has shown that the majority of these lesions can be treated conservatively.

Complications of colonic and rectal surgery: Results of a study of early presumptive antimicrobial therapy of serious infections in surgical patients with intestinal diseases

SummaryDuring a 201/2-month period, 115 surgical patients with intestinal diseases were evaluated for possible systemic infection. In 101 patients infection was suspected; antimicrobial therapy was administered promptly on the basis of a presumptive diagnosis after appropriate smears and cultures were obtained, but before the causal organisms were definitively identified or theirin-vitro susceptibility was determined. Of the 101 patients, serious infection was proved in 79; septicemia occurred in 25 per cent. Septic shock developed in 15 patients; only five died. The low mortality was attributed to prompt diagnosis and treatment. Further reduction in the incidence and mortality of septic shock may result from utilization of appropriate preventive measures.

Transmural Colitis: Medical and Surgical Management

Although transmural colitis can be differentiated from the mucosal or ulcerative type with 95% accuracy—a distinction vital to the therapeutic approach—diagnostic error is not uncommon. A patient is presented whose progressive deterioration, originating in early misdiagnosis, eventually required colectomy and ileostomy. Continuous medical supervision is as important after operation as before.

Septicemia in surgical patients with intestinal diseases

SummaryA study was undertaken to define the microbiologic spectrum of septicemia in surgical patients with intestinal diseases, to learn more about its clinical manifestations, and to determine factors related to its pathogenesis and outcome. During a 2 1/2-year period we detected and treated septicemia in 27 patients, of whom ten died. Results indicated that septicemia was caused by a wide variety of opportunistic bacteria or fungi and was produced by infections in a number of anatomic locations. Underlying noninfectious diseases, especially severe malnutrition and cachexia secondary to intestinal conditions and intractable renal failure, often were important determinants of a fatal outcome of infection. Early manifestations of septicemia frequently were subtle, atypical, or mistaken for expressions of other illnesses. The urinary or respiratory tracts and indwelling intravenous catheters served as apparent portals of entry for septicemia in a sizable proportion of the patients; adoption of additional preventive measures for those types of hospital-acquired infections, hopefully, may further reduce the low incidence of septicemia in our patients in the future.