INTRODUCTION: The passage of flatus and stool, as well as tolerating a solid diet, represents a crucial moment in recovery after colonic resections. The present study compares functional recovery after left and right colectomies for colon cancer. MATERIALS AND METHODS: This is a retrospective analysis. Consecutive patients with elective left and right colon resections were examined. Primary analysis compared time to first bowel motion and development of postoperative ileus. Secondary analyses tried to define risk factors for prolonged restoration of bowel function in right- and left-sided resection groups. RESULTS: In total, 147 patients were included. While laparoscopic approach was preferred for both sides (87% vs. 87%; p=0.496), left colectomies took longer (183 vs. 153 min; p=0.012), the lymph node harvest was smaller (16 vs. 20; p=0.005), and there was an increased need for perioperative fluids (4451 vs. 4039ml; p=0.006). Epidural use, postoperative potassium level, and glycemia were similar. Also, no significant differences were observed for complications and length of stay. First flatus was observed at postoperative day 1, 9 (left), and 2.5 (right), respectively (p=0.002). There was no significant difference in passage of first stool and intake of first solid food. Twenty-seven patients (35%) needed a postoperative nasogastric tube after right colectomy compared to 11 patients (16%) after left colectomy (p=0.012). Right-sided colectomies required the tube for longer (6.1 vs. 3.4; p=0.005). CONCLUSIONS: Postoperative ileus was more frequent after right-sided colectomies despite shorter operative time. The reason for this finding is currently unknown and deserves further attention. For the time being, we can just be more cautious with early feeding after right colectomy.
- MeSH
- délka pobytu MeSH
- flatulence komplikace chirurgie MeSH
- ileus * epidemiologie etiologie chirurgie MeSH
- kolektomie škodlivé účinky MeSH
- laparoskopie * škodlivé účinky MeSH
- lidé MeSH
- nádory tračníku * chirurgie MeSH
- pooperační komplikace epidemiologie etiologie MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Gastrointestinální komplikace kriticky nemocných během pandemie covid-19 mohou představovat diagnostické a léčebné dilema. Kazuistika: Představujeme dva případy SARS-CoV-2 pozitivních pacientů, kteří byli na našem oddělení léčeni pro perforaci tračníku. První byl operován pro perforaci distendovaného caeca při paralytickém ileu. Perforace ve druhém případě byla asociována s divertikulární nemocí tračníku. Závěr: Těmito dvěma případy chceme poukázat na to, že covid-19 se nemusí projevit pouze typickými respiračními, ale i zažívacími příznaky. A ať už přímo, či narušením homeostázy vnitřního prostředí může být příčinou perforace zažívacího traktu.
Introduction: Gastrointestinal complications in critically ill patients during the COVID-19 pandemic pose a diagnostic and treatment dilemma. Case report: We present two cases of SARS-CoV-2 positive patients treated in our department for colon perforation. One patient was operated for a diastasic right colon perforation due to acute over distension of the bowel. The perforation in the second case was associated with chronic diverticulitis. Conclusion: These cases highlight the fact that besides typical respiratory symptoms and signs of COVID-19, digestive symptoms also occur. These can caused by intestinal perforation, be it directly or due to changing homeostasis of the internal environment.
- MeSH
- COVID-19 * diagnóza komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- perforace střeva * chirurgie diagnóza MeSH
- peritonitida diagnóza terapie MeSH
- pneumonie * diagnóza farmakoterapie MeSH
- pneumoperitoneum diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
