The colon influences ileal resection diarrhea

Mitchell, Judith E.; Breuer, Richard I.; Zuckerman, L; Berlin, Jordan; Schilli, Rudi; Dunn, J. K.

doi:10.1007/bf01312730

Cited by 85 publications

(35 citation statements)

References 18 publications

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“…The significant increase of water, sodium, and potassium fecal losses in ESBR with right colectomy compared with resection sparing the ileocecal valve and cecum is in good agreement with the findings of Cummings et al (4) and Mitchell et al (15) in less extensive ileal resections.…”

Section: Discussionsupporting

confidence: 80%

Role of the Ileocecal Valve and Site of Intestinal Resection in Malabsorption after Extensive Small Bowel Resection

Cosnes

Gendre

Quintrec³

1978

Digestion

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Intestinal absorption after extensive small bowel resections, for diseases other than Crohn’s disease, was studied in 17 patients. When the ileocecal valve and the right colon were preserved, malabsorption was transient and moderate and had no prejudicial nutritional effect (fecal fat: 8.8 ± 1.8 g/24 h in resections sparing the 2 distal bowel loops, and 16.2 ± 4.8 g/24 h in resections including the distal ileum; mean ± SEM). When colectomy was associated, malabsorption was severe and persistent (fecal fat: 47.4 ± 12.2 g/24 h; mean ± SEM). These findings suggest that the most important prognostic factor in extensive small bowel resection is the site of the resection, and particularly the presence or absence of the right colon and ileocecal valve.

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Section: Discussionsupporting

confidence: 80%

Role of the Ileocecal Valve and Site of Intestinal Resection in Malabsorption after Extensive Small Bowel Resection

Cosnes

Gendre

Quintrec³

1978

Digestion

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“…The reabsorption of sodium and chloride ions together with water (combined with the secretion of potassium and bicarbonate ions) is of great importance in preventing excessive fluid loss [13,30]. The specific abilities of secretion and reabsorption gradually diminish towards the distal end of the colon.…”

Section: How Much Of Which Bowel Segment Can Be Used Without Major Mementioning

confidence: 99%

“…The loss of bile acids by the ileum exceeds the increased production in the liver, and greatly impaired absorption of lipids follows. The amount of excreted lipids in the stools correlates with the length of resected ileum [30]. The concomitant diarrhoea is steatorrhoeic [2,13,16,29,33,50].…”

Section: How Much Of Which Bowel Segment Can Be Used Without Major Mementioning

confidence: 99%

“…Without the regulatory effect of the ileocaecal valve, transit time is shorter, with a consequent risk of diarrhoea and malabsorption due to too short a contact time. Other disadvantages consist ob bacterial overgrowth in distal parts of the small intestine [10,12,26,29,30,32,41], and this may lead to disturbances in lipid metabolism and to hyperammonaemia in patients with impaired liver function.…”

Section: How Much Of Which Bowel Segment Can Be Used Without Major Mementioning

confidence: 99%

“…In such patients it could be shown that the severity of diarrhoea depends more on the amount of resected colon than on the amount of resected ileum [30]. Thus, the resection in the same patient of a large distal ileal segment and part of the colon should be avoided.…”

Section: How Much Of Which Bowel Segment Can Be Used Without Major Mementioning

confidence: 99%

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Bladder reconstruction with bowel after radical cystectomy

et al. 1992

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When a urinary reservoir intended to replace the bladder is made from bowel, it should meet several requirements: good capacity, viscoelasticity and compliance, voluntary control of micturition without residual (infected) urine, a sensation of the filled state and urinary continence. In addition, there should be no major metabolic changes due to malabsorption after bowel resection or due to reabsorption of urinary constituents by the reservoir. In this review several conflicting aspects of bladder reconstruction are addressed: the persisting intestinal peristalsis and urinary incontinence, the volume of the reservoir and its metabolic impact, the bowel segment to be used and the amount that can be resected without the risk of long-term sequelae. Our clinical experience with ileal bladder substitutes in 80 patients underlines the theoretical aspects. After careful instruction, our patients increased the functional capacity of their reservoirs to 500 ml, a precondition for good urinary continence. Provided that the patients were regularly followed-up, the functional, clinical and metabolic results were good. The operative procedure was easy to perform, and no major metabolic sequelae occurred during a maximal observation time of 6 years. Nevertheless, continuing careful follow-up for the detection of potential long-term sequelae, such as disturbances in lipid metabolism or chronic bone demineralisation, are required before definitive statements on the role of intestinal bladder substitutes can be made.The therapeutic benefits of a radical cystectomy for invasive bladder cancer must be considered in the light of the impact of urinary diversion on the quality of life and the associated morbidity. Although today the ileal conduit is still considered to be the standard urinary diversion with * To whom correspondence should be addressed which any other form must be compared, the first attempt at continent urinary drainage, a case of ureterosigmoidostomy, was reported as early as in 1852 by J. Simon [40]. Various forms of intestinal segments were in use for continent urinary reservoirs and bladder substitutes at the turn of this century [46]. High rates of surgical, metabolic and infectious complications have precluded the widespread use of bladder substitutes. However, a better understanding of intestinal physiology, the metabolic implications of the use of the intestine as part 0fthe urinary tract and increasing knowledge of the urodynamic aspects of urinary continence have led to a r~ni~issance of continent diversion first in the 1950s and then again in recent years.The intestinal bladder substitute should be a low-pressure, capacious and high compliance reservoir that can be voided without residual urine as the patient desires. The state of fullness should be appreciable by the patient. The bladder should provide voluntary control of urine as well as continence. Renal functions must be preserved, but at the same time intestinal malabsorption, fluid and electrolyte imbalances and metabolic long-term sequelae caused by...

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Classification of the sequelae of bowel resection for Crohn's disease

Cosnes

Parades

Carbonnel

et al. 1994

Journal of British Surgery

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A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0.64 and 0.90, and 0.60 and 0.99 respectively in the retrospective series; values were 0.80 and 0.71, and 0.25 and 1.00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.

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The colon influences ileal resection diarrhea

Cited by 85 publications

References 18 publications

Role of the Ileocecal Valve and Site of Intestinal Resection in Malabsorption after Extensive Small Bowel Resection

Role of the Ileocecal Valve and Site of Intestinal Resection in Malabsorption after Extensive Small Bowel Resection

Bladder reconstruction with bowel after radical cystectomy

Classification of the sequelae of bowel resection for Crohn's disease

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