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Titolo:
COLONIC PERFORATION BY AIR AND LIQUID ENEMAS - COMPARISON STUDY IN YOUNG-PIGS
Autore:
SHIELS WE; KIRKS DR; KELLER GL; RYCKMAN FR; DAUGHERTY CC; SPECKER BL; SUMMA DW;
Indirizzi:
WALTER REED ARMY MED CTR,DEPT RADIOL WASHINGTON DC 20307 CHILDRENS HOSP RES FDN,DEPT BASIC SCI CINCINNATI OH 45229 MCKINSEY & CO CHICAGO IL 60603 CHILDRENS HOSP MED CTR,DEPT RADIOL CINCINNATI OH 45229 UNIV CINCINNATI,DEPT SURG CINCINNATI OH 45221 UNIV CINCINNATI,DEPT PATHOL CINCINNATI OH 45221 UNIV CINCINNATI,COLL MED,DEPT RADIOL CINCINNATI OH 45221 UNIV CINCINNATI,COLL MED,DEPT PEDIAT CINCINNATI OH 45221 UNIFORMED SERV UNIV HLTH SCI,DEPT RADIOL BETHESDA MD 20814
Titolo Testata:
American journal of roentgenology
fascicolo: 5, volume: 160, anno: 1993,
pagine: 931 - 935
SICI:
0361-803X(1993)160:5<931:CPBAAL>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTUSSUSCEPTION; REDUCTION;
Tipo documento:
Article
Natura:
Periodico
Citazioni:
11
Recensione:
Indirizzi per estratti:
Citazione:
W.E. Shiels et al., "COLONIC PERFORATION BY AIR AND LIQUID ENEMAS - COMPARISON STUDY IN YOUNG-PIGS", American journal of roentgenology, 160(5), 1993, pp. 931-935

Abstract

OBJECTIVE. Hydrostatic enema reduction of intussusception in childrenhas been replaced by pneumatic reduction in a number of institutions. Colonic perforation occurs in as many as 2.8% of enema reductions, and questions persist about the relative safety of enemas performed withair vs fluid. The objectives of this study were to investigate and compare the pathologic patterns of in vivo colonic perforation and fecalspillage in young pigs given air and hydrostatic enemas, with and without the Valsalva maneuver. MATERIALS AND METHODS. Colonic perforations were induced in 135 juvenile pigs. The pigs were divided into five groups, and enemas with air, barium, and water-soluble contrast material were given with and without the Valsalva maneuver to induce the perforations. During the enemas, the Valsalva maneuver was observed when the animals strained. In each animal, the enema was continued and pressure increased until a perforation was detected with fluoroscopy. Radiographic, gross, and histologic examinations of each animal were performed after perforations occurred. Differences in fecal spillage were noted, and the morphologic variations of the perforations and the surrounding tissue were determined. RESULTS. Perforations with hydrostatic (barium, water-soluble) enemas occurred at approximately 120 mm Hg of pressure (average bag height, 57 in. [143 cm]). No significant variations were found between the type of material used for contrast or the use of the Valsalva maneuver. With air enemas, perforations occurred at a mean pressure of 108 mm Hg without the Valsalva maneuver and at 145 mm Hg with the Valsalva maneuver. Perforations during air enemas did not occur during the Valsalva maneuver (pressures as high as 270 mm Hg), but rather between Valsalva maneuvers. Hydrostatic enemas produced full-thickness tears that were larger than those induced by air enemas in all cases. Air enemas with and without the Valsalva maneuver produced partial-thickness tears in 45% and 10%, respectively, of the pigs. Fecal spillage was diffuse in all hydrostatic perforations. In air enemas, spillage was focal in 55% and 90%, respectively, and absent in 45% and 10%, respectively, of perforations produced with and without theValsalva maneuver. CONCLUSION. Our results suggest that air enemas are safer than liquid enemas. Perforations that occurred during air enemas were smaller and associated with less fecal spillage and peritonealcontamination. The Valsalva maneuver appears to prevent colonic perforation during air enemas.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/12/20 alle ore 06:12:31