Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
199,705
result(s) for
"Emergency Medicine"
Sort by:
2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation
ᅟ
Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC).
Methods
The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017.
Results
CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann’s procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted.
With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.
Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required.
Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation.
Conclusions
The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.
Journal Article
Treatment and Prevention of Heat-Related Illness
Climate change is resulting in higher temperatures and increased risks of mild to life-threatening heat-related illnesses. Risk can be reduced by counseling susceptible persons about risk-reduction strategies.
Journal Article
Frailty in Older Adults
Assessing older patients for frailty enables clinicians to tailor clinical care, including decisions about stressful treatments. The authors review the assessment, pathophysiology, and management of frailty.
Journal Article
Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults
In this randomized trial, the use of video laryngoscopy in critically ill patients undergoing intubation in the ED or ICU resulted in a higher incidence of successful intubation on the first attempt than direct laryngoscopy.
Journal Article