povidone-iodine and Intestinal-Obstruction

The use of intraperitoneal povidone iodine as an agent for peritoneal lavage in colorectal surgery is controversial. Although it possesses a wide range of antimicrobial activity and is rapidly lethal to dissociated colorectal cancer cells in vitro, concern about its potential toxicity remains.. Two cases of sclerosing encapsulating peritonitis (SEP) following elective colorectal surgery are presented. In each case the peritoneal cavity was lavaged with an aqueous povidone iodine solution. The surgical literature on the intraperitoneal use of povidone iodine is reviewed.. Significant morbidity resulted from the postoperative development of SEP in both of our patients. In one patient an ileo-anal pouch could not be fashioned following an initial colectomy, and in the second patient a small-bowel obstruction required a laparotomy and a period of intravenous nutrition before an oral diet could be tolerated.. The use of povidone iodine for peritoneal lavage in colorectal surgery is to be cautioned against in concentrations of > 1%.

Topics: Adult; Aged; Animals; Anti-Infective Agents, Local; Female; Humans; Intestinal Obstruction; Intestines; Male; Peritoneal Lavage; Peritonitis; Povidone-Iodine; Rats; Sclerosis

We investigated the effect of intraoperative lavage with various solutions on the morphology of the mucosa adjacent to the anastomosis performed in left-sided colonic obstruction. After 24 hr of ligature obstruction to the pelvic colon, 108 male Wistar rats underwent colonic resection followed by primary anastomosis and were randomized for lavage with one of four different solutions: saline, povidone-iodine, 10% hypertonic glucose (HG), and short-chain fatty acids (SCFA). A control group had no lavage. The anastomotic region was studied both macroscopically and with light microscopy after three or six days. At day 3, lavaged animals, especially those with SCFA, had significantly smaller ulcers than controls, and at day 6 only rats lavaged with SCFA and HG were free of large ulcers. At day 3, median (interquartile range) crypt depth was higher in SCFA [360 (286-374) microm] and HG animals [306 (279-315) microm] when compared with controls [243 (225-252) microm; P < 0.05], and SCFA [67 (53-89)] rats showed more cells per crypt than controls [48 (39-52); P < 0.05]. No differences occurred on the sixth day. We conclude that intraoperative lavage with nutrient solutions, particularly with SCFA, has a trophic effect on the colonic mucosa. The suture line gap in the mucosa may be filled more quickly, thus contributing to improve the healing of a colonic anastomosis.

Topics: Anastomosis, Surgical; Animals; Colon; Fatty Acids, Volatile; Glucose; Hypertonic Solutions; Intestinal Mucosa; Intestinal Obstruction; Intraoperative Care; Male; Povidone-Iodine; Rats; Rats, Wistar; Therapeutic Irrigation; Time Factors; Wound Healing

Four patients with partial obstruction of the colon, in whom adequate standard preparation for colonic resection was not possible, are presented. Clinically, these patients did not show sufficient signs of obstruction to require a preliminary colostomy. A technique of quarantining the area of tumor resection from the abdominal cavity is described, allowing for adequate preparation of the colon lumen at the site of anastomosis. After completion of the anastomosis, a large caliber (36 French) colonic tube is inserted, per rectum, through the anastomosis and the proximal colon irrigated with Betadine solution adequately emptying and sterilizing the lumen of the bowel to allow for primary anastomosis without a protective colostomy. The criteria for selection of patients for this technique are discussed. No complications, of significance, ensued. This method of intraoperative rectal tube irrigation, for prevention of colostomy in partial colonic obstruction, is safe when properly performed in the appropriate patient.

Topics: Adult; Aged; Colonic Diseases; Colostomy; Female; Humans; Intestinal Obstruction; Intraoperative Care; Methods; Middle Aged; Postoperative Care; Povidone; Povidone-Iodine; Rectum; Therapeutic Irrigation

The two cases reported here show intestinal obstruction may occur by coagulation of lymph around the loops. They permit us to better understand the physiopathology of blockage of the lymph vessels whether congenital as in the first case or traumatic as in the second case. Traumatic rupture of the cisterns chyli is exceptional. The histological lesions observed on clamped biopsies show clearly the pathology of protein-losing enteropathy.

Topics: Adult; Biopsy; Chyle; Chylomicrons; Chylous Ascites; Humans; Intestinal Mucosa; Intestinal Obstruction; Intestine, Small; Iodized Oil; Ligation; Lymphangiectasis, Intestinal; Lymphatic System; Male; Middle Aged; Povidone-Iodine; Radiography; Serum Albumin, Radio-Iodinated; Thoracic Duct