Gastrostomy-induced duodenal obstruction after gastric bypass.
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Biomedical subjects
Publications and source records attributed to E Avinoah.
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From 1976 to 1982, seven cases of free perforation of the sigmoid colon were treated at the Soroka University Hospital. None of the patients suffered any known underlying disease of the affected bowel such as malignancy, diverticulosis, stercoral ulcer, colitis, or trauma. The only feature common to all seven patients was a long history of chronic constipation. All patients were treated surgically with no mortality and with minimal morbidity. We believe that severe untreated chronic constipation may, on rare occasions, cause free perforation of the sigmoid colon.
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Various preparatory techniques were used to improve scanning electron microscopy images of the fine structure of vascular, cellular, and cordalreticular components of normal human spleens. The progressive method of fixation (GTGO) applied in the present study, allowed air drying of the tissues and rendered the specimens conductive even in newly fractured surfaces. Vascular perfusion proved necessary only in studies of the splenic blood vessels, while a simple immersion of tissue blocks in the washing solution resulted in better images of the white pulps. Interstitial (transsplenic) perfusion was found to be superior to vascular perfusion for routine preparation of spleen tissues, and freeze-cracking did not necessarily lead to improved images of the specimen's surfaces. Combined with proper washing and shaping protocols, the GTGO procedure is shown to be a superior mode of specimen preparation, abolishing most traditional artifacts and obtaining clear images of the complex splenic tissue.
In four patients, acute cholangitis was found to result from a ruptured hydatid cyst. In three patients, the diagnosis was established before operation by ultrasonography, and the fourth case was diagnosed during operation. Once the diagnosis of cholangitis is reached, our working policy includes administration of antibiotics and fluids, accelerated diagnostic workup, and operation as soon as possible. Our suggested operative procedure is cholecystectomy, choledochotomy, choledochoduodenostomy, and removal of the echinococcal cyst. In all four cases treated by us, there were no deaths, and only one patient who did not undergo removal of the echinococcal cyst at the initial operation needed a second operation 2 months later.