[Obstruction of the small intestine caused by a gallstone 13 years following cholecystectomy].
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Biomedical subjects
Publications and source records attributed to K Rösner.
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Report on a 67-year-old man with echinococcus-granulosus-cysts in liver, lungs, spleen and mesentery since at least 31 years. In 1969 and 1974 surgical intervention was performed. In 1983 suppurative colliquation and spontaneous depletion by a fistula of a cyst of the liver, output of the cysts of the right lung by coughing. In 1986 spontaneous resorption of a cyst of the left lobe of the liver. In 1987 measurable shrinking of a cyst of the left lower lobe of the lung. Two until today existing cysts (spleen and upper part of the abdomen in the midline) are in supervision by sonography.
On the occasion of a case of death during performance of pneumoperitoneum before peritoneoscopy the presence of adhesions in the left lower quadrant of the abdomen in 850 peritoneoscopied patients was investigated. In 91,55% of the evaluated results the left lower quadrant of the abdomen was free from adhesions. Thus, the Monroe-point is even further on the place of choice in order to make the pneumoperitoneum. The Verres-needles are preferable to all other types of needles.
It is reported on a 61-year-old patient in whom since 1959 has been existing a diabetes mellitus in need of insulin. 1973 in the endoscopic control of roentgenological findings of a stomach suspect to tumour by means of the Wolf-Schindler gastroscope the suspicion to a gastric carcinoma was expressed. In May 1975 he was again admitted to hospital on account of a hypoglycemic shock. Roentgenologically large filling defects in the stomach were found, gastroscopically macroscopically no clearly explained whitish yellow masses (Histology: remains of food, chronic superficial gastritis, extended settlement of fungi). Only after several days of food carency and daily gastric lavages gastroscopically normal findings could be made. Together with the roentgenological findings of the stomach the diagnosis gastroparesis diabeticorum was made. Therapeutically an optimum stopping of diabetes is recommended and the application of metoclopramide. A surgical intervention is not advisable.
In a female patient with Dunbar-syndrome the cause of the complaints is not recognized during 18 years. Therefore, the symptomatology of the stenosis of the truncus coeliacus is briefly outlined. The patient reacts more and more neurotic on the misunderstanding of organically conditioned complaints, so that at last a consilium of experienced specialists makes the diagnosis "functional intestinal disturbances, hypchondriac depressive syndrome in accentuated personality". Therefore functional disturbances are to be diagnosed only then (also in the psychopathologic behaviour of the patients!), when an organic disease is excluded. The difficulty to justify such a demand is great.
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On the basis of a follow-up period lasting at least 6 years concerning 23 patients, in whom on account of a Raynaud-syndrome a thoracoscopic sympathicotomy in the region Th 2-5 was carried out in most cases bilaterally in two sessions, in comparison with the sympathicectomy performed in major surgery can be established:no mortality, no serious complications, duration of stay in hospital 5-7 days, no absolute healing. In a follow-up period of the same length in an approach of major surgery absolute healings are possible, but only in 35%. This gain is loaded by a longer stay in hospital of at least 10 days and a mortality of 4.3% as well as by a complication rate of 6-41%, to which in 8-13% of the cases a Horner-syndrome comes. Therefore, before an approach in major surgery a thoracoscopic intervention is to be tried. The thoracoscopic operators should strive for a sympathectomy with destroy of the ganglia Th 2 and 3 instead for a sympathicotomy.
On occasion of peritoneoscopy of a 76-years old man with gastrectasia by cancer of the pylorus, the gastric wall became perforated. He was cured by followed urgent surgical intervention. Causes and conclusions to prevent this complication are discussed.
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