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PubMedDate not supplied

Pathogenesis of aortoenteric fistula. An experimental study.

The pathogenesis of aortoenteric fistulas was studied in the experimental laboratory. In 23 dogs patch of woven dacron was interposed in the anterior wall of the infrarenal abdominal aorta. In two groups (I and II), the serosa denuded duodenal wall was sutured to an opening of the proximal anastomosis--creating a pseudoaneurysm--, with induction of staphylococcal bacteremia, without (group I) and with simultaneous administration of methicillin (group II) pre and postoperatively. In the remaining two groups (III and IV), the serosa stripped duodenal wall, was simply attached to overlay the intact proximal anastomosis, with induction of staphylococcal bacteremia, without methicillin in group II and with administration of methicillin without bacteremia in group IV. Aortoduodenal fistulas developed in 100% of animals in group I, 80% in group II and 14% in group III. No aortoduodenal fistula was observed in group IV. We conclude that mechanical factors have the decisive role for the formation of aortoenteric fistulas, especially the development of a false aneurysm, which subsequently ruptures into the duodenum or the bowel.

Animals↗
PubMed1977

[Surgical therapy in diverticular disease of the large bowel].

Operative proceeding, postoperative complications and postoperative mortality in 97 selective and 44 emergency operations for different states in diverticular disease are reported. In states of uncomplicated, chronically recurrent inflammation, one-stage resection is indicated. General condition of the patient and severe complicated diverticulitis may require two- or three-stage therapy. Our experience of 141 operations prompts us to propose early resection in states of chronically recurrent inflammation.

Chronic Disease↗
PubMed1978

[Surgery of complicated diverticular sigmoiditis. Report of 138 cases (author's transl)].

The authors analyse a series of 138 cases of complicated diverticular sigmoiditis treated surgically. They noted 50% of pyostercoral peritonitis, 32% of persigmoid abscesses, 13% of case of intestinal obstruction, and 5% of cases of fistual or hemorrhage. The overall mortality was 28% and depended mainly more on the surgical management adopted than on the type of complication. In this respect, simple colostomy with drainage of the septic focus had a mortality of 18%. The results suggest surgical operation in two stages, in the form of colonic resection, with, depending on each case, an anastomosis straight away with transverse colostomy or segmental colectomy with bitubular colostomy (Mikulicz procedure) or, in rarer cases, simple colostomy. The authors emphasise the interest of early surgery in sigmoiditis with complications and contrast the mortality of cold surgery which is now about 5% compared with 28% in emergency cases with complications.

Abscess↗
PubMed1979

[Complications of idiopathic chronic colitis].

The Authors reviews the acute and chronic complications of chronic idiopathic colitis in a series of 112 cases of his own observation. He discusses perforation, toxic megacolon and massive hemorrhage in terms of their pathogenesis, diagnostic procedures and incidence in the course of ulcerative colorectitis (Crohn's disease). He deals to some length with surgical indications and the choice of operation, both being the subject of considerable controversy, and he outlines his own views in the matter. Among chronic local complications he lists benign stenosis, pseudopolyposis, and fistulization; all of which, unlike neoplastic complications, seldom require surgery.

Abscess↗
PubMed1988

[Clinical experience with the Kock continent ileal urinary reservoir].

From May 1985 through July 1987, 22 patients underwent Kock continent ileal reservoir for urinary diversion. There were 19 males and 3 females, between 38 and 82 years old (mean age 63.1 years). A one-stage radical cystectomy and Kock pouch construction were performed in 21 patients. One patients was converted from standard ileal conduit to this new reservoir. The keys to success of the Kock pouch are creation and maintenance of the nipple valve to prevent reflux and to ensure continence. Mesenteric fat is removed with CUSA for 8 cm along the afferent-efferent limbs of the pouch and exclusion of mesentery is limited for only 3-4 cm. This important modification will ensure adequate ileal intussusception and vascular supply to the valves. To prevent eversion and prolapse, the nipple valve is anchored to the wall of reservoir. A strip of sauvage filamentous Dacron serves as a collar to fix the afferent-efferent limbs to the pouch. There were 2 postoperative deaths and two major early complication: 1 acute renal failure and 1 intestinal fistula, both of which were treated conservatively. Late complications occurred in 6 patients. Of these 6 patients, 1 required reoperation and revision of the continence valve mechanism and 1 required hospitalization for entero-pouch fistula. Serum electrolytes and vitamin B12 remained normal in all patients. Patients perform self-catheterization every 4-6 hours during the day and once at night for volumes ranging up to 1,000 ml. The end result in 19 of 20 patients was excellent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Surgical therapy of Crohn disease and ulcerative colitis].

Surgical treatment of Crohn's disease and ulcerative colitis is standardized today, despite several unresolved problems. Cooperation between gastroenterologist and surgeon is essential to establish the indication for surgery in emergency situations and during the chronic phase, as well. The surgical procedures aim for maximum preservation of function; in Crohn's disease salvage of bowel by means of limited resections and strictureplasty has priority, whilst in ulcerative colitis the preservation of sphincter function is the paramount goal, wherever possible, by means of ileorectostomy and ileal pouch procedures.

Anal Canal↗
PubMed1987

Crohn's disease of the small intestine.

The small bowel remains the most frequent site of inflammation in Crohn's disease, involving 75 to 85 per cent of all patients. In spite of the advent of newer imaging modalities and the increasing sophistication of endoscopy, barium studies remain the primary method of diagnosis and evaluation of small bowel Crohn's disease. It is important not only to detect the presence of disease, but also to give a correct anatomic distribution as well as identify possible complications.

Barium Sulfate↗
PubMed1987

Emergency abdominal re-exploration in a district general hospital.

A series of 3600 consecutive patients undergoing laparotomy was studied prospectively. Fifty six patients required a total of 64 urgent re-explorations of the abdomen during the period of hospitalisation after the first operation. The re-exploration rate was 1.7%. Re-laparotomy was most often necessary in the elderly and following gastroduodenal or intestinal operations. The indication for re-operation must in part reflect the nature of surgical practice but in this general surgical unit the most common complications requiring re-laparotomy were sepsis, small bowel obstruction and wound dehiscence. Biliary operations were relatively uncomplicated. Mortality rose with age. Diagnosis depends upon the ability to distinguish the clinical symptoms and signs of developing complication from the clinical features inevitable following abdominal surgery. We believe that the decision to re-operate and the second operation should normally be undertaken by experienced surgical staff.

Abdomen, Acute↗
PubMed1986

[Laparostomy in diffuse suppurative peritonitis].

The authors describe results and the technique of treatment of diffuse fecal and purulent peritonites by an open method in 15 patients. Three patients died. Small intestinal fistulas were observed as complications of laparostomy in three cases.

Acute Disease↗