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PubMed1987

Does local intestinal ascorbate deficiency predispose to fistula formation in Crohn's disease.

Samples of maximally diseased and adjacent macroscopically normal intestine from 52 patients undergoing surgery for Crohn's disease were analyzed for ascorbate content; 26 of the patients had intestinal fistulas and 26 did not. Ascorbate analyses were also performed on samples of normal intestine from ten control patients. Diseased intestine from both groups of patients with Crohn's disease contained significantly more ascorbate than the adjacent macroscopically normal intestine. Their diseased intestine also contained significantly more ascorbate than normal intestine from controls. Whereas diseased intestine from patients without fistulas contained 47 percent more ascorbate than their normal intestine (P less than .001), the diseased intestine from patients with fistulas contained only 23 percent more ascorbate than their normal intestine (P less than .02). Patients with fistulas appear unable to concentrate as much ascorbate in their diseased intestine as patients without fistulas. This difference may be a factor in the pathogenesis of fistula formation in Crohn's disease because of the importance of ascorbate in collagen production.

Adult↗
PubMed2006

[Role of vacuum therapy in the management of the septic abdomen].

Progress in intensive care medicine contributed substantially in lowering the mortality rate of patients suffering from diffuse secondary peritonitis. In the medical care of patients presenting a septic abdomen the persisting septic focus is one of the greatest problems. This is associated with other problems like temporary closure of the abdomen, complications due to re-laparotomies, healing of the abdominal wall after soft tissue infection, loss of abdominal wall musculature, or persisting enteral fistulas. The vacuum therapy is used with increasing frequency for the treatment of septic complications in different areas of the body. The excellent drainage characteristics of the vacuum therapy appear to be a therapeutic option for the control of surgically untreatable septic processes in the abdominal cavity. More and more experience is gathered with the successful treatment of enterocutaneous fistulas, small intestine and pancreatic fistulas as well as anastomotic leakage after rectal surgery. There exist hardly any evidence-based recommendations for the application of vacuum therapy for treatment of the septic abdomen. But the good results of temporary closure of open abdomen of trauma patients by the vacuum therapy arises hope that the results can be transferred to the treatment modalities of persisting peritonitis. Additionally, these patients could profit from the drainage characteristics of the vacuum therapy.

Abdominal Wall↗
PubMed1978

[Internal biliary fistulae and acute intestinal cholelithic obstruction].

From 1945 to 1976 the authors observed 19 patients with internal biliodigestive fistulae. 2 types of the clinical picture were noted: cholangitis phenomena and acute cholelithic ileus. In one patient only internal biliodigestive fistulae were diagnosed preoperatively. All the patients were operated upon. Some technical difficulties due to an inflammatory infiltration in the right hypochondrium tissues were noted.

Acute Disease↗