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PubMedDate not supplied

Adenocarcinoma in perineal fistulas of Crohn's disease.

Until recently, Crohn's disease has not been regarded as a premalignant lesion, but the increasing number of patients with Crohn's disease in whom adenocarcinoma of the gastrointestinal tract develops strongly suggests that these patients are indeed at a higher risk for carcinoma. These patients are usually young and tend to develop a malignancy in the bypassed ileum or right colon. Patients with such lesions usually have a poor prognosis. Adenocarcinoma arising in perineal fistulas secondary to Crohn's disease has not been reported in English medical literature except for one case published in 1975. In this article, the authors report a second, similar case of Crohn's disease with recurrent perineal fistulas. An infiltrating adenocarcinoma developed in these fistulas, in the anorectal region, and in the left labia. The risk of malignancy should be seriously considered in the management of Crohn's disease, especially in young patients. Because of the risk of adenocarcinoma in these patients, resection rather than bypass is recommended in the surgical management.

Adenocarcinoma↗
PubMedDate not supplied

[Nitrogen balance of children with fistulae of the small intestine kept on a diet with a protein enteral feeding formula].

Sixteen children with small bowel fistulas receiving hospital diets and 9 children with the same condition kept on the diets including products for enteral nutrition were examined over time. The use of the hospital diets alone brought about the lowering of the patients' body weight, high protein excretion via fistulas, negative nitrogenous balance, and protracted clinical course of the disease. After the patients were placed on the diet including products for enteral nutrition, the protein content amounting up to 50%, the body weight gain, a 2-times reduction in protein losses with the chyme, establishment of the positive nitrogenous balance, increase in the total blood protein, and a more favourable clinical course of the disease were recorded.

Adolescent↗
PubMed1977

Conservative treatment of gastrointestinal fistulas.

Conservative measures were instituted as the primary treatment of 39 consecutive patients with high output fistulas of the gastrointestinal tract and related organs. Nutritional status was maintained by an intravenous feeding regimen, using peripheral vein infusion sites and supplying 60% of the calorie intake by a fat emulsion. This regimen had no serious complications. These patients died during treatment. The fistulas healed spontaneously in 35 of the remaining 36 patients. None of these patients had obstruction distally or other factors tending to prevent spontaneous closure. Under these circumstances, nonoperative treatment is safest and best. Surgical closure was necessary in one patient after two months of conservative treatment and was successful.

Adolescent↗