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PubMed1976

Fistula-in-Ano: perineal fistula of intra-abdominal or intrapelvic origin simulating fistula-in-ano--report of seven cases.

Fistulas manifesting in the perianal region but originating in the abdomen often have their true origin not recognized for extended periods. Examples of seven such complex cases are presented and discussed. Removal of the abdominal abnormality is mandatory before any cure can be effected; the perianal portion usually heals without any special local treatment.

Abscess↗
PubMed1976

[Diverticulosis of the sigmoid colon from the radiological point of view (author's transl)].

Diverticulosis is one of the most common diseases of the colon. Its importance arises from complications. In countries of the Western hemisphere the incidence is 10-20% beyond the age of 50. Among the natives of Africa and South-Eastern Asia it is practically unknown. It is suggested that the disease is caused by low residue diet, modern living conditions. and constitutional disorders. 500 barium enemas revealed 13,4% patients with diverticula including a 5-year-old child and a 32-year-old woman. The incidence of diverticulosis among patients over 40 years of age is 19,6%. The sex distribution is 1 : 1,9 male to female. The complications are demonstrated by case histories: Diverticulitis with ileus, foreign body trap, sub-acute perforation, sigmoid-vaginal fistula, sigmoid-bladder fistula, sigmoid-uterus fistula in a 5-year-old girl.

Aged↗
PubMed1979

The Hartmann procedure for complications of diverticulitis.

A Hartmann procedure was performed on 25 patients with complications of acute diverticulitis. Of the 20 patients in whom both stages were completed, 14 had a smooth course. Total hospitalization for both stages averaged 23 days. Mortality was 8%. The initial resection usually is not difficult. Subsequent reanastomosis is facilitated by an interval of at least three months between stages. The advantages of the Hartmann procedure are as follows: (1) The diseased bowel is removed at the first stage. (2) The risk of primary anastomosis is avoided. (3) Hospitalization and overall time of treatment are reduced. (4) Mortality is relatively low. The Hartmann procedure should be considered for a broader selection of patients with complications of acute diverticulitis.

Abscess↗
PubMed1984

[Fistulas of the small intestine with evisceration. New therapeutic approach. 120 cases].

One hundred and twenty cases of post-operative jejuno-ileal fistula with evisceration are reported: 90% of the patients came from other departments. Depending on their mechanism, these fistulae fell into two categories: out-flowing fistulae (93 cases) consecutive to spontaneously opened peritonitis draining through the surgical incision, and in-flowing fistulae (24 cases) resulting from trauma of a superficial small bowel loop; 48% of open small bowel fistulae were due to a questionable operation. Unfavourable prognostic factors were: age over 50, supramesocolic initial lesion, fluid production equal or superior to 1000 ml/24 h, history of at least 2 previous median laparotomies and presence of one or several of 7 severity factors. The overall mortality rate was 46%, falling to 38.5% (inoperable cases excluded) after active treatment. The authors propose to concentrate on prolonged medical intensive care, salvage operations being reduced to a minimum. Over the last 4 years, this approach has brought down to 36% the overall mortality rate.

Adolescent↗