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PubMed1990

[Use of imaging procedures in gallstone ileus].

Gallstone ileus is a rare complication of cholecystolithiasis with a high mortality and a high rate of postoperative complications caused by the advanced age of the patients and the often delayed diagnosis. The article shows that the consistent use of conventional radiological methods helps to reduce the high incidence of undetected gallstone ileus. A plain film of the abdomen is mandatory because it yields important information on the presence of an ileus and allows to diagnose gallstone ileus if air in the biliary tree and an aberrantly located gallstone is visible. Signs of an ileus are a frequent finding on abdominal scout films (9 of 9 cases) while the additional signs are often absent (5 of 9 cases). Contrast x-ray studies of the intestine, especially the upper gastrointestinal series with water-soluble contrast media, are of importance because they can help in detecting biliary enteric fistulas or gallstones located in the intestine. Hence, the consistent use of this roentgenologic routine methods can promote the accuracy of correct preoperative diagnosis (4 of 7 cases).

Aged↗
PubMed1989

[The surgeon facing malignant non-Hodgkin's lymphoma of the abdomen in children].

From February 1981 to December 1988, 30 children with Abdominal Malignant Non Hodgkin's Lymphoma (NHL) have been followed and treated in the Department of Pediatric Surgery of Saint Vincent de Paul's Hospital. The place of surgery in the Diagnosis, Evolution and Treatment of NHL is defined. In the diagnostic Stage, Surgery should be a fortuitous event, as in some cases of acute Intestinal Intussusception, or Appendicectomy, where lymphoma is an unexpected discovery. In all other cases, a cytologic study of ascites and/or pleural effusion that should be searched, can give a quick and reliable Diagnosis. Exceptionally, a complication of chemotherapy, as a peritonitis, with or without intestinal perforation, require an intervention. Most often in cases of already diagnosed and treated NHL, an abdominal residual mass have to be removed surgically and submitted to careful pathologic examination, to determine further treatment. If in some cases, initial Diagnosis is an unexpected discovery, the treatment of NHL is essentially medical. Surgery takes place in the Remission Evaluation after conventional chemotherapy.

Abdominal Neoplasms↗
PubMed1989

[Complications of acute gastroenteritis caused by Salmonella no typhi].

A review was made of the histories of 125 adult patients admitted for acute gastroenteritis (GEA) due to Salmonella no typhi. The complications that appeared in the series are analyzed. A total of 16 patients (12.8%) presented complications: the most common was bacteremia, 3 had renal tubular necrosis, 2 alithiasic cholecystitis that required surgery, 2 toxic megacolon, 2 rectal hemorrhage, 1 erythema nodosum and 1 intestinal perforation. The authors review the features of each complication.

Acute Disease↗
PubMed1989

[Non-excisional treatment of spontaneous rupture of the esophagus].

We present 7 personal cases of Boerhaave syndrome, 6 treated surgically and one managed with conservative measures. Boerhaave's syndrome is one of the most serious gastro-intestinal perforation pictures. Although its frequency is scant, because of its seriousness it is important to be aware of it for early diagnosis. While a prompt diagnosis is important in any pathology, it is even more so in this syndrome since there is a clear relationship between the time lapse from perforation to the onset of treatment and the rate of survival. Although we present one case cured medically, this is exceptional and treatment is eminently surgical and should be as early as possible. The technique that provides the best results and an excellent morbimortality rate in relation to efficacy is primary suture followed by a fundal patch. In delayed cases with patients in deteriorated condition, other techniques can be considered. Due to its initial severity and a tendency to postoperative complications, the patient should be closely controlled, and correct antibiotic therapy and complete parenteral support nutrition are very important in treatment.

Adult↗
PubMed1989

[Intubation of the small intestine in ileus. Technic, results, complications].

Operative intestinal intubation with Miller-Abbott-tube was performed on 188 patients from 1974 to 1988 in the Surgical Department of Dresden Academy of Medicine. In a retrospective analysis, the advantages and disadvantages of the method in treating the adhesion ileus are described and complications and lethality after predominantly orthograde nasal intestinal intubation are discussed. Exact indications and various operational details may help to reduce complications due to the tube-method to a minimum. The relatively high postoperative lethality (22.3%) was mainly caused by cardiopulmonary illness and peritonitis and does not result from the operative procedure. The fact that no early recurrent bowel obstruction was observed may be stated as an essential result, even though a relaparotomy due to late recurrence had to be made within 1 to 5 years after the first operation in 4% (8 patients) of 188 intestinal intubations.

Adolescent↗
PubMed1988

Childhood Degos disease with prominent neurological symptoms: report of a clinicopathological case.

Degos disease is a rare disorder, characterized by a vasculopathy of unknown origin that leads to typical skin lesions and involves other organ systems. It is frequently a lethal condition; death occurs as a consequence of intestinal perforation. In about 20% of cases, the central nervous system is involved and the neurological symptoms can be prominent. The incidence of the disease in children is very uncommon. We report the case of teenage girl who had Degos disease with prominent neurological involvement.

Adolescent↗
PubMed1977

[Utilization of the small intestine fistula technique in paralytic ileus. Report on clinical experience].

Seventy-three patients with paralytic ileus hospitalized at the Surgical Clinic of the Hospital in Herford during the years 1971-1975 are reviewed. All the patients were treated with a small bowel fistula according to a modified technique of Witzel-Heidenhain. The special indication, the technical details, and the results are discussed. The overall mortality of a total of 73 patients with paralytic ileus undergoing a small bowel fistula operation was 19%. The temporary small bowel fistula according to the modified technique of Witzel-Heidenhain is proposed as a simple, safe, and with accurate indication an effective method for accomplishing total decompression of distended bowel.

Adolescent↗