Management of enterovesical fistulas

Article Abstract:

Fistulas (passageways between parts of the body that do not normally connect) between the bladder and the digestive tract (enterovesical fistulas) are an uncommon complication of certain conditions, such as cancer and inflammation. A study was made of 51 patients with these fistulas. The fistulas developed as a result of a variety of disorders, including diverticulitis, inflammation of a pouch-like protrusion of part of the wall of the stomach or bowel (21 patients); Crohn's disease, a chronic, inflammatory condition of the bowel (nine patients); and colorectal cancer (eight patients). Other forms of cancer, benign disease, and complications of previous surgeries were also implicated. The most frequent symptoms were irritation associated with voiding (urinating) and recurrent cystitis (bladder infections). Pneumaturia (air in the urine) was a symptom in 69 percent of the patients. Approximately half the patients reported gastrointestinal symptoms, such as diarrhea or nausea. Analysis of the urine revealed the presence of Escherichia coli, an organism associated with the bowel, in 88 percent of the samples. The clinical history and results of urinalysis provided a correct diagnosis in all cases except one. Almost 150 diagnostic studies were performed, and cystoscopy (viewing the inside of the bladder with a bright light) was the most frequently used procedure. However, even this approach revealed the fistula only 67 percent of the time. Additional studies of the bowel were essential to distinguish diverticulitis from colorectal cancer. Forty-three of the patients underwent surgery and the remaining eight, most with end-stage malignancy, were medically treated. Surgery consisted of resection (removal) of the affected area (35 patients), or diversion of the bowel (colostomy). Thirty-two of the 33 patients with benign disease underwent surgery. Overall, the principal pathological process in enterovesical fistula formation is usually found in the intestinal tract. This condition can be successfully treated with surgical resection (removal) of the bowel. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Fistula, Fistulas

---

Role of surgery in multimodality therapy for gastrointestinal lymphoma

Article Abstract:

There has been an increase in the incidence of primary gastrointestinal lymphoma, a cancer of the lymphatic system in the region of the stomach and intestine. At one medical center, the incidence tripled from the 1960s to the 1980s. The best treatment for this malignancy is not known. A study was undertaken to evaluate the influence of different treatments on survival of 49 patients with gastrointestinal lymphoma. The study group consisted of 33 men and 16 women, and the average patient age was 63 years. The most common site of the lymphoma was the stomach (67 percent), followed by the small intestine (22 percent) and the colon, or large intestine (10 percent). The initial symptoms were pain (38 patients), weight loss (14), and bleeding (11). The diagnosis of stomach lymphoma was usually made prior to surgery based on the findings of diagnostic tests (barium contrast, computed tomography and endoscopic biopsy), whereas diagnosis of small intestine lymphoma was made at the time of surgery. One patient received only supportive care; the other 48 patients were treated. Treatment consisted of surgery (31 patients), chemotherapy (33), and radiotherapy (16); 30 patients had more than one form of treatment. Analysis of factors influencing survival indicated that surgical treatment was the most important factor influencing survival; this was of greater significance than the specific stage of disease. However, earlier stage of disease was also linked to better survival rates, as was younger patient age. The results suggest that surgery should be used for most of these patients, and that radiotherapy is safe and very effective. In patients with stage I/IIE tumors, chemotherapy did not appear to improve survival, but previous studies show that most patients, especially those with advanced disease, benefit from the use of multiple treatment methods, including chemotherapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Reports, Lymphomas, Gastrointestinal diseases, Combined modality therapy

---

Inguinal hernia repair in early infancy

Article Abstract:

The most common condition requiring surgery in children is inguinal hernia. Inguinal hernia occurs when a loop of intestine enters the inguinal canal; in a man it may fill the entire scrotal sac. Surgery is performed to place the section of intestine back in its proper anatomic location and to prevent it from becoming strangulated or obstructed. There is controversy over when surgery should be performed in young children. A report is presented of 384 infants under two months old who underwent inguinal hernia repair. The average patient age was 38 days. The hernia was incarcerated (exceedingly difficult to place back into the abdominal cavity) in 24 percent of babies. Six babies required urgent surgery to correct incarceration, but in no case was it necessary to remove a portion of bowel. Exploration of the groin area on the opposite side was carried out in 96 percent of cases, with findings of another hernia on the opposite side in 85 percent of these cases. Follow-up was possible in 82 percent of the patients over an average of 27 months. The rate of hernia recurrence was 1 percent. Nine patients (2.3 percent) developed complications including hernia recurrence, wound infection, and hydrocele (accumulation of fluid in a saclike cavity). There were no deaths related to the hernia. Spinal anesthesia was given to 63 patients (17 percent); no postoperative apnea (cessation of breathing) occurred in these patients. Two patients who had received general anesthesia via endotracheal tube developed postoperative apnea, but none required mechanical ventilation (use of a breathing machine). These results indicate that inguinal hernia repair can be successfully carried out on young infants with very low rates of recurrence and complications, comparable to the rates in older children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Evaluation, Infants, Pediatric anesthesia, Inguinal herniorrhaphy, Regional anesthesia

Similar abstracts:

• Abstracts: Management of empyema in children. The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage
• Abstracts: Meta-analysis of empirical long-term antiarrhythmic therapy after myocardial infarction. Meta-analytic evidence against prophylactic use of lidocaine in acute myocardial infarction
• Abstracts: Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia
• Abstracts: Management of severe postpartum hemorrhage by intrauterine irrigation with prostaglandin E2. Evaluation of nitric oxide as a mediator of severe preeclampsia
• Abstracts: Evaluation of obstetric ultrasonography at the first prenatal visit

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.