Treatment of external small bowel fistulae by high-pressure suction and a normal diet [experimental study]

We have examined a simple and inexpensive method for treating an established entero-cutaneous fistula using a balloon tipped catheter [Foley's] to block up the fistula and portable suction bottle, to keep the fistula dry. No parenteral feeding was used. The dogs ate normal dog food and moved around. This study was conducted in The Veterinary Hospital, Abbasia, on 12 dogs in 2 groups. The difference in the outcome between the two groups was significant. In the experimental group [6 dogs], the fistulae in 5 dogs closed after 5 days [83.3%]; while in the control group [6 dogs] the fistula closed spontaneously after 9 days only in one dog [16.7%] and the remaining 5 had continued profound discharge. Histologic study showed each of the fistula clinically closed, was histologically healed as well. We conclude that this method is effective as healing is rapid, simple to apply and of low cost, require a shorter hospital stay and permit normal eating and activities. We believe it is worth trial in our surgical patients, when the fistula is recent but well defined

Post cholecystectomy bile duct stricture, important factors influencing the outcome in Egypt

The aim of this paper was to define important factors affecting the results of treatment of the post cholecystectomy bile duct stricture, in Egypt. We managed 22 patients with bile duct stricture following cholecystectomy refered to Ain Shams University Hospital over 11 the past 6 years. On presentation, 20 patients [90.9%] had abnormal liver functions, 13 patients [59%] a low serum albumin, 12 [54.5%] associated portal hypertension and 8 [36.4%] had previous major infection. 18 patients [81.8%] operated on: 8 by stricture repair alone [no other procedure], 10 by stricture repair and gastrooesophageal devascularization. Of these patients treated by stricture repair alone 87.5% have good results with mean follow up of 2.8 years, and mortality of 12.5% [one patient], but in the presence of portal hypertension the mortality was 40% [4 patients]. Our conclusion was that, in Egypt; the most important single factor that increased the mortality was the presence of portal hypertension. Other important factors were the number of previous operations, the site of stricture, the history of major infection and the preoperative serum albumin concentration. All these factors should be taken in consideration on planing treatment. Non-operative endoscopic dilatation for bile duct stricture is worth-trial for those patients with portal hypertension