ABSTRACT
Gastro-jejuno-colic fistula caused by recurrent ulcer was a frequent complication of surgery for peptic ulcer. Since the completion of the vagotomy in the surgical treatment of this pathology, gastr-jejuno-colic fistula is becoming increasingly rare but continues to see. We try to study different profiles: clinic, diagnostic, and therapeutic of this complication. Six cases of gastro-jejuno-colic fistula caused by recurrent ulcer were studied retrospectively between 1969 and 2009. All the patients were operated for duodenal ulcer; the first intervention consisted of gastro-entro-anastomosis alone in three cases. Clinical presentation was dominated by diarrhea, abdomen pain and weight loss. Fistula was demonstrated on barium enema in three patients. All our patients had a one stage resection and repair of the fistula by gastro-jejunal anastomosis in three cases; segmental resection of the colon was done in two cases; postoperative recovery was simple. In spite of varied clinical presentation, gastro-jejunal-colic fistula caused by recurrent ulcer can be readily diagnosed by barium enema. A one stage resection is the procedure of choice
ABSTRACT
To evaluate and identify high risk patients having superficial bladder cancer and to assess the role of radical cystectomy as primary treatment modality. An eight-year retrospective analysis of bladder cancer patients presenting to SlUT was undertaken. After clinical evaluation and routine laboratory investigations, IVU, sonography, CT Scan/MRI, cystoscopy, histopathology, were performed when indicated. A follow-up cystoscopy was carried out at regular intervals [3-6 months] up to a maximum of 8years. Of the 550 [59.7%] patients diagnosed as urothelial tumours, 61/330 [18.4%] had pT1G3 disease, with a male to female ratio of 14:1. Most of the cases [81.7%] were between 41-70 years of age. Haematuria was the presenting symptom in every case, followed by frequency 82.4%, dysuria 32.7% and clot retention 32.7%. There was no significant occupational association, however 25 [40.9%] were smokers for over 25 years. Filling defect on IVU was seen in 52 [85.2%] cases whereas Sonogram revealed echogenic masses in 44 [72.4%]. The morphological site, as per CT scan and cystoscopy was 72.1% lateral wall, 6.6% dome, 3.3% base and 18% were multicentric disease. Growth less than 1 cm was seen in 27%, 1.5 cm in 41% while greater than 5 cm in 32% of cases, All patients underwent endoscopic resection. Intravesical Mitomycin C was given to 27 and BCG to 15 cases. Of the high risk patients, 12 were primarily treated by radiation therapy whereas 22 underwent primary radical cystectomy and 16 had a salvage cystectomy and ileal conduit. Recurrence of the carcinoma was seen in 12 patients who had received intravesical chemo/immunotherapy, in 8 treated initially with radiotherapy and 8 subjected to radical cystectomy. The management of pT1G3 is still a controversial area of carcinoma bladder treatment. In view of the high cost of therapy, fast progression, high recurrence rate and metastasis, we in our setup recommend an early radical surgery in pT1G3 disease. This not only eliminates the lesion but is also cost effective