Gastrojejunocolic fistula following surgery for peptic ulcer.

This article aims to emphasize that gastrojejunocolic fistula following peptic ulcer surgery, though uncommon in the post vagotomy era, still continues to occur. We stress the changing trends in its epidemiology, aetiopathogenesis and treatment. The case records of 12 patients with gastrojejunocolic fistula (seen over a 15 year period) were reviewed. Details regarding clinical presentation, investigations and treatment were analyzed and the results compared with previous published series. All the 12 patients in this study had a short loop posterior retrocolic gastrojejunostomy as part of the primary peptic ulcer surgery. Diarrhoea and profound weight loss was present in all of them. Incompleteness of vagotomy was proved in all the six patients investigated for the same. The fistula was demonstrated in all of them on barium enema, while it was seen on upper GI endoscopy in 4. Eight patients were treated by a one stage resection and repair of fistula. A three stage procedure was performed in two.

Partial cholecystectomy in elective and emergency gall bladder surgery in the high risk patients--a viable and safe option in the era of laparoscopic surgery.

Partial cholecystectomy was performed in this Institute in fifteen patients in the last 8 years. Three were performed in cirrhotic patients with bleeding diathesis. The other indications were obscure anatomy, intraperitoneal adhesions, Mirizzi syndrome and poor general condition of the patient. None of these had any major morbidity in the immediate postoperative period. Partial cholecystectomy is a safe and viable option in a difficult situation.