ABSTRACT
The main observation criterion of the present retrospective study is the insufficiency rate after machine closing of the duodenal stump (TA-clip seam device, Auto-Suture), as a consequence of gastrectomy, resection of the stomach with Billroth II respective Roux-Y reconstruction, depending on the used type of clip. Between January 1, 1985 and October 2, 1989 the closing of the duodenal stump was routinely carried out with metal clips (n = 253) in the City Hospital Offenbach. Between October 3, 1989 and December 31, 1991 polysorb staples (n = 96) were exclusively used. The patient collectives were comparable regarding age, sex, health status, basic diseases, accompanying diseases and surgical methods. Closing of the duodenal stump by polysorb staples demonstrated with 13.5% more dehiscent seams than with metal clips (4.7%). As a result of the present study, we cannot recommend the use of polysorb clips for the closing of the duodenal stump.
Subject(s)
Duodenum/surgery , Gastrectomy/instrumentation , Polymers , Stomach Diseases/surgery , Stomach Neoplasms/surgery , Surgical Staplers , Surgical Wound Dehiscence/etiology , Sutures , Adolescent , Adult , Aged , Aged, 80 and over , Anastomosis, Roux-en-Y/instrumentation , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
In a 67-year-old man with upper abdominal and gastrointestinal bleeding gastroscopy revealed a duodenal ulcer which was initially taken to be the source of the bleeding. But subsequent retrograde cholangiography demonstrated nearly complete occlusion of the right hepatic duct and a suspicious tumour-like structure. At laparotomy a tumour was excluded and the supplying artery to the ulcer was ligated to arrest the bleeding. Gastrointestinal bleeding recurred postoperatively so that selective angiography of the hepatic artery had to be performed. This demonstrated an aneurysm of a branch of the hepatic artery near the hilus. No further bleeding occurred after its embolization. Haemobilia is a rare cause of upper abdominal bleeding and may be difficult to diagnose, except by selective imaging techniques.
Subject(s)
Cholestasis/complications , Gastrointestinal Hemorrhage/etiology , Hemobilia/complications , Hepatic Duct, Common , Aged , Aneurysm/complications , Aneurysm/diagnostic imaging , Aneurysm/therapy , Cholestasis/diagnosis , Cholestasis/surgery , Diagnosis, Differential , Duodenal Ulcer/complications , Embolization, Therapeutic , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/surgery , Hemobilia/diagnosis , Hemobilia/surgery , Hepatic Artery/diagnostic imaging , Hepatic Duct, Common/diagnostic imaging , Humans , Male , Peptic Ulcer Hemorrhage/diagnosis , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Postoperative Complications/therapy , Radiography , UltrasonographyABSTRACT
Case report of a 28-year old black sickle cell anemia patient with salmonella osteomyelitis of the radius. Aside from sickle cell anemia patients this skeletal complication of enteric salmonellosis is an extreme rarity. Description of the typical roentgenological features including intracortical fissures and sequestration.
