ABSTRACT
The case of a 13-year old girl who presented with generalised peritonitis, septic shock and laboratory features of perforated typhoid enteritis is presented. At laparotomy 25 perforations involving the distal jejunum and the entire ileum were noted with extensive peritoneal soilage. The perforations were successfully closed in single layer using vicryl (polyglactin 910) sutures and the peritoneum thoroughly lavaged. The patient has been followed up for thirty months with only minimal complications. We believe that single layer closure of extensive multiple typhoid perforations in a poor risk patient when weighed against resection and anastomosis with the possibility of short bowel syndrome is safer, quicker and more effective as long as the procedure is undertaken after adequate resuscitation and under appropriate antibiotic cover.
Subject(s)
Ileal Diseases/microbiology , Ileal Diseases/surgery , Intestinal Perforation/microbiology , Intestinal Perforation/surgery , Jejunal Diseases/microbiology , Jejunal Diseases/surgery , Suture Techniques , Typhoid Fever/complications , Adolescent , Female , Humans , Polyglactin 910/therapeutic useABSTRACT
Four hundred patients with resectable colon and rectal cancers were operated on by 37 surgeons at 31 institutions. Patients were monitored with carcinoembryonic antigen (CEA) level determinations and clinical examinations. One hundred thirty patients had recurrences, and 75 were reoperated on, with 43 reoperations CEA-directed and 32 clinically directed. Two of 75 died within 1 month after the second operation. Twenty-two second-look patients remain free of disease 5 years after their second operation. The highest resectability of recurrent cancer occurred in patients with a CEA level below 11 ng/ml in whom the CEA level was determined at intervals of 1 to 2 months.
