[Problems posed by secondary peritoneal carcinosis of digestive origin]. / Problèmes posés par les carcinoses péritonéales secondaires d'origine digestive.

Secondary peritoneal carcinoma occurs in cases of malignant bowel disease after the initial curative operation or rarely after palliative surgery. The main problems are frequent overshoot in the diagnosis and correct management. Based on our experience with 101 patients with secondary peritoneal carcinoma treated over the last 10 years, we determined the therapeutic possibilities. In 23% of the cases no surgery was possible and in only 4% underwent a second palliative operation. Survival was basically dependent on the initial malignant disease. More aggressive therapeutic methods are currently under study.

[Textiloma. Apropos of 25 cases and review of the literature]. / Textilomes. A propos de 25 cas et revue de la littérature.

It is exceptional to "forget" a compress in a operative wound, but the consequence are important. We report 25 cases of textilomes operated over a period of 18 years. There were 18 cases involving visceral surgery and 7 involving bone surgery. Sixty percent of the patients were women and 82% were adults. Emergency surgery was required in 70% of the bone operations and in only 33% of the visceral indications. Twelve percent of the cases were discovered fortuitously and 40% led to pain or occlusion, 24% leading to a digestive tract fistula and 24% to an inflammatory tumour formation. Standard X-rays and echography were sufficient for diagnosis in the abdominal cases. CT scan or MRI may be useful. Ablation of the abdominal foreign body was the followed by complications in two-thirds of the cases with a mortality of 25%. No deaths were observed in the other localizations but the functional result was impaired. We reviewed the literature reporting 117 such cases.

[Management of patients over 75 years of age with digestive or abdominal disease. A series of 660 cases]. / Prise en charge des patients âgés de plus de 75 ans présentant une pathologie digestive ou abdominale. A propos de 660 observations.

Over a period of 3 years, the authors cared for 660 patients over 75 years of age with diseases of the digestive tract. In 180 cases, the initial hospitalization had been previously planned and in 480 (72.7%) emergency admission was necessary. The diagnosis had not been confirmed in 90% of the emergency admissions. Half of the patients suffered from major illness (ASA III, IV). Planned hospitalization in a surgical unit involved cancer in 60% of the cases among which about one-half were colorectal cancers. In this latter group, mean hospitalization was 12 days and hospital mortality was 9.7%. For the patients with emergency admissions, diagnosis was only established after exploratory examinations (echography 296, endoscopy 205, opacification of the digestive tract 157...). No diagnosis could be established in 1.6% of the patients. Four types of emergency patients could be identified: occlusions 39.6%, painful abdomen 37%, haemorrhage 13.9% and jaundice 7.7%. In these groups, surgery was required in 64.7%, 69.1%, 72% and 40.5%, and mortality was 21.9%, 20.3%, 21.6% and 8.1% respectively. Duration of hospitalization was however similar (12 days). The overall mortality in this series was 14% (5.7% in non-operated patients and 16.7% in operated patients with a distinction between planned operations, 9.7%, and emergency operations, 20.3%). The two main risk factors were underlying disease and the need for emergency surgery. Age over 90 was also aggravated prognosis.

[Severe hemorrhage from gastroduodenal ulcer. Apropos of 100 cases]. / Hémorragies graves des ulcères gastro-duodénaux. A propos de 100 cas.

Over a period of 7 years, 100 patients (70 males and 30 females; mean age 66 years) were operated for digestive tract haemorrhage originating in an ulcer. There was a past history of ulcer in 21% and 29% had been taking drugs known to have a toxic effect on the stomach. Patent bleeding was observed by endoscopy in 32% with clear arterial flow, or a visible vessel in 10. In 20 patients a fresh clot was observed. Surgery had been indicated for massive haemorrhage in 25 cases, for persistent bleeding in 27, for recurrent bleeding in 37 and due to a visible vessel in 11. Conservative treatment was possible in three-fourths of the cases. Gastrectomy was performed in 26. Follow-up was uneventful in 55. There were 18 cases with complications and 27 deaths factors leading to fatal outcome and the data reported in the literature were analyzed.