ABSTRACT
Gastrocolic fistula caused by benign gastric ulcer is an intriguing condition when it occurs in the patient who has not had prior operation. Four such cases are presented here and similar past cases are reviewed. The authors recount the history of surgical thought concerning this disorder and make recommendations for the preoperative and intraoperative approach to these patients.
Subject(s)
Colonic Diseases/etiology , Gastric Fistula/etiology , Intestinal Fistula/etiology , Stomach Ulcer/complications , Adult , Aged , Body Weight , Colonic Diseases/diagnosis , Colonic Diseases/surgery , Diarrhea/etiology , Female , Gastric Fistula/diagnosis , Gastric Fistula/surgery , Gastroscopy , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/surgery , Male , Methods , Middle Aged , Preoperative Care , Stomach Ulcer/surgeryABSTRACT
The severity of Crohn's disease has not been objectively estimated for patients treated at community hospitals. During an 11-year period, 105 patients underwent initial intestinal resection for Crohn's disease at a large community hospital. Follow-up data were actuarially analyzed. The overall resectional reoperation rate was 4.0 per cent per year the first seven years after initial resection and 1.9 per cent per year for the next ten years. Patients with small-bowel disease had a better prognosis than did patients with ileocolic disease. Patients who were less than 30 years of age at initial resection needed a second resection more often than did older patients. The 81 patients with initial resection after 1970 have had the lowest resectional reoperation rate yet reported: 2.8 per cent per year for ten years. The resectional reoperation rate for patients with Crohn's disease treated at this community hospital compares favorably with reoperation rates reported for patients at referral centers.
