[Surgical tactics in treatment of duodenal injuries after endoscopic sphincterotomy]. / Taktyka chirurgiczna w leczeniu uszkodzen dwunastnicy po endoskopowej sfinkterotomii.

The procedure in case of injury of the duodenum as a complication of endoscopic sphincterotomy remains controversial. We have studied all the cases of duodenal injury after endoscopic sphincterotomy during last 5 years to indicate the best strategy of surgical treatment. We observed 10 cases of duodenal perforations following 464 endoscopic sphincterotomies. Other 4 patients came from different hospitals. Six patients were managed with nonoperative treatment (group I), four patients were operated on right after the diagnosis (group II), and other four patients were initially managed with nonoperative treatment and then were operated at least 3 days after the complications occurred (group III). All the patients treated nonsurgically recovered. All the patients from group III and one from group II died, as a result of duodenal fistula and sepsis. Spontaneous recovery was observed in those cases in which gradual improvement appeared during first 24 hours. Operation should be undertaken when the symptoms are quickly increasing and primary nonsurgical treatment is not satisfied. The operations delayed for more than 3 days give poor results.

[A case of Lesniowski-Crohn disease preceded by Yersinia pseudotuberculosis infection]. / Przypadek choroby Lesniowskiego-Crohna poprzedzony infekcja Yersinia Pseudotuberculosis.

In etiopathogenesis of Lesniowski-Crohn disease we consider environmental genetical, immunological and physical factors. Among the bacteria that are of importance in a disease process there are: Jarsinia, tubercle bacillus and para- tubercle bacillus. We are to state that the pro.... of the bacteria per se doesn't influence the initiation of a disease. The initiation is caused by a change of the immune response. The introduced case shows the occurrence of Lesniowski-Crohn disease proceeded by Jarsinia pseudotuberculosis. Thai sequence of occurrence doesn't prove the dependence of an effect upon the cause. What is more-there are many controversial opinions in literature considering Lesniowski-Crohn disease. That is why we would like the introduced case to be a contribution to a discussion on the subject of: Possibility of a distant initiation of a disease by some bacterial infection types.