Prepyloric antrectomy, truncal vagotomy, and front pylorotomy for the treatment of duodenal ulcer.

We have performed a suprapyloric antrectomy with anterior pylorotomy and truncal vagotomy in 106 patients with chronic duodenal ulcer between 1975 and 1990. Follow-up was carried out in 94 patients, during a mean time of 6 years. We have had no postoperative mortality and no long-term recurrence. The percentage of Visick I patients is similar to that after truncal vagotomy and antrectomy. We, therefore, believe that this procedure is safe and can be performed when an antrectomy is mandatory to avoid the operative morbidity and mortality of classic antrectomy.

[The treatment of a simple pancreatic pseudoaneurysm or one associated with hemosuccus pancreaticus]. / Tratamiento del seudoaneurisma pancreático simple o asociado a hemosuccus pancreaticus.

When a permanent communication occurs between an artery and a pancreatic pseudocyst, the pseudocyst becomes a pseudoaneurysm. Pancreatic pseudoaneurysms are primarily found in patients with alcoholic chronic pancreatitis. Fistulization of a pseudoaneurysm into the main pancreatic duct results in ductal hemorrhage. From 1980 to 1990, 43 cases of pancreatic pseudoaneurysm and 24 cases of ductal hemorrhage (15 of these secondary to pancreatic pseudoaneurysm) have been published. Pancreatectomy, ligation of the affected vessel (alone or in combination with a drainage procedure), or intraarterial embolization have all been used to treat pancreatic pseudoaneurysms. We herein describe two patients with alcoholic chronic pancreatitis and pancreatic pseudoaneurysm; one patient presented with ductal hemorrhage. The inferior pancreatico-duodenal artery was the affected vessel. Both patients were treated with suture-ligation; an internal drainage was added to the patient presenting with ductal hemorrhage.

Exteriorized colonic anastomosis.

The risk of anastomotic failure in the unprepared colon is generally high. Therefore, Hartmann's operation is frequently employed in emergencies. We present an alternative technique, the exteriorized anastomosis described until now only for cases of perforation. Exteriorized anastomosis was performed in 14 patients. The preoperative diagnosis was occlusive neoplasm, perforated diverticulitis or traumatic performation of the sigmoid colon. Four patients subsequently developed partial anastomotic dehiscence, but without the consequences of intraperitoneal dehiscence. We think that exteriorized anastomosis is a useful alternative in high risk situations.

[Histopathologic changes seen during the reopening of the intestinal lumen after obliteration of the digestive tract with nonabsorbable material. Experimental study in the rat]. / Cambios histopatológicos observados durante la repermeabilización de la luz intestinal después de obliterar el tránsito digestivo con material irreabsorbible. Estudio experimental en la rata.

The constant pressure exerted by occlusive ligation on the intestinal wall produces ischemia and ulceration of the mucosa, interruption of the muscular layer and transmural inflammatory reaction, which terminates when the ligature is eliminated and the injured tissues are repaired.