[Gallstone disease in the elderly]. / Galsteensiekte in bejaardes.

The clinical manifestations, management and outcome of gallstone disease in 100 elderly patients are described. A total of 65 patients presented with a complication, acute cholecystitis (43), gallstone pancreatitis (8) and obstructive jaundice (6) being the commonest manifestations. The clinical picture was often misleadingly mild. Associated disease occurred in 70 patients but precluded surgery in only 3. Emergency surgery was indicated in 18 patients. Surgery was performed on 96 patients (cholecystostomy 2, cholecystectomy 94); 35 explorations of the common bile duct were done, with stones present in 33. Four patients died, 1 following an endoscopic retrograde cholangiopancreatography (ERCP) and 3 postoperatively (2 patients with gallstone pancreatitis); no death occurred following an elective operation. Alternative modalities of treatment of gallstone are expected to play a minor role in the management of gallstone disease in the elderly.

Penetration of a gastric ulcer into the right ventricle. A complication of para-oesophageal hiatus hernia.

A 74-year-old woman presented with massive upper gastro-intestinal tract bleeding that necessitated an emergency laparotomy. At operation a para-oesophageal hiatal hernia with an ulcer in the herniated fundus of the stomach penetrating the right ventricle was discovered to be the source of the bleeding. Although various complications of para-oesophageal hiatal hernias have been reported, including bleeding, this is the first reported case of ulcer penetration into the ventricle.