Long term effects of arterialization of the portal vein stump in dogs with Eck's fistula.

This study investigates the possibility of avoiding the sequelae of Eck's fistula in dogs by preserving the hepatic blood flow with an autologous vein graft inserted between the infrarenal aorta and the transected stump of the portal vein as its entrance into the liver. Ten dogs with such experimental preparation were observed for signs of encephalopathy; the patency of the grafts was assessed by periodic arteriograms. The signs of encephalopathy and general deterioration usually observed in dogs with Eck's fistula were prevented; however, marked dilation of the intrahepatic branches of the portal vein leading sometimes to spontaneous rupture of the liver or to thrombosis of the venous graft was observed. Thus, this technique does not appear to be a satisfactory long term solution for preventing the deleterious effects of Eck's fistula in dogs.

Surgical treatment of toxic megacolon and proposal for a program of therapy.

Experience with 12 patients with toxic megacolon that required surgical intervention is described and analyzed. Ten patients had ulcerative colitis and 2 had Crohn's colitis; 9 were treated with corticosteroids before operation. The diagnosis was established by radiologic studies, operative findings and examination of the surgical specimens. The operations performed in these patients were proctocolectomy and ileostomy in five, abdominal colectomy and ileostomy with preservation of the rectum in five, and loop ileostomy and colonic venting in two. All patients had prolonged and complicated recovery periods; 1 died in the postoperative period and 10 reassumed their pre-illness activities. A highly specific therapy program is proposed for managing patients with toxic megacolon.

Spontaneous rupture of the spleen. An unusual complication of anticoagulant therapy.

A 44-year-old man, who had been taking warfarin sodium because of a previous myocardial infarct, suddenly developed abdominal pain and signs of peritoneal irritation, requiring exploratory laparotomy. The spleen was ruptured. There were not any systemic diseases nor antecedents of trauma that could be considered predisposing factors for the apparently spontaneous rupture of the spleen. The only abnormality recorded was an elevated prothrombin time. Thus, a coagulopathy produced by the anticoagulants appeared to be the only possible predisposing factor for his splenic rupture.

Reversibility of severe hepatic damage caused by jejunoileal bypass after re-establishment of normal intestinal continuity.

This case report attempts to document the reversibility of advanced hepatic anatomical and clinical alterations compatible with advanced hepatic cirrhosis that occasionally develop in patients with jejunoileal bypass performed for morbid obesity. The advanced stage of this complication can be fatal unless the intestinal continuity is returned to normal.