[Diagnostic image (204). A man with abdominal pain and fever]. / Diagnose in beeld (204). Een man met buikpijn en koorts.

In a 53-year-old man with acute sigmoid diverticulitis abdominal CT revealed septic thrombophlebitis with gas configurations in the inferior mesenteric vein.

[Primary venous mesenterial thrombosis in three patients]. / Primaire veneuze mesenteriale trombose bij 3 patiënten.

Three patients, a woman aged 72, a man aged 25 and a woman aged 42 years, presented at the casualty department with a subacute form of primary venous mesenterial thrombosis. As symptoms and laboratory findings are aspecific, CT scan is the gold standard for the diagnosis of this condition. In these patients no cause or predisposing factor was detected, so the disease was considered to be primary. Treatment generally consists of anticoagulant therapy and if peritonitis is present operation is indicated. Hyperdynamic circulation and inotropica are indicated after surgery and in cases of critical illness. Based on clinical findings the third patient was treated successfully with anticoagulants only. The other two also underwent partial small intestinal resection. All three patients were discharged in good health and were prescribed lifelong anticoagulants. If a cause of venous mesenterial thrombosis can be found, this must first be treated before deciding on whether lifelong treatment with anticoagulants is indicated.

Revision of failed below knee amputations. Local debridement with gentamicin collagen.

OBJECTIVE: To describe our results with a new technique of revision of failed below knee amputation stumps using gentamicin impregnated collagen sponge. DESIGN: Open study. SETTING: District hospital. SUBJECTS: 31 patients who underwent below knee amputations between 1988 and 1992, compared with 31 historical controls who were operated on between 1984 and 1988. INTERVENTIONS: Two thirds of the stumps that failed to heal underwent excision of necrotic and devitalised tissue; half had shortening of tibia and fibula and a gentamicin impregnated collagen sponge was left in the wound, which was then closed. MAIN OUTCOME MEASURES: Successful wound healing and rehabilitation. RESULTS: 12 Stumps failed to heal, 8 of which were suitable for local treatment with the gentamicin sponge. All 8 healed satisfactorily, though one required revision of the scar 6 months later. Of the remainder, the stumps were converted to above knee amputations (n = 3) and one was disarticulated at the knee. In the control group 5 of the 7 stumps in which healing failed, were converted to above knee amputations and the other two healed after split skin grafting. CONCLUSION: We think that local treatment with the collagen sponge with gentamicin offers a viable alternative to conversion to above knee amputation for below knee amputation stumps that fail to heal. The treatment should now be subjected to a randomised controlled trial.

Surgical treatment of cholecystosis--report of 43 patients and review of the literature.

The results of cholecystectomy have been studied in a series of 43 patients with pain suggestive of biliary origin in the absence of gallstones. The most probable diagnosis in these cases is cholecystosis of the gallbladder usually to be ascertained by careful scrutiny of the gallbladder periphery on a good cholecystogram. Based on the present results and those reported in the literature, cholecystectomy can be advocated as treatment of patients with adenomyomatosis and other forms of cholecystosis of the gallbladder.

Seven years survival after a conservatively treated leaking aneurysm of the abdominal aorta.

The case history is presented of a seventy-year-old male with a leaking abdominal aortic aneurysm which at laparotomy, in 1977, was not thought to be resectable. No reconstruction was performed. Despite multiple periods of abdominal pain the patient is still alive and well over seven years after the first leakage of the aneurysm.

Twenty years' experience of surgical treatment of the ruptured atherosclerotic aneurysm of the abdominal aorta.

The results of surgical treatment of 209 ruptured abdominal aortic aneurysms are reviewed. The mortality over the first period of ten years was 37.8% and over the second ten years 44.9%. An attempt was made to analyse the reasons for this somewhat disappointing experience, shared by other authors. The broader indications for surgical treatment and the rise in the average age of our patients at presentation may be partially responsible. This elderly aged group had a greater incidence of coexistent disease leading to increased postoperative complications. The duration of preoperative shock had a direct inverse relationship to mortality. It is stressed that, apart from close collaboration between surgeon and internist with early detection of many postoperative complications such as gastrointestinal bleeding, anuria or heart failure, correct and early diagnosis of the ruptured aneurysm offers the best chance for the improvement in the survival rate of these patients.