Peritoneal abscesses due to bowel perforation: effect of extent on outcome after percutaneous drainage.

PURPOSE: To determine the effect of extent of peritoneal contamination in enteric abscesses on final outcome and duration of percutaneous drainage. PATIENTS AND METHODS: Results were retrospectively reviewed for 11 patients with varying degrees of peritoneal contamination secondary to subacute bowel perforation who were primarily treated with percutaneous drainage. Stepwise linear regression analysis of duration of drainage was performed with use of patient age and immune status, the site of bowel perforation, and the number of peritoneal compartments involved in the resultant contamination as independent variables. RESULTS: In 10 of 11 patients (91%) treatment of the resultant intraperitoneal collections with percutaneous drainage was successful irrespective of the extent of peritoneal contamination. There was no correlation between duration of drainage and extent of peritoneal contamination but good correlation with patient age and site of bowel perforation (r = 0.82, P = .02). CONCLUSION: In patients with enteric abscesses due to subacute bowel perforation, the duration of drainage and final outcome after percutaneous drainage are independent of the extent of peritoneal contamination.

Follow-up of patients who have undergone ileogastrostomy.

Patients who have had ileogastrostomy for the treatment of morbid obesity require close, long-term follow-up. From a prospective study of a large number of variables in 12 consecutive patients, and from experience with more than 200 patients who have undergone this procedure since 1982, a protocol has evolved. The authors outline the associated morbid conditions, operative complications and biochemical alterations that are important in the management of these patients.

Pancreatic pseudocyst. Changing concepts in management.

One hundred seven patients with pseudocyst managed during the past decade were reviewed. The mortality rate of 11.2 percent compares favorably with the rates in other recent series. Twenty-two percent of the patients were managed conservatively, and 76 underwent exploration. None of the nonoperative patients died from complications of the cyst. In all five patients (4.8 percent) who died, the cause was sepsis and multiorgan failure unrelated to the cyst. Patients with external drainage had a 90 percent complication rate. In addition, in four of five patients attempts at treatment by needle aspiration failed. Internal drainage of all types was complicated in 50 percent of patients, with a surprising absence of complications associated with cystojejunostomy. Asymptomatic pseudocysts may be safely treated conservatively with a good expectation of spontaneous resolution. Eight patients had pseudocysts secondary to biliary tract disease alone. Perhaps the incidence of this complication would have been lower if the biliary disease had been treated. This would support the argument for early surgical intervention in patients with acute pancreatitis secondary to biliary stones.