[Large excision for caustic gastroduodenal burn]. / Exérèse large pour brûlure caustique gastro-duodénale.

A patient presenting with gastric and duodenal necrosis following ingestion of sulphuric acid was successfully treated by excision of the stomach and duodeno-pancreas with delayed re-establishment of digestive tract continuity. This technique would not be possible without continuous enteral nutrition.

[Vater's ampulla neoplasms. Diagnostic and therapeutic approach. Apropos of 18 cases]. / L'ampullome vatérien. Approche diagnostique et thérapeutique. A propos de 18 observations.

Diagnostic and therapeutic aspects of neoplasms of the ampulla of Vater are discussed in relation to a relatively small but homogeneous series of 18 cases. The presenting sign is almost always jaundice, with or without associated manifestations of the angiocholitic type, sometimes regressive but recurrent. A rapid diagnosis should now be possible by ultrasound imaging of the dilated intra- and extra-hepatic biliary pathways, complemented by either fibroscopy with or without retrograde catheterization or trans-parieto-hepatic-cholangiography. The most effective therapy appears to be cephalic duodeno pancreatectomy, pathologic examination of fresh specimens of possible adenopathies being of doubtful interest since the presence of N + lymph nodes does not prevent prolonged life expectancy. The principal technical problem is related to the pancreatic stump, since this is formed of healthy parenchyma capable of provoking a fistula whether or not a pancreatico-digestive anastomosis has been performed. It might be possible in the future to use substances blocking the external secretion of the pancreatic stump left in place, in order to diminish the risk of fistula and its well-known consequences. Tumors of the ampulla of Vater have a relatively favorable prognosis when compared with that of other neoplasms in the biliopancreatic intersection zone, and an aggressive attitude to their therapy is therefore fully justified.

[Palliative retrosternal reconstruction in cancer of the esophagus]. / Les plasties rétro-sternales palliatives dans le cancer de l'oesophage.

Among patients presenting with a cancer of the esophagus, only a third will have a theoretical radical resection. Out of our management: 1 - By pass with operatory abdominal and cervical check up--2 - Chemotherapy--3 - Total esophageal resection by thoracotomy, 29 patients get through the first stage only, which is then considered as a palliation method. Results obtained about the degree of palliation, i.e. quality of life, pathologic incidences, mortality rates are compared with other methods.

[Caustic digestive stenosis involving the hypopharynx. Esophagopharyngoplasty using a right ileocolic graft]. / Sténoses digestives caustiques intéressant l'hypopharynx. Oesophagopharyngoplastie par greffon iléo-colique droit.

The authors describe an oesophago-laryngoplastic technique using a retrosternal ileocolic graft and involving anterior pharyngotomy above the hyoid bone. The technique was applied to five cases of major destructive lesions of the hypopharynx with fibrotic stenosis, due to severe burns of the upper digestive tract by ingestion of caustic substances. Continuity between the oral cavity and the digestive tract was re-established in all cases.

[Esophagopharyngoplasty by transplantation of a right ileocolic graft in the treatment of sequelae of esophageal and hypopharyngeal caustic stenosis]. / L'oesopharyngoplastie par transplantation d'un greffon iléo-colique droit dans le traitement des séquelles des sténoses caustiques de l'oesophage et de l'hypopharynx.

Esophagopharyngoplasty was employed to treat 7 cases of severe stenosis from scarring due to caustic burns. Emphasis is placed on the advantages of retrosternally applied right ileocolic transplants using the supraphyoidal anterior pharyngeal approach. Results were considered as satisfactory in 4 cases, exclusively oral alimentation being possible, though bougierage, sometimes repeated, was necessary. The 3 unsuccessful cases were due to loss of oropharyngeal muscle peristaltism in one case, progression of scar retraction in the second patient, and the psychological behavior and lack of essential active cooperation in the third case.