[Multi-septate gallbladder as a cause of colic]. / Mehrfach septierte Gallenblase als Ursache von Koliken.

A case of multiseptate gallbladder is presented in this paper. No acute inflammation was found. The symptoms were caused by pressure in the small chambers and delay in emptying caused by stones. In our opinion the symptoms give support to indication for cholecystectomy.

Afferent loop obstruction after gastrectomy simulating acute pancreatitis.

After gastrectomy and Billroth II anastomosis, if the afferent loop is too long, it may kink and herniate, resulting in obstruction. If it is too short, it may produce acute angulation with obstruction. This condition often simulates acute pancreatitis when the amylase level in urine and serum is increased. Three cases of afferent loop obstruction are reported. The patient who did not undergo laparotomy died; the other two were operated on and survived. The diagnosis, etiology and treatment of these complications are discussed, and similar cases reported in the literature are cited.

[Peritoneal lavage as diagnostic aid in contuse abdominal trauma (author's transl)]. / Diagnose des stumpfen Bauchtraumas durch Peritoneallavage.

Peritoneal lavage is a reliable and valuable diagnostic aid in contuse abdominal trauma. It is particularly useful in unconscious and polytraumatised patients. The present article discusses the indications and results obtained with this method. 96.5 per cent positive results were obtained with 132 patients, whereas false negative results were recorded with 3.5 per cent. The present study has confirmed the importance of this method, which should be employed as a routine measure in every contusion, especially in patients who have lost consciousness and have been polytraumatised.

[Treatment of choledocholithiasis in the elderly]. / Zur Behandlung der Choledocholithiasis im höheren Alter.

Treatment of cholelithiasis and its complications in aged patients is a very difficult problem. Early cholecystectomy is regarded as riskless in patients less than 60 years old. In case of optimal indications we perform choledochoduodenostomy following cholecystectomy. To assess late results 68 patients aged 60-90 years were examined 20 to 7 years after primary operation. The results were good in 86,7 per cent.

[Injuries of stomach (author's transl)]. / Traumatische Magenperforation.

Rupture of the stomach occurs in between 0.8 to 1.7% of cases of blunt trauma of the abdomen. Isolated injuries of the stomach are rare, we have found 62 cases in the medical literature. In most cases (59--75%) the injured stomach was full. Diagnosis is by means of clinical symptoms, X-ray, and peritoneal lavage. Therapy consists of operative oversewing and possible application of anastomosis. Three of our cases are described and the literature is reviewed. The mortality rate is 32%.

[Delayed splenic rupture (author's transl)]. / Zweizeitige Milzruptur.

Splenic rupture is a common injury associated with blunt abdominal trauma. In contrast, delayed splenic rupture is less frequent and comprises about 8--28% of cases of splenic rupture. The symptom free period can last for days or weeks. The mechanism is explained as follows. A rupture of the parenchyma occurs but the spleen capsula remains intact. A hematoma forms below the capsule and causes a strong overdistension of the capsule so that a bursting and release of blood into the abdominal cavity results. The mortality rate with splenic ruptures in 6--55% and with delayed splenic ruptures 14.6%. Our experiences are reviewed. After commencement of the hemorrhage therapy must consist of treatment for shock and immediate laparotomy and splenectomy.

[Volvulus of the afferent loop after Billroth II operation (author's transl)]. / Volvulus der Zuführenden Schlinge nach Magenresektion--Fehldiagnose: Pankreatitis.

A case report is given of a patient, who had a volvulus of the afferent loop after Billroth II operation; on relaparotomy it was found, that this loop had slipped cranially through the mesocolic slit, twisted, and become gangreneous, due to bad adjustement of the slit. Increased levels of serum amylase initially had given rise to the suspicion, that the deteriorating condition of the patient was due to pancreatitis. The patient recovered fully after resection had been done and an Y-Roux-anastomosis established. A review is given covering 22 cases from the literature.

[Treatment of biliary tract carcinoma with metal endoprosthesis]. / Die Behandlung des Gallengangkarzinoms mit Metallendoprothesen.

The application of endoprosthesis in the surgery of biliary tract carcinoma is a very valuable method to prolong the life of cancer patients. The metalendoprosthesis with drain for continuously rinsing the bile duct to avoid incrusation showed good results in 9 patients for short survival time of 5-26 months. Two patients were treated with bifurcated Y-shape prosthesis after resection of bile duct carcinoma.

[Retroperitoneal perforation of the gallbladder (author's transl)]. / Retroperitoneale Gallenblasenperforation.

Perforation of the gallbladder into the retroperitoneum is a very rare event. A case report is given of a 71 year old patient suffering from acute cholecystitis. A perforation occurred and a retroperitoneal abscess developed. Cholecystectomy, appendectomy and retroperitoneal drainage were performed, and the patient recovered. A review from the literature is given covering 6 other cases.

Acute non-calculous cholecystitis in burns.

Seven burned patients developed acute cholecystitis within 10-37 days of injury, associated with jaundice in 5. There were 6 males and 1 female, with 5 patients aged 28-40 years, the others being 56 and 69 years. Cholecystectomy was performed in all patients with 1 death. It is suggested that the cause of post-burn cholecystitis is traumatic and septic shock with consequent biliary stasis.

Enchondroma of the hand.

Thirty-three patients with enchondroma of the hand underwent operation for removal of the enchondroma and filling of the cavity with bone meal. Twenty-six patients had pathological fractures of the phalanges or metacarpals.

[Corpus luteum bleeding, mistaken for acute appendicitis (author's transl)]. / Uber die Fehldiagnose einer akuten Appendizitis bei Corpus-luteum-Blutung.

Bleeding out of a ruptured corpus luteum can be misinterpreted as acute appendicitis. When an appendectomy is done because of this false diagnosis the tear in the ovary should only be closed by sutures. No ovarectomy.

[Torsion of the gallbladder (author's transl)]. / Die Torsion der Gallenblase

The torsion of the gallbladder is a rare disease. A case of torsion of the gallbladder is reported who came to surgery under the diagnosis of acute appendicitis in an elder person. Factors facilitating torsion of the gallbladder are discussed. The only form of therapy is immediate cholecystectomy.