[Post-appendectomy fistulas of the cecum. Apropos of 22 cases]. / Fistules caecales post-appendicectomies. A propos de vingt-deux cas.

Appendicitis, usually a benign disease, can have its prognosis worsened in case of postoperative fistula. The latter occurs rarely after open appendectomy (0.133%), but accounts for 10% of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period (January 1970 to December 1993). The aim of these retrospective study was to precise their clinical features, to evaluate paraclinical examinations in diagnosing these complications and to give guidelines for their treatment. Fistulas occurred at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perforated) or appendectomy quoted as technically difficult. Location of the appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the aspect of the drainage fluid in 14 cases. Diagnosis workup of the fistula associated plain abdominal radiograph and abdominal ultrasonography (n = 22). Fistulography (n = 6) confirmed the clinical diagnosis of fistula, showing the leaking in all cases. Medical treatment was attempted first in 14 cases and was successful in 11 cases with a healing time from 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases because of medical treatment failure: one patient died and 5 patients underwent re-operation (right colectomy in 3 cases, bypass in 1 case and re-drainage in 1 case). Fistulography in our experience, is highly reliable and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modality. Surgery must be contemplated in case of established external fistulas, and of purulent or faecal fistulas. Nevertheless, prognosis remains poor (50% re-operation rate).

[Organization of emergency pediatric surgery at the University Hospital in Nantes]. / Organisation des urgences chirurgicales pédiatriques au C.H.U. de Nantes.

A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.

[Aimed fistulization in spontaneous ruptures of the thoracic esophagus after delayed diagnosis. Apropos of 4 cases]. / Fistulisation dirigée dans les ruptures spontanées de l'oesophage thoracique vues tardivement. A propos de 4 cas.

Of four cases of spontaneous rupture of thoracic esophagus treated, three were the object of direct fistulization on a Kehr's drain because of the delay in diagnosis. This technique remains valid since it provides satisfactory drainage without excluding the focus, reduces the time of hospital care when compared with that for simple suturing, and appears preferable to methods of esophageal exclusion which often require a secondary surgical procedure.

[Linitis plastica of the proximal part of the duodeno-jejunal angle. Apropos of a case]. / Linite plastique de l'angle duodénojéjunal. A propos d'un cas.

The authors report the first case to date of primary linitis plastica localised to the proximal part of the small bowel. A 44-year-old man with a one-month history of vague abdominal symptoms was treated for a proximal jejunum perforation due to a linitis plastica and died 2 months later.

[Signet-ring cell adenocarcinoma involving the bladder and the rectum. Apropos of two cases]. / Adénocarcinome à cellules isolées envahissant la vessie et le rectum. Rapport de deux cas.

Two cases of primary signet-ring cell carcinoma involving the urinary bladder, with invasion of the rectum, are presented. Pelvic exenterations were performed, followed by a rapidly fatal outcome (6 and 7.5 months). These cases of signet-ring cell carcinoma of the bladder were reviewed with 33 previously reported cases in the literature. The clinical characteristics, histologic findings, pathogenesis, and effectiveness of aggressive treatment of this rare bladder malignancy are discussed.