[Lateral anastomosis techniques: Partington-Rochelle and V-shaped excision]. / Laterale Anastomosentechniken : Partington-Rochelle und "V-Shape-Exzision"

Characteristic symptoms of chronic pancreatitis are difficult to manage conservatively. They include severe pain and endocrine and exocrine insufficiency. Surgical treatment with simple and extended draining procedures addresses pain relief and the management of chronic pancreatitis-associated complications of adjacent organs. Following the assumption that pancreatic duct changes with intraductal hypertension are the reason for pain, simple drainage procedures have reduced pain in up to 80% of patients, with low morbidity and mortality. In case of complications involving adjacent organs with inflammatory pancreatic head tumor and stenosis of the distal bile duct, extended drainage procedures with limited pancreatic head resection according to Frey and V-shaped excision of the ventral aspect of the pancreas have been performed successfully.

[Partial ischemia. Occlusive and nonocclusive mesenteric ischemia, ischemic colitis, systemic lupus erythematosus]. / Partielle Ischämien Okklusive und nichtokklusive Darmischämie, ischämische Kolitis, systemischer Lupus erythematodes.

Partial mesenteric ischemia is defined as an incomplete occlusion of the superior mesenteric artery resulting in acute abdominal pain, distended abdomen,and bowel hypomotility on auscultation. This disease can be acute or chronic and is caused by vascular occlusion or non-occlusive mechanisms. CT scan and ultrasound show a thickening of the ischemic bowel wall. On endoscopy, initially mucosal edema is observed which may proceed to necrosis. Therapy modalities depend upon the clinical findings: prevailing acute abdominal pain and peritonitis result in emergency laparotomy; prevailing cramping abdominal pain without clinical signs of peritonitis allows time for further diagnostic steps such as mesenteric angiography and interventional procedures. Laparoscopy should be performed in exceptional situations only.

[Abdominal compartment syndrome]. / Das abdominelle Kompartment-Syndrom.

The abdominal compartment is limited by the abdominal wall, Mm. Psoas, vertebral column, diaphragm and the pelvis. Thus the retroperitoneum is included. Elevated intraabdominal pressure may profoundly impair the function of the entire gastrointestinal tract, the cardiovascular, respiratory, and renal system. Reduction of increased intraabdominal pressure may reverse all these adverse effects. The most common causes of elevated intraabdominal pressure are abdominal operations, abdominal trauma, diffuse peritonitis, ascites and peritoneal edema following resuscitation. Excessively increased intraabdominal pressure may result in a total loss of function and may lead to death. Such a condition is called an abdominal compartment syndrome. It usually requires operative decompression. According to animal experiments and clinical experiences suggestions for treatment are given. Diagnostic suspicion of elevated intraabdominal pressure may be confirmed with objective measurements. Since bedside manometry using a Foley catheter provides a valuable estimate of intraabdominal pressure and is easy to perform, intraabdominal pressure values may contribute to medical decision making. At this time there is a great need of controlled clinical trials to point out the importance of increased intraabdominal pressure and the abdominal compartment syndrome.

[Churg-Strauss syndrome]. / Churg-Strauss-Syndrom.

In a 47-year-old man presenting with chronic bronchitis since 1978, a weight loss of 11 kg in 9 months and deteriorated general condition, the x-ray film of the thorax revealed numerous pulmonary nodules of up to 4 cm size. Laboratory findings were characterised by enhanced ESR, blood eosinophilia of 7% and a lot of eosinophilic granulocytes in the sputum. The findings could not be clarified despite many additional examinations including bronchoscopy with transbronchial biopsy. Thoracotomy was finally considered imperative. Pulmonary biopsy revealed necrotising vasculitis, eosinophilic infiltration and epithelioid granuloma, characteristic changes of allergic granulomatous vasculitis (Churg-Strauss syndrome). The condition quickly responded to corticosteroid administration.