Perianal fistulas in patients with Crohn's disease.

A series of 55 patients with perianal fistulas and Crohn's disease is reported herein. Thirteen patients (24%) did not need specific treatment of the fistula. Primary proctectomy was necessary in five patients. Defunctioning enterostomy was used in nine patients, followed by healing of the fistula in four patients. Local surgery of the fistula was performed in 28 patients, with an overall success rate of 79%. Healing of the fistula was not influenced by activity of the disease, type of fistula, or condition of the rectum. Local surgery did not cause incontinence in this series.

Peritoneal lavage in closed abdominal injury.

Peritoneal lavage is a sensitive method of detecting intra-abdominal injuries following closed abdominal injury. Our indications for peritoneal lavage are: severe head injury, severe thoracic injury, unexplained hypotension in a patient with possible blunt abdominal injury and patients on artificial ventilation. We present 40 patients with multiple injuries who underwent peritoneal lavage for suspected closed abdominal injury. Twenty-two lavages were positive and 19 laparotomies were performed, of which 18 revealed intra-abdominal injuries. Eighteen lavages were negative; no laparotomy was performed in this group. There was one false positive, but no false negative lavage.

Surgical management of ileosigmoid fistulas in Crohn's disease.

Thirty-two instances of ileosigmoid fistula complicating Crohn's disease were seen in a series of 231 patients treated for this disorder. Conservative surgical treatment, consisting of dissection of the inflammatory mass and oversewing of the remaining defects in the sigmoid was possible in 23 patients. There was no mortality and there were no anastomotic leakages or postoperative fistulas. A plea is made for avoiding sigmoid resection whenever possible.

Fistulas of the bladder in Crohn's disease.

Fourteen patients with fistulas of the bladder complicating Crohn's disease are reported. In one-half of the patients, the presence of Crohn's disease was known before; in the other one-half, the appearance of urinary symptoms led to the diagnosis of Crohn's disease. The symptom most commonly encountered was chronic pyuria, while pneumaturia as an early sign was found in only three patients. Cystoscopy proved to be the most useful diagnostic procedure. The results of this examination demonstrated lesions in 11 of 13 patients investigated and was instrumental in arriving at the correct diagnosis in four patients. Treatment should be surgical and consist of intestinal resection and suturing of the usually small defect in the bladder. The results of the operation are good with respect to the complication of the urinary tract.

Psoas abscess in Crohn's disease.

In a series of 161 patients treated surgically for Crohn's disease, 7 patients were seen with a psoas abscess as a complication of the bowel disease. Drainage only was not sufficient to check the rapid downhill course in these patients. Resection of the underlying bowel disease was performed in all patients. There was one death from pulmonary embolism and 3 patients required drainage on more than one occasion.

Low dose subcutaneous heparin and wound hematoma formation in inguinal hernia operations--a double-blind randomized clinical trial.

Postoperative wound bleeding and wound hematoma formation were studied in a prospective double-blind randomized clinical trial in selected patients undergoing surgery for inguinal hernia. With careful surgical technique, prophylactic administration of low dose subcutaneous heparin did not result in a significant increase in wound hematoma formation or wound bleeding. The postoperative decrease in the hemoglobin concentration, resulting from operative and postoperative blood loss, was -0.59 mmol/l, +/- 0.54 SD, in the control group and -0.60 mmol/l, +/- 0.57 SD, in the heparin group.