Journal of clinical gastroenterology
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Although the right to terminate life-sustaining treatment is clear from the medical, ethical, and moral perspective, the legal methodology is fragmented and variable depending upon the jurisdiction in which you practice. A few general principles do emerge which may be useful for the clinical gastroenterologist. DNR orders may be entered into a patient's orders provided the patient, if competent, or his or her family or guardian, if the patient is incompetent, gives informed consent. ⋯ A hospital or institutional policy regarding termination decision-making is highly desirable. If unsure, legal counsel should be sought before terminating life support. Jurisdictions which define death by both cardiopulmonary and neurologic criteria make the termination decision easier in that brain-dead patients can be removed from life support without risk of liability.(ABSTRACT TRUNCATED AT 250 WORDS)
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In most instances, patients with an acute abdomen and pneumoperitoneum have a perforated hollow viscus as the underlying cause. Clinicians must not forget, however, some of the less common causes of free air in the abdomen. We describe pneumoperitoneum from a vaginoperitoneal fistula, developing after hysterectomy, well known to gynecologists, but rarely noted in the medical literature.
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J. Clin. Gastroenterol. · Jun 1981
Case ReportsUnusual periduodenal fistulas in peptic ulcer disease.
I recognized fistulas between the stomach and descending duodenum and between the duodenal bulb and descending duodenum in three patients by upper gastrointestinal study. The many recent papers on the "double pylorus" together with these three previously unreported examples suggest that periduodenal fistulas are not infrequent complications of peptic ulcer disease. ⋯ Congenital duplication is usually noncommunicating and most often occurs at the mid portion of the stomach's greater curvature. Awareness of variety of these fistulas and special effort to demonstrate their presence should help interpretation during endoscopy and radiologic examination.