Acta Chir Belg
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We wanted to test the role of laparoscopy in complicated diverticulitis. ⋯ In perforated diverticular disease, even though laparoscopic lavage and drainage avoids a colostomy and facilitates a 2nd stage resection, few patients have complete resolution of the inflammatory process. Resection remains mandatory after 8 to 12 weeks. In Hinchey stage III, the success rate still remains to be investigated and weighed against the Hartmann procedure or primary resection. Faecal peritonitis and instable patients should not be considered for laparoscopy.
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Biliary fistula is a fairly uncommon complication of blunt liver injury, but with more liberal use of a nonoperative approach to the treatment of hepatic injury, the incidence is rising. If present, it becomes evident with physical examination aided by common diagnostic modalities (ultrasonography, computed tomography, cholangiography). The treatment, though, still presents a significant dilemma and often results in high morbidity with prolonged hospital stay and unnecessary expenses. Information was collected prospectively on a group of 26 consecutive patients with blunt hepatic trauma. Three cases of biliary fistulas were diagnosed, all after bile peritonitis ensued, or after a continuous discharge of bile through a postoperative drain took place. In one case, the diagnosis was confirmed by ultrasonography and computed tomography. Endoscopic retrograde cholangiopancreatography was used in all cases for diagnostic work-up and therapy. Endoscopic placement of a nasobiliary catheter was the definitive treatment in all cases. In all three patients, abdominal drains were removed two days after placement of a nasobiliary catheter. Diversion of the bile flow was discontinued after 6-7 days with no recurrent bile leak. No mortality due to hepatic injury or its complications was observed. ⋯ Posttraumatic bile fistulas are relatively easy to diagnose and their management with endoscopic drainage of the biliary tree through a nasobiliary tube is safe and effective. Adequate perihepatic drainage prevents relaparotomy for bile peritonitis. The possibility of biliary leakage does not reduce the relative safety of non-operative treatment of injury to solid organs.
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Gastrocolic fistula formation is an extremely rare complication of gastric ulcer disease. We report a case of a 55-year-old man who presented with a two-month history of abdominal discomfort, postprandial diarrhea, nausea and faecal vomiting. Upper gastrointestinal endoscopy showed an ulcer in the greater curvature of the stomach. ⋯ The involved segment of the colon was excised and truncal vagotomy and antrectomy was performed. The patient was discharged on the 7th postoperative day. It is concluded that cases with postprandial diarrhea and nutritional disturbances after gastric surgery should remind us of the probability of gastrocolic fistula formation.