Acta Chir Belg
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Fournier's gangrene is a rare, rapidly progressive, necrotising fasciitis of the external genitalia and perineum with high morbidity and mortality. ⋯ Aggressive surgical debridement and combined antibiotherapy are essential in the management of Fournier's gangrene. FGSI and BSA are useful to assess the severity and prognosis of the disease.
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Because of their rarity and late diagnosis, gastro-intestinal bezoars can be treated after the occurrence of some complications such as acute intestinal obstruction, strangulation, decubitus ulceration and bleeding. In this study, reasons for bezoar formation, measures to be taken and treatment modalities were investigated. ⋯ Even though rarely seen in digestive tract diseases, the probability of BZ formation should always be remembered. After the removal of BZs by conservative methods or surgery, precautions should be taken against recurrence and possible underlying psychiatric disorders should be treated.
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Delayed intestinal perforation after blunt trauma is very rare. Peri-appendicitis is the serosal inflammation of the appendix, which is generally caused by extra-appendicular sepsis. Our purpose is to present this case with delayed ileum perforation after blunt trauma and peri-appendicitis. ⋯ Delayed postraumatic perforation of the intestine occurs as a result of ischaemia. There is no reported case of a patient with situs inversus totalis. If acute abdomen is the case even with a history of minimal abdominal trauma, delayed intestinal trauma should be considered in the diagnosis. Peri-appendicitis secondary to intestinal perforation, which is a rare condition, should come to mind at the diagnosis.
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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.