Search

Eleven cases of duodenal injury are reviewed. A correct preoperative diagnosis was made in only one patient. In 10 patients, the duodenum was disrupted in the second part. When duodenal injury was associated with devitalisation of tissue or there was delay in operative intervention, repair was aided by a serosal patch graft. In these high risk cases, an attempt to defunction the injured area was done by suction gastrostomy or gastrojejunostomy with vagotomy, Three patients died and in two of these, there was delay in surgical intervention.

The efficacy of paravariceal sclerotherapy for bleeding oesophageal varices was evaluated. Alcoholic and post-hepatitis liver cirrhosis were the main causes of portal hypertension. A total of 28 patients between June 1982 and December 1983 were treated by this method using a flexible endoscope. Bleeding was initially controlled in 90% of patients. However 30% of patients developed recurrent bleeding within 12 months. One year survival of the patients was 70% indicating this treatment has no effect on the long term survival of the underlying disease. The technique is discussed and its complications analysed.

There is fairly widespread belief that suppuration superimposed upon acute cholecystitis is a rather uncommon condition. Scanty information on this subject is found in the published literature. No doubt, the scarcity of data further reinforces this clinical impression. Yet, from the few studies available, a surprisingly high incidence (7-11%) is documented. We reviewed 518 patients who underwent emergency cholecystectomy and found 139 cases to have frank pus present within the gallbladder. The clinical presentation is often difficult to distinguish from that of acute cholecystitis but diagnosis is crucial to identify this potentially fatal surgical emergency. There are encouraging reports of specific ultrasonic features which can demonstrate the increased viscosity produced by the purulent and fibrinous content within the gallbladder.