[Hemorrhagic gastro-duodenal ulcers. In which cases should emergency surgery be performed?]. / Ulcères gastro-duodénaux hémorragiques. Lesquels faut-il opérer en urgence?

From January 1983 to December 1987, 127 patients with bleeding peptic ulcer were admitted to hospital. The mean age of the 85 males was 57 years and 72 years for 42 females. All but four of the patients were managed medically after emergency endoscopy. Twenty-seven patients required surgical operations (21.2%): seven for cataclysmic haemorrhage, eight for persistent haemorrhage, twelve for recurrent bleeding. An analysis of factors leading to the necessity of surgical haemostasis was undertaken by considering the clinical status, endoscopic findings and laboratory results. The size of the ulcer (greater than 2 cm) was the most significant parameter (less than 0.01). Five other criteria (rectal bleeding) shock, endoscopic signs of recent haemorrhage, gastric or duodenal posterior ulcer) were also significant (p less than 0.05). Considering the gravity of these patients (six deaths among twenty-seven), clinical trials in bleeding peptic ulcer disease should only include patients in the high risk group.

[Role and results of surgery in Crohn disease in adults]. / Place et résultats de la chirurgie dans la maladie de Crohn chez l'adulte.

Because of new medical treatments, the authors propose a review of the principal surgical indications in Crohn's disease in adults and the current prognosis based on the literature. Schematically, these indications correspond to failures of drug treatment, apart from emergency situations. Relapses are still very frequent, but may remain responsive to medical treatment. However, coloproctectomy, a fairly invasive operation, provides the best results in the colonic forms.

[Mesocoloplasty of sigmoid volvulus. An alternative to colonic resection]. / La mésocoloplastie pour volvulus sigmoïdien. Une alternative à la résection colique.

Based on 4 operations, the authors stress the value of intestinal preservation in subjects with poor general suffering from volvulus or with signs of sigmoid torsion by means of mesocolonoplasty. The technical simplicity of this operation allows it to be proposed in the course of laparotomies indicated for any other abdominal pathology.