[Does one have to be aggressive in the surgical management of diverticular disease of the colon (author's transl)]. / Faut-il être agressif dans le traitement chirurgical de la diverticulite colique?

A series of 61 consecutive cases with diverticular disease and its complications is presented. Fourteen cases with uncomplicated diverticular disease and 3 with massive GI tract hemorrhage underwent an uneventful (segmental) resection. Of 6 cases operated for fistula formation 1 died. Surgical therapy for abscessformation, peritonitis and "pseudo-tumoral" obstruction (38 cases) carried a high mortality (26.3%). The application of a one-staged aggressive and curative surgical approach lowers the mortality considerably, especially in the complicated forms of the disease. In a group of 30 cases so treated only 1 death occurred (3.3%). This in contrast with a group of 31 patients treated with a two-staged and initially palliative procedure with a mortality of 10 (32.2%). The Hartmann procedure with total excision of the lesion and avoidance of an enteroenteric anastomosis gives excellent results in the treatment of the complicated forms of the disease.

[Complications of jejunal diverticulosis. Apropos of 2 cases]. / Complications de la diverticulose jéjunale. A propos de 2 cas.

Two cases of acute jejunal diverticulitis are presented and confronted to data found in the literature. Acquired jejunal diverticulosis is a rare disease; its complications occur in a small percentage of cases. Chronic complications (malabsorption, megaloblastic anemia) should be treated medically. Acute complications (diverticulitis, perforation, haemorrhage, obstruction) require an emergency operation. Preoperative diagnosis is rarely made. Radiological or peroperative discovering of asymptomatic jejunal diverticula does not justify surgical treatment.

Intussusception in adults--report of 3 cases.

Intussusception in the adult is rare. The cases reported here illustrate the usual clinical development of the condition: incomplete, subacute, or chronic subobstruction. Intussusception is usually associated with a localized lesion, mostly a small bowel benign tumor, and a colonic malignant tumor. Diagnosis is effected using barium enema, ultrasonography, or CT scanning. Treatment of intussusception requires surgical intervention.

[Prophylaxis of postoperative deep vein thromboses by means of weak doses of subcutaneous heparin (author's transl)]. / Prophylaxie par l'héparine sous-cutanée à faibles doses des thromboses veineuses postopératoires

The authors intend to control with the marked fibrinogen test, the real frequency of postoperative deep vein thromboses (DVT) and the eventual prophylactic effect of subcutaneous heparin in weak doses. Heparin was administered 2 hours before the operation and every 8 hours during 6 days thereafter, each time at the dose of 5,000 U subcutaneously. Ninety-nine patients undergoing major surgery were randomized into two groups of 55 control operated patients and 44 operated patients treated with heparin. The radioactive fibrinogen test was used in 27 patients of the control group and in 23 of the treated group. In the control group of 55, 7 DVT were clinically recognized : the isotopic test was positive in 17 patients. In the treated group of 44 no DVT was clinically diagnosed : 6 DVT were recognized by the marked fibrinogen test. There were no noticeable hemorrhagic complications in the treated group. Low dose of subcutaneous heparin is an efficient and safe prophylactic method in postoperative thromboembolic accidents.

[Acute appendicitis: the benefit of a wait-and-see attitude]. / Appendicite aiguë: bénéfice d'une attitude attentiste.

Acute appendicitis. Acute appendicitis is often suspected but in 70% of the cases the complaints to an other diagnosis. Aggressive therapy is therefore not indicated. A 12 to 24 h observation allows to avoid surgery and complications which are not exceptional.

[2 cases of duodenal duplication]. / A propos de 2 cas de duplication duodénale.

Two cases of duodenal duplication are reported. It is a rare disease and is found commonly during infancy. Symptoms of partial duodenal obstruction are dominating the clinical picture. Upper gastrointestinal contrast radiography seems to be the best paraclinical examination. The surgical treatment is governed by the relationship of the cyst to the biliary and pancreatic ducts and the presence of ectopic gastric mucosa. If total resection of the cyst implicates a danger of injury to the common bile duct and the head of the pancreas and when one is tempted to perform a cystoenterostomy, the authors insist on the necessity to detect the presence of ectopic gastric mucosa by fluid pH determination and frozen section biopsy of the cyst wall. The presence of ectopic gastric mucosa requires a total resection of the cyst.

[Acute necrotizing pancreatitis. Large bowel complications (author's transl)]. / Les complications coliques de la pancréatite aiguë. A propos de 12 observations avec revue de la littérature.

Fifteen large bowel lesions are reported among 12 patients with acute necrotizing pancreatitis: 6 stenosis (transient in one case), 5 necrosis and 4 perforation. In 7 cases out of 12, abdominal plain film was suggestive of colonic involvement. Barium enema and coloscopy may confirm the diagnosis. Previously reported cases (56 stenosis, 84 perforations, 35 necrosis) are reviewed and clinical course radiographic features and the results of surgical management are discussed.

[Digestive system surgery in octogenarians]. / Chirurgie digestive chez l'octogénaire.

Between October 1, 1977 and June 30, 1983, 139 G.I. tract operations were performed in patients over 80 years-old. 45,3% were post-operatively admitted to the I.C.U.; the criteria for admission were emergency surgical interventions, the type and duration of the operation. The operative mortality was 15,8%. Contributory factors were the type of the intervention, its curative nature and the necessity for post-operative reanimation. The urgent nature of the intervention as well as the histology of the lesion had no bearing on the mortality. Local complications were noted in 34,5% of the cases and were mainly superficial and deep wound infections. General complications, mainly involving the cardio-pulmonary and urinary tract systems, occurred in 68,3% of the cases. Morbidity was mainly associated with the timing of the intervention.

[Recurrent retroperitoneal liposarcoma, diagnostic and therapeutic problems]. / Liposarcomes rétropéritonéaux récidivants, problèmes diagnostiques et thérapeutiques.

Retroperitoneal liposarcomes are characterised by their tendency to recurrence, Eight cases are related, from which no one get out of this rule. Late diagnosis is due to their silent growth and poor symptomatology. Ancillary procedures, particularly computerised tomography, and histological examination, allow to confirm diagnosis. The main treatment is surgery, it must be as aggressive as possible, it allows to confirm histologically the nature of the tumor. Postoperative radiotherapy is helpful and chemotherapy can be associated, if it seems that complete excision has not been possible or if metastasis are detected. Histologically, these sarcomes seem to derive from a pluripotential mesenchymatous cell, it explains their polymorphic differentiation. A clinical prognosis, based on histology, seems to be illusive.

Biliary pleural fistula as a complication of radiofrequency ablation for liver metastasis.

Radiofrequency ablation (RFA) recently emerged as an efficient and safe local ablative method to treat unresecable liver tumours. Currently however, the full spectrum of potential complications of RFA remains undetermined. We report a case of severe biliary complication, associating main bile duct stricture and biliary pleural fistula, arising after extensive RFA for unresectable liver metastasis of central location. Treatment consisted of external drainage of the pleural effusion and internal endoscopic drainage via a biliary stenting. This description of a life-threatening complication emphazises the need to better knowledge of the contraindications of RFA, particularly for the treatment of large tumours at proximity of main bile ducts.

[Medico-surgical attitude in the treatment of cancer of the bile ducts]. / Attitude médico-chirurgicale dans le traitement des cancers des voies biliaires.

In order to evaluate the operative possibilities in patients with obstructive carcinoma of the biliary tract a precise diagnosis of local extent of the tumor and metastasis is essential (cholangiography, US, CTscan). The treatment is preferably surgical whether the tumor be resectable or not. However some patients who, for any reason, are not surgical candidates can be helped by new endoscopic intubation techniques. Medical and surgical consultation is essential to set the criteria for the best treatment modality in all patients with this disease, especially those who are not surgical candidates.

[Surgery of acute cholecystitis in patients 80 years of age or older]. / Chirurgie de la cholécystite aiguë au-delà de 80 ans.

In 17 Belgian surgical centers, 324 operations have been performed for acute cholecystitis in patients 80 years of age or older. In this group of patients: 1. The incidence of acute cholecystitis is hardly higher in women than in men. 2. The patients were operated within 24 hours of admission in 38% of cases. The main bile duct was surgically explored in 1/3 of patients. Cholecystostomy or simple drainage were used in 1/10 of cases only. 3. Operative mortality was 19%. It was higher for patients operated as emergencies than for delayed operations and higher also when the cholecystectomy was associated with an exploration of the bile duct. The ideal treatment for such patients should thus be a cholecystectomy with an endoscopic sphincterotomy.

[Esophageal perforation caused by a foreign body. Apropos of a case report]. / Perforations oesophagiennes par un corps étranger. A propos d'une observation.

This report describes an esophageal foreign body perforation treated with T-tube drainage. The clinical diagnosis was delayed erroneously and by the absence of extravasation of water--soluble contrast material. The diagnosis has finally been made by a fiberoptic oesophagogastroscopy and a mediastinal computed tomography. As the external drainage by pleural drainage was inefficient, the authors opted for a surgical treatment, and the perforation was closed on a T-tube. Considering this case as well as the review of the different reports, urgent surgery seems to be only recommended for large esophageal perforations and for small non-cervical perforations where external drainage is inefficient.