Barogenic rupture of the esophagus (Boerhaave's syndrome): successful treatment of a late case.

This article presents a case of barogenic (postemetic) rupture of the esophagus that was diagnosed more than 48 hours after the acute event and subsequently treated successfully. The initial approach of direct esophageal repair, pleural drainage, antibiotics, and intravenous hyperalimentation was not successful. The repair site disrupted, and the patient became critically ill and septic. Salvage of the patient with closure of the fistula and normal alimentation was accomplished by partial distal esophageal occlusion, utilizing a serrated (Miles) vena cava clip.

Superficial spreading adenocarcinoma of appendix, cecum, and terminal ileum.

A case of superficial spreading adenocarcinoma involving terminal ileum, appendix and cecum is presented. The tumor might primarily arise from the proximal part of the appendix with extension to the cecum and terminal ileum, although multicentric origin of the tumor cannot be excluded. The mechanism underlying superficial infiltration of the tumor is through close contact and intramucosal lymphatic spread.

Ischemic colitis.

Fifteen patients with ischemic colitis were treated; in every case the diagnosis was made at operation or autopsy. Abdominal pain, tenderness, and distention were the most common findings. Five patients had the transient form of the disease, two stricturing, and eight gangrenous. Five patients were operated upon, two because of stricturing disease, three because of gangrene of the colon. Both of the former patients survived, one of the latter. Diagnosis of transient ischemic colitis can be made by barium enema studies. This form of the disease is self-limiting and recovery should be expected. Stricturing ischemic colitis may be diagnosed by barium enema, but doubtful cases will require laparotomy and resection. It is difficult, if not impossible, to differentiate the gangrenous form of the disease from other abdominal catastrophes without operation. When the condition is found at celiotomy, bowel resection without anastomosis is recommended.