The outcome of intestinal fistulae: the Louisiana State University Medical Center--Shreveport experience.

Fistulae arising from the intestinal tract are associated with significant morbidity and mortality rates. Most contemporary studies of fistulae report mortality rates between 6 and 20 per cent. The major causes of death in these patients are sepsis, electrolyte imbalance, and malnutrition. A total of 48 patients with either external or internal intestinal fistulae were reviewed in this study over a 5-year period at the Louisiana State University Medical Center at Shreveport. Intestinal fistulae were classified into three types, anatomic site, physiologic type, and etiology, to evaluate morbidity and mortality rates. We also attempted to evaluate the role of parenteral nutrition in this patient population, but our data were inconclusive because of the limited number of patients. There was no difference in mortality rates associated with anatomical sites. High-output fistulae were associated with a higher mortality rate compared to low-output fistulae. Fifty-six per cent of the patients achieved closure. The overall mortality rate was 21 per cent. Spontaneous closure rates were lower when compared to those in other studies. This was attributed to sepsis, malignancy, and history of previous radiation therapy. Management of intestinal fistulae includes control of sepsis, correction of electrolyte disturbances, nutritional support, and operative intervention if necessary.

Snake bite poisoning in pregnancy. A review of the literature.

With our 2 cases, there are 30 reported cases in English of snake bite poisoning in pregnancy with some details presented and 20 cases without details, for a total of 50 cases. We reviewed the maternal and fetal outcomes in the 30 cases that had such information. Poisoning by members of the Crotalidae family (rattlesnakes, cotton-mouths [water moccasins] and copperheads) during pregnancy carries with it a fetal wastage rate of 43% and a maternal mortality rate of 10%. Pit viper bites cause a bleeding diathesis from the fact that the venom of these snakes contains a procoagulant that defibrinates the blood and leads to bleeding throughout the body.

Indigenous amebiasis.

A case of amebic anemia in a 53-year-old Louisianian prompted us to report it, in order to create awareness of such cases occurring in the absence of foreign travel. If one is cognizant of amebiasis it will be included in the differential diagnosis when it is proper to do so.

Trichotillomania resulting in a trichobezoar: a case report.

This paper presents a case of a 19-year-old, 10 1/2-week-pregnant woman with trichotillomania that resulted in a trichobezoar. The case illustrates typical presentation, patient behavior, symptomatology, and physical findings of patients with trichobezoars. The hypothesized methods for trichobezoar formation, complications, and treatment are discussed. The diagnostic criteria, epidemiology, and treatment of trichotillomania are also discussed.

Retroperitoneal necrotizing fasciitis.

We present a case of retroperitoneal necrotizing fasciitis treated by urgent abdomino-perineal resection of the rectum with permanent colostomy. We can find no prior case in the English literature treated in this manner. Retroperitoneal occurrence of this disease is unusual. The process originated from perianal sepsis following chemotherapy for head and neck cancer.

Spontaneous biliary enteric fistulas.

Biliary enteric fistulas usually occur as a complication of chronic cholelithiasis, may be difficult to document preoperatively, and often pose problems in surgical management. We reviewed 13 cases of spontaneous biliary enteric fistulas to identify methods of diagnosis, management, and complications. There was no specific set of clinical symptoms or signs that led to the diagnosis of a fistula. In six cases the diagnosis was made preoperatively by x-ray films showing pneumobilia, gallstone in the small bowel, or fistula. Initial surgical treatment included cholecystectomy in six cases, small bowel enterotomy and removal of gallstones in four, and vagotomy and antrectomy in one case. Two patients initially treated without operation were lost to follow-up. Eight complications occurred in six patients, and there were three deaths due to underlying cardiac disease. The morbidity and mortality of biliary enteric fistulas associated with chronic cholecystitis may be avoided by performing elective cholecystectomy when the patient is in optimal condition.