One hundred and five colonic interpositions were performed in 102 patients. The indications for operation were caustic stenosis in 57 cases (Group A) and esophageal cancer in 45 patients (Group B). The right colon was used in 97 cases and isoperistaltic transverse colon in 8 cases. Eighty-nine transplants were anastomosed to the cervical esophagus and 16 to the pharynx. The distal anastomosis was to the antrum in 67 cases, to the second duodenum in 37 cases, and to the jejunum in 1 case. The overall mortality rate was 8.6 percent (9 cases), 5.3 percent (3 cases) in group A and 13.6 percent (6 cases) in group B (p less than 0.05). The morbidity rate was significantly higher in group B than in group A (77.3 percent vs 53.7 percent, p less than 0.05). Ischemic necrosis (3 cases) and chronic ischemia of the transplant (7 cases) were the major complications. Strictures occurred at the proximal anastomosis significantly more often in group B (63 percent) than in group A (40 percent) (p less than 0.05). Seven failures occurred in 93 survivors, i.e. oral feeding was impossible. In conclusion, mortality and morbidity rates of coloplasty are high. The use of colon as an esophageal substitute is justified only in case of caustic stenosis with unavailable stomach.
One hundred and five colonic interpositions were performed in 102 patients. The indications for operation were caustic stenosis in 57 cases (Group A) and esophageal cancer in 45 patients (Group B). The right colon was used in 97 cases and isoperistaltic transverse colon in 8 cases. Eighty-nine transplants were anastomosed to the cervical esophagus and 16 to the pharynx. The distal anastomosis was to the antrum in 67 cases, to the second duodenum in 37 cases, and to the jejunum in 1 case. The overall mortality rate was 8.6 percent (9 cases), 5.3 percent (3 cases) in group A and 13.6 percent (6 cases) in group B (p < 0.05). The morbidity rate was significantly higher in group B than in group A (77.3 percent vs 53.7 percent, p < 0.05). Ischemic necrosis (3 cases) and chronic ischemia of the transplant (7 cases) were the major complications. Strictures occurred at the proximal anastomosis significantly more often in group B (63 percent) than in group A (40 percent) (p < 0.05). Seven failures occurred in 93 survivors, i.e. oral feeding was impossible. In conclusion, mortality and morbidity rates of coloplasty are high. The use of colon as an esophageal substitute is justified only in case of caustic stenosis with unavailable stomach.
The authors report a retrospective study of 193 adults who ingested liquid chlorine bleach. This number represents 37% of caustic product ingestions treated in the department from 1975 to 1985. 85% of the cases were suicide attempts. All the patients underwent esogastric fibroscopy on the day of ingestion. The serious lesions, classified as stage II and stage III, represented 38% of the cases. Emergency surgery was necessary 10 times, for complications occurring during the first 3 weeks postingestion. Compared with other caustic agents, liquid chlorine bleach ingestion is characterized by gastric lesions and digestive perforations by secondary necrosis. This necrosis occurs after an interval ranging from 2 to 26 days.
A case of splenic volvulus, a rare complication of a rare malformation, mobile spleen, is reported, only 150 similar cases being documented in the literature. The diagnosis can be suspected preoperatively by ultrasound imaging. Different etiologies of this lesion are discussed and the various complementary examinations allowing preoperative diagnosis described.
Between 1975 and 1986, 96 adult patients were operated upon for gastro-esophageal reflux using the abdominal approach to Nissen's operation, eight of these patients having undergone previous surgery to treat reflux. Diagnosis in 44 patients was stage III esophagitis, and in 16, symptomatic peptic stenosis. Mortality was 0.9% (1 case) and morbidity 14%. Morbidity was not increased in previously operated patients. Based on these results and a literature review, different technical factors are discussed that could reduce morbidity of Nissen's operation.
