[Gastrointestinal hemorrhage after operation for dissecting aneurysm of the thoracic aorta]
Kirchgatterer A. Punzengruber C. Zisch R. Balon R. Knoflach P.
Abteilungen fur Interne I, Krankenhaus der Barmherzigen Schwestern, Wels, Osterreich.
We present the case of a 45-year-old man who underwent surgical repair of a dissecting aneurysm of the descending thoracic aorta. 25 days postoperatively, the patient unexpectedly developed hematemesis and hypovolemic shock. Emergency gastroscopy was performed and a suspected aortoesophageal fistula was diagnosed. Unfortunately, the patient died prior to emergency surgery. Aneurysms of the aorta or of aortic grafts occasionally lead to the development of fistulae to the upper gastrointestinal tract. Once this rare, but life-threatening complication is suspected, endoscopy must be performed immediately. Emergency surgery is associated with a high risk, but represents the only possibly chance of survival for the patient.
Results of the treatment of colorectal cancer complicated by obstruction.
Stoyanov H. Julianov A. Valtchev D. Matev A.
Department of General Surgery, Thracian University, Stara Zagora, Bulgaria.
654 patients with colorectal cancer were operated on during the period 1982-1993. Acute surgical intervention was performed in 232 cases because of large bowel obstruction, whereby the obstruction tumor was localized in the colon in 160 patients and in the rectum in the remaining 72 patients. 53 of the patients were designated as stage T3,4N-M0 stage, 97 as T3,4N+M0 and 82 as T3,4N+/-M1. Histologically, well- and moderately-differentiated adenocarcinoma was diagnosed in 69%, poorly differentiated and mucinous adenocarcinoma in 29% and squamous cancer in 2% of the cases. The patients were distributed in 4 groups according to the clinical presentation of the obstruction: acute (n = 60), subacute (n = 52), recurring (n = 42) and chronic (n = 78) forms. 122 radical and 110 palliative operations were performed. 34% of the patients had postoperative complications. The overall postoperative mortality was 25% AND it was highest in one-stage operation with a primary anastomosis (p < 0.05). The 5-year survival in patients with obstructive colon and rectal tumours was 32% and 27%, respectively (p = 0.631). The patients with differentiated adenocarcinoma have a better prognosis, as well as those without regional lymph node metastases (p < 0.05). The patients without obstruction operated on during the same period, had a higher 5-year survival for both colon (p < 0.01) and rectal (p < 0.0019) cancer.
Chronic gastrointestinal symptoms in hemodialysis patients.
Hammer J. Oesterreicher C. Hammer K. Koch U. Traindl O. Kovarik J.
Klinische Abteilung fur Gastroenterologie und Hepatologie, Universitatsklinik fur Innere Medizin IV, Vienna, Austria.
INTRODUCTION: Gastrointestinal disorders occur frequently in dialysis patients. Few data are available on the prevalence of symptoms originating from the gastrointestinal tract in this group of patients. Our aim was to obtain data on the prevalence of chronic gastrointestinal symptoms in patients undergoing hemodialysis. METHODS: All 109 patients of our dialysis unit were given a questionnaire to complete which was previously validated and designed to measure the occurrence of gastrointestinal, and some general symptoms during the preceding year. 105 subjects responded (96% response rate). RESULTS: 79% of dialysis patients had at least one of the following chronic gastrointestinal symptoms: Esophageal symptoms were reported in 21% abdominal pain in 28% and dyspeptic symptoms in 48%. The irritable bowel syndrome was diagnosed in 12 patients (11%), 40% had chronic constipation and 24% had chronic diarrhoea. Colonic pain was described in 20% of patients. Frequent general symptoms (such as weakness, headaches, insomnia and fatigue) were described in up to 51%, and patients were severely bothered by symptoms in up to 33% of cases. CONCLUSION: Although patients on hemodialysis generally report a good quality of life, the prevalence of gastrointestinal symptoms and of general symptoms is high and many dialysis patients consider these symptoms to cause major impairment of daily life.
[Aneurysm of the cystic artery as a rare cause of hemobilia]
Kirchgatterer A. Allinger S. Spottl A. Zisch R. Funk S. Messenback F. Haidenthaler A. Hobling W. Kramar R.
III. Interne Abteilung, Barmherzigen Schwestern, Wels, Osterreich.
A 52-year old woman was admitted to the hospital because of upper abdominal pain and hematemesis. Laboratory parameters showed marked cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) lead to the diagnosis of hemobilia. CT-scan and angiography revealed an aneurysm of the cystic artery as the cause of hemobilia. Cholecystectomy was performed because of concomitant cholecystitis. Anatomical examination confirmed clinical diagnosis.