R Downing — Page 6 | PubMed Health

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A self-regulating device for continuous reinfusion of jejunostomy effluent.

The management of a patient with an enteric fistula producing a large volume of effluent is time-consuming and complicated. In patients requiring defunctioning procedures the eventual aim is restoration of intestinal continuity. Prior to surgery however it is prudent to ensure that the bowel distal to the stoma will cope with the sudden return to its normal role without diarrhoea or colic. This paper describes a simple, cheap, portable device which can be easily made. The device is closed, self-regulating and can be adjusted to patients' requirements.

Equipment Design↗

PubMedDate not supplied

Abdominal aortic aneurysms complicated by spontaneous iliocaval or duodenal fistulae.

Seven hundred and twenty one abdominal aortic aneurysms were treated between 1960 and 1985. Twenty one of these (2.9%) were complicated by the development of a spontaneous primary fistula, 16 (2.2%) into the vena cava or iliac veins and 5 (0.7%) into the duodenum. A correct preoperative diagnosis was made in only four instances, two aorto-caval and two aorto-duodenal fistulae. Hospital mortality was 44% for aorto-caval and 60% for aorto-duodenal fistulae. Despite the lack of a precise preoperative diagnosis in the majority of cases, the prognosis for aorto-caval fistula remained comparable to that for patients undergoing emergency surgery for uncomplicated ruptured aortic aneurysms. The mortality of spontaneous aorto-duodenal fistulae was appreciably higher and the aneurysmal contents of 4 out of these 5 cases had positive bacterial cultures.

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