PubMed · 5453424
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G M Campbell, N C Tanner. 1970. Massive small bowel resection.. https://pubmed.ncbi.nlm.nih.gov/5453424/
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BACKGROUND: The celiac sprue, a small intestinal disease usually becoming apparent by a malabsorption syndrome, is caused by gluten respectively gliadin intolerance which leads to intestinal mucosal damage finally resulting in complete villous atrophy. CASE REPORT: A propos of the case of a 60-year old woman with an uneventful course of celiac sprue of many years we report about a rare complication of this disease. Investigating recurrent attacks of abdominal pain a barium contrast examination revealed an intestinal stenosis which clinically resulted in an acute abdomen finally requiring surgery. Histologically a chronic ulcerative jejunoileitis was found. The main differential diagnosis is a malignant intestinal lymphoma, this however couldn't be found. Regarding this differential diagnosis surgical removal of the diseased parts of the bowel is the therapy of choice. Because of the possible transition from ulcerative jejunoileitis to intestinal lymphoma a postoperative close follow-up is recommended.
OBJECTIVE: To compare clinical characteristics, including postoperative outcomes, in Korean patients 65 years and older with those of younger patients. DESIGN: A retrospective medical record review. SETTING: An adult university hospital. PARTICIPANTS: All patients who underwent various operative procedures, especially for stomach cancer, acute surgical abdomen, and abdominal wall hernia, in the Department of Surgery at Seoul National University Hospital, Seoul, Korea, in 1994 and 1995. MAIN OUTCOME MEASURES: Demographics, disease pattern, length and extent of operation, hospital course including postoperative complications, and mortality. RESULTS: A clear increase in the patients 65 years and older was found. Of 2893 patients who underwent surgery in 1994, 735 were 40 years and younger (group 1), 1691 were 41 to 64 years old (group 2), and 467 were 65 years and older (group 3). The most common disease was stomach cancer in all age groups, with the highest incidence in group 3. Emergency operations were performed most often in group 1 (P<.05; chi2 test). Malignant neoplasm requiring a surgical procedure was identified more frequently with age (P<.001). Among patients with acute surgical abdomen, acute appendicitis was the most common disease in all age groups, whereas more serious diseases were found with age. In the analysis of stomach cancer, male patients increased with age (P<.001). Patients in group 3 had a poor preoperative physical status, and their perioperative courses were the most eventful among all groups (P<.05). However, no statistical differences among groups were present for resectability, postoperative length of hospitalization, postoperative complication, and mortality. In the analysis of operations for acute surgical abdomen including acute appendicitis, with their unfavorable preoperative physical status and eventful postoperative courses, perforation of the appendix and postoperative complications were most common in group 3 (P<.001). No statistical differences among groups were noted for operative mortality. In addition, in the analysis of abdominal wall hernia, no statistical differences among groups were found for postoperative complication and mortality. CONCLUSIONS: The proportion of patients 65 years and older among all surgical cases has increased in recent years. The proportion of malignant neoplasms, especially stomach cancer, was higher in the aged patients. Most operations were performed electively on the aged patients, as were those on younger patients. In the case of the acute surgical abdomen, severe diseases with an underlying malignant neoplasm were more frequently found in the aged patients. Despite their generally poor physical status, the patients 65 years and older proved to be able to tolerate elective major operations, such as radical gastrectomy for stomach cancer, when optimal perioperative management was provided. However, results of emergency operations in these elderly patients were poorer, with a higher complication rate. Therefore, the aged patient should be regarded as a candidate for surgery but with a more careful and comprehensive approach to his or her treatment perioperatively.
The ruptured abdominal aortic aneurysm as an incidental finding in emergency laparotomy for acute abdominal symptoms is a rare event. For this reason it is more important to know the necessary diagnostic and therapeutic strategies. Nowadays sonography facilitates the preoperative diagnosis. The performance of an additional computed tomography or angiography depends on the clinical appearance of the patient. In hemodynamically instable patients with a ruptured aneurysm, an immediate laparotomy is mandatory. If intraoperatively the aortic aneurysm has a diameter of more than 5 cm and shows no signs of rupture, implantation of an aortic prosthesis is indicated. This procedure has also priority when patients with a ruptured aneurysm are suffering from an additional abdominal disease. If additional septic reasons are diagnosed intraoperatively, the abdominal operation has to be performed synchronously with the aortic prosthesis. Alternatively, the use of an antimicrobial vascular prosthesis or resection of the aortic aneurysm with extra-anatomic bypass has to be considered. The technical difficulty of the operation is in the control of the proximal aorta. The lethality of operations for ruptured aneurysm has been consisted high (between 21 and 70%) in the past. In an elective operation, mortality has how improved up to 5%. This indicates that the essential prognostic factors, degree of retroperitoneal hematoma and hemorrhagic shock, and the condition of the patient, are not influenced by modern patient management. However, a further dominant prognostic parameter for lethality, how qualified the surgeon is in vascular surgery, can be influential.