[Fistulas of the small intestine with evisceration. New therapeutic approach. 120 cases].
One hundred and twenty cases of post-operative jejuno-ileal fistula with evisceration are reported: 90% of the patients came from other departments. Depending on their mechanism, these fistulae fell into two categories: out-flowing fistulae (93 cases) consecutive to spontaneously opened peritonitis draining through the surgical incision, and in-flowing fistulae (24 cases) resulting from trauma of a superficial small bowel loop; 48% of open small bowel fistulae were due to a questionable operation. Unfavourable prognostic factors were: age over 50, supramesocolic initial lesion, fluid production equal or superior to 1000 ml/24 h, history of at least 2 previous median laparotomies and presence of one or several of 7 severity factors. The overall mortality rate was 46%, falling to 38.5% (inoperable cases excluded) after active treatment. The authors propose to concentrate on prolonged medical intensive care, salvage operations being reduced to a minimum. Over the last 4 years, this approach has brought down to 36% the overall mortality rate.
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006555:Hernia, Ventral / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007077:Ileal Diseases / Q000628:therapy*; D007412:Intestinal Fistula / Q000209:etiology / Q000628:therapy*; D007421:Intestine, Small / Q000601:surgery; D007579:Jejunal Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000150:complications / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis
Fistules de l'intestin grêle avec éviscération. Nouvelle approche thérapeutique. Cent vingt observations.