Faculty Bibliography

Intussusception secondary to long intestinal tubes is a relatively uncommon but potentially fatal occurrence. From 1976 to 1979 we have studied five patients with this complication. The mercury-filled bag stimulates peristalsis, the tube is drawn forward, and there is resultant telescoping and 'pleating' of the proximal small bowel. If these pleats become fixed by adhesions, they may act as a lead point for intussusception, even after tube withdrawal. Early diagnosis is essential for effective therapy

To compare the accuracy and safety of open abdominal paracentesis and lavage vs percutaneous paracentesis and lavage, 210 consecutive patients were prospectively randomized into two groups of 105 each. There were no false-negative diagnoses in either group. The accuracy rate for the open method was 98.1%, and 91.4% for the percutaneous method. Six major complications were encountered with the percutaneous method, for a complication rate of 5.7% compared with no major complications with the open method. The results suggest that the open technique is superior to the percutaneous method

Injuries to the portal vein are rare but have a high risk with a mortality of 50--70% secondary to exsanguinating hemorrhage. When managing injuries to the portal vein, lateral venorrhaphy, end to end anastomosis, or an interposition graft should be attempted whenever possible. However, in a hemodynamically unstable patient or when confronted with a nonreconstructable injury, acute portal vein ligation may be the procedure of choice as it is safely tolerated in some 80% of patients. Of eleven reported patients in whom the portal vein was ligated acutely for traumatic injury, six survived. Four of the nonsurvivors died of massive associated injuries. Of the six surviving patients, five tolerated acute ligation of the portal vein without complication. Should portal vein ligation be performed a 'second look' operation is essential in 24 hours to examine the bowel for viability. A portosystemic shunt with its inherent complications should not be done as a primary procedure when attempts at reconstruction of the portal vein have failed. Shunting should be reserved for those few patients who develop stigmata of portal hypertension or impending infarction of the bowel

The most serious complication following distal pancreatectomy is the development of a pancreatic fistula or subphrenic abscess. These complications are particularly prone to occur following distal pancreatectomy for trauma. The injured pancreas is divided in a contaminated field, often in the presence of hemorrhage and partly devitalized tissues, in which identification and secure closure of the transected pancreatic duct may be difficult. A review of 12 surgical publications describing experience with 234 distal pancreatectomies performed for trauma found the average pancreatic fistula rate to be 13% an in some reports as high as 25% to 30%. In an attempt to decrease the high postoperative fistula rate after distal pancreatectomy, transection of the gland with the autosuture has been investigated. There are at least three theoretical advantages of this technique. The pancreas is transected through healthy tissue, the pancreatic duct is closed securely, and stainless steel sutures are used, which probably are more resistant to the development of infection than other suture material. This report describes a technique of distal pancreatectomy for both trauma surgery and elective surgery with the TA-55 Auto Suture stapler. TA-55 Auto Suture stapler, with 3.5 mm staples, is placed across the mobilized pancreas, and two rows of staggered stainless steel staples are laid down. The gland distal to the stapler then is amputated. At present this technique has been used in a total of 12 cases--four for trauma and eight during elective procedures. One fistula related to pancreatectomy performed with the Auto Suture stapler developed, for a complication rate of 8.3%. This preliminary experience indicates that a more widespread evaluation of this technique is indicated

Radiation disease of the intestine is usually iatrogenic and frequently unavoidable. The disease, its treatment, and the disability produced are formidable. There is hope that means may be found to increase the resistance of the intestine to radiation damage. Radiation enteropathy is an insidious, progressive disease that is seen with increasing frequency. Serious disabilities may develop after years of gestation. Those patients who require surgery are treated by control of sepsis, correction of metabolic abnormalities, and reversal of protein/calorie malnutrition prior to definitive surgery. The treatment of choice is resection with anastomosis, but recurrences may occur many years later in intestine grossly normal at the time of surgery