Research Article| Volume 18, ISSUE 2, P177-190, August 1945

Gastrojejunocolic fistula

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      • 1.
        1. Forty-seven patients with marginal or jejunal ulcer were treated surgically at the University Hospital during the period 1934 to 1944. Eight patients, or 17 per cent of the surgical cases, had the serious complication of gastrojejunocolic fistula.
      • 2.
        2. During the period 1925 to 1944, eighteen unmistakable cases of gastrojejunocolic fistula have been observed. Fourteen of these patients were treated by surgical operation.
      • 3.
        3. All of these cases of gastrojejunocolic fistula represented a late complication of posterior gastroenterostomy for duodenal ulcer.
      • 4.
        4. The longest interval between the original operation for ulcer and the hospital entry for fistula was twenty-six years; the shortest interval was one year and the average time nine years and six months.
      • 5.
        5. Nearly all patients exhibited serious nutritional disturbances requiring intensive preoperative treatment. The time spent in the hospital prior to operation ranged from two to thirty-one days, the average time being 12.3 days.
      • 6.
        6. The surgical operation in all cases consisted of a one-stage procedure. In ten instances a restorative type of operation was performed, whereas in four cases, gastric resection was included. There was one postoperative death in each group, or a mortality of 14.3 per cent for the entire series.
      • 7.
        7. Follow-up studies showed that all patients who survived operations involving gastric resection had good results, whereas, only four of the nine patients surviving the more conservative operative procedures remained free of ulcer symptoms. Three of the five patients with recurrent ulcer subsequently required further surgical therapy. No deaths occurred among these patients who later required reoperation. While gastric resection is ordinarily desirable at the time of the operation for the repair of the fistulas, it is not always feasible or safe. Restoration of the tract to normal, therefore, is a useful procedure in certain cases. This is particularly true inasmuch as many of the original gastroenterostomies were performed upon meager indications as judged by present-day standards. If further surgery for recurrence of the ulcer later becomes necessary in certain cases, subtotal gastrectomy can be carried out upon a patient in good condition with a very low mortality.
      • 8.
        8. Gastrocolic fistulas due to primary disease of the stomach or colon are discussed. These patients present similar problems in preoperative care and in certain matters of surgical technique.
      • 9.
        9. A small group of gastroenteric fistulas due to surgical errors at the time of the original operation for ulcer is considered briefly.
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