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Original communication| Volume 13, ISSUE 1, P122-130, January 1943

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Conservatism in the surgical management of acute regional enteritis

DOI:https://doi.org/10.5555/uri:pii:S0039606043904015
Conservatism in the surgical management of acute regional enteritis
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      Abstract

      • 1.
        1. Five cases of acute regional enteritis are reviewed. All were managed by simple exploration and appendectomy and none showed progression of the disease.
      • 2.
        2. That a strong tendency toward spontaneous healing is present in certain instances of acute regional enteritis is illustrated by Case 5, in which prompt healing followed primary closure of a perforated cecum in the presence of a very active acute process.
      • 3.
        3. Conservative management is mechanically essential in a smaller group of acute cases showing either massive involvement of the bowel or extensive “skip areas.”
      • 4.
        4. Spontaneous disappearance of acute regional enteritis occurs in a large number of instances, progression to the chronic phase in few.
      • 5.
        5. Recurrence after radical resection is relatively frequent, not to mention a formidable mortality rate in patients subjected to radical surgical treatment during the acute phase.
      • 6.
        6. In order to detect the occasional case showing a tendency to progress to chronic regional enteritis, conscientious observation and frequent postoperative x-ray study are essential in the acute case managed by simple exploration and appendectomy.
      • 7.
        7. Progression from acute to chronic under observation and thorough preoperative preparation by general supportive measures, transfusions, and enteral chemotherapy constitute a far more desirable form of management than radical resection in an unprepared acute case just recently admitted to the hospital.
      • 8.
        8. Appendectomy is incidental in the conservative form of surgical treatment; it does not materially increase the risk of fistula formation.
      • 9.
        9. If the appendix is not removed at operation, eventual involvement of it by the acute granuloma may cause appendical obstruction from edema with consequent early rupture and peritonitis.
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      Article info

      Publication history

      Received: March 30, 1942

      Identification

      DOI: https://doi.org/10.5555/uri:pii:S0039606043904015

      Copyright

      © 1943 Published by Elsevier Inc.

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