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A technique for drainage of enterocutaneous fistulas
137
ABSTRACTS
raphy showed no signs of a portal hypertension. Several esophagoscopies showed slight esophagitis. Not until a fourth contrast examination of the stomach, when the infant was 9 mo old, was slow emptying of the stomach observed, and in a right lateral oblique projection a web-like membrane was found to obstruct the pyloric channel. Excision of the membrane, pyloroplasty, and fundoplication were performed at the age of 113 mo and resulted in full cure.-Therese Wyss-Blijchlinger
A New Appliance for the Premature or Newborn Baby With Roback, (May),
Intestinal Stoma. V. Wilson,
and A. S. Leonard.
Surgery
S.
A.
77:715-716
1975.
This article describes a stoma1 appliance successfully used at the University of Minnesota Hospitals in I2 infants with intestinal stomas.William
K. Sieber
A Technique for Drainage of Enterocutaneous Fistular. M. MocFodone and 1. Frawley. Surg Gynscol Obstet
141:263
(August),
1975.
The authors describe a technique of using subcutaneous tubing around a cutaneous fistula opening and obtaining a perfect seal. A small incision is made about 4 cm away from the fistula opening. Another one is made approximately 10 cm away. A &cm-diameter polythene tubing with multiple perforations at one end is passed subcutaneously between the two skin incisions. The end with the perforations is placed over the opening of the fistula. The tubing is sutured in place where it emerges from the subcutaneous tunnel. The surrounding skin including that over the subcutaneous tunnel is either sprayed with an adhesive skin dressing or painted with benzoin tincture to enhance the adherence of a transparent self-adhering surgical drape. It is essential that an air-tight seal be obtained around the fistula opening including the area over the subcutaneous tunnel. The tube is connected to a pump with negative pressures up to 120 cm of water. It is necessary to keep the drape completely collapsed on and around the exposed tubing and fistula opening. The system will usually operate for a period of 7 days. In the 11 patients managed by this technique there has been no problem with infection in the subcutaneous tunnel although this may be one of its theoretical disadvantages. The technique was successful in all II patients and surgical closure was not required in any. The longest
period
of drainage
was
19 days.-George
Hol-
comb Studies on the Healing of Anastomous of Small and large intestines. 1. Wise and
P.
Schuck.
(August),
Surg
McAlister,
Gynacol
Obstet
T.
Stein,
141:191
1975.
The authors undertook studies to elucidate the pathophysiologic basis of the fact that large intestine anastomoses tend to leak more frequently than small intestine anastomoses. Single-layer interrupted silk-suture anastomoses were performed in both the distal part of the ileum and the distal part of the colon in 29 dogs. The anastomoses were resected at I-8 days and 19-31 days after operation. Collagen response, vascular response, and bursting strength at the site of anastomoses were investigated. The results demonstrated a stastically significant decrease in the collagen and vascular response of the large versus the small intestine. These studies showed that the muscularis had about ten times the concentration of collagen as that of the mucosa or serosa. Also, by using microangiography, it was demonstrated that there was better cross circulation at the small intestine anastomosis than the colonic anastomosis. The authors concluded this differential response may play a roll in the mechanism of the relatively high incidence of suture-line separation observed after colonic anastomoses.George Holcomb Enterocolitis of the Newborn and of the Pmmature Infant. 1. P. Chappuis, M.
Daudet.
April),
Ann
Chir
Infant
l&l
Lt. 17-126
Salle,
and
(March-
1975.
This paper reports 16 cases of newborn and premature infants with necrotic enterocolitis. Eleven infants weighed less than 2000 g, and in six cases a respiratory distress syndrome was found during the perinatal period. The necrotic lesions were most frequently situated in the terminal ileum, the cecum, and the ascending colon. Histologic findings showed a predominance of mucosal lesions. After a latent period of l-20 days the illness usually developed with general signs of a toxemia: shock, hyperthermia, dyspnea, and respiratory irregularities. Within the next 24 hr abdominal symptoms such as meteorism, vomiting, and diarrhea were added to the picture. Radiologic findings were intestinal distension in nine cases, intramural pneumatosis in another nine cases, pneumoperitoneum in three cases, and pneumatosis of
ABSTRACTS
raphy showed no signs of a portal hypertension. Several esophagoscopies showed slight esophagitis. Not until a fourth contrast examination of the stomach, when the infant was 9 mo old, was slow emptying of the stomach observed, and in a right lateral oblique projection a web-like membrane was found to obstruct the pyloric channel. Excision of the membrane, pyloroplasty, and fundoplication were performed at the age of 113 mo and resulted in full cure.-Therese Wyss-Blijchlinger
A New Appliance for the Premature or Newborn Baby With Roback, (May),
Intestinal Stoma. V. Wilson,
and A. S. Leonard.
Surgery
S.
A.
77:715-716
1975.
This article describes a stoma1 appliance successfully used at the University of Minnesota Hospitals in I2 infants with intestinal stomas.William
K. Sieber
A Technique for Drainage of Enterocutaneous Fistular. M. MocFodone and 1. Frawley. Surg Gynscol Obstet
141:263
(August),
1975.
The authors describe a technique of using subcutaneous tubing around a cutaneous fistula opening and obtaining a perfect seal. A small incision is made about 4 cm away from the fistula opening. Another one is made approximately 10 cm away. A &cm-diameter polythene tubing with multiple perforations at one end is passed subcutaneously between the two skin incisions. The end with the perforations is placed over the opening of the fistula. The tubing is sutured in place where it emerges from the subcutaneous tunnel. The surrounding skin including that over the subcutaneous tunnel is either sprayed with an adhesive skin dressing or painted with benzoin tincture to enhance the adherence of a transparent self-adhering surgical drape. It is essential that an air-tight seal be obtained around the fistula opening including the area over the subcutaneous tunnel. The tube is connected to a pump with negative pressures up to 120 cm of water. It is necessary to keep the drape completely collapsed on and around the exposed tubing and fistula opening. The system will usually operate for a period of 7 days. In the 11 patients managed by this technique there has been no problem with infection in the subcutaneous tunnel although this may be one of its theoretical disadvantages. The technique was successful in all II patients and surgical closure was not required in any. The longest
period
of drainage
was
19 days.-George
Hol-
comb Studies on the Healing of Anastomous of Small and large intestines. 1. Wise and
P.
Schuck.
(August),
Surg
McAlister,
Gynacol
Obstet
T.
Stein,
141:191
1975.
The authors undertook studies to elucidate the pathophysiologic basis of the fact that large intestine anastomoses tend to leak more frequently than small intestine anastomoses. Single-layer interrupted silk-suture anastomoses were performed in both the distal part of the ileum and the distal part of the colon in 29 dogs. The anastomoses were resected at I-8 days and 19-31 days after operation. Collagen response, vascular response, and bursting strength at the site of anastomoses were investigated. The results demonstrated a stastically significant decrease in the collagen and vascular response of the large versus the small intestine. These studies showed that the muscularis had about ten times the concentration of collagen as that of the mucosa or serosa. Also, by using microangiography, it was demonstrated that there was better cross circulation at the small intestine anastomosis than the colonic anastomosis. The authors concluded this differential response may play a roll in the mechanism of the relatively high incidence of suture-line separation observed after colonic anastomoses.George Holcomb Enterocolitis of the Newborn and of the Pmmature Infant. 1. P. Chappuis, M.
Daudet.
April),
Ann
Chir
Infant
l&l
Lt. 17-126
Salle,
and
(March-
1975.
This paper reports 16 cases of newborn and premature infants with necrotic enterocolitis. Eleven infants weighed less than 2000 g, and in six cases a respiratory distress syndrome was found during the perinatal period. The necrotic lesions were most frequently situated in the terminal ileum, the cecum, and the ascending colon. Histologic findings showed a predominance of mucosal lesions. After a latent period of l-20 days the illness usually developed with general signs of a toxemia: shock, hyperthermia, dyspnea, and respiratory irregularities. Within the next 24 hr abdominal symptoms such as meteorism, vomiting, and diarrhea were added to the picture. Radiologic findings were intestinal distension in nine cases, intramural pneumatosis in another nine cases, pneumoperitoneum in three cases, and pneumatosis of