A series of 75 patients with 87 postoperative enterocutaneous fistulas (PEF) is reported. All received parenteral nutrition after the diagnosis of PEF was made. There were 16 deaths (21.3 per cent) and 62 fistulas (71.2 per cent) closed spontaneously. A classification of PEF is proposed according to the results obtained. The therapeutic approach cannot be uniform in all types of PEF. We feel that parenteral nutrition has substantially improved the prognosis of fistulous patients by increasing the rate of spontaneous closure and improving the nutritional status of patients needing repeated operations. Comparison between series of patients to establish the usefulness of parenteral nutrition is bound to yield inconclusive data due to marked differences in patient populations. We suggest that proper information be obtained by studying series of homogeneous patients, namely those who develop oesophageal, gastric or intestinal fistulas after surgery.
Colonic perforation is the second most common complication of colonic neoplasms and is associated with an elevated morbidity and mortality. We undertook a two-centre retrospective analysis of 378 colonic neoplasms seen from 1978 to 1985. Thirty-six patients (9.5%) presented with a perforated colonic carcinoma. Two-thirds had a past history suggesting colonic disease while in the remaining one-third, the perforation was the first manifestation of the disease. Resection was carried out initially in 33 cases (21 Hartmann's procedure, 9 primary anastomosis, 2 mucous fistula and 1 abdominoperineal excision). Two patients had a proximal colostomy only and 1 an exploratory laparotomy only because of disseminated disease. Postoperative mortality was 14% (five cases). Actuarial survival rate was 52% at 1 year and 40% at 2 years. Eleven patients are still alive after a mean follow-up of 43 months.
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