Internal gall bladder fistulas with a hollow viscus following dislocation of a gallstone into the intestine represent one of the late sequelae of cholelithiasis. We report the case of a 78-year-old patient, who suffered from a cholecystogastric fistula with consecutive stone transmigration into the stomach.
Endoscopic decompression of the bowel in "toxic megacolon" is presented in two cases as an alternative procedure to Turnbull's technique using multiple bowel fistulas. In our opinion this technique seems to be a substantial improvement in the treatment of "toxic megacolon" and may even help to prevent ileotomy-colotomy in some cases.
Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.
A case of "bowenoid" leukoplakia in the anal region of a 31-year-old woman is presented to our knowledge for the first time in the literature. Clinically the lesion appeared as a "simple" leukoplakia. Although excision of the lesion was performed as histologically shown in toto, three recurrences followed. Both retinoid therapy and local treatment with 5-fluorouracil were unsuccessful, whereas radiation therapy apparently cured the patient.
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