A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene. Plain X‐ray and Gastrografm studies may kelp to elucidate the situation in particular cases, but are no substitute for repeated careful abdominal examination. It is suggested that large doses of penicillin be employed where possible in the management of these cases, in addition to such antibiotic therapy as may be expected to be effective against the usual Gram‐negative bowel flora.
Microsurgical revascularization In the neck has Improved the survival rate of free small-bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked-eye technique good results have been reported lollowing free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and In this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and lour within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In ail four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arterler were patent and two where they were not; immedlate anastomotic healing Was not guaranteed by graft survlval or arterial patency.
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