Arthur C. Beall

Surgical considerations of massive gastrointestinal tract hemorrhage caused by aortoduodenal fistula

Abstract Fifteen cases of primary or secondary aortogastrointestinal tract fistula, secondary to abdominal aortic aneurysms or previous aortic grafting procedures, have been seen among approximately 3,000 patients treated for various abdominal aortic lesions in the Baylor University College of Medicine Affiliated Hospitals. Two patients died without benefit of surgery. Thirteen fistulas were repaired with eleven initially successful results. Two delayed deaths occurred, one at ten days and one at four months after operation. Successful surgical repair was performed nine times in eight patients. Aortoduodenal fistulas were corrected in one patient on two separate hospital admissions nineteen months apart. The remaining patients have been asymptomatic six months to six years following operation. The diagnosis of aortogastrointestinal tract fistula should be considered in all instances of gastrointestinal tract hemorrhage, particularly in patients with previous aortic reconstructive surgery or a known abdominal aortic aneurysm. Once this diagnosis is suspected, immediate surgical therapy is mandatory. Prevention following aortic reconstructive procedures consists in the use of improved synthetic grafts, such as Dacron, and the interposition of viable tissue between the graft and the posterior wall of the duodenum.

Carotid artery injuries

One-hundred twenty-nine patients with carotid artery injuries were analyzed to compare the results of revascularization with those of ligation or occlusion. In patients who present with central neurologic deficit short of coma (Grades 1 to 4), revascularization is clearly the operative method of choice. Revascularization in patients with preoperative coma (Grade 5) is also indicated when ischemia has only been present for a short period of time before surgery. Controlling cerebral edema and minimizing infarct size in patients with severe deficits may be essential to optimize the chance of recovery of these patients.

Surgical experience with 220 acute arterial injuries in civilian practice

Abstract During the past decade 220 cases of acute arterial injuries were encountered in civilian practice. Primary repair was performed in 167 instances with restoration of peripheral pulse in 86 per cent of these cases. A graft was employed in the repair of twenty-three cases. Amputation was necessary following unsuccessful repair in eleven patients. The four basic technics employed in arterial reconstruction were lateral suture, end-to-end anastomosis, graft replacement and bypass graft. Immediate repair of all arterial wounds should be performed except under the most extenuating circumstances. Attention to minute details and fastidious technic provide the greatest opportunity for salvage of life and limb.

Diagnosis and management of abdominal trauma

Summary A review of the problem of major abdominal trauma has been presented with discussion of both general and specific problems of abdominal wounds and injury to various organs. Discussion of injuries of the urinary tract, although they occur frequently in association with abdominal trauma, has not been included. The problem of management of major vessel injuries has been discussed, as these injuries contribute greatly to the mortality rate associated with abdominal trauma. Prompt control of hemorrhage, cleansing of the peritoneal cavity, repair of all injuries to all organs and proper wound management represent the primary considerations in treatment of abdominal trauma.