John H. Garlock

Suppurative Pylephlebitis with Multiple Liver Abscesses Complicating Regional Ileitis: Review of Literature–1940-1960

THE COMBINATION of its unusual rarity, the striking clinical features and the diversified surgical implications constitutes sufficient reason to record the story of a patient with regional enteritis complicated by suppurative pyleplilebitis with multiple liver abscesses. As far as can be determined,

Ileocolostomy with exclusion for non-specific ileitis

1. A series of 40 cases of regional ileitis treated by ileo-colostomy with exclusion is reported. 2. There were no operative mortalities nor any serious post-operative complications. 3. 40 cases were available for follow-up studies. There was recession of disease in the excluded loop in 35. 4. The above five failures include two cases complicated by a large ileo-sigmoidal fistula. In this type of case the operation is ineffective and cannot be expected to offer satisfactory results. If this type of case be excluded, the ratio of unsuccessful cases is 3 out of 38. 5. Appearance of disease in proximal segments previously uninvolved occurred in 1 case. 6. Proximal extension of the disease appears to be independent of the type of operation used to treat the primary lesion. 7. The important factor in preventing such extension appears to be to carry the site of exclusion or resection sufficiently orad.

Immunocytochemical Reactions of Serum from Ulcerative Colitis Patients.

Conclusion Increased gamma globulin was demonstrated in the intestinal tract of patients with active regional ileitis and ulcerative colitis. The indirect fluorescent antibody technic revealed a gamma globulin in the serum of 3 of 25 patients with ulcerative colitis which was bound to epithelial glands of colonic mucosa and of hepatic bile ductules. Sera of normals and hospital controls did not bind to colonic mucosa.

The surgical treatment of ulcerative colitis

Summary and Conclusions The markedly improved results of the surgical treatment of nonspecific ulcerative colitis over the past 20 years have been owing largely to the elimination of ileostomy complications and a better understanding of the physiologic changes which occur after operation. Complete rehabilitation of patients after appropriate surgical procedures may be expected in the great majority of these cases. Indications for surgical therapy are usually clearly defined and have been discussed. Routine use of proctocolectomy in one stage for all cases of ulcerative colitis is to be deprecated, mainly, because this removes forever, the possibility of re‐establishment of intestinal continuity. The problem of reconnection, i.e., ileorectal anastomosis, demands serious consideration. It is extremely doubtful whether this operation should be carried out in the presence of active disease in the rectum or any rectal complications, such as fistula, anal incontinence, polyposis and stricture. There is urgent need for individualization and careful appraisal of each patient.Summary and ConclusionsThe markedly improved results of the surgical treatment of nonspecific ulcerative colitis over the past 20 years have been owing largely to the elimination of ileostomy complications and a better understanding of the physiologic changes which occur after operation. Complete rehabilitation of patients after appropriate surgical procedures may be expected in the great majority of these cases.Indications for surgical therapy are usually clearly defined and have been discussed.Routine use of proctocolectomy in one stage for all cases of ulcerative colitis is to be deprecated, mainly, because this removes forever, the possibility of re-establishment of intestinal continuity.The problem of reconnection, i.e., ileorectal anastomosis, demands serious consideration. It is extremely doubtful whether this operation should be carried out in the presence of active disease in the rectum or any rectal complications, such as fistula, anal incontinence, polyposis and stricture. There is urgent need for individualization and careful appraisal of each patient.