Search

Evaluation was made of the present condition of a girl, a boy and a woman subjected to choledochocystoduodenostomy eleven, eight and one and a half years previously. At the time of operation their ages were five and one-half, six and one-half and thirty-one years, respectively. Each patient had complained of episodes of pain in the upper part of the abdomen associated with nausea and vomiting. The boy also had had subclinical jaundice during his attacks of pain. None of the patients had a palpable abdominal mass on physical examination. During the eleven years since her operation, the girl has had no symptoms except for three brief episodes of subcostal discomfort which occurred in January, 1963 and may have been due to cholangitis. The boy, in the eight years following his operation, has also been well except for three bouts of abdominal pain, fever and elevated leukocyte count which occurred late in 1962. These may have been due to cholangitis from partial obstruction of the anastomotic opening since each bout followed ingestion of nut meats. On eliminating nut meats from his diet, he has had no further trouble. The woman has remained asymptomatic. Proximity of the common bile duct to the duodenum makes choledochocystoduodenostomy a simpler and safer operation than others that have been advocated for treatment of congenital cystic dilatation of the common bile duct. Unless it is diseased, the gallbladder is best not removed.

Thirty patients with carcinoid tumors of the ileum over a recent 10-year period have been analyzed. Seventeen patients were symptomatic and 13 others were found to have tumors incidentally at autopsy or celiotomy. Patients with symptoms almost invariably had metastatic disease, yet preoperative diagnosis was rarely achieved. Arteriography in five patients with intestinal angina demonstrated encasement, kinking, and irregularity of mesenteric branches due to nodal metastasis. In five patients, each with liver metastasis, the classic carcinoid syndrome developed. Multiple primary carcinoid tumors were found in 9 of 30 patients (30 percent); 14 had an associated second malignant neoplasm (47 percent), most frequently colorectal carcinoma. En block surgical excision was the only effective therapy. Despite a prolonged natural history, the 5-year actuarial survival rate from the date of diagnosis was only 31 percent.