One of the most baffling and devastating conditions occurring in gastro-intestinal surgery is a duodenal fistula—baffling from the standpoint of anatomy and devastating from that of the physiology of the canal at this particular point.
Cameron 1 reported twenty-nine cases compiled from the literature, but this probably represents a small fraction of the actual occurrence. He gives the causes as (1) proteolytic action of the discharge from trypsin, a most powerful enzyme; (2) infection; (3) intraduodenal pressure, and (4) diminished resistance. With a small opening there may be spontaneous healing, but this does not usually occur. Patients may die in two or three days, death usually occurring from exhaustion, emaciation and peritonitis caused by the discharge of everything through the fistula which enters the duodenum from various sources, and the powerful digestive action of the pancreatic juice. Mayo2 reported three cases, all ending fatally. Cameron reviews the literature in
POTTER C. THE TREATMENT OF DUODENAL FISTULA: REPORT OF CASE. JAMA. 1927;88(12):899–901. doi:10.1001/jama.1927.02680380023009
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