A study of the conservative treatment of 109 patients with penetrating neck injuries was carried out over 3 years. Patients with clinical or radiological evidence of injury to the oesophagus or trachea were included in the study while nine patients with major vascular trauma were explored immediately and excluded. Three late vascular operations were performed. The remaining 106 patients were treated conservatively. There were two deaths, both from associated injuries. The remaining 104 patients were treated successfully with only three cases of minor wound sepsis. We conclude that oesophageal and tracheal injuries after stab injuries and low velocity gunshot wounds can be treated successfully by non-operative treatment.

Amoebic perforation of bowel, the final and most serious manifestation of transmural amoebic colitis, is due to thrombotic occlusion of vessels supplying the segment of bowel with subsequent infarction and ischaemic necrosis. The ischaemic nature of the necrosis is confirmed by its shape and the demonstration of vascular thrombosis in the resected specimens of perforated amoebic colitis. Specimen angiography confirms the avascular area confined to the macroscopic lesions. Thrombotic occlusion and amoebic invasion of blood vessels have been demonstrated histologically. This new information suggests that amoebic perforation of the bowel is due to vascular compromise.

Two hundred and fifty one cases of penetrating wounds of the chest were studied prospectively. Clinical evidence is presented to show that: (1) basal intercostal drains are adequate to remove both air and fluid from within the pleural cavity; (2) frequent chest radiographs are unnecessary and intercostal drains may be removed on clinical grounds alone; (3) long term antibiotic prophylaxis is unnecessary; (4) eight per cent of those undergoing initial observation will develop a delayed haemothorax or pneumothorax of sufficient size to require drainage; (5) subcutaneous emphysema is of no prognostic significance in the symptomless patient with minimal intrapleural damage on admission; and (6) outpatient follow up is not required.Intercostal tube drainage after penetrating chest trauma not affecting the heart or great vessels has been the standard method of treatment for many years at the King Edward VIII Hospital in Durban. Several questions concerning this approach, however, remain unanswered. The use of serial chest radiographs and long term antibiotics, the outcome in those undergoing simple observation, the importance of surgical emphysema in the symptomless patient, the need for outpatient follow up, and the optimum time for drain removal are all matters on which no set guidelines have emerged. This study discusses these problems and offers a standard protocol to be followed in cases of penetrating pleural injury.

A prospective analysis is presented of a selected group of 45 consecutive patients with transmural amoebic colitis treated by laparotomy, colonic lavage and ileostomy (phase 1 surgery) over 3 years. The diagnosis of amoebic colitis and amoebic perforation of the bowel were difficult and therefore all patients with 'acute abdomen' had proctosigmoidoscopy and a trial of metronidazole for 24-48 h before laparotomy. At laparotomy, adhesive wraps were present in all patients; 13 perforations were exposed by inadvertent disturbance of adhesive wraps but were successfully closed by suture to any available organ in close proximity, such as the omentum or small bowel. Four patients (9 per cent) died after phase 1 surgery. After 6 weeks when the acute disease had healed, 33 of the remaining 41 patients (80 per cent) required closure of ileostomy only, five had resection of stricture and three (7 per cent) needed stricturoplasty (phase 2 surgery). Two patients (5 per cent) died after phase 2 surgery. Thus, in surgery for transmural amoebic colitis adhesive wraps should not be disturbed as they mechanically protect the peritoneal cavity from faecal soiling when perforation occurs. The colon should be emptied by lavage and the faecal stream diverted to avoid secondary bacterial effects.

No abstract