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HAN C. KUIJPERS, MD, PHD; WALTER MASTBOOM, MD; THEO WOBBES, MD, PHD; FRANS SCHOOTS, MD
Nijmegen, the Netherlands

Arch Surg. 1990;125(11):1517.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.—Dr Schein disagrees with our supposition that the occurrence of nontraumatic small-bowel perforations during open treatment for intra-abdominal sepsis has not been described so far and states that it is a well-known and documented entity.

Intestinal perforations and fistulizations are indeed common complications in patients treated for intra-abdominal sepsis, but there are obvious causes for fistulization in all cases reported in the literature, such as abdominal reentry damage, anastomotic breakdown, or abdominal-wall dehiscence.

Dr Schein cites several references to support his argument but, again, all these cases had obvious causes. The article by Sitges-Serra et al deals with 87 fistulas, all secondary to either anastomotic breakdown, direct trauma to the small bowel, or small-bowel inflammation. In the article by Levy et al, causes for fistulization were anastomotic dehiscence (52%), small-bowel trauma (41%), abdominal-wall necrosis (1.7%), and a combination of these factors (5.3%). Schein's own group¹ described a . . . [Full Text PDF of this Article]

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