Based on the modality of treatment, historically the management of enterocutaneous fistula has been grouped into three periods. The era of antibiotics (1945-1960), the era of intensive nurse care (1960-1970) and the era of intravenous hyperalimentation (1970-1975). Schein's modification of Sitges-Serra classification of enterocutaneous fistula is now preferred to the old classification of high-output type and low output type. A major cause of enterocutaneous fistula is technical failure. Serum level of short-turn over proteins such as albumin retinal-binding protein, thyroxin binding pre-albumin as serum transferring are predictors of mortality and spontaneous fistula closure. Immediate surgical correction of the fistula is not a priority of treatment. The control of sepsis and adequate nutrition are the two most important aspects of management. The use of somatostatin and octreotide has been shown to shorten the period of spontaneous closure of the fistula.

Background: Until recently ulcerative colitis (UC) was considered rare among Arabs. Information on its occurrence among Saudi is scant and limited to a few reports from urban populations. Aim of study: to assess the frequency and clinico-pathologic pattern of this disease in a rural population in Gizan region, Saudi Arabia. Methods: thirty three patients found to have UC over a 4-year period in King Fahad Central Hospital were analyzed retrospectively. Results: there were 24 males and nine females patients with UC (ages ranged from 17-70 years, mean age 43.5 years). The commonest presenting symptoms were abdominal pain and diarrhea in 30 and 26 patients respectively. Extra-intestinal manifestations were rare, occurred in only two patients. Total or pancolitis was found in ten (30%) patients and it was severe in nine of them. The disease extended to the splenic flexure in eight (24.2%) of the patients. A total colectomy was required in one patient with severe pan-colitis and a focus of malignancy was present in the resected specimen. No patient died during the follow-up period that ranged from one to six years. Conclusion: the study confirmed the occurrence of UC among the rural population studied. The male preponderance, the older age at presentation and relatively milder diseases appeared to be differentiating features from the pattern among western populations.

Background: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for insertion of gastrostomy tube for patients with dysphagia due neuromuscular disorders. Aim : this article highlights the role of PEG for such patients, how safe, effective than standard gastrostomy in providing long -term nutritional support for patients with dysphagic stroke. Methods: Over a four-year period (1995-1998), 27 patients had percutaneous endoscopic gastrostomy performed for neuromuscular dysphagia. A Wilson Cook (24G) gastrostomy tube was used and it was inserted with Ponsky-Gauderer pull technique. Results: All the patients tolerated the procedure well. Stroke (81%) was the most common indication for PEG. Major gastroscopic finding was found in eight patients (29%). Minor complication was seen in only three patients (11%). Conclusion PEG Feeding is safe, simple and effective procedure with no serious side effects. Patients and their relatives accept PEG better than nasogastric tube feeding. However, the ideal timing at which to institute gastrostomy feeding after dysphagic stroke is still not clear.

The aim of the study: to evaluate primary ascitic fluid infection (PAFI) among patients with chronic liver disease (CLD), to study the incidence, clinical features, laboratory findings and short term prognosis of PAFI and also to evaluate factors that may affect incidence and prognosis. . Patients and Methods: Seventy eight patients with CLD were studied between July 1996- to July 1997 in Baghdad Teaching Hospital. Results: thirteen patients developed PAFI (16.7%), no significant differences in the age or gender between the infected and the non-infected groups were found. (P>0.05). The incidence of PAFI is significantly higher among patients with Child's Pugh class C (P<0.005). Low ascitic fluid protein (<10g/L) was more common among the infected group, yet this does not reach statistical significance (P>0.05). The presenting symptoms were abdominal pain (53.8%), fever (46.2%); abdominal tenderness (38.5%), encephalopathy (30.7%), hypotension (15.3%), full triad (15.3%) and asymptomatic patients at presentation were (30.7%). Ascitic fluid culture (by conventional methods) was positive in 46%. All the culture positive samples grew Gram-negative bacilli; E. coli being the most common microorganism (50%). Among five parameters (age, positivity of ascitic fluid culture, severity of CLD, presence of encephalopathy and lack of peritoneal irritation signs), only the increased age seems to be associated with higher in-hospital mortality.