PROCEDURES FOLLOWING NEPHRECTOMY

1. THE TRANSPERITONEAL CLOSURE OF DUODENAL FISTULAS FOLLOWING NEPHRECTOMY  Injuries to the third portion of the duodenum may occur during right nephrectomy. In a previous communication I¹ reported three such cases. The injury is most apt to occur in the attempt to secure the pedicle for the purpose of ligation, and is especially liable to happen when the pedicle i s greatly infiltrated with inflammatory products and fixed in close relationship with the duodenum. Under such circumstances, the vascular pedicle of the kidney may slip from the retaining forceps or ligature during attempts at ligation. Efforts to grasp with toothed forceps the bleeding vessels in the bottom of the wound may result in the duodenal injury. The perforation follows after some days due to necrosis of the devitalized portion of the duodenum. All the patients reported on in my first communication died within three weeks from the date of