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Diseases of the digestive tract 

The digestive tract diseases most frequently treated at the specific care HELIOS Hospital Emil Von Behring are intestinal cancer, gall bladder, pancreatic, colorectal and esophagus diseases as well as inguinal, umbilical and abdominal hernias. These diseases are predominantly treated operatively. Interdisciplinary collaboration of Internal Medicine (Gastroenterology) and Visceral Surgery is a key factor in the diagnosis and treatment of disorders of the digestive tract.

The Diseases
Intestinal Cancer (Colorectal Carcinoma)

Intestinal cancer is one of the most common cancers in the western world.

6,906 patients with malignant gastrointestinal diseases were treated at the HELIOS hospitals in 2005. In contrast to lung cancer, for instance, intestinal cancer can be prevented through early removal of (still) benign polyps or completely healed through early detection. In addition to dietary habits, genetic factors also contribute to the onset of intestinal cancer. The dangerous thing about intestinal cancer is that it often grows and gets bigger in the intestine for years without causing symptoms. The first signs can also be confused with other harmless diseases. As the chances of recovery crucially depend on a malign tumor being detected as early as possible, precautionary examinations are particularly important with intestinal cancer. Complaints in the gastrointestinal area, such as frequent constipation, cramps or recurrent diarrhea, should always be discussed with a doctor.

Diseases of the Gallbladder and Bile Ducts

Gallstones (cholelithiasis) are very widespread. However, they only lead to gallstone complaints in around one fifth of gallstone carriers. If no symptoms are presented, an operation is generally not required. However, if symptoms arise such as lasting or repeated pain in the right upper abdomen, a pulling or abdominal fullness or colic in the upper abdomen spreading into the right shoulder and right arm, removal of the gallbladder is advisable. This can avoid complications such as migration of a gallstone into the gall duct, jaundice due to occlusion of the bile ducts if a stone is caught up in the gall duct with pancreatic inflammation, severe feverish, pyogenic inflammations of the gallbladder and, in rare cases, malignant degeneration. Removal of the gallbladder in good time can therefore prevent serious secondary diseases.

Diseases of the Pancreas

Pancreatic inflammation can occur acutely or progress chronically and recurrently over several years. In any case, it is a serious disease that needs immediate medical treatment. Typical symptoms of acute pancreatitis are severe stomach pains, cramps, nausea, fever and feeling very ill. Yellowing of the eyes and skin can also occur. Chronic pancreatitis usually causes fewer complaints. Often, sufferers first show food intolerance, particularly to fatty meals, and weight loss. In general, pancreatitis is cured with appropriate treatment. However, in rare severe cases it can be fatal. 1,077 patients with acute pancreatitis were treated in the HELIOS hospitals in 2005; 2.1% of these patients required a pancreas operation.

Cancer of the pancreas is rare, but very dangerous due to the often late diagnosis. The HELIOS hospitals treated 1,067 patients. 52 pancreasectomies due to cancer were carried out.

Inguinal, Umbilical and Abdominal Hernias

With hernias, gaps form in skin or muscle tissue. Parts of entrails, for example small intestine, less frequently abdominal organs, can emerge through these.

An abdominal hernia is defined as a sac-like protuberance of the peritoneum (hernial sac) through a gap in the abdominal wall (hernial orifice). Sections of entrails (hernial content) can emerge and get caught in this hernial sac. A hernia cannot be healed spontaneously. It can only be rectified by an operation.

The most common type of hernia is an inguinal hernia. The hernial sac emerges through the inguinal channel, a congenital passage of the spermatic cord through the abdominal wall or, alongside this, through the abdominal wall. Abdominal hernias rarely occur in women. Most inguinal hernias are harmless, but severe complications can occur due to constriction or blockage of the intestines, necessitating emergency surgery.

The other abdominal hernias follow other weak points of the abdominal wall structure. These weak points are on the umbilicus (umbilical hernia) and at the points of the abdominal wall where no muscles reinforce the abdominal wall structure, e.g. in the midline. Umbilical hernias that arise at the "scar" weak point after abdominal operations are particularly significant.

Typical symptoms of hernias are protrusions, especially when standing and stretching, that can be pushed back into the stomach. In the case of an incarceration, there is a severe pain in the abdominal cavity as well as an occasional pressure pain of the hernia; it can no longer be pushed back into the stomach; the symptoms of an intestinal obstruction can frequently be detected.

4,867 hernia patients were operated on at the HELIOS hospitals in 2005.

Other Diseases of the Digestive Organs

The other diseases are mostly those of the liver, which are not described in further detail here.

Diagnosis and Therapy
Diagnosis

The following diagnosis options are available at our hospital:

• Endoscopies: Stomach examination (gastroscopy), intestinal examination (colonoscopy), rectum examination (rectoscopy) with biopsies (tissue extraction for histological examination)
• ERCP (endoscopic retrograde cholangiopancreatography)
• Capsule video endoscopy
• Examination for occult blood as intestinal cancer screening
• Computer tomography
• Spiral computer tomography with colonography
• Magnetic resonance tomography
• X-rays, with contrast agent if applicable
• Abdominal sonography (ultrasound examination)
• Skeletal scintigraphy
• Laboratory examination

Therapy

We offer the following options for treating the diagnosed clinical pictures:

• All usual operating techniques
• Minimally invasive operations (keyhole operation)
• Chemotherapy with intestinal cancer
• Combined radiotherapy and chemotherapy for cancer
• Stent insertion into the esophagus (esophagus stent)
• Open hernia operations
• Keyhole hernia operations (minimally invasive).
• Gallbladder removal using the keyhole technique if possible (minimally invasive), otherwise open
• Operation to remove pancreatic tissue (pancreatic resection)
• ERCP, if applicable with expansion of the mouth of the bile duct systems through an incision (papillotomy), endoscopic removal of the gallstones if possible
• Insertion of a stent into the bile ducts
• Removal of liver metastases (by cryotherapy, radiofrequency ablation, alcohol ablation, laser therapy)