[An antro-bulbar fistula (double pylorus)].
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A case of a 61-year-old patient is reported who underwent laparotomy for presumptive torsion of an ovarian tumor. The acute abdominal symptoms were caused by a fish bone which had perforated the omentum. Bilateral ovarian cystadenofibromas were present, yet torsion had not occurred; they were exstirpated. In addition, a case of a 70-year-old patient is presented who underwent relaparotomy for a cervicosigmoidal fistula. The fistula contained a poultry rib. Complete healing was observed after removal of the bone and suturing of the cervical sigmoidal defects.
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Lysozyme is present in the salivary secretions and a low level has been reported for the bile and the pancreatic juice. It has been found to be absent from the digestive material of the rabbit stomach and small and large intestines as well as from the intestinal secretions taken from temporary fistulae placed at the duodenal, jejunal, ileal and colic levels. However, secretions obtained by permanent intestinal and gastric fistulae showed high enzyme levels. Lysozyme is thus of probable plasmatic origin. The question of Paneth cell secretion is still to be determined.
BACKGROUND: Three models of covered metal stents are available to seal esophageal fistulas. METHODS: Stainless steel covered stents were inserted in 5 patients (group I); nitinol covered stents were inserted in 12 patients (group II) with malignant (n = 14) or benign (n = 3) esophageal fistulas. RESULTS: Stent positioning was satisfactory in all cases. Fistula sealing was complete in 1 of 5 (20%) and 12 of 12 (100%) patients of groups I and II, respectively (p < 0.005). Continued esophageal leakage was initially related to the passage of fluids alongside the stent covering (n = 3) and to early stent migration (n = 1). Complications related to stent placement were observed in 2 of 17 (12%) patients and were fatal. During follow-up (mean 153 +/- 143 days), esophageal fistulas relapsed after initial sealing in 5 of 13 (38%) patients. Further treatment (glue or fibrin sealant injection, additional stent insertion) was attempted in 7 cases of persistent or relapsing esophageal fistula, with sealing obtained in 5 of them. The costs per patient and per day free from symptoms due to the esophageal fistula were $106 and $57 in groups I and II, respectively. CONCLUSION: Nitinol covered stents more frequently provided complete esophageal fistula sealing, as compared with stainless steel covered stents. Further treatments tailored to the mechanisms of fistula persistence or relapse often provided sealing.
The author approaches about historical aspects, concepts, etiology and treatment of digestive fistula. The skin care and drainage control are the basis of stomal therapy. So, the author discusses the specific nursing and ET care in this subject, including evaluation, procedures and resources.
An aneurysma of the distal thoracic aorta developed in an 65 year old man. Several weeks later, the man was admitted to hospital because of upper gastrointestinal bleeding. The diagnosis of an aortoesophageal fistula was made not until several endoscopic investigations. The patient died from a major bleeding soon after. The aneurysm proved to be an aneurysma spurium.
Twenty-five patients with epiphrenica diverticula were studied to clarify the mechanism for esophageal regurgitation and to evaluate methods of treatment. Esophagogastroduodenoscopy, esophageal motility, and cineradiographic studies were performed. With probes in the tubular esophagus and diverticula of two patients, motility and cineradiographic studies were performed simultaneously to correlate symptoms and pressure changes with movement of diverticular and esophageal contents. Nineteen patients were operated, and six relatively asymptomatic patients were not. There was no operative mortality, and the one esophageal fistula that occurred healed spontaneously. Results were excellent or good in 10 operated patients followed long term after resection or imbrication of the diverticula. Eight patients did not undergo myotomy. Results in four of these patients followed long term were excellent. Retrograde movement of diverticular contents into the esophagus depends on pouch volume and a pressure gradient between the pouch and the tubular esophagus after an esophageal contraction wave in the tubular esophagus has dissipated. The height of esophageal reflux and resulting symptoms depend on these factors and the lower esophageal sphincter pressure (LESP). Asymptomatic patients with an epiphrenic diverticulum do not require operation. Resection or imbrication of a diverticulum are the operative methods of treatment. We prefer the abdominal approach when this is possible. Myotomy in contraindicated when gastroesophageal reflux exists or the LESP is below normal.
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We report a 67-year-old man with highly symptomatic polycystic liver disease. Fenestration was selected to treat symptoms because the cysts were scattered diffusely and the normal liver volume was limited. Although this patient was relieved from symptoms of liver cysts consequently, several severe postoperative complications including disseminated intravascular coagulation, respiratory failure, liver failure, and biliary leakage occurred resulting in a 6-month postoperative hospital stay. Although various treatments for symptomatic adult polycystic liver disease have been advocated, a definitive treatment remains controversial, especially in diffuse adult polycystic liver disease. Fenestration is one of the alternative treatments for the patients whose cysts are difficult to resect. However high morbidity rate should be carefully assessed, if extensive fenestration is needed to treat diffuse adult polycystic liver disease. Further consideration of appropriate treatments for diffuse adult polycystic liver disease is needed.
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