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At least 379 records · Page 21Linked to original sources
PubMed1989

Gastrointestinal disconnection and the treatment of intra-abdominal sepsis.

Current operative treatment for intra-abdominal sepsis secondary to internal gastrointestinal fistulas is aimed at wide drainage of septic foci and elimination of continued peritoneal soilage. Although methods for surgical drainage of abscesses and fistulous tracts are well established, the optimal method for surgical prevention of continued peritoneal soilage remains controversial. The authors applied the principle of complete gastrointestinal disconnection and performed diversion of the gastrointestinal tract and tube decompression proximal to the fistulous opening in the treatment of 22 critically ill patients with intra-abdominal sepsis from gastric or small bowel fistulas. Patient survival varied according to the level of the site of gastrointestinal leakage. All patients (5 out of 5) who had leakage in the distal small bowel survived. Six of nine (66%) patients with leakage from the proximal jejunum and six of eight (75%) of patients with gastroduodenal leakage survived. The overall survival rate of 77 per cent observed in this group of patients supports the authors' hypothesis that complete gastrointestinal disconnection is a valuable adjunct in the treatment of these severely ill patients.

Abdomen↗
PubMed2006

Laparoscopic transvesical urethrorectal fistula repair: a new technique.

INTRODUCTION: Urethrorectal fistulas are rare, and several open operative approaches and techniques have been used in treatment. We report our preliminary experience with laparoscopic transvesical urethrorectal fistula repair after iatrogenic urethrorectal fistula. A 65-year-old man with insulin-dependent diabetes mellitus and peripheral vascular disease was hospitalized 6 months after transurethral resection of the prostate for benign prostatic hyperplasia with a recurrent urinary tract infection, fecaluria, and urine leakage from the rectum during voiding. Urethrocystoscopy revealed a urethrorectal fistula in the prostatic fossa. Primary conservative treatment failed. TECHNICAL CONSIDERATIONS: The patient was placed in the lithotomy position, and the suprapubic tract was dilated to allow a 10-mm telescope. Carbon dioxide gas was used to distend the bladder (15 mm Hg, flow rate 3 L/min). Next, two 3-mm pediatric trocars were inserted under direct vision. The fistula was identified and the edge of the fistula excised. A running suture (3-0 PDS, RB needle) was used to close the fistula. Finally, a 16F Foley urethral catheter was passed under direct vision, followed by a suprapubic catheter. On postoperative day 12, retrograde cystography revealed no contrast leakage from the rectum. Follow-up after 3 months showed no recurrence of the fistula. CONCLUSIONS: A transvesical laparoscopic technique might be useful for selective cases of urethrorectal fistula. Other methods of laparoscopic urethrorectal fistula repair have included bivalving of the bladder and omental interposition. The laparoscopic transvesical approach provides many advantages, including easy access and identification of the fistula tract, good surgical exposure, and minimal tissue manipulation.

Aged↗
PubMed2005

Presternal gastric bypass for late postpneumonectomy esophagopleural fistula.

SUMMARY: A 71-year-old diabetic patient underwent right pneumonectomy with wide mediastinal lymph node dissection for lung cancer (right upper lobe). Postoperatively he developed pleura empyema that was successfully treated - drainage and Eloesser window, followed by adjuvant radiotherapy. Two months later he developed an esophagopleural fistula. Due to the patient's physical condition primary repair of the esophageal rupture was considered a high-risk operation. Stenting was also considered as inappropriate due to the existing contamination. Bypassing with the use of the stomach as conduit was preferred due to its simplicity compared to the colon. In order to avoid mediastinum after the postradiation alterations and because of the Eloesser window we adopted a presternal subcutaneous position. Twenty-eight months after the by pass procedure the patient is in good health being able to eat and drink, has gained weight and shows no evidence of malignancy. Presternal gastric esophageal bypass has never been reported as a treatment for esophagopleural fistula. This case report indicates its possible successful use in this debilitating setting, although more experience is needed.

Aged↗
PubMed2003

Congenital bronchobiliary fistula: MRI appearance.

Congenital bronchobiliary fistula (CBBF) is a rare anomaly. Twenty-three cases have been reported since the anomaly was first described in 1952. Most of these cases were diagnosed by bronchoscopy, cholangiography, or hepatobiliary nuclear imaging. Our case of a newborn with bilious emesis with CBBF was depicted by T1-weighted gradient-echo MRI sequences.

Bile Duct Diseases↗
PubMed2000

Endoscopic biliary stenting for treatment of persistent biliary fistula after blunt hepatic injury.

BACKGROUND: Surgical treatment for persistent biliary fistula after blunt hepatic injury is often technically difficult. Endoscopic treatment for such fistulas has been described only infrequently. METHODS: We reviewed 6 patients who underwent endoscopic biliary stent placement with (n = 1) or without (n = 5) sphincterotomy for persistent (12 to 138 days; mean 48 days) biliary fistula after blunt hepatic injury. RESULTS: ERCP showed bile leakage from a second-order or more peripheral branch of the intrahepatic bile ducts in 5 patients but failed to reveal the fistula in 1. Stent placement was successful without complications in all patients. Bile leakage resolved within 1 to 3 days in 5 patients. After 36 to 86 days, the stent was removed and ERCP confirmed disappearance of the fistula. These patients have remained asymptomatic for a mean of 2.6 years since stent removal. In the patient in whom ERCP had not shown a fistula, bile leakage continued despite successful stent placement. CONCLUSIONS: Endoscopic biliary stent placement is a rapid, safe and effective treatment for persistent post-traumatic biliary fistula demonstrated by ERCP.

Adult↗
PubMed2003

An endoscopic approach to the management of surgical bile duct injuries: nine years' experience.

BACKGROUND: The evaluation of the endoscopic treatment of surgical bile duct injuries, especially in the management of post-operative strictures, remains controversial. AIM: The aim of this study was to evaluate the feasibility of using endoscopic management from a study of the clinical reports of two of the main endoscopy units in Sicily. PATIENTS AND METHODS: A total of 137 consecutive patients were selected. There were 85 simple biliary fistulas: 64 from the cystic duct stump; 19 from the gall bladder bed; and two from intra-hepatic bile ducts. There were 52 biliary lesions: 15 complete transections; 12 incomplete lesions of the common bile duct with six associated strictures; five complete or incomplete sections of the right antero-medial duct; and 20 incomplete strictures (without leak). RESULTS: The success rate was 96.3% for simple biliary fistulas. Endoscopic therapy was feasible only in 40.6% of lesions of the common bile duct or the right antero-medial duct (13/32), but with 100% success. In the case of strictures (with or without associated leak), there was a good outcome in 88.2% of patients who completed the therapeutic procedure. CONCLUSIONS: Endoscopic management of simple biliary fistulas and incomplete lesions of the common bile duct is the preferred approach. If continued for 12-24 months, with the placement of three or more 10F stents, the management of stenoses is guaranteed to yield good results.

Adolescent↗
PubMed2003

Esophagogastric varices due to arterioportal shunt in a serous cystadenoma of the pancreas in von Hippel-Lindau disease.

Von Hippel-Lindau (VHL) disease is an autosomal dominant inherited disorder characterized by extensively vascularized tumors and cysts in specific organs. Angiogenesis is a striking future of VHL disease with its characteristic cysts and well-vascularized tumors. The hypervascular nature of VHL lesions has been linked to the overproduciton of vascular endothelial growth factor (VEGF) through increased expression of hypoxia inducible factor-1alpha (HIF-1alpha). Here we describe a rare case of VHL disease with esophageal and gastric varices due to arterioportal shunt in a serous cystadenoma of the pancreas, which, upon immunohistochemical examination, exhibited HIF-1alpha and VEGF expression. Rupture of esophageal varices was successfully treated with endoscopic injection sclerotherapy.

Angiography↗
PubMed2002

Complicated diverticulosis.

"Uncomplicated" diverticulitis can be prevented from progressing into "complicated" diverticulitis by early diagnosis and active medical treatment. Complicated diverticulitis develops from a peridiverticular abscess, to a perforation with peritonitis, to fistulation into adjacent viscera, to luminal narrowing by inflammation or stricture formation causing obstruction. Computer tomography (CT) scanning is the diagnostic imaging modality when diverticulitis is suspected and allows percutaneous drainage of peridiverticular abscesses that will enhance the effect of antibiotic therapy with resolution of the acute episode in 75% of patients. Thus, an emergent or urgent operation is converted to an elective operation and a two-stage operative procedure, namely a temporary stoma and a second operation, is avoided. Interventional surgery is urgent for perforation and obstruction. While a Hartmann's resection and temporary colostomy has been the favoured operative procedure, under favourable conditions resection with primary anastomosis is preferable. Although a temporary stoma may be required with primary anastomosis, and hence the procedure is a two-stage one similar to a Hartmann's, the closure of the stoma is less demanding and has a lower morbidity. A single-stage resection and anastomosis is the standard elective treatment for symptomatic fistulas and strictures.

Digestive System Surgical Procedures↗
PubMedDate not supplied

Hydatid disease of the liver in children: evaluation of surgical treatment.

The medical records of 55 paediatric patients with hepatic hydatidosis, who were treated between 1990 and 2001 at Atatürk University, Turkey, were reviewed retrospectively. The most common symptoms at presentation were abdominal mass (32.7% of cases) and pain (81.8% of cases) in the right upper quadrant of the abdomen. Cysts were found in the right lobe in 41 patients, in the left lobe in four patients and in both lobes in 10 patients. Multiple hepatic cysts were present in 12 cases and eight patients also had cysts in other organs. Surgical procedures were evacuation of the cyst and management of the cavity with tube drainage, capitonnage, omentoplasty, cystectomy or segmentectomy. Long-lasting biliary fistula (two patients) and cholangitis (two patients) developed following evacuation and tube drainage, and one patient developed cholangitis after capitonnage. This review suggests that omentoplasty and capitonnage are more effective than tube drainage in the management of the cyst cavity.

Adolescent↗