PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Digestive System Fistula”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2003

Multivariate analysis suggests improved perioperative outcome in Crohn's disease patients receiving immunomodulator therapy after segmental resection and/or strictureplasty.

BACKGROUND: Medical management of moderate to severe Crohn's disease (CD) using immunomodulator agents has not eliminated surgical treatment of disease complications. The effect of improved medical treatment on perioperative CD surgical outcome is not known. We analyzed the impact of immunomodulator therapy on the rate of intraabdominal septic complications (IASC) in CD patients undergoing bowel reanastomosis or strictureplasty. METHODS: Surgical outcome was reviewed in 100 consecutive CD patients who underwent segmental resection with primary anastomosis or strictureplasty between 1998 and 2002. Multivariate analysis was performed to determine the effect of immunomodulator therapy on rate of IASC (intraabdominal abscess, anastomotic leak, or enterocutaneous fistulae). Immunomodulator agents included azathioprine, 6-MP, methotrexate, and infliximab. RESULTS: IASC developed in 11 of 100 (11%) operations. Immunomodulator use was associated with fewer IASC (4/72 procedures; 5.6%), compared with 7/28 (25%) cases with patients not on therapy (P<.01). IASC were not influenced by steroid use, smoking status, preoperative abscess, or fistula or albumin levels. Immunomodulator use did not affect the length of resection or the rate and number of strictureplasties. CONCLUSION: Medical management with immunomodulator therapy is safe and significantly decreases postoperative IASC in CD patients undergoing surgical procedures requiring bowel anastomosis or strictureplasty.

Abdominal Abscess↗
PubMed2003

V-Y advancement flap for treatment of fistula-in-ano.

PURPOSE: The management of high fistula-in-ano presents a difficult surgical challenge. Laying open of high transsphincteric, intersphincteric, and suprasphincteric fistulas is associated with incontinence. Mucosal advancement flap can be technically difficult and is associated with ectropion and incontinence. We report a new technique for the treatment of fistulas, which may eliminate these problems. PATIENTS AND METHODS: Between 1997 and 2002, 18 patients (13 males), median age 46 (range, 25-64) years with high fistula-in-ano were treated. There were ten transsphincteric, four intersphincteric, and four suprasphincteric fistulas. In all patients, perianal sepsis was allowed to resolve completely with a drainage seton before definitive surgery. The surgical technique used involved core fistulectomy, curettage of any cavity, closure of the defect in the internal anal sphincter, and a V-Y advancement buttock flap to cover the internal opening, leaving the site of the external opening for drainage while preserving both internal and external sphincters. Outcome was assessed in terms of healing and continence. RESULTS: Most patients were discharged from the hospital within 48 hours. Median follow-up was 19 (range, 3-60) months. There were three patients who failed to heal. Of these, two underwent repeat surgery and healed. Two further patients had recurrent fistulas, both of whom continued with conservative treatment. Overall, 15 of 18 (83 percent) patients experienced healing of their fistula. Continence was preserved in all patients. CONCLUSION: This procedure is easy to perform, healing is rapid, and it appears to be effective in curing fistula-in-ano while preserving both external and internal anal sphincters.

Adult↗
PubMed2005

[Method of the surgical treatment of nonspeciphic extrasphincteric rectal fistula].

The method of treatment of nonspeciphic extrasphincteric rectal fistula was proposed, which consists of the fistula channel excision en bloc with external and internal (the anal sinus, which bears the fistula) apertures on perineum, subsequent layer by layer restoration of the rectal wall, as well as the sphincters and the anal levators muscles integrity (if necessary) and the formed cavity drainage. The operation was performed in 25 patients. Its performance have guaranteed the recurrences rate lowering as well as the postoperative incontinence occurrence.

Digestive System Surgical Procedures↗
PubMed2006

Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy.

BACKGROUND AND OBJECTIVE: Pancreatic fistula is a common complication of distal pancreatectomy (DP). Although various surgical procedures have been proposed for DP in an attempt to decrease the high incidence of pancreatic fistula, the prevention of pancreatic fistula remains a major problem in DP. Endoscopic pancreatic stenting for the treatment or prophylaxis of such a fistula has been rarely described. METHODS: We reviewed 9 patients who underwent preoperative endoscopic pancreatic stenting for the prophylaxis of pancreatic fistula development after DP. RESULTS: Preoperative endoscopic pancreatic stenting was successfully performed with a 7F stent in all the 9 patients. Two patients, both with intraductal papillary mucinous tumor, developed mild acute pancreatitis after the stent placement. None of the 9 patients developed pancreatic fistula. The pancreatic stent was removed from 8 to 28 days (mean 11 days) postoperatively. CONCLUSIONS: Preoperative endoscopic pancreatic stenting may be an effective prophylactic measure against pancreatic fistula development following DP in selected patients.

Adenocarcinoma, Mucinous↗
PubMed2004

Rectovaginal septal repair: case presentations and introduction of a modified reconstruction technique.

Rectovaginal fistula are a relatively rare kind of anorectal fistulas. Spontaneous healing is rare and the rectal advancement flap repair is the most popular procedure with success rates ranging between 60% and 80%. We present a new technique for repairing damage in the rectovaginal septum that consists of placing a folded polyglycolic acid mesh (Dexon) between the levator ani muscle closure area and the vaginal wall. This absorbable mesh separates the suture lines on the vaginal and rectal walls, and induces fibrosis and healing. The technique was performed in four women suffering from a rectovaginal fistula due to different causes. It was successful in all cases.

Adult↗
PubMed1952

Gastroduodenostomy after gastric resection.

Gastroduodenostomy after gastric resection is a procedure which can be readily performed if the short gastric vessels are first divided. It makes for a more physiological restoration of the gastrointestinal tract than is accomplished with gastrojejunostomy and permits proper admixture of the food with the bile and pancreatic enzymes. It avoids several potential dangers such as leakage from the duodenal stump, the possibility of a gastrocolic fistula, and malfunction of the anastomosis due to distortion of a jejunal loop. Apparently the "dumping syndrome" does not occur after gastroduodenostomy as it sometimes does after gastrojejunostomy.

Bile↗
PubMed2002

Anorectal abscess fistula: what do we know?

Anorectal abscess and fistula are intimately connected in anatomy, etiology, and morbidity. They have been extensively described, but only sparingly studied in randomized controlled trials. These trials, covering such issues as primary suture of abscess, whether or not to perform a fistulotomy at the time of abscess drainage, and comparison of fistulotomy and fistulectomy, are the focus of this article. Important gaps in our knowledge and subjects for new trials are also discussed.

Abscess↗
PubMed2004

A comparison of two surgical strategies for the emergency treatment of gallstone ileus.

INTRODUCTION: Debate currently exists regarding the appropriate surgical strategy for emergency treatment of gallstone ileus. This relates to the need for definitive biliary tract surgery after relief of mechanical obstruction. Our study reviews treatment by enterolithotomy alone and enterolithotomy combined with definitive biliary tract surgery and fistula closure to determine if there is advantage of one treatment option over the other. METHODS: The clinical, operative and follow-up data on 19 consecutive patients treated by emergency surgery for gallstone ileus from January 1992 to December 2000 was retrospectively reviewed. RESULTS: There were 15 women and four men, with a mean age of 74.6 (range 62-91) years. Pre-operative diagnosis was made in only nine of 19 patients. Enterolithotomy alone (E group) was performed in seven patients and enterolithotomy with cholecystectomy and fistula closure (E+C group) in 12 patients. In the E group, more patients had significant co-morbidity as identified by poorer American Society of Anesthesiologists (ASA) status, poorer pre-operative status (shock at presentation) than in the E+C group. Operative time was significantly shorter in the E group. However, there were no significant differences in morbidity, and both groups had zero mortality. CONCLUSION: Both procedures can be carried out safely and with zero mortality. Relief of obstruction remains the mainstay of treatment. The better surgical option in our series is enterolithotomy alone. It is safe in both low and high-risk patients, and requires a shorter operating time as it is technically less demanding. In the longer term, the remnant fistula also does not appear to lead to further complications.

Aged↗
PubMed2005

[Indications and contraindications to extraperitoneal closing external intestinal fistulas].

Prognostic factors of recurrent external intestinal fistulas after extraperitoneal closing them were studied in 74 patients operated on in the Sverdlovsk region clinical hospital N1 in 1990-2004. There were no lethal outcomes. Good results were noted in 40 out of 74 (54.05%) patients. Postoperative complications developed in 34 (45.95%) patients, including 21 (28.38%) recurrent intestinal fistulas. Using the methods of mathematical analysis it was found that the recurrent intestinal fistulas resulted from persisting inflammatory alterations in the tissues of the peritoneal and intestinal walls and also from appearing due to operation mechanical injuries of patency of the intestine canal in the places of suturing the fistulas or the initial ones - in the abducent parts of the intestine. The indications and contraindications are proposed concerning the using, rational technical means of extraperitoneal closing the external intestinal fistulas.

Adolescent↗
PubMed1978

Visualization of the intestinal tract by amniography in a fetus with esophageal atresia.

In pregnancies complicated by hydramnios, amniography can be used for the detection of fetal gastrointestinal obstruction. A case is presented in which the appearance of contrast material in the fetal gastrointestinal tract was noted in an infant who proved to have esophageal atresia and tracheoesophageal fistula. Presumably, the contrast reached the intestinal tract by aspiration and passage through the fistula.

Adult↗
PubMed2004

The use of synthetic vascular prosthesis in the surgical treatment of secondary aorto-duodenal fistulas.

In this paper the methods with synthetic vascular prosthesis used in surgical treatment of the secondary aorto-intestinal fistula are presented. 10 cases of 22 patients treated in the years 1993-2003 for secondary aorto-intestinal fistulas as a complication of vascular prosthesis infection are analysed. In all patients the abdominal CT, scintigraphy with technetium 99m labeled leucocytes and endoscopy were performed. The patients underwent the operation of infected dacron prosthesis' replacement with silver/collagen coated prosthesis or extraanatomic bypass (subclavian to femoral). To close the intestinal fistula the duodenectomy with gastroenterostomy was performed or the duodenum was sutured and protected with the use of pedicled omentum. In 4 patients extraanatomic subclavian-femoral of polytetrafluoroethylene (PTFE) bypass was used. In these cases the intestinal surgery was composed of the partial duodenectomy with fistula excision and duodenal stumps formation followed by antecolic gastrojejunostomy with the Braun's enteroanastomosis and pyloroplasty. In this group 2 patients (50%) died in the follow up period. There were two extraanatomic bypass thromboses in the 30 days follow up and one amputation (25%). The infected vascular prosthesis was replaced with silver/collagen coated prosthesis in the 6 patients. In these cases duodenal fistula was closed with two layers of stitches and additionally protected with pedicled fragment of the greater omentum, which was sewn on the duodenum. In this group 1 patients (16.7%) died in the follow up period. In one case (16.7%) in 9 months after operation reinfection od silver prosthesis was observed. There were no significative differences (p = 0.45) in terms of early mortality between both group of patients. The treatment of the fistula is a difficult and hazardous surgical procedure, results of which are unpredictable.

Adult↗
PubMed1980

[Malabsorption from the surgical viewpoint].

Malabsorption following surgical procedures on the GI-tract happens only in rare cases, such as blindloop-syndrome, short gut-syndrome, internal fistulae and dumping syndrome after partial gastric resection. Pathophysiological background and therapeutical possibilities as well as parenteral nutrition are discussed in detail.

Avitaminosis↗
PubMed2003

Free perforation in Crohn's disease.

BACKGROUND: Free bowel perforation is one of the indications for emergency surgery in Crohn's disease. It is generally accepted that 1-3% of patients with Crohn's disease will present with a free perforation initially or eventually in their disease course. OBJECTIVES: To evaluate the incidence and treatment results of free perforation in patients with Crohn's disease and, based on our experience, to suggest recommendations. METHODS: Between 1987 and 1996, 160 patients with Crohn's disease were treated in our department and were followed for a mean period of 5 years. RESULTS: Of the 83 patients (52%) requiring surgical intervention, 13 (15.6%) were operated due to free perforation. The mean age of the perforated CD was 33 +/- 12 years and the mean duration of symptoms prior to surgery was 6 years. The location of the free perforation was the terminal ileum in 10 patients, the mid-ileum in 2 patients, and the left colon in 1 patient. Surgical treatment included 10 ileocecectomies, 2 segmental resections of small bowel, and resection of left colon with transverse colostomy and mucus fistula in one patient. There was no operative mortality. Postoperative hospital stay was 21 +/- 12 days (range 8-55 days). All patients were followed for 10-120 months (mean 58.0 +/- 36.7). Six patients (42%) required a second operation during the follow-up period. CONCLUSION: The incidence of free perforation in Crohn's disease in our experience was 15.6%. We raise the question whether surgery should be offered earlier to Crohn's disease patients in order to lower the incidence of free perforation.

Adolescent↗
PubMed2005

Diagnosis and treatment of a patient with gallstone ileus.

BACKGROUND: A 79-year-old white woman presented with upper abdominal pain. She had a history of rheumatoid arthritis since she was 19 years old, which was treated with prednisolone, leflunomide, diclofenac and pantoprazole. She also had factor VII deficiency. The patient had been hospitalized 2 months previously with sepsis presumed to be due to urinary infection, and was treated with antibiotics. Sonography at this time revealed a gallbladder with a monstrous thick wall and stones, and the first differential diagnosis was cholecystitis. Cholecystectomy was planned after amelioration of the patient's general state, but her general state worsened. INVESTIGATIONS: Sonography, endoscopy of the upper and lower intestine, and CT scan. DIAGNOSIS: Biliodigestive fistula and gallstone ileus. MANAGEMENT: Enterolithotomy, stenting, endoscopic retrograde cholangiopancreatography, and surgery.

Aged↗
PubMed2006

Interventional pancreaticojejunostomy after pancreatoduodenectomy.

BACKGROUND: Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy (PD) is closely associated with intra-abdominal hemorrhage with ensuing high mortality. METHODS: Interventional pancreaticojejunostomy was performed in 10 patients with external drainage of pancreatic juice after two-staged PD or leakage from pancreaticojejunostomy after PD. The jejunum was punctured using a 22-gauge needle into the pancreatic fistula during endoscopic observation of the jejunal lumen, followed by the insertion of two 0.35-inch guide-wires into the jejunum and pancreatic fistula. Finally, a stenting tube was placed between the jejunum and pancreatic fistula. RESULTS: No severe complications developed. Oral intake was instituted the following day in 8 of 10 patients, and on the 7th day in the remaining two patients. CONCLUSION: This interventional procedure is considered to be safe and easy to perform, and in the future, it may permit a reduction in the number of second laparotomies in pancreatic fistula.

Aged↗
PubMed2005

Perianal Crohn disease: predictors of need for permanent diversion.

OBJECTIVE: Fissures, fistulas, abscesses, and anal canal stenosis are manifestations of perianal Crohn disease (CD). There are no known predictors of which patients will fail sphincter-sparing surgical therapy and ultimately require fecal diversion. METHODS: Of 356 consecutive patients with CD, 24% (86) had perianal CD (age range, 14-83 years), and women were slightly more frequently affected. Clinical variables were examined for factors predictive of the need for permanent fecal diversion. RESULTS: CD associated with perianal CD was limited to the small bowel and/or ileocolic area in 23% of patients; the remainder had colorectal CD. Eighty-six patients underwent 344 operations. Forty-two patients (49%) ultimately required permanent diversion; among them were 21 of 32 patients (66%) with anal stricture and 12 of 20 women (60%) with rectovaginal fistula. Univariate analyses of clinical variables were performed with respect to need for permanent fecal diversion. Significant univariate predictors were the presence of colonic CD (P = 0.0045, odds ratio [OR] 5.4), avoidance of ileocolic resection (P = 0.0147, OR 0.4), and the presence of an anal stricture (P = 0.0165, OR 3.0). In multivariate logistic regression, the presence of colonic disease and anal canal stricture were predictors of permanent diversion. The OR associated with the risk of permanent diversion in the presence of colonic disease and in the absence of anal stricture was 10 (P = 0.0345). In the presence of both colonic disease and anal canal stenosis, the OR associated with permanent stoma was 33 (P = 0.0023). CONCLUSIONS: The management of perianal CD continues to be challenging. Roughly half of patients required permanent fecal diversion, which was even more frequently true for patients with colonic CD and anal stenosis. Recognizing these tendencies will assist both patients and surgeons in planning optimal treatment.

Abscess↗
PubMed1986

Possible Waardenburg syndrome with gastrointestinal anomalies.

We describe a patient with possible Waardenburg syndrome associated with anal atresia and oesophageal atresia with tracheooesophageal fistula. Three other published cases with atretic gastrointestinal anomalies associated with the Waardenburg syndrome are reviewed. We conclude that the association between atretic lesions of the gastrointestinal tract and the Waardenburg syndrome may be a significant one.

Abnormalities, Multiple↗