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 667 records · Page 37Linked to original sources
PubMed1993

[Mirizzi syndrome--a contraindication for laparoscopic surgery].

The Mirizzi syndrome refers to a benign obstruction of the common hepatic duct by a stone impacted within the cystic duct or the neck of the gallbladder causing an obstructive jaundice. According to McSherry's subclassification based on endoscopic retrograde cholangio-pancreatography we distinguish a type I, involving an external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch without lesion of the gallbladder or the common hepatic duct wall. In type II a cholecysto-choledochal fistula is present, caused by a calculous which has already eroded partly or completely into the common bile duct. The type I is better treated with a partial cholecystectomy, the type II with a partial cholecystectomy and a bilio-digestive anastomosis. Due to a severe inflammatory process with dense adhesions and odematous changes of the hepato-duodenal ligament, it is dangerous to prepare the Calot's triangle, in case of conventional cholecystectomy and/or in case of laparoscopic cholecystectomy. From 1986-1991 we have successfully treated 10 patients according to this concept (7 patients with type II, 3 patients with type I). We have no mortality and no lesion of the biliary system. One patient has been reoperated because of a postoperative hemorrhage and biliary fistula. One patient developed a benign stricture which could be dilated two months after the procedure. Two patients were found with an incidental carcinoma of the gallbladder.

Adult↗
PubMed2002

Influence of experience on laparoscopic ileocolic resection for Crohn's disease.

PURPOSE: The technical difficulties that are frequently encountered in surgery for Crohn's disease have led some authors to suggest Crohn's cases should not be attempted early in one's laparoscopic colorectal surgery experience. This article reviews one surgeon's experience with laparoscopic terminal ileal resections for Crohn's disease to assess the safety of beginning laparoscopic colorectal resections with these procedures. METHODS: A retrospective review of all laparoscopic ileocolic resections performed by a single surgeon was performed. RESULTS: Sixty-nine (82 percent) of 84 procedures were completed laparoscopically. Reasons for conversion were dense adhesions (n = 5) and complex masses (n = 10). The mean operating time for the entire group was 145 +/- 39 (range, 87-289) minutes. Postoperative length of stay was 5.6 +/- 2.4 (range, 2-21) days. The mean incision length in the laparoscopic group was 4.5 +/- 1.15 cm. If the series is examined in three equal intervals, the number of patients with multiple difficulties (abscess, fistula, and previous resection or mass) increased in the final part of the study, without affecting complication or conversion rates. Despite the increased case complexity, average length of stay was significantly reduced between the second and third time periods (P = 0.008). CONCLUSIONS: Despite its technical demands, laparoscopic ileocolic resection was a safe procedure with potential advantages to patients. Laparoscopic resection is possible in the vast majority of patients with ileocolic Crohn's disease, regardless of the nature of the pathology. Previous resections, abscesses, fistulas, and phlegmons do not preclude success, although these cases should likely not be the first attempted.

Adult↗
PubMed1981

Copper metabolism and requirements in total parenteral nutrition.

Copper metabolism and requirements in patients receiving total parenteral nutrition were studied in 28 patients with gastrointestinal diseases. During each of the 3 wk of the study period, each of 24 patients received in their total parenteral nutrition solutions, a daily dose of copper amounting to 0.25 mg, 1.05 mg, or 1.85 mg, in a random order. The other 4 patients received a fixed daily dose of 1 mg throughout the 3 wk. Increased losses of copper through the gastrointestinal tract occurred in patients with diarrhea or high-output stomas or fistulas. Patients with abnormalities of liver excretory functions had decreases in gastrointestinal copper losses. Urinary copper excretion was twice that of normal subjects. Copper infused in excess of the requirements was retained and not excreted. Plasma copper did not reflect the copper balance and cannot be used as a guide for copper supplementation. Copper requirements were found to be 0.3 mg/day in patients with normal amounts of gastrointestinal excretion. In the presence of diarrhea or increased fluid loss through gastrointestinal stomas or fistulas, the copper requirements for total parenteral nutrition are 0.4--0.5 mg/day.

Adolescent↗
PubMed2005

Major anastomotic dehiscence after repair of esophageal atresia: conservative management or reoperation?

SUMMARY. The authors report a case of recurrent anastomotic dehiscence following surgical repair of type C esophageal atresia according to the Gross classification. Surgical repair was followed by a recurrence, which was successfully managed with conservative treatment. Esophageal atresia with fistulization of the lower pouch in a male newborn with the VACTER association was repaired with a high-tension single-layer anastomosis. On the fifth postoperative day, major anastomotic dehiscence (> 4 mm) was diagnosed. The breach was re-sutured and the anastomosis reinforced with fibrin glue, but dehiscence recurred again 4 days later. Surgery was deferred and the infant was treated conservatively with continued chest-tube drainage and total parenteral nutrition. After 43 days, complete closure of the anastomosis was documented. Even major anastomotic dehiscence can be successfully managed with conservative treatment (chest-tube drainage, suspension of oral feedings, total parenteral nutrition). If the patient is otherwise stable, we feel that this approach should be attempted even when major leakage is present.

Anastomosis, Surgical↗
PubMedDate not supplied

[Reconstruction following proximal pancreatoduodenectomy by simplified pancreatojejunal anastomosis. Operation results in 198 patients].

INTRODUCTION: The pancreatojejunal anastomosis is considered the weak spot when carrying out a duodenopancreatectomy, because it causes most of the complications following a Whipple surgery. Here we present a series of cases using a single technique for performing this anastomosis. MATERIAL AND METHODS: During the period between October 2002 and August 2005, 49 duodenopancreatectomies were performed at the 3AII Department of the National Hospital Edgardo Rebagliati Martins (H.N.E.R.M.) in 31 of these cases a lateral mucosa to mucosa pancreatojejunal anastomosis was carried out by the same surgeon. RESULTS: The most frequent complication was infection of the operating wound followed by pancreatic fistula and intra-abdominal hemorrhage and the overall morbidity was 29%. Pancreatic fistula developed in 13% of the cases; however, no patient required additional treatment and the fistula closed maximum twenty days after the surgery. On average, patients resumed oral food intake after 6 days and remained hospitalized for 16 days. Mortality was 3%, because a patient developed a pseudo-aneurysm of the hepatic artery, which ruptured 17 days after the operation. CONCLUSIONS: The mucosa to mucosa pancreatojejunal anastomosis is a safe technique with a low index of pancreatic fistula and mortality.

Adolescent↗
PubMed2002

[The role of strictureplasty in the treatment of Crohn's disease].

Crohn's disease is pandigestive disease of unknown aethiology, with tendency to reccurrences. Until now it is impossible to heal this disease either by medical or surgical treatment. All unfavourable consequences of this disease are result of inadequate treatment of complications which are leading to systemic weakening, with further progression of morbid process. Therefore, the principle of timely and minimal invasive surgical procedure has been generally adopted. Introduced in eighties, strictureplasty is a procedure of such characteristics. During the period 1980-2001 this method was used in 1/3 of 126 patients with Crohn's disease. There were 79 strictureplaties performed, 9 long and 70 short. Out of these 42, 12(28.6%) were postoperative recurrences, and there was one case of duodenal strictureplatsty. Postoperative small bowel fistulae were not observed, and there was no mortality in this group. During the follow up period of at least 5 years, in only two cases (4.76%) some functional disturbances of digestive functions were observed, without indications for reoperation. In this article indications and details of operative technique are discussed.

Anastomosis, Surgical↗
PubMed1991

[Evaluation of metabolic disorders in surgical patients].

The paper treats the problems of metabolism derangement in surgical patients. Special emphasis is laid on the correction of metabolic abnormalities in the pre- and postoperative periods and on the use of parenteral feeding in surgical complications: incompetence of anastomosis sutures, peritonitis, intestinal fistulas, and so forth. The authors define the role of the drugs of directed action in such a severe pathology as hepatorenal insufficiency.

Amino Acids↗
PubMed1993

[Effect of the starch sources barley, corn and potatoes and their ration portions on nutrient digestibility and energy utilization in ruminants. 3. Energy utilization in cattle].

With investigations on the influence of different starch origins (barley, maize and raw potatoes) and different portions of the starch origins in the rations (50, 25 and 10% of the net energy fat, cattle (NEFr) content of the rations) on the energy utilization of rations a contribution was made to the development of the energetic feed evaluation within Rostock NEF-system. The experiments were carried out with fattened oxen using the methods of total metabolism technique and duodenal passage measurement by means of reentrant fistula. The nutrition levels amounted to 1.7 and 1.1 of energy maintenance requirement. The utilization of metabolizable energy for deposition of the 9 rations-including 3 variants of starch origins barley, maize and raw potatoes with parts in the rations of 50, 25 and 10%--was measured as 65, 61 and 59%, 61, 60 and 58% as well as 59, 61 and 55%. The energy maintenance requirement amounted to 526 kJ ME/kg LM 0.75.d. The gradations of energy utilization are caused by the connection between energy concentration and utilization of rations in ruminants. With comparable parts of the rations the different starch sources had no relevant influence on the energy utilization of the rations. Despite a wide range of starch plus water soluble carbohydrates (WSC) intake between 896 and 3426 g/animal.d no correlation between the kind of digestion (fermentative or enzymatic) of starch and WSC and the energy utilization of the rations was measurable, because the part of the ruminal digestion amounted to 86.0 and 97.2%. The result presented for the energy and nitrogen metabolism measurements are in good agreement with results of former experiments with 92 rations.

Animal Feed↗
PubMed2006

[Endoscopic prosthetic treatment of the esophagojejunal leaks after total gastrectomy: clinical experience].

The Authors, on the basis of their experience on the use of self-expanding prostheses in abdominal surgery, report on the use of these prostheses in two patients who, having undergone a gastrectomy for cancer, developed a fistula of the esophago-jejunal anastomosis. Given recent data from literature, using a prosthesis for an anastomotic fistula may be a valid alternative to a second operation, which, apart from obvious difficulties, has a high mortality rate in patients in weakened general health conditions. In these cases, after the application of a stent, excellent results can be obtained and, after some days, the patients can begin a semi-liquid diet, then proceeding to a semi-solid diet, improving quality of life; in addition, within a reasonable time span, after the healing of the fistula, the prosthesis can easily be removed by endoscopy.

Adenocarcinoma↗
PubMed1998

Corrosion injury of the upper gastrointestinal tract after swallowing strong alkali.

OBJECTIVE: To review our experience of 9 patients who had attempted suicide by swallowing alkaline substances. DESIGN: Retrospective study. SETTING: Two university hospitals, Finland. PATIENTS: During the years 1987-1996. 9 patients who had swallowed more than 100 ml of strong alkali. RESULTS: 2 patients with oesophagorespiratory fistulas of the four with third degree injuries died in hospital, the first died of overwhelming sepsis and the second of multiple organ failure. The other two survived emergency staged resection and subsequent reconstruction. Delay between swallowing the alkali and the initial operation, and development of oesophagorespiratory fistulas were the most important predictors of death. Four patients with second degree injuries underwent oesophageal resection and reconstruction after they had developed oesophageal strictures. Two of these six survivors developed anastomotic strictures after reconstruction, both of which necessitated repeated oesophageal dilatations. One patient with a first degree injury was treated conservatively. CONCLUSIONS: An early and aggressive approach to severe third degree corrosive injuries of the upper gastrointestinal tract is needed to resect all necrotic tissue and to make it possible to do a successful reconstruction later. The development of oesophagorespiratory fistulas requires immediate attention, whereas first and second degree injuries can be treated after the patient has been stabilized.

Adolescent↗
PubMed1991

[Enteral feeding in adults: indications].

In this overview article the author examines successively: (1) the effects expected from enteral nutrition in adults: general and/or local nutritional effects, temporary arrest in progressive intestinal lesions, partial intestinal function replacement; (2) indications in gastrointestinal and non-gastrointestinal pathologies and modalities of application to each indication (route of administration, elemental, semi-elemental or polymeric nutrients, incremental or non-incremental calorie intake, necessity or lack of necessity for addition of fibres, value of ambulatory methods); (3) results according to indications: chronic inflammatory intestinal diseases, notably Crohn's disease, short small bowel syndromes, fistulae and stomies, preoperative period in gastrointestinal surgery, support of heavy treatments in non-terminal cancers, hypermetabolic states, notably stress; (4) absolute or relative contraindications of enteral nutrition.

Adult↗
PubMed1976

[Changes in magnesium levels in surgery of the digestive tract].

We studied serum concentrations of magnesium post-operatively in 41 patients divided up into four distinct groups, depending on the degree of seriousness of the operation, the loss of body fluids and the duration of intravenous feeding. The results thus obtained showed us that in digestive disorders there is an initial fall in blood magnesium accentuated in operated patients submitted to continous gastric aspiration or an external biliary drain. In these same patients, there is a tendency to normalisation from the second day after the operation. Only patients with gastric or intestinal fistulas had a curve which fell to the seventh post-operative day reaching severe levels of hypomagnesemia.

Adolescent↗
PubMed2000

[Endoscopy in inflammatory bowel disease].

Fiberoptic endoscopy is well established, safe and accurate for diagnosis and management of inflammatory bowel disease (IBD). Direct visualization of the mucosa and biopsy of suspected abnormalities are possible. The principal applications of endoscopy in IBD include discrimination of Crohn's disease from ulcerative colitis of o other inflammatory conditions (acute infectious colitis, chronic infections, microscopic colitis, ischemic/radiation colitis, colitis induced by NSAID), delineation of the sites of disease or extent, grading of endoscopic disease severity, and confirmation of complications such as stricture, fistula or mass. Finally, diagnosis of pouchitis, surveillance to detect precancer, or therapeutic interventions such as dilatation of strictures of electrocautery of bleeding sites are also important endoscopic applications.

Diagnosis, Differential↗
PubMed1992

[Incidents, accidents and limits of cholecystectomy by celioscopy].

Series of coelioscopic cholecystectomy until 1991 has shown that morbidity rate of this procedure remains higher than conventional laparotomy. Complication are related to technical problems included: (a) biliary leak with a rate of 0.5%; (b) hemorrhage; and (c) digestive perforation. Contra-indication of this procedure are: cirrhosis, portal hypertension, bilio-biliary fistula and severe cholecystitis. Progress is expected with willing to open cholecystectomy; improvement of intervention, perioperative cholangiography and specific train of surgeons involved in the field of surgery.

Cholecystectomy↗
PubMed2000

Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique.

BACKGROUND/PURPOSE: This report describes a new technique of laparoscopically assisted anorectal pull-through (LAARP) for repair of high imperforate anus. The procedure utilizes minimal perineal dissection, preservation of the distal rectum, and accurate placement of the rectum within the levator ani and external anal sphincter muscle complex. METHODS: Sharp dissection and cautery was used laparoscopically to expose the rectal pouch down to the urethral or vaginal fistula, which was clipped distally and divided. The pelvic floor musculature was then assessed and the levator sling identified. Externally, electrostimulation was used to define the center of the anal dimple. An 8-mm skin incision was made, centered at the strongest cephalad contraction. Using a hemostat, minimal blunt dissection on the perineum was guided by transillumination from the laparoscopic light source. A trocar, consisting of a radially expandable sheath over a Varess needle, was passed through this defined plane in the external sphincter muscle complex and advanced into the pelvis between the 2 bellies of the pubococcygeus muscle, guided by laparoscopic visualization. This perineal trocar therefore formed a passage through the center of the striated muscle complex and levators. The rectal fistula, which had been dissected out laparoscopically, was grasped using the perineal trocar and exteriorized to the perineum. Anorectal anastomosis was performed with absorbable interrupted suture. RESULTS: Seven patients were treated with initial colostomy in the newborn period followed by delayed LAARP 2 to 12 months later. In 4 newborn infants, the LAARP was performed as a primary procedure without prior colostomy. Laparoscopic mobilization has been possible on all cases attempted. All of the patients have a brisk and symmetric anal contraction with perineal electrostimulation. CONCLUSIONS: Lack of long-term follow-up precludes accurate assessment of the potential for fecal continence. However, short-term experience has been that this new method of pull-through for imperforate anus offers many advantages, including excellent visualization of the rectal fistula and surrounding structures, accurate placement of the bowel through the anatomic midline and levator sling, and minimally invasive abdominal and perineal wounds.

Anus, Imperforate↗