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 721 records · Page 40Linked to original sources
PubMed2001

Fistula-in-ano in infants: is nonoperative management effective?

PURPOSE: Recently, a number of studies have reported positive results from the nonoperative management of fistula-in-ano in infancy, although it has not been of use in all patients. The purpose of this study was to discern the effective treatment methods of fistula-in-ano in infants. METHODS: A retrospective review was done of 310 children who required operative management for fistula-in-ano or perianal abscess between January 1991 and July 2000. Eighteen patients displayed an onset of symptoms at less than 1 year of age and a duration of symptoms longer than 12 months. The authors analyzed these patients' medical records. RESULTS: All patients were boys. The mean duration of the symptoms was 26.6 +/- 27.5 months. Fourteen patients had shown an onset of symptoms at less than 6 months of age. The longest duration was 10 years. The patients showed conservative periods of over 12 months because their parents did not want them to undergo surgery. The disease in these patients followed 2 patterns. One (6 patients) was an onset of symptoms followed by a silent fistula-in-ano state. The other (12 patients) was an onset of symptoms followed by an intermittent relapse of inflammation. All patients underwent fistulotomy, and none of them had recurrent fistula during the follow-up period. CONCLUSIONS: Although the advantages of a nonoperative management of fistula-in-ano in infants include the avoidance of general anesthesia and surgical intervention, the lesions cannot be cured by a period of conservation. Surgical management is more effective in respect to the time factor.

Child↗
PubMed2002

Chylomicron components mediate intestinal lipid-induced inhibition of gastric motor function.

Lipid, particularly long-chain triglyceride, initiates feedback regulation of gastrointestinal function. To determine whether the site of action of lipid is pre- or postabsorptive, we investigated the ability of mesenteric lipid-fed lymph to inhibit gastric motor function. Lymph was collected from awake lymph-fistula rats during intestinal infusion with either a glucose-saline maintenance solution or lipid. Intra-arterial injection of lymph collected during intestinal lipid infusion significantly inhibited gastric motility in anesthetized recipient rats compared with injection of equivalent amounts of triglyceride or lymph collected during intestinal infusion of maintenance solution. Lymph collected from rats during lipid infusion with Pluronic L-81 [an inhibitor of chylomicron formation and apolipoprotein (apo) A-IV secretion] compared with lymph injection from donor animals treated with Pluronic L-63 (a noninhibitory control for Pluronic L-81) was significantly less potent. Injection of purified recombinant apo A-IV significantly inhibited gastric motility. Products of lipid digestion and absorption, other than fatty acids or triglyceride, released by the intestine during lipid digestion likely serve as signals to initiate intestinal feedback regulation of gastrointestinal function. Most likely, apo A-IV is one of the signals involved.

Animals↗
PubMedDate not supplied

Laparoscopic repair of small bowel perforation.

OBJECTIVES: For years, limiting operative wound sepsis and its resultant morbidity in patients with small bowel perforations has been a major headache for surgeons. The present study was intended to extend the benefits of minimally invasive surgery to traumatic and typhoid small bowel perforations, in terms of assessing its feasibility and limiting wound sepsis. METHODS: Twenty-five patients (20 with typhoid ileal and 5 with traumatic small bowel perforation) presenting within 96 hours of the catastrophe were included in the study. All were explored laparoscopically, and the perforation repaired by intracorporeal suturing. RESULTS: Time of operation varied from 45 minutes to 92 minutes. Two patients developed port-site infection. None of the patients developed postoperative fistula, and no mortalities occurred. Postoperative hospital stay was between 7 days and 10 days. CONCLUSION: Benefits of minimally invasive surgery can be safely and efficaciously extended to select patients with small bowel perforation in terms of limiting sepsis-related wound complications.

Abdominal Injuries↗
PubMed1997

[Primary curative incision in the treatment of perianorectal abscess].

More than 50% of the patients with perianorectal abscess treated with traditional incisional drainage will lead to fistula formation postoperatively. We present a procedure of primary curative incision for treatment with perianorectal abscess without fistula formation. The result of primary curative incision in comparison with traditional incisional drainage in a randomized control study showed that the incidence of postoperative fistula formation and recurrent abscess was 2.56% in the former and 56.25% in the latter. The key points of the procedure were discussed in detail and the causes and prevention of the disease occurred after injection of sclerotic drugs for hemorrhoids were also discussed.

Abscess↗
PubMedDate not supplied

[Therapeutic aspects of dehiscence of a laparotomy wound after a digestive fistula or following intervention for acute pancreatitis].

Fourteen cases of digestive fistulas, complicated by a dehiscence of the laparotomy wound, are described. Ten patients have a single fistula and 4 have multiple digestive fistulas. There were eleven survivors. This represents a mortality of 21.4%. In 9 cases, the spontaneous recovery of the fistulated zone is followed by a losing of the laparotomy wound. In 2 cases, surgical intervention was necessary to permit the recovery of the fistula and of the dehiscence of the laparotomy. The treatment of such patients requires a mean hospitalization in an intensive care ward of about 48 days +/- 25.8 (SD). The authors report the different therapeutic aspects : the nutritional support, the control of the infection and of the locoregional and systemic complications.

Acute Disease↗
PubMedDate not supplied

[Therapeutic aspects of laparotomy after digestive fistula or after surgical intervention for acute pancreatitis (author's transl)].

Fourteen cases of digestive fistulas, complicated by a dehiscence of the laparotomy wound, are described. Ten patients have a single fistula and 4 have multiple digestive fistulas. There were eleven survivors. This represents a mortality of 21.4%. In 9 cases, the spontaneous recovery of the fistulated zone is followed by a losing of the laparotomy wound. In 2 cases, surgical intervention was necessary to permit the recovery of the fistula and of the dehiscence of the laparotomy. The treatment of such patients requires a mean hospitalization in an intensive care ward of about 48 days +/- 25.8 (SD). The authors report the different therapeutic aspects: the nutritional support, the control of the infection and of the locoregional and systemic complications.

Acute Disease↗
PubMed1994

Somatostatin: physiology and clinical applications.

Somatostatin (SOM) was originally isolated as the hypothalamic inhibitor of growth hormone release but was subsequently shown to have a widespread distribution including the gastrointestinal tract. In fact the gastrointestinal tract contains about 70% of the total body SOM. SOM has inhibitory actions on gastrointestinal exocrine and endocrine secretions, motility and blood flow. Within the gut it functions as an endocrine, paracrine, autocrine and neurocrine factor. SOM is released by a meal, and a number of neurotransmitters and regulatory peptides also influence SOM release. SOM is a key component of the gastrin-acid feedback loop as luminal acid releases SOM, which in turn has inhibitory effects on both gastrin and gastric acid. Consistent with the diverse functions of SOM, a number of different although related SOM receptors with distinct distribution patterns and intracellular mediators have been cloned and sequenced. SOM is the first of the gut regulatory peptides to have a significant therapeutic use. By inhibiting both the target cell (e.g. parietal cell) and the release of the active agent (e.g. gastrin) the therapeutic potential of SOM is magnified. To date most of the clinical experience has been with the one analogue, octreotide. This analogue has a longer half-life than SOM (hours versus minutes) but has only minimal oral activity, therefore requiring subcutaneous injections several times a day. The definite gastrointestinal applications include treatment of gastroenteropancreatic tumours. It is also becoming a favoured treatment for gastrointestinal fistulae, variceal bleeding and diarrhoea. However, octreotide has no consistent effect on tumour growth. The high density of SOM receptors on tumours has allowed localization of tumours using in vivo scintography with labelled octreotide. The sequencing of a variety of SOM receptors with different distributions and differing cellular effector systems raises the likelihood of developing SOM analogues for specific clinical applications.

Amino Acid Sequence↗
PubMedDate not supplied

[Biliary ileus: diagnosis and therapy].

BACKGROUND: Gallstone ileus represents 1-3% of mechanical obstructions of the bowel. The surgical treatment performed in urgency has a mortality rates of 10-13% because galistone ileus is frequent in the elderly. Some diagnostic and therapeutic problems are debated in this paper. METHODS: 9 cases of gallstone ileus were analysed retrospectively in a series of 736 mechanical obstructions of the bowel submitted to surgery since 1969. The Authors report the clinical and physical data, the laboratory data and the results of the radiological procedures performed (plain abdominal X-ray, abdominal US, CT, MNR). The patients are stratified according to ASA system and the surgical treatment. The accuracy of the diagnostic procedures and the surgical mortality and morbidity are reported. RESULTS: The preoperative diagnosis was correct in 5 patients. History, clinical and laboratory findings are not specific. The plain abdominal X-ray was specific in 1/9 case, Us in 4/9, CT in 2/3, MNR in 1/1. 1 patient was included in ASA 1 class, 3 in ASA 2 class, and 5 in ASA 3 class. Enterolithotomy alone was performed in 3 cases and the one stage treatment (enterolithotomy and bilio-digestive fistula repair) in 6. No patient was submitted to two stage procedure because 2 of the patients submitted to enterolithotomy alone had a neoplastic fistula and 1 had a very high operative risk. No intraoperative mortality was registered. A wound infection developed in 4 patients. None of the patients had a recurrence of gallstone ileus. CONCLUSION: Evidence from this study supports one stage treatment when the diagnosis of gallstone ileus is correct because it is possible to delay the surgery and to perform a preoperative treatment to decrease the operative risk in the elderly. The correct preoperative diagnosis is often difficult but CT and MNR heve an high sensibility and specificity.

Aged↗
PubMed2004

The management of combined oesophageal and duodenal atresia.

Duodenal atresia (DA) in babies with oesophageal atresia (OA) is associated with significant morbidity and mortality. The management protocol for this combination of anomalies is not well defined and evolving. The aim of this study was to review our experience with combined OA and DA and to note the evolving trend in management at Sydney Children's Hospital. Over the last 30 years, 225 babies with OA have been treated at our institution. Ten babies had associated DA. A total of 19 anomalies were noted; one child had multiple lethal anomalies and received no treatment. In three babies the diagnosis of associated DA was missed initially. For the nine babies who were treated, four had a primary OA repair followed by a delayed DA repair; one had cervical oesophagostomy, gastrostomy and DA repair; and two had a simultaneous repair of OA and DA with a gastrostomy. The last two patients in this series have had a primary simultaneous repair of both anomalies without a gastrostomy. The complications noted in the nine patients treated included anastomotic strictures in five, recurrent tracheo-oesophageal fistula in one, food bolus obstruction in one, and a megaduodenum requiring tapering in one. We believe that adopting a management protocol of primary simultaneous repair of both anomalies without a gastrostomy is justified. There was no apparent increase in morbidity and mortality with such an approach.

Abnormalities, Multiple↗
PubMedDate not supplied

Modified Hassab procedure in the management of bleeding esophageal varices--a two-year experience.

BACKGROUND/AIMS: Esophageal varices are one of the most common complications (varices, ascites, hypersplenism and encephalopathy) of portal hypertension. Endoscopic sclerotherapy or band ligation is the first choice for esophageal varices today. However, immediate surgical intervention is always needed whenever endoscopic therapy fails to control acute bleeding. Therefore, a simple, effective and less time-consuming procedure is worthwhile for patients who needed immediate surgical treatment. METHODOLOGY: A modified gastroesophageal decongestion and splenectomy GEDS (Hassab) was performed on patients who need immediate surgical intervention for variceal bleeding. There were 15 consecutive patients who received this operative method and the outcome of all patients were reviewed. RESULTS: During follow-up, esophageal varices were resolved in 8 patients (62%), diminished in size in 3 patients (23%) and remain unchanged in 2 patients (15%). Gastric varices disappeared in all patients. The rebleeding rate was 23% in our studies. Encephalopathy was not found in all patients. Moreover, no surgical mortality was found by using this surgical method. CONCLUSIONS: In this study the modified gastroesophageal decongestion and splenectomy (Hassab) was an effective life-saving procedure for its safe, simple and less time-consuming advantages. No esophageal transection was performed in this procedure; therefore esophageal fistula, which had high mortality, did not occur. We believe that our procedure may perhaps be an alternative choice for patients who need immediate surgical intervention for bleeding varices.

Adult↗
PubMedDate not supplied

[Reconstruction technique after pancreaticoduodenectomy].

The many techniques proposed for the reconstruction of the digestive path after pancreaticoduodenectomy show the continuous research of the most anatomical and safest way to achieve the best results. Most of the technical variations concern the treatment of the pancreatic stump and are directed to prevent the pancreatic fistula that is the most frequent cause of postoperative mortality and morbidity. None of the pancreatico-digestive reconstruction ways is absolutely better than the others and we think neither the total obstruction of the Wirsung duct is the solution of the problem of the pancreatic fistula. The accuracy and technical precision, the availability to modify the technique in relationship to different anatomy and functional conditions of the pancreatic stump are essential to improve the results. To achieve this goal is decisive the experience and patients volume of the surgeon and of the institutional team.

Digestive System Surgical Procedures↗
PubMed1993

[The results and a discussion of the esophagogastroduodenoscopic studies performed successfully, early and postponed in patients with upper digestive tract hemorrhages in 1980-1990].

For a period of 10 years (1980-1990) a total of 2034 emergency, early and postponed endoscopies have been performed in patients with upper digestive tract bleeding at the Department of Emergency Surgery in Sofia. Duodenal ulcer has been the leading cause of bleeding--41.19 per cent of the cases, with gastric ulcer ranking second--14.94 per cent. There followed in descending rank order: gastric and duodenal erosions--12.34 per cent; gastric cancer--5.06 per cent; hemorrhagic gastritis--2.56 per cent; esophageal varices--7.27 per cent; Mallory-Weiss syndrome--1.62 per cent. Bleeding from the digestive tract of patients with CNS trauma based on acute stress ulcer and erosions and activated old callous ulcer occupied the 12th place in rank order. On the 13th place ranked upper digestive tract bleeding in patients who had undergone thermic trauma (2.01 per cent). Much fewer wer the cases of bleeding secondary to peptic ulcer of the jejunum, gastric and duodenal diverticulosis, acute ulcers in patients with cardiovascular diseases, blood diseases, liver, bile duct and pancreas diseases, aorto-duodenal fistulas and drug-induced diseases. The cause remained unknown in 1.77 per cent of the patients. On the basis of the indisputable achievements in [correction of ti] the diagnosis of acute upper digestive tract hemorrhage, the approach to these grave nosologic entities has essentially been altered.

Acute Disease↗
PubMed1995

Duplications of the alimentary tract in infants and children.

Duplications of the alimentary tract are rare congenital anomalies that could present a diagnostic as well as therapeutic challenge. Twenty-seven patients with duplications of the alimentary tract were treated at Childrens Hospital Los Angeles between 1961 and 1992. Ages ranged from a few days to 5 years (67% younger than 1 year). The most common symptoms were nausea and vomiting, and the most common sign was a palpable abdominal mass. Three patients presented with gastric duplication, which was excised. The majority of the duplications were in the jejunum and ileum. All patients except one had primary resection of the duplication. One patient with a 45-cm tubular jejunal duplication was treated with mucosal stripping of the duplication. Five patients had cecal duplication, three patients presented with melena because of ectopic gastric tissue in the duplication, and two presented with intestinal obstruction. One of the latter patients presented with intussusception with cecal duplication as the leading point. Three patients with colonic duplication presented with abdominal pain and vomiting leading to excision of the duplication. Of the five patients with rectal duplication, three presented with chronic constipation. The other two patients presented elsewhere with perianal swelling, which eventually was drained because of a mistaken diagnosis of perianal abscess. Subsequently, these two patients came to us with persistent perineal fistula. In all our patients, rectal duplications were removed through a sacroperineal incision. The only patient in this series who died was a 6-week-old boy with gastric duplication; his death was attributed to an associated severe cardiac lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed2005

[Surgical treatment of the single non traumatic perforation of small bowel: excision-suture or resection-anastomosis].

OBJECTIVE: To evaluate morbidity and mortality following excision-suture and resection-anastomosis for single non traumatic perforations of small bowel (SNTPB). METHODS: From July 2002 to June 2003, a simple blind randomized study comparing excision-suture with resection-anastomosis SNTPB. RESULTS: Of the 125 patients included, 112 were operated by surgeons on training (89.6%). The perforation sat on the antimesenteric edge of the last ileal portion with an average diameter of 0.8 cm (extreme 0.1 and 4 cm). An excision-suture was performed 66 times (52%) including 5 times by an experienced surgeon. 56 patients had simple continuations (45.2%). Morbidity concerned 68 patients (54,8%). 06 patients died of general complications (4.8%). The technique did not influence the mortality. All dead patients were operated by surgeons on training, P=0.25. The complications were significantly more frequent after resection-anastomosis (79.7%) than after excision-suture (32.3%). The difference was significant for the parietal abscesses (P=0,01), the exteriorized fistulas (P=0.04), the septic shocks (P=0.05). CONCLUSION: Whereas mortality was not influenced by the technique, the postoperative course was more complicated after resection-anastomosis (performed in majority by less experienced surgeons). We recommend excision-suture to repair SNTPB.

Adolescent↗
PubMed1976

[Hyperproduction of the epithelium and its vital rejection in the lumen of the small intestine outside the "rejection zone"].

Whole and histologically-treated biopsy material of the small intestinal mucosa of dogs with a full intestinal fistulae and of dogs with a portion of the small intestine excluded from digestion was studied. An intensive production of the surplus epithelial structures (protrusions, layers) was revealed in the areas of the crypts and the base of the villi. Rejection of these structures into the intestinal lumen occurred outside the "expulsion zone" with the preservation of the intactness of the villar surface. Less marked signs of this process were seen in control material. The data obtained testify to the fact of the existence of another way of development of the crypt cell leaving the crypt-villus system in the composition of the branching and rejecting epithelial structures.

Animals↗
PubMed2000

Pavlov and integrative physiology.

Ivan Petrovich Pavlov was the first physiologist to win the Nobel Prize. The Prize was given in 1904 for his research on the neural control of salivary, gastric, and pancreatic secretion. A major reason for the success and novelty of his research was the use of unanesthetized dogs surgically prepared with chronic fistulas or gastric pouches that permitted repeated experiments in the same animal for months. Pavlov invented this chronic method because of the limitations he perceived in the use of acute anesthetized animals for investigating physiological systems. By introducing the chronic method and by showing its experimental advantages, Pavlov founded modern integrative physiology. This paper reviews Pavlov's journey from his birthplace in a provincial village in Russia to Stockholm to receive the Prize. It begins with childhood influences, describes his training and mentors, summarizes the major points of his research by reviewing his book Lectures on the Work of the Digestive Glands, and discusses his views on the relationship between physiology and medicine.

Animals↗
PubMed1994

Septation of the respiratory and digestive tracts in human embryos: crucial role of the tracheoesophageal sulcus.

Esophageal atresia and tracheoesophageal fistula, common malformations of the respiratory and digestive tracts, are of unsettled pathogenesis. Part of the difficulty in understanding these abnormalities arises from the uncertainties about the normal developmental processes in the region. This study examined the development and fate of the tracheoesophageal septum. Normal human embryos from the Carnegie Embryological Collection and fetuses from the Hopkins Pathology Collection were examined, and reconstructions of selected specimens were made from photomicrographs of serial histologic sections. The results show that the lung bud appears in Carnegie stage 12, rapidly enlarges, and bends caudally, thereby producing a sulcus between the foregut and the respiratory system on its caudal aspect. The cranial aspect of this tracheoesophageal sulcus remains fixed at the levels of the first cervical vertebra throughout subsequent embryonic and fetal development. At the same time the trachea and esophagus elongate to bring those part of the respiratory and digestive systems into their definitive anatomic positions. Examination of the tracheoesophageal sulcus shows that its growth-limiting properties may be explained by its catenoidal configuration. Catenoidal, or saddle-shape, sulci have been shown to have similar regional growth-limiting properties in the embryonic heart. These regions contrast with outwardly convex regions in both the developing heart and lung where growth of the tissues occurs. The observations made here suggest that the origin of the tracheoesophageal malformations must be sought in a configurational abnormality in the area of the developing lung bud in Carnegie stage 12.

Digestive System↗