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PubMedDate not supplied

Unusual presentations and problems created by mismanagement of foreign bodies in the aerodigestive tract of the pediatric patient.

Nine children who suffered unusual problems because of the mismanagement of ingested or inhaled foreign bodies are reported. The causes of mismanagement are discussed and the details of the histories, examinations and follow-up are given. The serious complications were pulmonary hemorrhage, tracheoesophageal fistulae, mediastinitis resembling a mediastinal tumor, periesophageal infection from perforation, loss of a Fogarty catheter tip in a segmental bronchus, laryngeal stenosis from a cricothyrotomy in an infant, and the displacing of a foreign body into an almost inaccessible distal bronchus. All of these unusual problems, and the resultant morbidity and financial cost, could have been avoided with proper management and early diagnosis.

Adolescent↗

PubMed2002

[Strategies of surgical treatment of chronic pancreatitis complicated by obstructive jaundice and cholangitis].

The results of treatment of 295 patients with complicated chronic pancreatitis (CP) for period from 1996 to 2000 yr were presented. CP without the ducts dilatation was revealed in 37 patients, ductal hypertension--in 19, calcinose fibrous-degenerative CP--in 73, cystic form of CP--in 142, CP in combination with external pancreatic fistula--in 24. Frequency of the complications occurrence in various forms of CP--the obstructive jaundice and cholangitis--was analyzed. Complex approach to the choice of tactic of the operation performance was proposed, application of additional methods of sorptional and immune therapy, depending on the CP form, complicated by the obstructive jaundice and cholangitis, was substantiated.

Adult↗

PubMedDate not supplied

[Percutaneous endoscopic cholangioscopy (percutaneous cholangioscopy)].

The aim of this paper is to present the percutaneous cholangioscopic method, objectives, indications, technique and advantages of this method in exploration and treatment of common bile duct disease. Percutaneous cholangioscopy is a complementary mini-invasive method, which is associated to classic or laparoscopic surgical procedures on common bile duct disorder. This method has the main characteristic intraductal approach, which is made via an external preformed fistula derived from an anterior surgical open or mini-invasive interventional procedures performed on the common bile duct. Percutaneous cholangioscopy is very performing in early or differential diagnosis determination of common bile duct malignant tumors and is a valuable method for mini-invasive intraductal treatment that can be performed by this method, avoiding another interventional surgical or endoscopical procedure on common bile duct.

Cholangiography↗

PubMed2004

Esophageal atresia and other visceral anomalies in a modified Adriamycin rat model and their correlations with amniotic fluid volume variations.

The Adriamycin rat model (ARM) has been used to produce visceral malformations in fetuses to explain the mechanisms of foregut division. The models vary in the dosage of Adriamycin (ADR) and in the number of applications. Our study of a modified ARM using 2.2 mg/kg of ADR for 2 days only, intraperitoneally in pregnant rats, is presented. A total of 81 fetuses were obtained with this model from the ADR group, 74 (91%) alive. Uretero-hydronephrosis (UHN) was observed in 70 fetuses (95%), esophageal atresia (EA) in 68 (92%), duodenal atresia (DA) in 68 (92%), bladder hypoplasia (BH) in 67 (90%), plus other malformations. In evaluating amniotic fluid (AF) volume of the fetuses with EA with tracheo-esophageal fistula (TEF) (group I) and EA without TEF (group II), both associated with bilateral UHN when compared with the control group (group III), groups I and II showed higher AF volume in groups I and II than the control group (group III) did ( p=0.0001). In conclusion, ARM was adequate to produce EA and other visceral malformations. The use of ADR in a higher dosage for a shorter period of time produced better results than those presented in previous literature. The increase of AF volume obtained in fetuses presenting EA plus bilateral UHN strongly suggests, despite ureteral dilatation (urinary obstruction), that a malformed communication may exist between the urinary system and the amniotic cavity, permitting the existence of polyhydramnios that is due to digestive obstruction such as EA and DA.

Abnormalities, Drug-Induced↗

PubMed1999

[Bouveret's syndrome: the clinical and radiological findings].

Bouveret's syndrome is an unusual presentation of gallstone ileus, due to duodenal obstruction. It is produced by the migration of biliary calculus through a cholecystogastric or cholecystoduodenal fistula. We present 3 new cases of Bouveret's syndrome, and the clinical and radiological findings on different imaging procedures (plain abdominal radiography, barium studies, ultrasonography and computed tomography). On the basis of these cases, we discuss the diagnostic and possibly therapeutic merits of digestive endoscopy and about the different surgical procedures.

Aged↗

PubMed2000

Unsatisfactory experience with 'minimal intervention management' for gastroschisis.

PURPOSE: The authors report, for cautionary reasons, their trial with "minimal intervention management" for gastroschisis. After the successful innovative experience with this approach, which Bianchi and Dickson described, they utilized it in 4 consecutive patients. METHODS: In the delivery room a plastic bag was placed over the intestines, which rested in a dependent position to reduce edema. The stomach was decompressed and the patients kept warm. Intravenous fluid at a maintenance rate was given. After about 5 hours an attempt at closure was undertaken in the newborn intensive care unit without anesthesia. An assistant lifted the anterior abdominal wall by applying upward traction on the umbilical cord. Over about 25 minutes the intestines were placed in the coelom, which was closed with a single suture. RESULTS: The outcome was uncomplicated in the first of 4 consecutive patients. The second patient had abdominal compartment syndrome requiring a silo and subsequent resection and has chronic malabsorption 16 months later. The third had an enterocutaneous fistula at 5 weeks that required a small bowel resection. Bedside closure was abandoned in the final case because too much resistance was encountered. She underwent primary repair in the operating room and eventually died of sepsis with intestinal dysmotility. CONCLUSIONS: The "minimal intervention approach" can be effective in some patients who have gastroschisis. This experience suggests that selection criteria are needed before this method can be recommended.

Digestive System Surgical Procedures↗

PubMed2003

Complications of mechanical suturing in pediatric patients.

BACKGROUND/PURPOSE: Although it is widely accepted that staplers are effective in reducing operating time, potential complications related to their use in the pediatric population are not well defined yet. The aim of this study is to evaluate the safety of mechanical suturing. METHODS: Between 1996 and 2001, 174 procedures were performed using circular staplers in gastrointestinal anastomosis, whereas linear staplers were used in gastrointestinal and lung resection. Intraoperative and early complications of each intervention were recorded. RESULTS: Overall, 12 complications occurred (6.9%). Two were caused by technical problems: In one case the stapler broke, in the other the anvil detached from the instrument shaft. Ten (5.7%) were major complications: 2 cases of leakage and 3 of bleeding in gastrointestinal procedures, and one case of bronchopleural fistula and 4 cases of bleeding during lung surgery. There was a significant correlation (P <.05) between type of stapler used and development of complications, suggesting a safer use of endoscopic staplers compared with conventional linear ones. CONCLUSIONS: Mechanical suturing in children is not used frequently, but some procedures could be used more widely because they are fast and safe.

Adolescent↗

PubMed1991

Bridging of benign choledochal stenoses by endoscopic retrograde implantation of mesh stents.

A prospective study of a new stent for bridging choledochal stenoses was performed in seven patients (5 females, 2 males, age range 49-80 years) with benign bile duct stenosis or bilioduodenal fistula in whom conventional bougienage (3 patients) and/or month-long implantation of plastic prostheses (7 patients) failed because of reocclusion. The self-expanding mesh stents (Wallstent) were implanted by duodenoscopy in six patients. In one patient with a B-II stomach, the stent could only be inserted by the percutaneous transhepatic route. All prostheses were inserted endoscopically without complications. At follow-up after an average of eight months prosthesis-related complications were found in only one patient; there was no case of prosthesis occlusion. One patient with a bilioduodenal fistula of unknown origin developed fever and sepsis three days after implantation and subsequently a liver abscess which resolved on repeated drainage and antibiotic therapy. Although definitive interpretation of the results requires a longer follow-up period, on the basis of the present data endoscopic reconstructive splinting of benign choledochal stenosis would appear to be a promising technique.

Aged↗

PubMed1994

Echocardiographic screening in neonates undergoing surgery for selected gastrointestinal malformations.

To compare echocardiography with clinical examination, radiography, and electrocardiography for the detection of congenital heart defects (CHD) a four year prospective study was carried out in 166 neonates with selected congenital gastrointestinal malformations (anorectal anomaly, tracheo-oesophageal fistula, duodenal atresia, exomphalos, and gastroschisis). Routine examination and investigation detected CHD in 16 neonates. Using echocardiography CHD was diagnosed in 38 (23%) neonates of whom five had two gastrointestinal malformations: in 22/57 (39%) with a tracheo-oesophageal fistula, 10/67 (15%) with an anorectal anomaly, 4/20 (20%) with exomphalos, 6/20 (30%) with duodenal atresia, and 1/7 with gastroschisis. A significantly higher incidence of CHD in neonates with gastrointestinal malformations was diagnosed using echocardiography (23%) compared with routine examination and investigation (9%). Early diagnosis of CHD allowed a unified approach to be presented to the family.

Abnormalities, Multiple↗

PubMed2004

Jejunal diverticulosis: a potentially dangerous entity.

Although jejunal diverticulosis is a rare entity and usually asymptomatic, it may cause chronic symptoms and acute complications. Because of the rarity of the entity, diagnosis is often delayed, resulting in unnecessary morbidity and mortality. The purpose of this study was to draw attention to jejunal diverticula and their complications. The medical records of 8 consecutive patients with complications due to small-bowel diverticula treated at our department during the past 4 years were reviewed. All diverticula were located in the jejunum. Seven patients had acute complications, 3 patients had an intra-abdominal abscess, 2 had free perforation with diffuse peritonitis, 1 had a bowel occlusion and 1 patient had concomitant bleeding and occlusion. One patient presented with chronic symptoms. A preoperative diagnosis of jejunal diverticula, before explorative laparotomy, was not reached in any of the 7 patients with acute symptoms. In the patient with chronic symptoms, multiple jejunal diverticula complicated by a jejuno-colic fistula and foreign body were found at laparotomy. On patient died of multiorgan failure. Small-bowel diverticulosis is a rare entity, but it should not be regarded as a clinically insignificant finding. It may be difficult to make a preoperative diagnosis. Patients with incidentally detected proximal jejunal diverticula, at imaging studies or at laparotomy, warrant close observation and awareness that the diverticula may cause serious complications.

Aged↗

PubMed1997

Postsurgical biliary tract complications.

Cholecystectomy and other biliary tract operations are being performed with an increasing frequency due to the prevalence of gallstones and pancreaticobiliary disorders among the aging population of the United States. Even in the current era of modern medicine, however, a wide spectrum of postsurgical biliary complications are encountered. Most are the result of preventable iatrogenic trauma or technical mishaps that occur with a much higher incidence during laparoscopic cholecystectomy than the conventional open procedure. These include bile leakage from an overlooked transection of normal or aberrant bile ducts, obstructive jaundice due to inadvertent ligation of the common duct or its postsurgical stricture, instrumentation injuries induced during biliary tract exploration, and the various types of biliary fistulas. These lesions are detectable by intraoperative or T-tube cholangiography, if the examination is performed and interpreted correctly. In most instances, however, the postoperative evaluation of the abdomen by computed tomography or ultrasonography will provide the initial clues to an otherwise unsuspected lesion. Radiologic imaging and interventional techniques play a crucial role in the diagnosis and management of postsurgical biliary tract complications, as illustrated in this review article.

Biliary Tract Diseases↗

PubMed1983

[Effect of different-sized rations on the physiology of the digestive and metabolic processes in sheep].

Tested was the effect of differently sized rations with sheep supplied with fistulae. The change in the size of the ration was said to bring about a change in the physiology of the digestive and metabolic processes as well as of the lung ventilation. The almost twice lowered size of the normal ration did not improve digestion and conversion when the ration had an improper structure. At an appropriate structure, though with a greater size the ration did not lower the level of the digestive and metabolic process, while the coefficients of digestibility substantially rose. It is believed, however, that the distribility coefficients alone cannot reflect thoroughly the physiology of digestion.

Animal Feed↗

PubMed2001

Partial caudal duplication in a newborn associated with meningomyelocele and complex heart anomaly.

BACKGROUND: Caudal duplication is a spectrum of rare congenital anomalies with a possible heterogeneous pathogenesis including incomplete separation of monovular twins. METHODS: We report an autopsy case of a full-term infant with incomplete caudal duplication syndrome associated with multiple anomalies. RESULTS: These anomalies included a duplicated penis; double urinary bladder with an attenuated tunica muscularis; duplication of lower bowel with two ilia, appendices and colons; colonic hypogangliosis and left imperforated anus associated with rectourethral fistula. Other anomalies consisted of sacral meningomyelocele, sacral duplication with hypoplastic left sacrum and pelvic bones, muscle atrophy and hypoplasia of the left lower extremity, abnormal lobation of liver with stomach entrapment, omphalocele, and right atrial isomerism syndrome. The complex pattern of anomalies suggests the possibility that partial caudal duplication might be part of the spectrum of conjoined twinning.

Abnormalities, Multiple↗

PubMed1997

[Follow-up of Crohn's disease: can hydro-MRI replace fractionated gastrointestinal passage examination?].

PURPOSE: To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease. METHOD: 22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T2-weighted TSE sequences and T1-weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations. RESULTS: In the upper gastrointestinal tract, the follow-through examination showed clear advantages compared with hydro-MRI for the demonstration of inflammatory changes in the gut; Hydro-MRI was, however, somewhat more reliable in the ileum and colon. It was also more sensitive than the follow-through for the demonstration of enteric fistulae (four as compared with two cases), and in demonstration extraluminal changes (free fluid in six against zero, and inflammatory adherent loops (four against zero)). Amongst the 22 patients, hydro-MRI was equal (in 10) or better (in 8) than the follow-through examination for demonstrating the intestinal manifestations of Crohn's disease, and follow-through was better in only four. CONCLUSION: For follow-up of Crohn's disease, hydro-MRI is at least as good as follow-through examination, and is even preferable, because of the absence of radiation exposure of the usually young patients.

Administration, Oral↗

PubMed2001

[Can common bile duct lithiasis be removed laparoscopically without external biliary drainage?].

AIM OF THE STUDY: To evaluate the indications, feasibility and results of laparoscopic treatment of common bile duct stones without biliary drainage. PATIENTS AND METHODS: Between 1992 and 1999, laparoscopic procedures were performed in 70 consecutive patients, mean age 60 +/- 15 years (range: 18-82). Stone removal was attempted via the cystic duct (n=25) or choledocotomy (n=45). The emptiness of the common bile duct was checked by intraoperative cholangiography or endoscopy. After choledocotomy, closure was performed by interrupted or non-interrupted suture with slowly resorbable thread. Transcystic drainage was used whenever necessary. RESULTS: Nine conversions to laparotomy were necessary (12.8%). Among the 61 patients who had an exclusively laparoscopic procedure, 21 were treated via the transcystic route and 40 through choledocotomy. Biliary endoscopy was possible in only 10 of the 21 patients (47.6%) treated via the transcystic route and in all with choledocotomy. No biliary drainage was used in 16 of the 21 patients treated via the transcystic route and in 39 of the 40 treated through choledocotomy. The 30-day mortality was 1/61 (1.6%). Morbidity was 9.8% and 2 patients underwent a second laparoscopic procedure (one fistula on a choledocotomy suture, one hemoperitoneum of unknown origin). An endoscopic sphincterotomy for residual stone was necessary in 4 patients (4/61, 6.5%), 2 after choledocotomy for an unrecognized stone without biliary drainage. CONCLUSIONS: These results confirm the feasibility of laparoscopic treatment of common bile duct stones and suggest it can be performed without biliary drainage in most cases.

Adolescent↗

PubMedDate not supplied

Intrabiliary rupture in liver hydatid cysts: results of 20 years' experience.

To assess the diagnostic tools and results of treatment of biliary rupture observed in liver cyst hydatids, clinical findings of 562 patients with hepatic hydatid disease were reviewed. Imaging techniques were not very effective to determine intrabiliary ruptures. Rates of rupture sizes determined in the patients were as follows; 22 (%24.7) large, 38 (%42.7) small, and 29 (%32.6) occult. Most frequently utilized procedures for patients with intrabiliary rupture were Roux-en-y cystojejunostomy, tube drainage + omentoplasty, sutured fistula + omentoplasty, and sutured fistula + tube drainage. Of the total 25 external biliary fistulas, 21 closed spontaneously. Of the four fistulas that did not close, one was managed by internal drainage and three by endoscopic sphincterotomy. Preoperative diagnosis of biliary rupture in liver hydatid cyst allows early planning of operation and helps the surgeon design the operative strategy. In the treatment of cases with large rupture, internal drainage may be proposed.

Adult↗

PubMedDate not supplied

Complications of the two major operations of Hirschsprung's disease: a single center experience.

This study was designed to determine and compare the results of the Duhamel and Swenson procedures. The hospital records of patients who had undergone the Swenson or Duhamel operation over a 17-year period were reviewed and the patients were contacted for a final evaluation. The early and late complications of these operations were defined and compared. It was determined that the Swenson operation had been performed in 138 patients and the Duhamel in 59. Among the various complications, such as wound infection, dehiscence, anastomotic leak, adhesive intestinal obstruction, pelvic abscess, intraabdominal abscess, mucosal prolapsus, anastomotic stricture and fistulas, only the anastomotic stricture showed significantly higher percentages in patients who had undergone the Swenson procedure. When urinary incontinence, enterocolitis, soiling and constipation were considered, there was no significant difference between these two groups. There was one death in the Swenson group and none in the Duhamel group. The authors suggest the Duhamel operation as a simpler and safer method for the treatment of Hirschsprung's disease.

Adolescent↗

PubMed1989

Abdominal organ cluster transplantation for the treatment of upper abdominal malignancies.

Ten patients with primary malignant tumors of the biliary tract, duodenum, or stomach and with secondary involvement of the liver underwent removal of most or all of the stomach, liver, pancreas, spleen, duodenum, proximal jejunum, terminal ileum, and ascending and transverse colon. The void in the upper abdomen was filled with an organ cluster graft consisting of the liver, pancreas, duodenum, and variable segments of proximal jejunum. Eight of the ten patients are alive after 3 to 9 months, all with good liver and pancreas function, and most with satisfactory function of the gastrointestinal tract. One of the surviving patients was in the hospital for 4 months because of multiple enteric fistulas and infections; the other seven survivors were discharged after an average of 43 +/- 17.61 (SD) days. Recurrent tumor has not been proved in any of the surviving recipients and is suspected in only one. The study of such cases should provide insight and guidelines applicable to other visceral transplantation procedures that may be attempted in the future.

Abdominal Neoplasms↗