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PubMed1984

[Nutritional management of anastomotic leakage after gastrointestinal surgery--with special reference to the serious cases].

Effects of intravenous hyperalimentation (IVH) were studied in 38 patients with anastomotic leakage following gastrointestinal surgery. Spontaneous closure of the leakage were found in 23 patients (60%), and surgical closure were needed in 9 patients (24%). The duration required for spontaneous closure was 5 weeks on the average; and closure occurred readily in cases of tubular fistula. Death occurred in 6 patients (16%); among these, 5 were MOF cases. The following three points are emphasized concerning measures to increase IVH efficacy in serious cases such as MOF. GFX-solution is efficacious for reduced glucose tolerance. Administration of canrenoate potassium(Soldactone), linoleic acid and BCAA enriched amino-acid mixture is effective for accelerated albumin synthesis. Concomitant treatment by IVH and ED(elemental diet) is efficacious in cases of high caloric administration.

Digestive System Surgical Procedures↗

PubMed1996

[Radiation injuries of the small intestine. Surgical treatment].

UNLABELLED: From 1978 to 1992, 55 patients (48 women: 87%) with a mean age of 62 years (35-89) underwent 70 operations for radiation injury of the small bowel. Primary pathology treated with radiotherapy was gynecologic cancer (40: 72%), digestive malignancy (9: 16%), male genital cancer (4: 7%), carcinoma of the bladder (2: 3%). External radiation was performed alone (47: 85.5%) or associated with intracavitary radium or cesium (8: 14.5%), mean radiation dose was 50 Gy for 35 patients and not specified for 20 but greater than 45 Gy for all patients. Fifteen patients had associated chemotherapy. Latent period between radiation injury and first symptoms was 39 months (1-16 years) and 72 months (3-26 years) between radiation and surgical treatment. There were 28 solitary lesions (mean length: 148.5 cm) with 5 associated colonic injuries, 27 multiple lesions of the small bowel (mean length: 187.5 cm) with 21 associated colonic injuries. Twenty-one lesions of the abdominal wall and 13 lesions of the urinary tract were also associated. Nineteen patients had pre-operative total parenteral nutritional assistance. Surgical treatment was performed for chronic obstruction in 46 patients, for fistulae in 5 or for an acute complication in 4 (perforating peritonitis: 3, occlusion: 1). Operations performed were: small bowel resection (32), associated with bypass (2); internal by-pass (15); dissection of adhesions and/or stomy (7). RESULTS: Operative mortality was 2 (6.2%). Morbidity occurred in 16 (29%) with 3 anastomotic fistulae. Functional results were good for 36 patients (24 resections, 7 by-pass), poor for 2 (1 resection). Failure leading to a second operation occurred in 15 (5 resections, 8 by-pass). COMMENTS: 1) pre-operative nutritional assistance improves operative results; 2) intestinal resection is preferable to internal by-pass whenever it can be performed without extreme risk or unacceptable sequelae.

Adult↗

PubMed1983

[Determination of the nutritional value of lignocellulose materials].

The determination of the nutritive value of various secondary wood products was conducted by the method of the in-vitro digestibility of dry matter (Mellenberger et al., 1970) and by detergent analyses of fibre (Goering and Van Soest, 1970). Rumen contents for trials in vitro were obtained from adult wethers having a permanent rumen fistula and fed good meadow hay ad lib. The animals also had free access to water and mineral lick for sheep. Out of the 11 lignocellulose materials tested, digestibility in vitro higher than 60% (equivalent to the digestibility of high-quality meadow hay) was only found in three samples. These are: a) beech sawdust II treated with 0.1M sulphuric acid at the hydromodulus of 1:8, temperature 100 to 130 degrees C for two hours, and pressure of 0.25 MPa and then with 0.47M nitric acid at the hydromodulus of 1:13, temperature 100 degrees C for two hours and pressure of 0.25 MPa; b) beech sawdust III treated as beech sawdust II and then neutralized with ammonia to pH 8; c) aspen sawdust treated hydrobarothermically at a temperature of 280 degrees C and pressure of 7 MPa in saturated vapour medium (Canon system). The high digestibility of these samples was due to a low lignin content so that the polysaccharides (cellulose and hemicelluloses) of these secondary wood sources could be sufficiently utilized by rumen microflora.

Animals↗

PubMed1979

[Digestive duplications affecting the pharynx or fistulae of the fourth endo-branchial pouch. Four cases (author's transl)].

Four cases of children with recurrent latero-cervical epithelial cystic tumours which where identified as exceptional derivatives of the 4th endobranchial pouch on the basis of their connections with the pharynx and in particular the piriform fossa. The opportunity is taken to review the characteristics of equally rare digestive, duplications and congenital diverticula at a cervical and buccopharyngeal level. This diagnosis was made initially in the first of these cases.

Branchioma↗

PubMed1992

Clinical application of ultrasonic probes in the biliary and pancreatic duct.

The clinical use of an ultrasonic probe with the radial scan transducer in the biliopancreatic ducts is reported in 35 patients with biliopancreatic lesions, including 11 cases of bile duct and 5 of pancreatic carcinoma. Two approaches are available for the intraductal scanning of bile and/or pancreatic ducts. One is the percutaneous insertion via a percutaneous transhepatic biliary fistula established for cholangioscopy. The other approach is the transpapillary insertion of the probe via the working channel of the duodenoscope. Using both approaches, ultrasonographic images of the bile duct wall, pancreas head and neighboring major blood vessels could be observed clearly. The extent of bile duct and pancreatic carcinoma could also be visualized. We believe that intraductal scanning using ultrasonic probes is a promising method in the staging of biliopancreatic malignancy.

Bile Duct Neoplasms↗

PubMed2006

Endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for multiple intraductal papillary mucinous adenomas.

In benign or low-grade malignant pancreatic tumors, complete removal of the lesion is sufficient for a cure, and thus minimal resection techniques with preservation of the pancreatic functional reserve have advantages over more extended pancreatic resections. However, a high incidence of postoperative pancreatic fistula in such procedures has been reported. Moreover, branch-type intraductal papillary mucinous neoplasms of the pancreas tend to locate in the head of the pancreas, and show less malignant potential. We describe an endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for branch-type multiple intraductal papillary mucinous adenomas, along with a gastric wall-covering method for the prevention of pancreatic leakage.

Adenoma↗

PubMed2005

Recent trends in the management of combined pancreatoduodenal injuries.

In an effort to better characterize the natural history of pancreatoduodenal injuries, we present a review of clinical experiences in the treatment of combined traumatic pancreatoduodenal injuries, focusing on patients in extremis. Records of patients with abdominal trauma admitted to a level 1 trauma center from 1997 to 2001 were reviewed. Of 240 patients who sustained a pancreatic or duodenal injury, 33 had combined pancreatoduodenal injuries. Eighty-two per cent of the patients (27/33) in this series had penetrating injuries, 72 per cent (24) sustained gunshot wounds (GSW). Thirty-one patients were male, and the mean age was 33 years (range, 7-74). These patients presented with an average Injury Severity Score (ISS) of 22 +/- 12 and an average Glasgow Coma Score of 14 +/- 2. Overall length of stay was 39 +/- 59 days (range, 0-351 days). These 33 patients underwent a total of 57 laparotomies with an average of 1.7 operations per patient (range, 1 to 5 operations). Eighty-four per cent of the patients had an associated gastrointestinal injury and 45 per cent had a major vascular injury. Thirteen of the 33 (39%) patients presented in extremis, all 13 underwent an abbreviated laparotomy. The complication rate was 36 per cent, including fistula, abscess, pancreatitis, and organ dysfunction. There were 6 hospital deaths for a mortality rate of 18 per cent. Pancreatoduodenal injuries are associated with a variety of other serious injuries, which add to the overall complexity of these patients. Abbreviated laparotomy may be helpful when managing combined pancreatoduodenal injuries in patients who are in extremis.

Abdominal Injuries↗

PubMed2006

Collagen in colon disease.

The pathophysiology of wound healing in the bowel wall suggests that collagen and matrix metalloproteinases (MMPs) have an important role in the changes of the bowel wall seen in several colonic diseases. Several recent studies suggest that disturbances of the collagen texture and the extracellular matrix (ECM) metabolism are major factors leading to the onset of diverticular disease. Changes of the ECM also play a role in the development of inflammatory bowel diseases. Regarding the permanent remodeling of the bowel wall, any imbalance of the ECM could support the onset of chronic inflammation and the development of fistula formation, such as that seen in patients with Crohn's disease. Disturbances of the ECM play a role in the pathogenesis of anastomotic leakage after large bowel surgery and suggest the presence of a genetically defined risk population with disturbed wound healing mechanisms. This concept could explain the well known situation where an anastomotic breakdown is observed, despite the absence of other known risk factors and after a technically correct anastomosis.

Collagen↗

PubMed2003

Cystic pancreatic neoplasms: enucleate or resect?

Asymptomatic cystic pancreatic neoplasms are being detected by abdominal imaging with increasing frequency. Enucleation of small cystic neoplasms can be performed without recurrence but has been associated with a higher incidence of pancreatic fistula. Thus the procedure has been modified to include intraoperative ultrasound imaging and closure of the pancreatic defect. This analysis was performed to determine whether these modifications have improved operative outcome. Thirty patients with mucinous cystic neoplasms (n=16), serous cystadenomas (n=10), and cystic islet cell tumors (n=4) were studied. Enucleation was performed in 11 patients (7 with mucinous cystic neoplasms, 2 with serous cystadenomas and 2 with islet cell tumors), whereas 19 underwent resection of cystic tumors (pancreatoduodenectomy in 8 and distal pancreatectomy in 11). The mean groups did not differ with regard to age (57 years), gender (73% female), presentation (63% incidental), or site (43% head, neck, or uncinate). Patients undergoing enucleation had smaller tumors (2.2 vs. 4.7 cm, P<0.01) that were less likely to be in the tail (9% vs. 42%). Operative time was significantly shorter in the enucleation group (199 vs. 298 minutes, P<0.01). Blood loss also was significantly reduced in the enucleation group (114 vs. 450 ml, P<0.001). Pancreatic fistula rates (27% vs. 26%) and length of hospital stay (12.6 vs. 15.7 days) were similar in the two groups. Enucleation of benign cystic pancreatic neoplasms reduces operative time and blood loss without increasing postoperative complications or length of stay. Therefore enucleation should be the standard operation for small benign cystic neoplasms in the uncinate, head, neck, and body of the pancreas.

Adenoma, Islet Cell↗

PubMed2005

Atresia of the colon.

BACKGROUND/PURPOSE: Colonic atresia (CA) is one of the rarest causes of neonatal intestinal obstructions, and no large series can be reported. Therefore, we did perform a retrospective clinical trial to delineate our CA cases and carry out a literature survey. METHODS: We reviewed the charts of CA cases treated in our center between 1992 and 2002. We aimed to collect all reported cases in Medline, and personal communications with the authors of published series were used to reach the missing data. RESULTS: The chart review revealed 9 newborns with CA treated in our center (6 cases of type III, 2 cases of type II, and 1 case of type IV). These accounted for 3.7% of all gastrointestinal atresias managed in our center. Of the CA cases, 3 were isolated and 6 had at least one or more associated congenital anomalies. The preferred surgical technique at the initial treatment of CA was performing a proximal stoma and distal mucous fistula in an average of postnatal 59.4 hours. The literature survey enabled us to reach 224 cases of CA, including our cases. CONCLUSIONS: Because of the low incidence of CA, delay in diagnosis and treatment may occur. The mortality is statistically higher when the surgical management is performed after 72 hours of age. However, the prognosis of CA is satisfactory if diagnosis and surgical management could be made promptly and properly.

Anastomosis, Surgical↗

PubMed2006

Risk factors for mortality and intra-abdominal complications after pancreatoduodenectomy: multivariate analysis in 300 patients.

BACKGROUND: Studies of risk factors after pancreatoduodenectomy are few: some concern restricted populations and others are based on administrative data. METHODS: Multicenter clinical data were collected for 300 patients undergoing pancreatoduodenectomy to determine (by univariate and multivariate analysis) preoperative and intraoperative risk factors for mortality and intra-abdominal complications (IACs), including pancreatic fistula. Fourteen factors including the center and volume effect were analyzed. RESULTS: In univariate analysis, mortality was increased with age 70 years or more, extended resection(s), and volume and center effects. IACs occurred more often with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, extended resection(s), and the center effect. Pancreatic fistula was more frequent with main pancreatic duct diameter of 3 mm or less, normal parenchyma texture, and the center effect. In multivariate analysis, independent risk factor(s) for mortality were age greater than 70 years (odds ratio [OR], 3; 95% confidence interval [CI], 1.3-8) and extended resection (OR, 5; 95% CI, 1.2-22), risk factors for IACs were extended resection (OR, 5; 95% CI, 1.2-22) and main pancreatic duct diameter of 3 mm or less (OR, 2; 95% CI, 1.1-3), and the risk factor for pancreatic fistula was main pancreatic duct diameter of 3 mm or less (OR, 2.5; 95% CI, 1.2-4.6). CONCLUSIONS: Age more than 70 years, extended resections, and main pancreatic duct diameter less than 3 mm are independent risk factors that should be considered in indications for and techniques of pancreatoduodenectomy.

Adult↗

PubMed1975

Potency and selectivity of methyl analogues of prostaglandin E2 on rat gastrointestinal function.

1 The potency and selectivity of action of prostaglandin E2 and its (15S)- or (15R)-15 methyl and 16, 16 dimethyl analogues on gastrointestinal function have been studied in the rat. 2 The (15S)-15 methyl and 16, 16 dimethyl analogues were 40 times as active as prostaglandin E2 in inhibiting pentagastrin-stimulated acid secretion on intravenous administration to the anaesthetized rat, and 100 times as active on subcutaneous injection to the chronic fistula rat. 3 In antisecretory doses, the analogues, like prostaglandin E2, caused bile reflux and, in higher doses, profuse diarrhoea. 4 The (15S)-15 methyl and 16, 16 dimethyl analogues were at least 30 times as active as prostaglandin E2 in causing changes in intestinal intraluminal pressure in vivo, but were equipotent on isolated smooth muscle. 5 In equivalent antisecretory doses, the methyl analogues had little effect on systemic arterial blood pressure and resting mucosal blood flow compared with prostaglandin E2. 6 The (15R) methyl epimer administered parenterally had little effect on gastrointestinal function but brief acid incubation greatly increased its activity.

Anesthesia↗

PubMed1991

Reoperation after cholecystectomy. The role of the cystic duct stump.

The so-called "Postcholecystectomy Syndrome" may be due to various pathological biliary causes. The aim of this study was to evaluate the significance of the cystic duct stump syndrome and if so, how often a long (greater than 1.5 cm) cystic duct stump was an indication for reoperation on the bile ducts after cholecystectomy in our patients. Three hundred and twenty two patients underwent a second operation on the bile ducts after cholecystectomy in the last ten years. In 35 patients (10.8%) a striking findings was a long cystic duct stump (greater than 1.5 cm). In 24 of these patients, a pathological finding, in addition to the long cystic duct stump, was found on exploration. Out of these 24 patients there were 14 with common bile duct stones; 6 with stenosis of the sphincter of Oddi; 3 with chronic pancreatitis and in one patient hepatitis was the cause of the symptoms. From the remaining 11 patients 8 had a stone in a partial gall bladder or cystic duct stump. One patient had a fistula between the cystic duct stump and duodenum and one a suture granuloma. There was only one patient where a 1.5 cm long cystic duct stump remnant was the only pathological finding. Four years after reoperation this patient is still suffering from the same intermittent gastrointestinal symptoms. We conclude that the cystic duct stump is hardly ever a cause for recurrent symptoms in itself. Total excision of the cystic duct does not eliminate the existence of postcholecystectomy symptoms.

Cholecystostomy↗

PubMed1999

Percutaneous cholecystostomy and endoscopic cholecystolithotripsy in the management of acute cholecystitis.

BACKGROUND: Percutaneous cholecystostomy is a valuable alternative temporary measure for acute cholecystitis in elderly patients with severe underlying cardiopulmonary disease, but the subsequent management of gallbladder calculi is still controversial. METHODS: Eleven patients treated with percutaneous endoscopic cholecystolithotripsy after percutaneous cholecystostomy were evaluated retrospectively. RESULTS: All patients showed clinical improvement after percutaneous cholecystostomy. Tract dilation succeeded in 9 patients. Complete stone clearance was achieved in seven patients over one to four sessions (average, two sessions). Stone extraction could not be completed in two patients because gallbladder access was lost in one patient, and the other refused further procedure. There were three complications, with two biliary fistulas and one major bile leakage leading to emergency cholecystectomy. The duration of the entire procedure ranged from 30 to 126 days (mean, 58 days). During the follow-up (mean 17.2 months), one patient had recurrent cholangitis and the others remained asymptomatic. CONCLUSIONS: Percutaneous cholecystolithotripsy after percutaneous cholecystostomy is a safe alternative in the management of high-risk elderly patients with acute cholecystitis.

Acute Disease↗

PubMed1999

[Augmentation ileocystoplasty as a treatment of vesicoureteral injury following rectal amputation: a case report].

A 65-year-old man underwent transperineal drainage of pelvic abscess after rectal amputation for rectal cancer. The bladder wall and right ureter were injured during this operation, which led to vesicoperineal fistula and contracted bladder. We performed partial resection of the bladder (fistulectomy), augmentation ileocystoplasty (Cup-patch technique), and bilateral ureteral reimplantation (LeDuc-Camey technique). After surgery, the patient was able to void without any residual urine or incontinence. There was no hydronephrosis or resicoureteral reflux postoperatively. Augmentation cystoplasty is usually performed to treat a contracted bladder, but it can also be applied for the reconstruction of complicated lower urinary tract injury, and may improve the quality of life (QOL) dramatically.

Aged↗

PubMedDate not supplied

Surgical results of corrosive injuries involving esophagus to jejunum.

BACKGROUND/AIM: Severe corrosive injury involving esophagus to jejunum remains an unique surgical problem which is associated with high mortality and morbidity. MATERIAL AND METHODS: Herein we report the outcomes of 28 caustic patients who underwent resections of the stomach, duodenum, a segment of jejunum, and adjacent involving organs. RESULTS: In all of these patients except one, esophagectomy was also performed. The concomitant procedures included pancreaticojejunostomy (n = 24), choledochojejunosotmy (n = 4), cholecystostomy (n = 4), common bile duct or pancreatic duct drainage, feeding and drainage jejunostomies, and cervical esophagostomy. Major complications consisted of bile leakage (n = 10), bile-bronchial fistula (n = 2), internal bleeding due to vessel necrosis (n = 5), peritonitis (n = 4), acute renal failure (n = 4), and septicemia (n = 4). There were 13 hospital deaths (46.4%) and three late deaths. Eight out of 12 survivors underwent subsequent reconstruction of esophagus. The remaining four survivors depended on jejunostomy feeding. CONCLUSIONS: Early approaches and appropriate procedures can save a number of patients with corrosive injury involving esophagus to jejunum.

Adult↗

PubMed2002

[Therapy of Crohn disease according to the guidelines of the German Society for the treatment of digestive and metabolic diseases].

Crohn's disease is still an incurable affliction: While various pathogenic mechanisms have been elucidated in detail, the etiology remains undetected. Conservative medical management is the mainstay of treatment with corticosteroids and azathioprin as pivotal drugs. Aminosalicylates are of minor importance. Infliximab may be effective for individual patients as a third line of treatment after failure of classical immunosuppression or when a rapid response is mandatory in a corticosteroid-resistant situation. Its long-term efficacy and safety in the treatment of fistulae is unknown. Antibiotics and nutritional measures may be of help in certain clinical conditions. Satisfactory means of maintaining remission in inactive patients is not available to date. Psychotherapy may be useful in helping patients to cope but does not significantly affect the course of the disease. The guidelines presented here are based on a consensus developed by the Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten in 1996 (26), updated in December 2001 (to be published) on the basis of recent randomized trials and meta-analyses.

Crohn Disease↗

PubMed1985

Comparison of two techniques used for the recovery of nematode infective larvae from pasture.

The recovery of gastrointestinal nematode infective larvae from herbage collected manually was compared with the recovery from herbage ingested by sheep with oesophageal fistulae, on five occasions during the grazing season. At least three times more larvae were recovered from the oesophageal fistulates than by manual collection. There was no significant variation between the numbers of larvae collected at 09.00, 12.00 and 15.00, nor was there any difference in the distribution of genera recovered by the two methods. The worm burdens of tracer lambs and the larval counts from the fistulated sheep were used to estimate the rate of larval establishment.

Animals↗