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 829 records · Page 46Linked to original sources

PubMed1997

Pattern of congenital alimentary tract malformation in Ibadan, Nigeria.

Nineteen children with congenital upper alimentary tract malformation were studied prospectively at the Department of Paediatrics, University College Hospital (UCH), Ibadan, over a period of 12 months. There were 20 cases, grouped into six types comprising congenital hypertrophic pyloric stenosis, seven; cleft lip and/or cleft palate, five; oesophagal atresia with or without tracheo-oesophageal fistula, four; jejunal atresia two and a case each of achalasia and annular pancreas. One patient had oesophageal atresia and congenital hypertrophic pyloric stenosis. The mortality rate was 31.51% (six out of nineteen). Low mortality was recorded in cases of cleft lip and/or palate, while mortalities of over 70% were recorded among cases of jejunal atresia, and oesophageal atresia with or without tracheo-oesophageal fistul. The common causes of death were milk feed aspiration (28.6%-two cases), purulent peritonitis (14.3%-one case), and probable septicaemia (14.3%-one case). The cause of death in two cases could not be determined.

Cause of Death↗

PubMed2004

Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei.

BACKGROUND AND AIMS: Surgical improvement can be achieved in selected patients with pseudomyxoma peritonei (PMP) by major cytoreductive surgery and intraperitoneal chemotherapy (IPEC). The purpose of this retrospective study was to analyze morbidity, mortality, and survival following therapy. PATIENTS AND METHODS: Between July 1995 and September 2003, 28 patients (mean age 56 years, range 28-79) with PMP were operated on with the aim of complete macroscopical cytoreduction. Surgery was followed by IPEC. RESULTS: A macroscopically complete cytoreduction was achieved in 11 patients (40%). The mean operating time was 6 h with a mean of three peritonectomy procedures per patient. Cisplatin (15 out of 28), mitomycin C (6 out of 28) and 5-FU (7 out of 28) were used for the intraoperative chemotherapy. Overall morbidity was 36%. Most frequent surgical complications were digestive fistulae (3 out of 28), abscesses (5 out of 28) and bleeding (2 out of 28). Two patients died postoperatively. Patients with low tumor volume (mean survival time 78+/-11 vs. 37+/-9 months, p=0.05) and complete cytoreduction (73+/-10 vs. 24+/-8 months, p<0.05) had an improved prognosis. CONCLUSIONS: Cytoreductive surgery combined with IPEC is associated with acceptable morbidity and mortality. Complete cytoreduction may improve survival, particularly in selected patients with PMP who have a low tumor volume, complete cytoreduction, and no organ metastases.

Adult↗

PubMed1999

Palliation of malignant dysphagia with expanding metallic stents.

PURPOSE: The authors describe their experience with expanding metallic stents for the palliation of malignant dysphagia. MATERIALS AND METHODS: During a 52-month period, 138 stents were inserted in 121 patients with malignant esophageal obstruction. The average age was 74 years; there were 78 men and 43 women. Data regarding the degree of initial dysphagia, presence of an esophago-respiratory fistula, effect of stent placement on swallowing ability, complications at the time of stent placement, and long-term survival were obtained. RESULTS: An improvement in dysphagia symptoms was recorded in more than 95% of patients. The average survival after stent placement was 24 weeks. Complications necessitating further intervention occurred in 26 patients. CONCLUSION: Insertion of self-expanding metallic endoprostheses for the palliation of malignant esophageal obstruction is an effective therapy that can be carried out with relative ease. Successful palliation of symptoms can be expected in more than 95% of cases.

Adenocarcinoma↗

PubMed1985

[Evaluation of perioperative cefoxitin in the prevention of infectious complications of surgery in cancer of the upper respiratory-digestive tracts].

Twenty-three patients (22 male and 1 female) aged 41 to 70 years (mean age 56.4 years) with cancer of the upper respiratory and digestive tracts were entered into the study prior to a major surgical procedure involving incision of cervical mucous membranes. Participants were randomly assigned either to a control group (10 patients) which received no routine intra or postoperative antibiotics, or to a treatment group (13 patients) given cefoxitin perioperatively. Treated patients were given 30 mg/kg cefoxitin intravenously over 30 mn, one hour before surgery was begun, and 30 mg/kg over one hour, 3 hours and 6 hours after the initial infusion was started. Rate of local infection was 80% (8/10) and 15% (2/10) in the control group and treated group respectively (p less than 0.001). In addition, a significant difference in rates of local complications was found: 7 disjunctions and/or fistulae or pharyngostomes in the control group against one suppuration with disjunction in the treated group. In the treated group, a mean 24.6 day reduction in time lapse to cicatrization was observed. Fever greater than or equal to 39 degrees C occurring or persisting beyond the 48th postoperative hour was also significantly more frequent in the control group (7/10 versus 3/13). In contrast, no significant difference was found between rates of other infectious localizations. Local bacterial flora recovered in both groups before and/or after surgery was unremarkable and prophylactic cefoxitin selected no particular pathogens.

Adult↗

PubMed1985

[Cholelithiasis associated with upper gastrointestinal pathology. Critical evaluation of the emerging incidence and diagnostic and therapeutic indications].

Although cases of upper G.E. tract diseases associated with simple cholelithiasis are described as specific syndromes in the literature (Saint's triad, Casten's syndrome, etc.) they may be usefully evaluated with the aim of checking the following parameters: a) incidence and importance of associated pathologies; b) etio-pathogenetic correlation between age, sex and incidence; c) clinical extent of the disease and factors determining choice of medical or surgical treatment; d) more specific presurgical diagnostic investigation for certain cases; e) effect of combined surgery on recovery. Recent research carried out (Choctaw) in which the term associated pathology was defined is described. A sample of 358 patients suffering from cholelithiasis was examined. Of these, 230 were suitable candidates for surgery and systemic presurgical examination by means of digestive tract X-ray investigation and fecal blood tests. 35% of cases were found to be associated pathologies including hiatal hernia, peptic ulcer, duodenal diverticula, gastric neoplasia and various diseases of the large intestine. These data were found to be statistically different from data collected from a similar group of patients complaining of abdominal colic who did not display symptoms of cholelithiasis although 17% had diseases of the upper G.E. tract. Combined surgery was carried out on 82% of patients and the subsequent follow-up period lasted for 1 to 3 years. A presurgical study programme aimed particularly at female patients over 50 was therefore designed. Post-surgical recovery was not affected by combined surgery.

Adolescent↗

PubMed2005

Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations.

BACKGROUND: Anorectal malformations (ARM) are common congenital anomalies seen throughout the world. Comparison of outcome data has been hindered because of confusion related to classification and assessment systems. METHODS: The goals of the Krinkenbeck Conference on ARM was to develop standards for an International Classification of ARM based on a modification of fistula type and adding rare and regional variants, and design a system for comparable follow up studies. RESULTS: Lesions were classified into major clinical groups based on the fistula location (perineal, recto-urethral, recto-vesical, vestibular), cloacal lesions, those with no fistula and anal stenosis. Rare and regional variants included pouch colon, rectal atresia or stenosis, rectovaginal fistula, H-fistula and others. Groups would be analyzed according to the type of procedure performed stratified for confounding associated conditions such as sacral anomalies and tethered cord. A standard method for postoperative assessment of continence was determined. CONCLUSIONS: A new International diagnostic classification system, operative groupings and a method of postoperative assessment of continence was developed by consensus of a large contingent of participants experienced in the management of patients with ARM. These methods should allow for a common standardization of diagnosis and comparing postoperative results.

Anal Canal↗

PubMed2000

Anorectal malformations in female children--10 years experience.

Despite enormous interest in the development of an ideal operative procedure to treat anorectal malformations, the situation is as confusing as it was 30 years ago. The reasons could be inconsistency of the nature of the lesions found in patients along with multi-system associated malformations primarily affecting the prognosis of available procedures. High imperforate anus is a complex anomaly that requires a combination of careful preservation of structures and precise anatomic reconstruction for optimal results. A retrospective study, comprising a consecutive sample of female children with anorectal malformations treated over a period of 10 years, is presented. Of 130 patients, 83% (n = 108) presented later than 3 months of age as they could pass stools through associated fistulae, of which the commonest type was found to be an ano- or recto-vestibular fistula (65%, n = 83). Ninety-four cases (72%) had what are traditionally known as "low" anorectal malformations (perineal fistulae, anteriorly placed anus and anorecto-vestibular fistulae). Ten percent (n = 14) had translevator, and 17% (n = 22) were found to have "high" lesions. Seventeen percent of patients (n = 22) had associated congenital malformations, predominantly in intermediate and high anorectal lesions, 40% of which pertained to the urogenital system. In total, 137 definitive operative procedures were done including Mollard's anterior perineal approach in 81 patients and posterior sagittal anorecto plasty (PSARP) in 38, enabling a comparison to be made of the functional results and complications in the two groups. Out of 24 post-operative complications noted in the series, 17 were found in the group who had Mollard's procedure carried out (including 3 deaths) as compared with 7 in these cases who had PSARP (two-sided P utilizing Fisher's exact test = 0.475).

Anal Canal↗

PubMed2003

Management of late complications of pelvic radiation in the rectum and anus: a review.

PURPOSE: Radiotherapy has become one of the most important treatment modalities for human malignancy. Tumors affecting the organs of the pelvis are increasingly being irradiated for local treatment benefit, with the subsequent complication of anorectal injury of varying extent. The aim of this review is to determine how to manage the consequences of long-term effects of radiotherapy on the rectum and anus. METHODS: A comprehensive search of the literature with manual cross-referencing was performed using the MEDLINE, PubMed, and Cochrane Databases. RESULTS: Long-term manifestations of injury caused by pelvic radiotherapy include abscess and fistula formation, stricture, mucus discharge, urgency, tenesmus, diarrhea, increased risk of cancer, and most commonly, bleeding. Most patients present with several symptoms; however, usually one symptom dominates. CONCLUSIONS: Many of these symptoms are self-limiting, and mucosal complications may often be treated by nonsurgical methods such as topical formalin application, endoscopic argon plasma coagulation, and hyperbaric oxygen therapy. Conservative measures have not been shown to be of benefit if symptoms persist. Structural abnormalities and septic complications are likely to require surgery. Modern techniques in the delivery of radiotherapy help minimize the likelihood of rectal complications.

Anal Canal↗

PubMedDate not supplied

[Incisional hernia repair using full-thickness intraperitoneal mesh].

Prosthetic materials proved to be a real success for incisional hernia repair, still there is a strong debate regarding the best mesh and procedure to be used. Most surgeons avoid full-thickness replacement with intraperitoneal mesh because, occasionally, an intense inflammatory response may lead to severe adhesions or enterocutaneous fistula. Still, interposition of the omentum between the abdominal contents and the mesh is a safe and natural method of visceral protection. Since July 1998, we used this technique in 33 cases treated for antero-lateral abdominal defects, operations that were followed by only 15% early and 3% late complications. Monofilament polypropylene meshes (Bard, Davol Inc.) were used in most cases. Although our results need further evaluation, may be considered favourable on short and medium term comparing to Romanian experience, which is based mainly on extraperitoneal placement of the mesh. The study is a good opportunity to review the literature regarding this issue.

Adult↗

PubMed2006

Perineal lipomas associated with anorectal malformations.

Newborns with anorectal malformations may have associated perineal lipomas. These lesions are rare but may make the repair of the anorectal malformation more complex. Knowledge about the functional consequences of these lesions is scanty. The purpose of this study was to review the experience of anorectal malformations with perineal lipomas in two Scandinavian paediatric surgical centres. Six patients with perineal lipomas and anorectal malformation treated in the two centres from 1991 to 2005 were retrospectively reviewed. Bowel function was evaluated in patients more than 4 years old. Three girls and three boys (age 4 months to 14 years) with anorectal malformations and perineal lipoma were included in the study. The boys all had high anorectal malformations with rectourethral or rectovesical fistulas. Two girls had a rectovestibular fistula and one girl had a cloaca. All patients had perineal lipomas, in one associated with an anterior meningocele. The lipomas were excised at time of anorectal reconstruction. One of the patients still has a colostomy, and two colostomies were recently closed. The bowel function was evaluated in three patients. Two patients have an ACE stoma to control constipation and soiling and one is soiling despite regular washouts. In conclusion, perineal lipomas associated with anorectal malformations are rare but may distort sphincter anatomy. Excision is best performed at time of anorectal reconstruction. Although our experience is limited, bowel function seems to be compromised by these lesions.

Adolescent↗

PubMed1989

Foreign bodies of the gastrointestinal tract, surgical considerations.

Foreign bodies (FBs) of the pharynx are likely to stop at the palatine or lingual tonsils, the cricopharyngeal muscle, or the beginning of the esophagus; they may be removed with direct vision. FBs of the esophagus should be located by esophagram; endoscopy may be diagnostic and therapeutic; sharp objects may cause laceration and vascular injury. In the stomach, the FB may pass through the intestinal tract or stop at the pylorus or duodenum; if after 5-6 days there is no evidence of passage in the duodenum, it should be recovered by gastrotomy or endoscopy. FBs in the small intestine, calculi, or phytobezoar usually stop at the ileocecal valve and should be recovered by enterotomy. They may produce a coloenteric or enteroenteric fistula leading to an inter-intestinal abscess leading to intestinal obstruction. They may pass in the colon and stop at the rectosigmoid junction leading to perforation simulating perforating sigmoid diverticulum. FBs of the rectum may be recovered by sigmoidoscopy. The strategy is exact radiological location and evaluation of whether there is absence or presence of retroperitoneal or perirectal air. Intraperitoneal perforation should be immediately treated by suture of the perforation and temporary sigmoid colostomy. Perforation below the peritoneal reflexion is treated by diverting sigmoid colostomy and extraperitoneal perirectal drainage. Compound lacerations of the rectosigmoid junction may need Hartmann's procedure followed three weeks later by a terminoterminal or terminolateral anastomosis using the EEA stapler.

Abscess↗

PubMed1986

Ursodeoxycholic acid, 7-ketolithocholic acid, and chenodeoxycholic acid are primary bile acids of the nutria (Myocastor coypus).

Because ursodeoxycholic and chenodeoxycholic acids are interconverted in humans via 7-ketolithocholic acid, bile acid metabolism was studied in the nutria (Myocastor coypus), the bile of which is known to contain these three bile acids. Relative concentrations of ursodeoxycholic (37% +/- 20%), 7-ketolithocholic (33% +/- 17%), and chenodeoxycholic (17% +/- 9%) acids in gallbladder bile were unchanged by 5-20 h of complete biliary diversion (n = 7). Injection of either [14C]cholesterol, [14C]ursodeoxycholic, [14C]7-ketolithocholic acid, or a mixture of [7 beta-3H]chenodeoxycholic acid and [14C]chenodeoxycholic acid into bile fistula nutria demonstrated that all three bile acids can be synthesized hepatically from cholesterol, that they are interconverted sparingly (2%-5%) by the liver, but that 7-ketolithocholic acid is an intermediate in the hepatic transformation of chenodeoxycholic acid to ursodeoxycholic acid. An animal that had been fed antibiotics showed an unusually elevated concentration of ursodeoxycholic acid in gallbladder and hepatic bile, suggesting that bacterial transformation of ursodeoxycholic acid in the intestine may be a source of some biliary chenodeoxycholic acid and 7-ketolithocholic acid.

Animals↗

PubMed2000

The role of overlapping sphincteroplasty in traumatic fecal incontinence.

Fecal incontinence is one of the most distressing conditions. Even there is a great variety of etiologic factors, they can be systematized in two main categories; fecal incontinence with normal and fecal incontinence with abnormal function of pelvic floor muscles. The latter is more interesting for surgeons since this category includes the great majority of surgically caused and surgically correctable fecal incontinences. Disruption of the anal sphincter caused by obstetric injury, anorectal operations or external trauma is the commonest cause of fecal incontinence. In the period 1990-1999, 53 patients with fecal incontinence caused by sphincter injury were treated on the third department for colorectal surgery, First Surgical Clinic. There were 43 females and 10 males with a mean age of 36.1 years (range 18-64). Causes of fecal incontinence were: obstetric trauma 38 patients. (71%), fistulotomy 9 (17%), war injuries 3 (6%) and nonspecific 3 (6%). The severity of incontinence was graded by Browning--Parks's classification. There were no patients in group A and B, in group C were 11 patients and in D group 37 patients. Wexner score system was also utilized preoperatively and postoperatively to determine continence function more precisely. Clinical exam, anoscopy and special investigations, such as anal manometry, EMG and defecography were carried out in all cases. Period between injury and repair was between 6 months and 20 years. Severe pudendal neuropathy was present in 17 patients. Five patients had oostomies performed at the time of injury. In three cases was present traumatic cloaca and in one case rectovaginal fistula. Overlapping sphincter repair technique was carried out in all cases. Full bowel preparation and antibiotics were prescribed. Anterior sphincteroplasty was performed in 39 cases, lateral in 7, posterior in 3 and anterior sphincteroplasty + posterior plication of puborectalis (Parks operation) in 4 patients. Protective colostomy was not performed in any case. The outcome of the procedure was considered as excellent, good, fair and poor (excellent when full control of solid and liquid stool and flatus was achieved, good when there was continence to feces but not to flatus, fair when patients could control only solid feces and poor when only partial control of solid feces was obtained). The overall functional results were as follows: Excellent in 25 patients (47.2%), good in 12 (22.7%), fair in 11 (20.7%) and poor in 5 (9.4%). Wound infection occurred in 9 (16.9%) patients, leading to disruption of sutures in three patients with consequent poor results. Two of them were reoperated. The duration of follow-up was from 5 to 60 months. We conclude that an overlapping sphincteroplasty is a method of choice in treating fecal incontinence caused by trauma. The best results are achieved with anterior sphincteroplasty. Results of posterior sphincteroplasty were disappointing. If present, pudendal neuropathy directly influences the outcome of sphincteroplasty. Manometric studies correlate with the clinical outcome.

Adolescent↗

PubMed1984

Percutaneous endoscopic gastrostomy following previous abdominal surgery.

During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy.

Adolescent↗

PubMed1999

Jejunostomy: techniques, indications, and complications.

Jejunostomy is a surgical procedure by which a tube is situated in the lumen of the proximal jejunum, primarily to administer nutrition. There are many techniques used for jejunostomy: longitudinal Witzel, transverse Witzel, open gastrojejunostomy, needle catheter technique, percutaneous endoscopy, and laparoscopy. The principal indication for a jejunostomy is as an additional procedure during major surgery of the upper digestive tract, where irrespective of the pathology or surgical procedures of the esophagus, stomach, duodenum, pancreas, liver, and biliary tracts, nutrition can be infused at the level of the jejunum. It is also used in laparotomy patients in whom a complicated postoperatory recovery is expected, those with a prolonged fasting period, those in a hypercatabolic state, or those who will subsequently need chemotherapy or radiotherapy. As a sole procedure it is advised for neurologic and congenital illnesses, in geriatric patients who pose difficult care demands, and for patients with tumors of the head and neck. The complications seen with jejunostomy can be mechanical, infectious, gastrointestinal, or metabolic. The rate of technical complications of the Witzel longitudinal technique is 2.1%, for the transverse Witzel up to 6.6%, for the Roux-en-Y 21%, for open gastrojejunostomy from 2%, and for the needle catheter technique from 1.5% with 0.14% mortality. The percutaneous endoscopic procedures have as much as a 12% complication rate; no figures exist for laparoscopy. The complications are moderate and severe: tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, pneumatosis, occlusion, and intestinal ischemia. The infectious complications are aspiration pneumonia and contamination of the diet. The gastrointestinal complications are diarrhea 2.3% to 6.8%, abdominal distension, colic, constipation, nausea, and vomiting. The metabolic complications are hyperglycemia 29%, hypokalemia 50%, water and electrolyte imbalance, hypophosphatemia, and hypomagnesemia. These complications are secondary to inadequate selection of nutrition relative to the characteristics of the patient, to inadequate management of the mixture, and to deficient clinical care. The ideal jejunostomy technique depends on the material resources but more importantly on the experience of the surgeon. The benefits of jejunostomy justify the risks.

Aged↗

PubMed2006

Situs anomalies and gastrointestinal abnormalities.

BACKGROUND/PURPOSE: The aim of the study was to review the gastrointestinal abnormalities occurring in association with situs anomalies. METHODS: Patients with situs anomalies were identified from the medical records of pediatric patients of Seoul National University Children's Hospital from January 1980 to July 2004. Retrospective study was undertaken. Diagnosis was made on the basis of the information obtained from a combination of echocardiography, angiography, abdominal ultrasonography, liver scan, upper gastrointestinal study, or abdominal computed tomography. RESULTS: A total 67 patients diagnosed as having situs anomalies were identified. There were 40 males and 26 females (1.54:1). Of these 67 patients, 45 patients (67%) were diagnosed as having situs inversus, 16 patients (24%) as having right isomerism, and 6 patients (9%) as having left isomerism. Of 45 patients with situs inversus, there were 26 patients (58%) who had intraabdominal abnormalities. These were duodenal atresia, biliary atresia, gastroschisis with malrotation, congenital hepatic fibrosis, tracheoesophageal fistula (type C), Currarino's triad, and pheochromocytoma. Of 16 patients with right isomerism, there were 14 patients (88%) who had intraabdominal abnormalities. These were hiatal hernia and diaphragmatic hernia. Of 6 patients with left isomerism, there were 4 patients (67%) who had intraabdominal abnormalities. These were malrotation and biliary atresia. CONCLUSION: When a patient is noted to have congenital heart disease as part of situs anomalies, or if an atypical position of organs is noted at imaging evaluation, we recommend that the patient undergo chest radiography, abdominal ultrasonography, upper gastrointestinal study, and abdominal computed tomography.

Abnormalities, Multiple↗

PubMed2003

Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature.

Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.

Endoscopy, Digestive System↗

PubMed1995

Octreotide versus pyloric exclusion in reducing gastrointestinal secretions entering the duodenum in a canine model.

Pyloric exclusion is advocated in the treatment of duodenal injury. The beneficial effect is thought to be due to diversion of gastric secretions and resultant reduction of biliary and pancreatic secretions. The long-acting somatostatin analog, Octreotide, makes the inhibitory actions of somatostatin on gastric, biliary, and pancreatic secretions a potential alternative to pyloric exclusion. We compared the effect of pyloric exclusion to the effect of Octreotide on the volume of gastrointestinal secretions entering the duodenum by creating a duodenal fistula using a canine model. Five animals had modified Thomas cannulas placed in the duodenum. Two animals had staple closure of the pylorus with a gastrojejunostomy in addition to the cannula. Gastrointestinal secretions were measured in 2- or 3-hour collection periods performed every third or fourth day. Animals were administered saline or Octreotide (100 micrograms/hour) intravenously during each collection. Up to 9 hours of collections under both saline and Octreotide (18 hours total) were done on each dog. Octreotide alone reduces gastrointestinal secretions entering the duodenum more than pyloric exclusion alone. Pyloric exclusion and Octreotide together offered no additional reduction in gastrointestinal secretions entering the duodenum over Octreotide alone.

Animals↗