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At least 19 recordsLinked to original sources
PubMed1995

[Arteriovenous and arterial-digestive system fistulas complicating isolated iliac aneurysm].

Isolated iliac aneurysms are often discovered when they rupture, sometimes into a neighbouring organ. We report 2 cases of aneurysm of the common iliac artery, one which ruptured into the right common iliac vein and the other in to the sigmoid. Diagnosis was made at laparotomy in the first case and on the CT-scan of the pelvis in the second. The first case was treated with an exclusion graft using ilio-iliac bypass with suture of the venous breach via the aneurysm. In the second case, the aneurysm was excluded by ligature of the iliac arteries with extra-anatomic crossed femoro-femoral bypass, sigmoid colostomy and drainage of the pelvis. These two cases illustrate the importance of digital examination of the pelvis and CT-scan for the diagnosis of complicated aneurysms of the iliac vessels. Rapid surgery is a determining factor in prognosis.

Aged↗
PubMed2000

Ketorolac improves recovery after outpatient anorectal surgery.

PURPOSE: The purpose of this study was to evaluate the effectiveness of ketorolac combined with local anesthetics for anorectal surgery. METHODS: From June 1998 through March 1999, 123 outpatients undergoing anorectal surgery were entered into a prospective, randomized, double-blinded study involving three treatment groups. All patients received intravenous sedation consisting of fentanyl and a propofol infusion, with a local anesthesia mixture of lidocaine, bupivacaine, and bicarbonate. Group A (41 patients) received placebo (saline) injections. Group B (41 patients) received 60 mg of intravenous ketorolac at the onset of the procedure, and Group C (41 patients) received 60 mg of ketorolac mixed with the local anesthetic. Data were analyzed using analysis of variance and chi-squared tests. RESULTS: All groups had similar demographic characteristics and operative procedures. Twenty-nine of the 123 patients were human immunodeficiency virus-positive. There was no difference in operative or anesthesia time. Anesthesia and fluids given were similar in across groups. A significantly higher percentage of Group A patients had pain (34 percent) and required additional oral analgesia (20 percent) in the Day Surgery Unit. Only 5 percent of Group B and Group C patients complained of pain, with oral analgesics given to 2 percent of Group B and none in Group C. Voiding difficulties were more common in Group A patients, one patient requiring catheterization. CONCLUSION: The addition of ketorolac (60 mg), either intravenous or injected with local anesthetics, reduces voiding problems and significantly decreases postoperative analgesic requirements in outpatients undergoing anorectal surgery.

Adult↗
PubMed2005

[Anastomotic fistula. Complication caused by surgery].

Chronic anastomotic fistula are an expression of a complication after anastomoses caused by surgery. The cause of this is diverse and reaches from incorrect seam technology, over factors of the comorbidity up to the fateful process. All regions from the esophagus to the rectum and, in addition, the biliary and pancreatic ducts can be affected. To evaluate the general problem localization diagnostics are necessary, whereby different endoscopic, radiological and combining techniques are being applied. The treatment of fistulas contains therapies of conservative, conservatively medicamentous over the intervention in endoscopic management up to the surgical treatment. In most cases the treatment of anastomotic fistula require an individual patient-fair therapy; exceptions are the pancreatic fistula.

Anastomosis, Surgical↗
PubMedDate not supplied

[The somatostatin analog SMA (201-995) as adjuvant treatment in patients with external fistulae of the digestive system].

Six patients with gastrointestinal fistulae treated with a potent inhibitor of gastrointestinal hormones, the somatostatin analogue SMS 201-995 are reported. All patients had severe intraabdominal diseases and underwent a mean of 3.5 surgery procedures during their hospital stay. When the patients were analyzed individually a mean reduction of 42.5% (P < 0.050 of basal fistulae output was observed after treatment. In three patients the fistulae closed after seven and ten days of treatment with the analogue; the other three patients died after a protracted hospital stay which included multiple admissions to the Intensive Care Unit. When the output of all fistulae treated where analyzed together it showed a tendency to decrease, but it didn't reach statistical significance.

Adult↗
PubMed2003

Comparison of surgical treatments of gallstone ileus: preliminary report.

Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1% to 4% of all intestinal obstructions. In the group of patients over 65 years of age, gallstones cause about 25% of all non-strangulated obstructions of the small bowel. Gallstone ileus is burdened with high mortality rate, ranging from 12% to 18%, and most patients are of advanced age, with many other concomitant diseases that may increase the operative risk. The purpose of this study was to compare the two investigated surgical procedures: treatment of intestinal obstruction alone or combined with urgent cholecystectomy and fistula repair. Analysis of 30 patients undergoing operation for gallstone ileus at the Clinical Hospital "Sestre milosrdnice" between 1985 and 2001 is presented. Patients were treated either for ileus alone (group 1, 11 patients) or as one-stage procedure with urgent fistula closure (group 2, 19 patients). Operating time was significantly longer for the one-stage procedure. Complications occurred in 3 of 11 patients (27.3%) from group 1 and in 11 of 18 patients (61.1%) from group 2 (one tailed, p = 0.043). One patient in group 1 died and two patients in group 2 died. Urgent fistula repair was significantly associated with the occurrence of complications (odds ratio [OR] 12.1, 95% confidence internal [95% CI] 1.2-121.5). Simple enterotomy should be the procedure of choice for patients with gallstone ileus. The one-stage procedure including urgent fistula repair should be reserved only for highly selected patients with absolute indications.

Aged↗
PubMed2005

Intestinal perforation in Crohn's disease. Factors predictive of surgical resection.

UNLABELLED: New medical therapeutic options challenge the usual surgical management of Crohn's disease patients with intestinal perforation. OBJECTIVES: To determine factors predictive of surgery for perforation in Crohn's disease and define a group of patients that may benefit from non-surgical treatment. METHODS: One hundred and sixty-two patients (69 males, 93 females, mean age 39) with perforated Crohn's disease (fistula, abscess, inflammatory mass) between January 1995 and September 2003 were studied retrospectively. RESULTS: One hundred and fifty-one patients (93%) underwent surgery: 70 had planned surgery and 81 had surgery for symptomatic deterioration. At two years, the cumulative probability of intestinal resection was 0.89 +/- 0.03, and the cumulative probability of unplanned intestinal resection was 0.72 +/- 0.05. Predictive factors of unplanned surgery were elevated platelet count (adjusted hazard ratio 3.15; 95% CI 2.21-4.50) and absence of fistula (adjusted hazard ratio 3.14; 95% CI 2.48-3.99). The rate of postoperative complications, the need for a stoma, and the length of bowel resection were not significantly different whether the surgery was planned or not. CONCLUSION: A significant proportion of patients with intestinal perforation complicating Crohn's disease, particularly those with a fistula, might benefit from non-surgical treatment.

Abscess↗
PubMedDate not supplied

Self-adhesive drape (Opsite) for management of leaking abdominal wounds.

BACKGROUND: Leaking abdominal wounds (LAW) are associated with high patient morbidity. OBJECTIVES: To evaluate the efficacy of a self-adhesive drape (Opsite) with suction drains for the management of LAW. METHODS: Twenty patients with LAW (14 intestinal fistula, 4 biliary fistula, 2 ascites leak) were subjected to the use of a self-adhesive drape with a Romovac suction drain. Conventional wound management was used for the first 5 days, followed by the application of Opsite drape. The parameters evaluated were quantity of the effluent, skin integrity, ease of application, patient comfort and cost effectiveness. A discomfort score (based on four parameters: mobility, skin excoriation, wetness and unpleasant odor) was recorded on day 1 (pre conventional), day 5 (post conventional-pre Opsite), and day 5 after Opsite application. Opsite drape was changed whenever required. RESULTS: The discomfort score was not altered with conventional therapy but was lower following Opsite application: mobility (0 vs 2), skin excoriation (0 vs 2), wetness (0.5 vs 2) and odor (0 vs 1). Opsite drape allowed accurate measurement of the effluent in all patients. The drape required change after a median of 14 days (range 10 to 18). CONCLUSIONS: Opsite drape is easy to apply on LAW, is effective in containing the effluent, and is associated with low patient morbidity.

Adult↗
PubMed2003

Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the "tissue-plug" technique.

Despite advances in head and neck reconstruction with free-tissue transfer techniques, oropharyngocutaneous fistulas continue to present challenging and potentially lethal complications. The authors present a system for prioritizing these fistulas and the surgical management of nine patients in whom critical fistulas developed after microsurgical head and neck reconstruction. The indications for aggressive management of these fistulas were primarily dependent on their location. Three peristomal and six midneck fistulas were considered critical because of the risk of aspiration pneumonia and carotid artery blowout, respectively. Fistulas located in the submental and/or submandibular region were considered noncritical and were managed conservatively. Using the concept of a "tissue plug" for fistula repair, a dermal component (i.e., a deltopectoral or pectoralis major pedicled flap) is guided through the fistula, and with external traction the tissue "plugs" the tract. No sutures are placed directly in the surrounding friable tissue. There were no partial or total flap losses. There were two fistula recurrences in patients who had received postoperative radiation therapy. One of these recurrences was due to tumor recurrence within the previous fistula and was managed with palliative measures. The other fistula recurrence was closed with a local-flap procedure on an outpatient basis. All patients resumed oral feeding, except for the patient in whom tumor recurrence was suspected. This tissue-plug technique can be used in the management of critical peristomal and/or midneck oropharyngocutaneous fistulas not only to obliterate the tract but also to augment volume and vascularity in already damaged, ischemic, and deficient tissue.

Cutaneous Fistula↗
PubMed2004

[Diagnosis and treatment of chronic anastomotic fistulas].

Treatment of anastomotic fistulas generally implies an individualized concept. The origin of these complications is multifactorial and comprises such factors as primary operation, oncologic situation, comorbidity, and patient age as well as fistula-specific considerations such as anatomic localization, secretion volume, etc. In the case of high-output fistulas, it is of great importance to counteract fluid and electrolyte imbalances. Furthermore, skin maceration due to aggressive secretion needs to be averted. Therapeutic options include operative and endoscopic interventions. Octreotide plays a role in high-output and pancreatic fistulas. Any underlying ailment (e.g., Crohn's disease) requires an optimal disease-specific treatment which characterizes an interdisciplinary approach to such fistulas. The following article discusses general and site-specific considerations in the diagnosis and treatment of anastomotic fistulas.

Anastomosis, Surgical↗
PubMed2004

Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease.

BACKGROUND: Percutaneous endoscopic gastrostomy is the standard for long-term enteral access. It can provide enteral nutrition or gastrointestinal decompression. Utilization of the gastrostomy for decompression has traditionally been reported in the setting of malignant obstruction. However, decompressive gastrostomy can play a role in the treatment of nonmalignant bowel dysfunction as well. METHODS: Over a 2-year period, 20 of 121 percutaneous endoscopic gastrostomies attempted by this surgical endoscopist were for gastrointestinal decompression. RESULTS: Eleven of 18 gastrostomies successfully placed for decompression were for benign conditions. In 5 patients with fistulous disease, the purpose of decompression was to divert the gastrointestinal tract until operative repair. Four of these patients have since undergone definitive surgery. CONCLUSIONS: This series presents the successful use of the percutaneous endoscopic gastrostomy for decompression of nonmalignant conditions. In such scenarios, the drainage gastrostomy can be employed as a bridge to future surgery, or as a means of long-term decompression for bowel dysfunction.

Adult↗
PubMed2000

Refractory abdominal-cutaneous fistulas or leaks: percutaneous management with a collagen plug.

BACKGROUND: We report the results of abdominal-cutaneous fistula tract occlusion with a collagen plug in a series of patients with fistulas or leaks refractory to conservative therapy. STUDY DESIGN: Seven patients were found to have persistent fistula or leak after percutaneous drainage of abdominal pelvic fluid collections. All patients but one were refractory to surgical or percutaneous drainage. Under fluoroscopic guidance, modified Vasoseal (Datascope Inc, Montvale, NJ) collagen plugs were deployed into the fistulas using catheter-directed techniques. The plugs were split longitudinally to fit into an 8F or 9F peel-away sheath, placed into the fistula, and deployed. Results were tabulated and patients were followed up. RESULTS: Six of seven patients undergoing fluoroscopically guided, catheter-directed tract occlusion had resolution of the fistula, with no evidence of fistula or abscess recurrence from 30 to 180 days after closure. There were no procedural complications. The technique was unsuccessful in dosing a gastrocutaneous fistula after removal of a large-bore gastrostomy tube; this failure was believed to be secondary to the short length and large caliber of the tract in a patient with hypercortisolemia. CONCLUSIONS: Closure of abdominal-cutaneous fistula tracts by occlusion with a modified Vasoseal collagen plug shows promise in the management of fistulas refractory to catheter drainage.

Abdomen↗