[Case of an internal bilio-small intestinal fistula and obturational intestinal obstruction caused by a biliary calculus].
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[Gastric fistula instead of large intestine fistula].
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[Vesico-intestinal fistulae].
Vesico-intestinal fistulae were observed in 14 patients within a period of 10 years (vesico-colonic: ten; vesico-rectal: two; vesico-ileal and vesico-rectal-ileal: one each). The causes were diverticulitis in five, carcinoma of the sigmoid in two, radiation damage after prostatic or cervical carcinoma in two, and Crohn's disease, abscess of Douglas's pouch after perforated appendicitis, ileal carcinoma, sarcoma of the pelvis, and ovarian carcinoma, one each. Pneumaturia, faecaluria and dysuria were the most frequent symptoms, treatment-resistant cystitis was present in three. Cystoscopy, intravenous pyelogram, retrograde cystogram, barium meal, barium swallow with follow-through, and rectosigmoidoscopy proved to be the best methods of diagnosis. Four patients had multiple operations, three one operation, with a cure in all. In the neoplastic fistulae the underlying carcinoma could not be radically operated on: colostomy or colostomy with palliative resection was performed. In four of these the fistulae then closed, once it remained open. One woman with a vesicorectal fistula due to ovarian carcinoma died of tumor cachexia 16 days after a colostomy had been made.
Abscess↗
[Management of postoperative intestinal fistulas with elemental diet (author's transl)].
From 1973-1976 sixteen patients with clinically manifest post-operative fistulas (7 small intestinal and 9 colonic) were studied. These patients received an elemental diet (ED) as their only nutritional support for 9-44 days. On ED spontaneous closure was observed in 4 out of 7 small intestinal fistulas and in 7 out of 9 colonic fistulas. Hemoglobin and serum albumin increased significantly on ED and nitrogen balance performed on 7 patients was in equilibrium or positive. Advantages of ED over intravenous nutrition in the treatment of intestinal fistulas are discussed.
Adult↗
[External intestinal fistulae and their treatment].
The results of treatment of 188 patients with different external fistulas of the intestine are reported. A detailed analysis of 23 observations of small intestine fistulas is given, including 16 cases with enterostomies complicated with phlegmon of the abdominal wall, emaciation and hemorrhage from acute intestinal ulcers. An early surgical treatment of such fistulas is recommended.
Adult↗
[External intestinal fistulae].
The authors describe external intestinal fistulae found within 11 years at 5000 urgent operations on abdominal organs in 56 patients. 20 of them showed fistulae of appendicular origin, 15 developed fistulae following various traumas of abdominal organs, 1--after intestinal ileus, in 3 cases fistulae were due to incarceration of hernia, in 17 cases external fistulae were applied in intestinal neoplasms. Small gut fistulae were noted in 15, colon fistulae--in 41 patients. The total of 19 patients died, most of them had malignant intestinal neoplasms.
Appendectomy↗
[Rehabilitation of children with external intestinal fistula].
Experience in the treatment of 153 children with external intestinal fistulas is discussed. In 6 children the intestinal fistulas occurred as the result of a pyodestructive process in the abdominal cavity, in 147 children they were formed for therapeutic purposes. The choice of the method of treatment is individual and is determined by the character of the fistula. A magneto-++-compressive inter-intestinal++ anastomosis (MCIA) was formed for exclusion of the intestinal fistulas. Under conditions of peritonitis in gun-barrel enterostomy intraoperative formation of the MCIA can be undertaken. The method was applied in 21 children, no complications occurred. In closure of gun-barrel enterostomy an operative method was elaborated with preservation of the greater part of the magneto-++-compressive anastomosis.
Abdomen, Acute↗
[Treatment of external intestinal fistulae].
The authors observed 105 cases of external intestinal fistula of various localization and found that the destruction of the intestinal wall under the conditions of suppurative peritonitis, together with the tampons and drainage tubes inserted into the abdominal cavity and left there for a long period of time, constitute the main causes of the occurrnce of intestinal fistula. Surgical treatment of a lip-shaped fistula (63 cases) of the small intestine and colon, mainly by the intraabdominal method, was carried out. Tubular fistula was closed conservatively in 22 cases. The intestinal motor activity was studied in 20 cases and potassium iodide resorption was investigated in the experiments on 20 animals. Some practically important recommendations are given.
Animals↗
[Treatment of external intestinal fistulas].
The paper based on own extensive clinical material of 29 cases stresses the value of conservative treatment of external intestinal fistulae as illustrated by a case of small intestine fistula associated with large bowel fistula treated previously many times surgically without success. Besides that the importance is emphasized of radiological treatment in the diagnosis and treatment of external intestinal fistulae.
Abdomen, Acute↗
[The treatment of unformed intestinal fistulae].
Experience in the treatment of 33 patients with unformed intestinal fistulas is discussed. The choice of the method for surgical management was determined by the localization of the fistulas, the possibility of their occlusion, and the severity of the patient's condition. Complex therapy included selective administration of antibacterial agents and extracorporeal detoxification by means of biohemosorption. Rational surgical tactics and complex treatment including extracorporeal detoxification in patients with unformed external intestinal fistulas made it possible to reduce the mortality rate from 33.4% to 21.2% (7 patients died).
Anastomosis, Surgical↗
[Urological aspect of vesico-intestinal fistulas. Apropos of 14 cases].
This series of 14 cases of vesico-intestinal fistulae, together with a review of the literature, led to a certain number of remarks: From an aetiological standpoint, in addition to classical concepts with the predominance of diverticulosis of the colon accounting for 46% of cases, followed by carcinoma of the colon (14%) and Crohn's disease, we feel it to be of interest to stress the possible urinary origin of vesico intestinal fistulae (4 of our cases, and 4.5% of the total number collectedin the literature). From a diagnostic standpoint, we would emphasise that these fistulae present almost solely with urinary symptoms and signs and stress the clinical importance of what is now known, since J. Cibert, as "pre-fistulous cystitis" preceding the development of pathognomic signs--faecaluria and pneumatria. Radiological opacification of the colon and rectum is essential in patients with a syndrome of chronic urinary infection unexplained by a urological cause. From a therapeutic standpoint, the surgical treatment of vesico-intestinal fistulae is associated with a high operative mortality (2 deaths amongst our 14 patients) and which, independently of the aetiological factor (predominance of carcinomas) is explained above all by the septic nature of the lesions.
Adult↗
[Differential therapy of vesico-intestinal fistulas].
40 patients with vesico-intestinal fistulas (50% inflammatory, 30% traumatic, 20% neoplastic) were treated within 10 years. Closure was achieved in 97% of 31 patients operated on with curative intention. The remaining 9 patients had palliative surgery, i.e. colostomy or cystostomy. The decision single- or multiple-stage procedure depends upon the etiology, localization and extent of the fistula.
Colostomy↗
[Tactics in the treatment of postoperative intestinal fistula].
The experience with treatment of 331 patient with external intestinal fistulas is summarized. It is necessary to remove the high non-shaped "emaciating" fistulas at day 1-2 after their development. A rational method for the treatment of other non-shaped intestinal fistulas is their open management with active aspiration, or flowing drainage. Conservative therapy of the shaped tubular fistulas is effective only within first 4 mos, and later, the operative treatment is indicated to the patients.
Drainage↗
[Treatment of patients with unformed intestinal fistulas].
Experience with the treatment of 81 patient with non-formed intestinal fistulas has shown that in high small intestinal fistulas and impossibility of their obturation, the operative intervention should be early, as the conservative methods and expectant tactics lead to irreversible aggravation of the state of the patients. In forced operative interventions in patients with peritonitis, the intra-aortal administration of the drugs permits to improve the results of treatment.
Adolescent↗
Celo-intestinal fistulae complicating advanced extra-uterine pregnancy.
Multiple celo-intestinal fistulae with the passage of fetal bones per rectum as a rare complication of advanced extra-uterine pregnancy is presented. This was further complicated by a recent intra-uterine pregnancy which culminated in obstructed labor and uterine rupture. The subsequent peritonitis was of etiological significance in the formation of the peritoneo- or celo-intestinal fistulae.
Adult↗
[Gastrointestinal haemorrhage due to aorto-intestinal fistula. 3 cases (author's transl)].
Three types of aorto-intestinal fistula may be associated with gastrointestinal bleeding: primary fistulae from an aneurysm, secondary fistulae related to an aorto-prosthetic anastomosis and paraprosthetic fistulae by intraduodenal protrusion of a graft. The prevalence of secondary and paraprosthetic fistulae increases with more widespread vascular surgery. Only if the diagnosis is always borne in mind in a patient with an aneurysm or an aortic prosthesis makes it possible to recognise an aorto-intestinal fistula in time. Upper GI series and endoscopy are more useful in reaching a diagnosis than arteriography but signs must be sought in the third and fourth parts of the duodenum. The lesion may even be missed on surgical exploration, being concealed before separation of the aorta and duodenum. Infection and the underlying general medical condition are factors in the gravity of the operative prognosis. One of our three patients treated surgically was saved by the insertion of an extra-anatomic bypass. The prognosis in paraprosthetic fistulae, the possible precursor stage of a secondary aorto-digestive fistula, is more favourable.
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[Contribution of arteriography to diagnosis of secondary arterio-digestive fistulas. Intestinal haemorrhage due to ilio-ileal fistula, a complication in vascular reconstruction (author's transl)].
The authors describe a case of secondary ilio-ileal fistula revealed by an intestinal haemorrhage which occurred ten years after vascular reconstruction. They stress the importance of arteriography which shows up the pseudo-aneurysm causing the fistularisation and vascular contrast material escaping into the digestive lumen. A complete review of the literature on arterio-colonic fistulas, and more particularly, ileo-ileal fistulas, shows that they usually express themselves clinically in the form of digestive haemorrhages occurring generally after vascular graft and after a variable lapse of time. The association of digestive haemorrhage and a previous vascular reconstruction should suggest the diagnosis of arterio-digestive fistula and should lead to early angiography to enable coherent surgical strategy to be put into operation.
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[Use of ferromagnetic rheological suspensions in the treatment of non-formed intestinal fistulas].
Data on treatment of 42 patients with nonformed intestinal fistulas with the help of ferromagnetic rheological suspensions are presented. The authors have shown that their method tested under experimental conditions is close to universal since it does not require selection of the individual obturator. The use of the method is not possible in patients with one or multiple abscesses of the abdominal cavity, through which the formed fistula passes.
Adult↗