RESUMEN
Gastropericardial fistula is a rare, extremely serious and life-threatening condition. Its most common aetiology is secondary to iatrogenic injury following gastric surgery. Clinical manifestations may be non-specific with precordial pain, simulating an acute coronary syndrome, and may be accompanied by electrocardiogram abnormalities. Diagnosis is made by thoracoabdominal computed tomography (CT) with oral and intravenous contrast. Treatment is surgical and consists of repair of the anomalous communication. We present the case of an 81-year-old male patient with gastropericardial fistula who underwent surgery, with the aim of reviewing the diagnosis and the appropriate therapeutic strategy.
Asunto(s)
Fístula , Fístula Gástrica , Cardiopatías , Pericardio , Humanos , Masculino , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Anciano de 80 o más Años , Fístula/diagnóstico por imagen , Fístula/etiología , Pericardio/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Fístula Gástrica , Obstrucción de la Salida Gástrica , Úlcera Péptica , Estenosis Pilórica , Humanos , Fístula Gástrica/complicaciones , Fístula Gástrica/diagnóstico por imagen , Úlcera Péptica/complicaciones , Obstrucción de la Salida Gástrica/diagnóstico por imagen , Obstrucción de la Salida Gástrica/etiología , DuodenoAsunto(s)
Vasoespasmo Coronario , Fístula Gástrica , Pericardio , Humanos , Vasoespasmo Coronario/complicaciones , Vasoespasmo Coronario/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/complicaciones , Pericardio/diagnóstico por imagen , Masculino , Angiografía Coronaria , Fístula/complicaciones , Fístula/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Persona de Mediana EdadRESUMEN
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
Asunto(s)
Fístula Biliar , Enfermedades de la Vesícula Biliar , Fístula Gástrica , Humanos , Endosonografía , Fístula Biliar/diagnóstico por imagen , Fístula Biliar/etiología , Fístula Biliar/cirugía , Enfermedades de la Vesícula Biliar/diagnóstico por imagen , Enfermedades de la Vesícula Biliar/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiologíaRESUMEN
Gastrosplenic fistula is a rare complication arising mainly secondary to involvement of the stomach or spleen by lymphoma. A delayed diagnosis is associated with high morbidity and mortality. We present a case of gastrosplenic fistula secondary to gastric and splenic involvement by diffuse large B-cell lymphoma with relevant imaging findings. The patient was successfully treated with surgical resection.
Asunto(s)
Fístula Gástrica , Linfoma de Células B Grandes Difuso , Enfermedades del Bazo , Humanos , Enfermedades del Bazo/complicaciones , Enfermedades del Bazo/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , EstómagoRESUMEN
La fístula gástrica aguda es una de las principales complicaciones vinculadas a la gastrectomía vertical laparoscópica (GVL). Existen múltiples opciones terapéuticas para su resolución, siendo el tratamiento endoscópico mediante colocación de clips o stents uno de los más importantes. La aplicabilidad de cada método va a depender del tipo de fístula y del estado del paciente. Presentamos el caso de una mujer de 35 años, que desarrolla una fístula aguda posterior a una GVL. Se realiza tratamiento endoscópico con colocaciónn del sistema "over-the-scope clip" (Ovesco®) a nivel del orificio fistuloso, con posterior colocaciónn de stent metálico auto expandible.
Acute gastric fistula is one of the main complications associated with laparoscopic vertical gastrectomy (LVG). There are multiple therapeutic options for its resolution, being endoscopic treatment by placing clips or stents one of the most important. The applicability of each method will depend on the type of fistula and the patient's condition. We present the case of a 35-year-old woman who developed an acute fistula after LGV. Endoscopic treatment is performed with placement of the over-the-scope clip system (Ovesco®) at the level of the fistulous orifice, with subsequent placement of a self-expanding metal stent.
A fístula gástrica aguda é uma das principais complicações associadas à gastrectomia vertical laparoscópica (GVL). Existem múltiplas opções terapêuticas para a sua resolução, sendo o tratamento endoscópico com colocação de clipes ou stents uma das mais importantes. A aplicabilidade de cada método dependerá do tipo de fístula e do estado do paciente. Apresentamos o caso de uma mulher de 35 anos que apresentou uma fístula aguda após GVL. O tratamento endoscópico foi realizado com a colocação do sistema de clipe over-the-scope (Ovesco®) no nível do orifício fistuloso, com posterior colocação de stent metálico autoexpansível.
Asunto(s)
Humanos , Femenino , Adulto , Endoscopía Gastrointestinal , Fístula Gástrica/cirugía , Laparoscopía , Fuga Anastomótica/cirugía , Stents Metálicos Autoexpandibles , Fístula Gástrica/etiología , Fístula Gástrica/diagnóstico por imagen , Gastrectomía/efectos adversosRESUMEN
We report a case of a 77-year-old man presented with abdominal pain, melena and weight loss.He underwent endoscopic evaluation revealed a 1.2cmX0.6cm ulcer of the greater curve of the antrum stomach and a 1.3cm fistulous tract .The gastroscope can smoothly enter the transverse colon through the fistula tract, and we can be able to visualize the colon wall and feces.After the diagnosis of gastrocolic fistula based on endoscopic findings. The patient was referred for surgical evaluation and underwent laparotomy. The patient subsequently underwent en-bloc resection of the fistula, a segment of the transverse colon, gastric perforation repair, intestinal adhesion lysis and peritoneal drainage. Examination of the specimen revealed a fistulous communication between the stomach and resected transverse colon segment. Finally, the patient was discharged 10 days after operation and without further complication.
Asunto(s)
Colon Transverso , Enfermedades del Colon , Fístula Gástrica , Fístula Intestinal , Úlcera Gástrica , Anciano , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Masculino , Úlcera Gástrica/complicaciones , Úlcera Gástrica/diagnóstico por imagen , Úlcera Gástrica/cirugíaAsunto(s)
Enfermedades del Colon , Fístula Gástrica , Fístula Intestinal , Enfermedades del Colon/complicaciones , Enfermedades del Colon/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , EstómagoRESUMEN
A 73-year-old woman presented with fever and right flank pain. The admission was complicated by sepsis, myocardial ischaemia and an upper gastrointestinal bleed. A gastroscopy eventually demonstrated a large antral adenocarcinoma. Further imaging showed no evidence of metastasis, but demonstrated a large segment 3 hepatic abscess. At laparotomy, a hepatogastric fistula (HGF) was noted and a synchronous subtotal gastrectomy and left lateral liver sectionectomy was performed. Final histology showed complete resection of the gastric cancer (T4bN2) and confirmed the presence of the fistula. The patient was discharged 10 days later. She passed away 6 months later with local recurrence, hepatic and pulmonary metastasis. We include a review summarising the other causes of HGF in the literature.
Asunto(s)
Adenocarcinoma , Fístula , Fístula Gástrica , Absceso Hepático , Neoplasias Gástricas , Adenocarcinoma/complicaciones , Adenocarcinoma/cirugía , Anciano , Femenino , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Humanos , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/etiología , Recurrencia Local de Neoplasia , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND: Both diaphragmatic hernia and thoracic gastropericardial fistula rarely occur simultaneously in patients with radical esophagectomy. CASE PRESENTATION: A 72-year-old man presented to our hospital with 1 day of nausea, vomiting and acute left chest pain. He had radical esophagectomy (Sweet approach) for esophageal cancer 18 years ago. Computed tomography (CT) of the chest revealed diaphragmatic hernias and air collection within the pericardial space. While an operation of diaphragmatic hernia repair was decisively performed to prevent further serious complications, unusually, a thoracic gastropericardial fistula was also found unusually. CONCLUSION: Diaphragmatic hernia and thoracic gastropericardial fistula may occasionally coexist in patients with esophagectomy. Upper GI radiograph with a water-soluble contrast agent is a better diagnostic tool than CT in visualizing the fistula.
Asunto(s)
Esofagectomía/efectos adversos , Fístula Gástrica/etiología , Hernia Diafragmática/etiología , Neumopericardio/etiología , Anciano , Medios de Contraste , Neoplasias Esofágicas/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/cirugía , Hernia Diafragmática/diagnóstico por imagen , Hernia Diafragmática/cirugía , Herniorrafia/efectos adversos , Humanos , Masculino , Neumopericardio/diagnóstico por imagen , Neumopericardio/cirugía , Radiografía , Tomografía Computarizada por Rayos X/efectos adversosAsunto(s)
Fístula , Fístula Gástrica , Hernia Hiatal , Úlcera Péptica Perforada , Úlcera Gástrica , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Hernia Hiatal/complicaciones , Hernia Hiatal/diagnóstico por imagen , Humanos , Úlcera Péptica Perforada/complicaciones , Úlcera Péptica Perforada/diagnóstico por imagen , Úlcera Péptica Perforada/cirugía , Úlcera Gástrica/complicacionesRESUMEN
A 25-year-old patient underwent laparoscopic Roux-en-Y gastric bypass surgery with an initially uneventful postoperative course. Two weeks postoperatively, the patient presented with acute abdominal pain. CT scan revealed a gastrogastric fistula from the gastric pouch to the gastric remnant. Laparoscopic drainage was performed, and intraoperative endoscopy confirmed a large gastrogastric fistula. Due to intense adhesions between pouch and remnant, a closure by suture of the fistula was not possible. The fistula was initially treated with a fully covered metal stent. After multiple stent migrations despite clip attachment to the mucosa, the stent was changed to a partially covered metal stent. Fistula healing progress was documented every 2 weeks. After 10 weeks of stent treatment, fistula closure was accomplished.In conclusion, early fistula from the gastric pouch to the gastric remnant is a rare complication and can be managed with endoscopic stent placement.
Asunto(s)
Derivación Gástrica , Fístula Gástrica , Laparoscopía , Obesidad Mórbida , Adulto , Derivación Gástrica/efectos adversos , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Humanos , Obesidad Mórbida/cirugía , Stents/efectos adversosRESUMEN
To the best of our knowledge, there are no previous reports of a gastro-colic fistula (GCF) secondary to primary high-grade B-cell gastric lymphoma associated with acquired immunodeficiency syndrome (AIDS). Here, we report a 37-year-old man who presented with paroxysmal abdominal pain for 4 months, diarrhea for 15 days and weight loss of 4 kg. He had a history of human immunodeficiency virus (HIV) infection and was diagnosed with AIDS in 2013. The patient was diagnosed with a GCF secondary to primary high-grade B-cell gastric lymphoma by gastroscopy and histopathological examination. Two weeks after diagnosis, he died in another hospital. This is an uncommon case in which the GCF occurred secondary to malignant gastric lymphoma in a patient with AIDS. Supported by the literature, patients with HIV infection who complain of abdominal pain or a mass, severe diarrhea, and weight loss should be assessed for a GCF secondary to lymphoma because of its worse prognosis.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Cólico , Fístula Gástrica , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Linfocitos B , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Humanos , Linfoma no Hodgkin , Masculino , Neoplasias GástricasAsunto(s)
Dolor Abdominal/etiología , Fiebre/etiología , Fístula Gástrica/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Enfermedades del Bazo/etiología , Adulto , Diagnóstico Diferencial , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/terapia , Humanos , Imagen por Resonancia Magnética , Masculino , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/terapia , Valor Predictivo de las Pruebas , Pronóstico , Enfermedades del Bazo/diagnóstico por imagen , Enfermedades del Bazo/terapia , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Gastrogastric fistulae (GGF) occur in 1-6% of Roux-en-Y gastric bypass (RYGB) patients. Many patients undergo abdominal computed tomography (CT) as an initial test owing to its wide availability; however, CT diagnostic accuracy for GGF is unclear. Our aim was to evaluate test characteristics of abdominal CT compared to upper gastrointestinal series (UGI) and esophagogastroduodenoscopy (EGD) for diagnosing GGF using surgery as a gold standard. METHODS: Retrospective review of RYGB patients who underwent abdominal CT with oral contrast within 1 year. Demographics, weight parameters, and symptoms were collected. Surgery within 1 year of the diagnostic tests was included as the gold standard comparison. Primary outcomes included CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) for GGF. RESULTS: One hundred thirty-seven patients were included, where 42 (30.1%) had positive CT and 95 (69.3%) had negative CT for GGF. Compared to surgical confirmation, CT abdomen with PO contrast had sensitivity of 73.1% (59-84.4), specificity of 95.2% (88.3-98.7), PPV 90.5% (77.4-97.3), NPV of 85.1% (76.3-91.2), and DA 89.7%. UGI series had sensitivity of 58.5% (42.1-73.7), specificity of 98.8% (93.5-99.9), PPV of 96% (79.7-99.9), NPV of 82.8% (73.9-89.7), and diagnostic accuracy (DA) of 85.4%. EGD had sensitivity of 78.3% (63.6-89.1), specificity of 98.8% (93.5-99.9), PPV 97.3 (85.8-99.9), and DA 91.5%. There were no significant differences in diagnostic test characteristics among modalities. CONCLUSIONS: Abdominal CT with oral contrast has similar diagnostic test characteristics to UGI and EGD at detecting GGF when using surgical diagnosis as a gold standard.
Asunto(s)
Derivación Gástrica , Fístula Gástrica , Laparoscopía , Obesidad Mórbida , Abdomen , Derivación Gástrica/efectos adversos , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Humanos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos XAsunto(s)
Enfermedades del Colon , Neoplasias del Colon , Fístula Gástrica , Fístula Intestinal , Colon , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/etiología , Neoplasias del Colon/complicaciones , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/etiología , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiologíaAsunto(s)
Enfermedades del Colon/etiología , Fístula Gástrica/etiología , Fístula Intestinal/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/cirugía , Fístula Gástrica/diagnóstico por imagen , Fístula Gástrica/cirugía , Humanos , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
This study aimed to establish the optimal diagnostic and treatment algorithm for the management of gastric fistula in the chest (GFIC) after sleeve gastrectomy (SG) through a systematic review of published cases. A multi-database search was performed, which produced 1182 results, of which 26 studies were included in this systematic review. The initial presentation included subphrenic collections, leaks, or (recurrent) pneumonia with associated symptoms such as persistent cough, fever, and/or dyspnea. Computed tomography (CT) scan in combination with either upper gastrointestinal (UGI) series or an esophagogastroduodenoscopy (EGD) was used to adequately diagnose the fistulas. Initial treatment was either with clips and/or clips and stents that were placed endoscopically. When unsuccessful in the majority of the cases, the surgical treatment consisted of total gastrectomy and Roux-en-Y esophagojejunostomy in a laparoscopic or open fashion.