RESUMEN
Surgery is the primary treatment for esophageal cancer, but the postoperative complication rate remains high. Therefore, it is important to prevent and manage postoperative complications to improve prognosis. Common perioperative complications of esophageal cancer include anastomotic leakage, gastrointestinal tracheal fistula, chylothorax, and recurrent laryngeal nerve injury. Respiratory and circulatory system complications, such as pulmonary infection, are also quite common. These surgery-related complications are independent risk factors for cardiopulmonary complications. Complications, such as long-term anastomotic stenosis, gastroesophageal reflux, and malnutrition are also common after esophageal cancer surgery. By effectively reducing postoperative complications, the morbidity and mortality of patients can be reduced, and their quality of life can be improved.
Asunto(s)
Fístula del Sistema Digestivo , Neoplasias Esofágicas , Humanos , Calidad de Vida , Complicaciones Posoperatorias/prevención & control , Fuga Anastomótica/etiología , Neoplasias Esofágicas/cirugía , Pronóstico , Esofagectomía/efectos adversos , Fístula del Sistema Digestivo/cirugía , Estudios RetrospectivosRESUMEN
Abstract The care of patients with enterocutaneous fistula constitutes a significant challenge owing to the alterations it usually brings about. For successful treatment, it is necessary to manage fluids and electrolytes adequately, provide practical nutritional support, and control sepsis until its eradication; thus, many fistulae close spontaneously. We present the case of a 36-year-old male patient with a four-month history of fecal-like umbilical secretion. When performing the fistulogram, we confirmed a fistulous tract of 9 cm, which ended at the level of the sigmoid colon, a rare location. In cases where the enterocutaneous fistula does not close, and surgical treatment is indicated, it is imperative to maximize perioperative care, decrease surgical time, choose the correct surgical technique, and prepare the patient for surgery to avoid complications with a fatal outcome.
Resumen La atención de los pacientes con fístula enterocutánea constituye un gran reto, por las alteraciones con las que suelen acompañarse. Para lograr un tratamiento exitoso es necesario realizar un adecuado manejo de los líquidos y electrolitos, brindar un apoyo nutricional eficaz y controlar la sepsis hasta lograr su erradicación; de esta manera, muchas fístulas cierran espontáneamente. Se expone el caso de un paciente de 36 años de edad, con un cuadro de secreción umbilical de aspecto fecaloideo de 4 meses de evolución. Al realizar la fistulografía se constató un trayecto fistuloso de 9 cm, el cual terminaba a nivel del colon sigmoide, localización poco frecuente. En los casos en que la fístula enterocutánea no cierre y tenga indicación de tratamiento quirúrgico, es necesario extremar los cuidados perioperatorios, minimizar el tiempo quirúrgico, elegir la técnica quirúrgica correcta y preparar al paciente para la cirugía, de modo que se eviten complicaciones que pueden tener un desenlace fatal.
Asunto(s)
Humanos , Masculino , Adulto , Colon Sigmoide/cirugía , Fístula del Sistema Digestivo/cirugía , Diverticulitis del Colon/complicaciones , Fístula del Sistema Digestivo/etiología , Atención PerioperativaRESUMEN
BACKGROUND AND AIM: Gastrointestinal (GI) fistula is a complication of surgery associated with potential morbidity and mortality. The aim of this study was to evaluate the efficacy and safety of over-the-scope clips (OTSC®) for closing GI fistulas. METHODS: Patients with GI fistula who underwent endoscopic closure using OTSC® were enrolled. The clinical date, duration, location and diameter of the fistula, technical success of the OTSC®, complications, follow-up periods and clinical success were recorded. RESULTS: A total of 98 patients with GI fistula underwent OTSC® closure. Their median age was 50 years (range 16-88 years), and the median duration of the fistula was 185.5 days (range 12-3129 days). The mean diameter of fistula was 4.64 ± 1.16 mm. Technical success was achieved in 100% of the patients, and clinical success was achieved in 55.10% (54/98) of the patients after a median follow-up of 168.5 days (range 36-424 days). Based on the location of the fistula, the clinical success rate of treating a fistula in the esophagus and small intestine was 100%, followed by the rectum (70%, 7/10), anastomotic stoma (61.90%, 13/21), duodenum (53.33%, 8/15), colon (47.06%, 8/17), stomach (43.47%, 10/23) and appendix stump (33.33%, 2/6). The duration of the fistula (HR 3.609, 95% CI 1.387-9.387, P = 0.009) was a risk factor for clinical success by multivariate analysis. CONCLUSION: OTSC® is a safe and efficient treatment for GI fistula and is a potential alternative to the surgical approach. Before OTSC® placement, the duration of the fistula should be assessed since it is related to the successful closures with OTSC®.
Asunto(s)
Fístula del Sistema Digestivo , Fístula , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fístula del Sistema Digestivo/cirugía , Endoscopía Gastrointestinal , Fístula/cirugía , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/PURPOSE: Although the lumen-apposing metal stent (LAMS) is useful for interventional endoscopic ultrasound (EUS) procedures, there has been some concern about the potential for stent-induced adverse events because of the high lumen-apposing force. A newly designed LAMS with less lumen-apposing force has been developed for use with a physician-controlled electrocautery-enhanced delivery system. The aim of this animal study was to evaluate the feasibility of performing interventional EUS using this newly designed LAMS system. METHODS: Endoscopic ultrasound-guided cystogastrostomy was performed using the novel LAMS three times in a wet simulation model. EUS-guided gastroenterostomy and EUS-guided gallbladder drainage were then performed using the system in four pigs. RESULTS: The LAMS was successfully placed in all three EUS-guided cystogastrostomy procedures using the wet simulation model and in all four EUS-guided gastroenterostomy and gallbladder drainage procedures in the animal model. In the 3 weeks following the procedure, eating behavior was normal in all animals and there were no adverse events. The stents remained patent during this time and were removed without difficulty. The fistula was mature in all cases and a standard upper gastrointestinal endoscope was easily advanced via the fistula to observe the afferent and efferent loops or the lumen of the gallbladder. Necropsy confirmed complete adhesion between the stomach and the wall of the jejunum or gallbladder. CONCLUSIONS: Our study findings demonstrate the feasibility of this new LAMS system and its potential clinical value for interventional EUS.
Asunto(s)
Anastomosis Quirúrgica , Electrocoagulación , Endosonografía , Implantación de Prótesis , Stents , Ultrasonografía Intervencional , Anastomosis Quirúrgica/instrumentación , Anastomosis Quirúrgica/métodos , Animales , Fístula del Sistema Digestivo/etiología , Fístula del Sistema Digestivo/cirugía , Drenaje/instrumentación , Drenaje/métodos , Electrocoagulación/instrumentación , Electrocoagulación/métodos , Endosonografía/instrumentación , Endosonografía/métodos , Vesícula Biliar/cirugía , Yeyuno/cirugía , Modelos Animales , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodos , Estómago/cirugía , Porcinos , Ultrasonografía Intervencional/instrumentación , Ultrasonografía Intervencional/métodosRESUMEN
BACKGROUND AND AIM: Endoscopic closure of chronic gastrointestinal fistulas (CGFs) is challenging due to their epithelialized surfaces. The aim of this study was to assess the efficacy and long-term closure rate of endosuturing for CGFs with an Apollo Overstitch device. PATIENTS AND METHODS: Consecutive CGF patients undergoing endosuturing for fistula closure from April 2018 to January 2020 at the First Affiliated Hospital of Nanjing Medical University were enrolled for retrospective review. Demographics, fistula characteristics, details of the suturing procedures and outcomes were collected for analysis. RESULTS: Twenty patients (mean age 59.8 ± 9.1 years; 85% males) with a total of 23 CGFs underwent sutured fistula closure. Esophagotracheal fistulas were the most common CGFs (12/23, 52.2%), and prior cancer surgery was the most common fistulization etiology (14/20, 70%). Twelve patients (12/20, 60%) had undergone failed endoscopic attempts at fistula closure before suturing. Additional endoscopic therapies used during suturing were 100% argon plasma coagulation, 50% clip fixation, and 10% stent placement. Although all patients undergoing suturing achieved immediate technical success of fistula closure, sustained fistula closure was observed in only 5 patients (5/20, 25.0%) on surveillance endoscopy 3 months after suturing with a mean follow-up of 19.5 months. Esophagotracheal fistula patients were predisposed to shorter dehiscence-free survival than those with other fistulas (HR 3.378; 95% CI 1.127-10.13). CONCLUSIONS: Endosuturing is safe and should be considered for use as the first-line or salvage therapy for CGF closure, primarily for patients with fistulas not involving the trachea. However, the long-term healing of CGFs by suturing is challenging, and CGF patients might not benefit from repeated suturing.
Asunto(s)
Fístula del Sistema Digestivo , Suturas , Anciano , Fístula del Sistema Digestivo/cirugía , Endoscopía Gastrointestinal/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND: Gastrointestinal (GI) fistula is a life-threatening condition and a therapeutic challenge. Endoscopic approaches include mucosal abrasion, clip closure, or stent diversion, with moderate success rates in the long term. We assessed whether fistula endoscopic submucosal dissection with clip closure (FESDC) could lead to complete resolution of fistulas even after failure of previous endoscopic therapy. METHODS: Patients with GI fistulas, including those with previous failed treatment, were retrospectively included. The primary outcome was long-term (>â3 months) success of fistula healing. Secondary outcomes included technical success, safety, and factors associated with FESDC success. RESULTS: 23 patients (13 refractory 57â%) were included. Tight immediate sealing was achieved in 19 patients (83â%; 95â% confidence interval [CI] 61â%-95â%). Long-term closure was achieved in 14 patients (61â%; 95â%CI 39â%-80â%), with median follow-up of 20 months. Complications occurred in two patients (9â%). Previous local malignancy (Pâ=â0.08) and radiotherapy (Pâ=â0.047) were associated with a higher risk of failure. CONCLUSION: This novel FESDC strategy was demonstrated to be safe and feasible for permanent endoscopic closure of GI fistulas. Further studies are warranted to determine the place of this technique in the management of chronic GI fistula.
Asunto(s)
Fístula del Sistema Digestivo , Resección Endoscópica de la Mucosa , Fístula , Fístula del Sistema Digestivo/etiología , Fístula del Sistema Digestivo/cirugía , Resección Endoscópica de la Mucosa/efectos adversos , Endoscopía Gastrointestinal/efectos adversos , Endoscopía Gastrointestinal/métodos , Fístula/etiología , Humanos , Estudios Retrospectivos , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient's prognosis.
Asunto(s)
Fístula del Sistema Digestivo/cirugía , Neoplasias Gastrointestinales/patología , Tumores del Estroma Gastrointestinal/patología , Tracto Gastrointestinal/patología , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Fístula del Sistema Digestivo/patología , Femenino , Neoplasias Gastrointestinales/cirugía , Tumores del Estroma Gastrointestinal/cirugía , Tracto Gastrointestinal/cirugía , Humanos , Mesilato de Imatinib/uso terapéutico , Mucosa Intestinal/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Completion proctectomy is traditionally performed using a combination of abdominal and perineal approaches. Access to and exposure of the pelvis through the abdominal cavity can be limited in patients with prior surgery or inflammatory conditions. We describe a novel technique for a total transperineal approach for proctectomy for Crohn's proctitis, avoiding technical challenges, risks, and recovery associated with abdominal surgery. TECHNIQUE: We utilized the skills and expertise acquired from our experience with transanal total mesorectal excision to perform a total transperineal laparoscopic proctectomy in a male patient with medically refractory proctitis. He previously underwent an anterior resection, drainage of a chronic presacral abscess, omental pedicle flap transposition to the pelvis, and end colostomy for severe Crohn's colitis. The total transperineal laparoscopic proctectomy approach avoids the need for abdominal access, including the risks associated with abdominal entry, adhesiolysis, pelvic access and visualization, and wound-related issues. Following an initial intersphincteric perineal dissection, the GelPOINT Path minimal access platform is utilized to perform a total transperineal proctectomy. RESULTS: The patient recovered uneventfully and was discharged to home 2 days after surgery. At 1-month postoperative follow-up, the patient is recovering well with complete healing of the perineal wound. CONCLUSION: We demonstrate the feasibility, safety, and technical steps of a minimally invasive completion proctectomy for fistulizing Crohn's proctitis by using a total transperineal approach. This approach allowed us to utilize direct, inline, high-definition visualization to access and safely operate in the distal aspects of a narrow, scarred, and fibrotic pelvis while avoiding the need for any abdominal access. Advanced experience with redo pelvic and minimally invasive transanal surgery is critical. See Video at http://links.lww.com/DCR/B664.
Asunto(s)
Enfermedad de Crohn/complicaciones , Fístula del Sistema Digestivo/cirugía , Perineo/cirugía , Proctectomía/métodos , Cuidados Posteriores , Enfermedad de Crohn/patología , Fístula del Sistema Digestivo/diagnóstico , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Cirugía Endoscópica Transanal/efectos adversos , Resultado del TratamientoRESUMEN
Despite current management strategies, digestive fistulae remain extremely debilitating complications associated with significant morbidity and mortality, generating a need to develop innovative therapies in these indications. A number of clinical trials and experimental studies have thus investigated the potential of stem/stromal cells (SCs) or SC-derived extracellular vesicles (EVs) administration for post-surgical and Crohn's-associated fistulae. This review summarizes the physiopathology and current standards-of-care for digestive fistulae, along with relevant evidence from animal and clinical studies regarding SC or EV treatment for post-surgical digestive fistulae. Additionally, existing preclinical models of fistulizing Crohn's disease and results of SC therapy trials in this indication will be presented. The optimal formulation and administration protocol of SC therapy products for gastrointestinal fistula treatment and the challenges for a widespread use of darvadstrocel (Alofisel) in clinical practice will be discussed. Finally, the potential advantages of EV therapy and the obstacles towards their clinical translation will be introduced.
Asunto(s)
Fístula del Sistema Digestivo/patología , Fístula del Sistema Digestivo/terapia , Vesículas Extracelulares/metabolismo , Células Madre Mesenquimatosas/metabolismo , Medicina Regenerativa/métodos , Células del Estroma/metabolismo , Animales , Enfermedad de Crohn/patología , Enfermedad de Crohn/terapia , Fístula del Sistema Digestivo/cirugía , HumanosRESUMEN
El ileo biliar es una rara complicación de la colelitiasis no tratada. Presentamos el cuadro clínico y el manejo de un paciente masculino de 72 años (AU)
The biliary or Gallstone ileus is a rare complication of the non-treated Cholelithiasis. We present the clinical features and the treatment of a 72 years old patient
Asunto(s)
Humanos , Masculino , Anciano , Íleon/anomalías , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Acidosis/etiología , Colelitiasis/complicaciones , Colangitis/diagnóstico , Fístula del Sistema Digestivo/cirugíaRESUMEN
Objective: To investigate the safety and feasibility of transgluteal percutaneous drainage using double catheterization cannula in the treatment of deep pelvic abscess. Methods: A retrospective analysis of the clinical data of patients who underwent transgluteal percutaneous drainage using double catheterization cannula with deep pelvic abscesses admitted to the Jinling Hospital from May 2017 to September 2020 was conducted. Seven patients were enrolled, including 5 males and 2 females, who aged 26-74 (median 53.0) years old, and all of them had digestive fistula. One male patient was punctured again due to the tube falling off, and a total of 7 patients underwent 8 times of transgluteal percutaneous drainage, all under the guidance of CT. The puncture and drainage steps of the double catheterization cannula group are as follows: (1) Locate the puncture point under CT in the lateral position; (2) Place the trocar into the abscess cavity; (3) Confirm that the trocar is located in the abscess cavity under CT; (4) Pull out the inner core and insert into the double catheterization cannula through the operating hole; (5) Confirmthat the double catheterization cannula is located in the abscess cavity under CT; (6) The double catheterization cannula is properly fixed to prevent it from falling off. The white blood cells, C-reactive protein (CRP), procalcitonin, and interleukin-6 (IL-6) of all patients before the drainage and 1 days, 3 days, and 5 days after the drainage were collected, as well as the bacterial culture results of the drainage fluid. The changes of various infection biomarkers before and after the drainage were compared. Results: All 7 patients were cured. No complications such as hemorrhage and severe pain were observed. The average time with drainage tube was 60.8 (18-126) days. Five patients finally underwent gastrointestinal reconstruction surgery due to gastrointestinal fistula. The median serum interleukin-6 of patients before drainage, 1 day, 3 days and 5 days after drainage were 181.6 (113.0, 405.4) µg/L, 122.2 (55.8, 226.0) µg/L, 59.2 (29.0,203.5) µg/L and 64.1 (30.0,88.4) µg/L, respectively.The level of serum interleukin-6 at 3 days and 5 days after drainage was significantly lower than before drainage (F=3.586, P=0.026). Although the white blood cell count, C-reactive protein, and procalcitonin decreased gradually after drainage compared with before drainage, the difference was not statistically significant (all P>0.05). Conclusion: Transgluteal percutaneous drainage with double catheterization cannula is simple and effective, and can be used for the treatment of deep pelvic abscess.
Asunto(s)
Absceso , Fístula del Sistema Digestivo/complicaciones , Drenaje/métodos , Infección Pélvica/cirugía , Absceso/etiología , Absceso/cirugía , Adulto , Anciano , Nalgas/cirugía , Cateterismo/métodos , Fístula del Sistema Digestivo/cirugía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infección Pélvica/etiología , Pelvis/cirugía , Estudios Retrospectivos , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Pleuro-peritoneal leakage is an uncommon complication of peritoneal dialysis (PD). In this study, we report the case of a male patient (age 83), treated with PD (daytime single-exchange). In October 2019, hospitalization was necessary due to dyspnoea and a reduction of peritoneal ultrafiltration. A right pleural leakage resulted at chest x-ray. A regression of the pleural leakage was immediately observed after interrupting PD. It was then performed a pleuro-peritoneal CT scan at baseline, followed by a second scan performed 4 hours after the injection of 2 L of isotonic solution with 100ml of contrast medium, which evidenced a pleuro-peritoneal communication. It was then decided to perform a video-assisted thoracoscopic surgery (VATS), that showed no evidence of diaphragm communication. It was then executed a pleurodesis using sterile talcum. The patient was released on the 3rd day, with a conservative therapy and a low-protein diet. After 2 weeks a new pleuro-peritoneal CT scan with contrast medium was executed. This time the scan evidenced the absence of contrast medium in the thoracic cavity. The patient then resumed PD therapy, with 3 daily exchanges with isotonic solution (volume 1.5 L), showing no complications. Concerning the treatment of pleuro-peritoneal leakage, VATS allows both the patch-repairing of diaphragmatic flaws and the instillation of chemical agents. In our case, VATS allowed the chemical pleurodesis which in turn enabled, in just 2 weeks of conservative treatment, the resuming of PD. In conclusion, this methodology is a valid option in the treatment of pleuro-peritoneal leakage in PD patients.
Asunto(s)
Fístula del Sistema Digestivo/cirugía , Diálisis Peritoneal/efectos adversos , Enfermedades Peritoneales/cirugía , Enfermedades Pleurales/cirugía , Fístula del Sistema Respiratorio/cirugía , Cirugía Torácica Asistida por Video , Anciano de 80 o más Años , Fístula del Sistema Digestivo/etiología , Humanos , Masculino , Enfermedades Peritoneales/etiología , Enfermedades Pleurales/etiología , Fístula del Sistema Respiratorio/etiologíaRESUMEN
To evaluate the effect of the open abdomen (OA) and closed abdomen (CA) approaches for treating intestinal fistula with complicated intra-abdominal infection (IFWCIAI), and analyze the risk factors in OA treatment.IFWCIAI is associated with high mortality rates and healthcare costs, as well as longer postoperative hospital stay. However, OA treatment has also been linked with increased mortality and development of secondary intestinal fistula.A total of 195 IFWCIAI patients who were operated over a period of 7 years at our hospital were retrospectively analyzed. These patients were divided into the OA group (nâ=â112) and CA group (nâ=â83) accordingly, and the mortality rates, hospital costs, and hospital stay duration of both groups were compared. In addition, the risk factors in OA treatment were also analyzed.OA resulted in significantly lower mortality rates (9.8% vs 30.1%, Pâ<â.001) and hospital costs ($11721.40â±â$9368.86 vs $20365.36â±â$21789.06, Pâ<â.001) compared with the CA group. No incidences of secondary intestinal fistula was recorded and the duration of hospital stay was similar for both groups (Pâ=â.151). Delayed OA was an independent risk factor of death following OA treatment (hazard ratio [HR]â=â1.316; 95% confidence interval [CI]â=â1.068-1.623, Pâ=â.010), whereas early enteral nutrition (EN) exceeding 666.67âmL was a protective factor (HRâ=â0.996; 95% CIâ=â0.993-0.999, Pâ=â.018). In addition, Acinetobacter baumannii, Pseudomonas aeruginosa, and Candida albicans were the main pathogens responsible for the death of patients after OA treatment.OA decreased mortality rates and hospital costs of IFWCIAI patients, and did not lead to any secondary fistulas. Early OA and EN also reduced mortality rates.
Asunto(s)
Fístula del Sistema Digestivo/mortalidad , Fístula del Sistema Digestivo/cirugía , Infecciones Intraabdominales/mortalidad , Infecciones Intraabdominales/cirugía , Técnicas de Abdomen Abierto , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Fístula del Sistema Digestivo/complicaciones , Fístula del Sistema Digestivo/economía , Femenino , Costos de la Atención en Salud , Humanos , Infecciones Intraabdominales/complicaciones , Infecciones Intraabdominales/economía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Técnicas de Abdomen Abierto/economía , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
HistoryA 55-year-old man with a history of chronic pancreatitis secondary to chronic alcohol abuse presented to the hospital with acute abdominal pain, generalized weakness, weight loss, and pyrexia. A clinical examination revealed he was tender to touch in the upper abdomen. Laboratory tests revealed a serum alkaline phosphatase level of 370 U/L (6.1 µkat/L) (normal range, 30-130 U/L [0.5-2.2 µkat/L]), a lipase level of 172 U/L (2.9 µkat/L) (normal range, 0-60 U/L [0-1.0 µkat/L]), a C-reactive protein level of 159 mg/L (1514 nmol/L) (normal value, <8.0 mg/L [76.2 nmol/L]), and a white cell count of 7 × 109/L (normal range, [4-11] × 109/L). During the present admission, the patient underwent urgent CT for his acute symptoms. His relevant medical history included a hospital admission 2 months earlier for abdominal discomfort. Given his history of chronic pancreatitis, baseline abdominal MRI was performed to determine the cause of his symptoms and to assess the pancreas.
Asunto(s)
Fístula del Sistema Digestivo/diagnóstico por imagen , Fístula del Sistema Digestivo/etiología , Conductos Pancreáticos/diagnóstico por imagen , Pancreatitis Crónica/complicaciones , Flebitis/diagnóstico por imagen , Flebitis/etiología , Vena Porta/diagnóstico por imagen , Fístula del Sistema Digestivo/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos XAsunto(s)
Humanos , Femenino , Adulto , Fístula del Sistema Digestivo/cirugía , Fístula del Sistema Digestivo/diagnóstico por imagen , Derivación Ventriculoperitoneal/efectos adversos , Tomografía Computarizada por Rayos X , Colonoscopía , Derivación Ventriculoperitoneal/métodos , Colon/lesiones , Procedimientos Quirúrgicos Mínimamente Invasivos , Antibacterianos/uso terapéuticoAsunto(s)
Carcinoma Hepatocelular/cirugía , Enfermedades del Colon/cirugía , Fístula del Sistema Digestivo/etiología , Fístula del Sistema Digestivo/cirugía , Drenaje/métodos , Fístula/cirugía , Absceso Hepático/cirugía , Neoplasias Hepáticas/cirugía , Ablación por Radiofrecuencia/efectos adversos , Carcinoma Hepatocelular/patología , Enfermedades del Colon/etiología , Humanos , Absceso Hepático/etiología , Neoplasias Hepáticas/patología , Rotura Espontánea , Resultado del TratamientoRESUMEN
BACKGROUND: Gastrointestinal-to-genitourinary fistulas may occur secondary to obstetric complications, radiation therapy, cancer without radiation, inflammatory bowel disease, or previous surgery. Flap reconstruction is useful for complex cases refractory to standard techniques, separating the fistula tracts to aid healing. The purpose of this study was to investigate outcomes and risk factors for complications in flap reconstruction of fistulas from several different etiologies performed over a 20-year period. METHODS: All patients who underwent flap reconstruction between January 1995 and December 2014 were reviewed. Patient demographics, prior treatment failures, surgical indications, and comorbidities were obtained. Operative and postoperative data were collected, including flap type, length of stay, early and late complications, recurrences, and follow-up time. Operative success was defined as definitive treatment of the fistula without recurrence within 6 months. RESULTS: There were 59 patients who underwent 66 reconstructions. The overall complication rate was 59.1%. Complications included infection (21%), dehiscence (17%), and partial flap loss (1.5%). Operative success rate was 51.5%. Smoking history (p = 0.021) and body mass index (BMI) > 35 (p = 0.003) were significantly associated with increased likelihood of postoperative complications following flap reconstruction in these patients. Additionally, fistulas due to cancer resections had a higher likelihood of postoperative complications compared with fistulas due to bowel disease or obstetric complications (p = 0.04). CONCLUSION: Flap reconstruction can be successfully used for complex or refractory gastrointestinal-to-genitourinary fistulas. However, considerable complication and recurrence rates were found in this population. Patients with a BMI > 35 and a history of smoking were at greatest risk in this cohort of experiencing postoperative complications.
Asunto(s)
Fístula del Sistema Digestivo/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Fístula de la Vejiga Urinaria/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Fístula Vesicovaginal/cirugíaAsunto(s)
Fístula del Sistema Digestivo/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Migración de Cuerpo Extraño/cirugía , Hemorragia Gastrointestinal/cirugía , Gastroplastia/efectos adversos , Complicaciones Posoperatorias/cirugía , Choque/cirugía , Remoción de Dispositivos/métodos , Fístula del Sistema Digestivo/complicaciones , Fístula del Sistema Digestivo/fisiopatología , Duodeno/cirugía , Falla de Equipo , Migración de Cuerpo Extraño/complicaciones , Migración de Cuerpo Extraño/fisiopatología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/fisiopatología , Humanos , Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/fisiopatología , Reoperación , Choque/etiología , Choque/fisiopatología , Resultado del TratamientoRESUMEN
Gastrointestinal fistula patients may suffer from complicated intra-abdominal infection and sepsis with improper treatment, which is characterized by high mortality ranging from 20% to 60%, as well as high medical costs. Gastrointestinal fistula patients with complicated intra-abdominal infections are not often diagnosed early, and proper treatment remains an unsolved problem. Therefore it is a great challenge for surgeons to repair broken intestines under complicated intra-abdominal infection conditions and to repair ruptured intestines under conditions of severe abdominal adhesions and swelling of the intestinal wall and mesentery. After the open abdominal approach was first adopted to treat complicated intra-abdominal infection patients by Duff and Moffat in 1981, it gradually began to be used more widely. However, some investigators have reported that the open abdomen approach has not been effective in controlling controlled mortality, instead, it may even increase mortality. For this reason, the approach has only been used in large medical centers rather than having been widely popularized. In this review, the effect, timing, indications of open abdomen approach and the principles for the open abdominal wound management are summarized, and the reason for the various efficacy among different centers is also analyzed. We provide a new perspective for clinicians to manage the gastrointestinal fistula patients with complicated intra-abdominal infection.
Asunto(s)
Cavidad Abdominal , Fístula del Sistema Digestivo , Infecciones Intraabdominales , Cavidad Abdominal/cirugía , Fístula del Sistema Digestivo/cirugía , Humanos , Infecciones Intraabdominales/cirugía , Sepsis/cirugíaRESUMEN
BACKGROUND AND STUDY AIMS: Post-laparoscopic sleeve gastrectomy (LSG) fistula is a major complication, responsible for high morbidity. Endoscopic treatment represents an alternative to surgical management, with variable approaches and success rates. In this study, we aimed to evaluate the efficacy of endoscopic treatment in a tertiary care center. PATIENTS AND METHODS: Between March 2010 and March 2015, all patients referred to our center for endoscopic treatment of fistula related to laparoscopic sleeve gastrectomy were included. The primary endpoint was defined as a complete closure of the fistula without recurrence within the 2 months. RESULTS: A total of 26 patients were retrospectively included (73% female). The mean time between fistula diagnosis and first endoscopy was 27.4 days (± 22). Twenty-three (88.4%) patients had a complete fistula closure after endoscopic treatment. The healing delay was 76.4 days (± 42.8), and an average of 3.5 (± 1.4) endoscopic procedures were required. Clinical efficacy was 100% when the endoscopic treatment was performed within the first 3 weeks, or 70% afterwards (p = 0.046). The fistula closure rate was similar between patients with endoscopic drainage (with or without other endoscopic techniques) and patient with closing techniques alone (85.7% vs. 89.5%, respectively). CONCLUSION: Endoscopic treatment of fistula after LSG is efficient but requires early procedures within the first 3 weeks. Endoscopic strategies involving closing procedure or drainage procedure seem to be similar, but these data must be confirmed in large prospective clinical studies.