Assuntos
Fístula Cutânea/cirurgia , Esofagectomia/efeitos adversos , Fístula Gástrica/cirurgia , Coto Gástrico/cirurgia , Complicações Pós-Operatórias/cirurgia , Técnicas de Sutura , Fístula Cutânea/etiologia , Fístula Cutânea/patologia , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Fístula Gástrica/etiologia , Fístula Gástrica/patologia , Coto Gástrico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Suturas , CicatrizaçãoAssuntos
Fístula Gástrica/patologia , Neoplasias Gástricas/patologia , Teratoma/patologia , Adulto , Angiografia , Fístula Gástrica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Gástricas/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Duodenopatias/induzido quimicamente , Fístula Gástrica/patologia , Hemorragia Gastrointestinal/induzido quimicamente , Ibuprofeno/efeitos adversos , Úlcera Péptica/induzido quimicamente , Piloro/patologia , Idoso , Analgésicos não Narcóticos/efeitos adversos , Analgésicos não Narcóticos/uso terapêutico , Asma/tratamento farmacológico , Dor nas Costas/tratamento farmacológico , Duodenopatias/complicações , Endoscopia , Fístula Gástrica/cirurgia , Hemorragia Gastrointestinal/patologia , Hemorragia Gastrointestinal/terapia , Humanos , Ibuprofeno/uso terapêutico , Laparotomia , Ligadura , Masculino , Úlcera Péptica/complicações , Prednisona/efeitos adversos , Prednisona/uso terapêutico , Piloro/cirurgia , Resultado do TratamentoAssuntos
Fístula Anastomótica/cirurgia , Cáusticos/efeitos adversos , Esofagectomia/efeitos adversos , Esôfago/lesões , Pneumonia Aspirativa/complicações , Estômago/patologia , Adulto , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/prevenção & controle , Endoscopia Gastrointestinal/métodos , Esôfago/patologia , Esôfago/cirurgia , Esvaziamento Gástrico/fisiologia , Fístula Gástrica/patologia , Fístula Gástrica/cirurgia , Hematemese/diagnóstico , Hematemese/diagnóstico por imagem , Hematemese/etiologia , Humanos , Pulmão/patologia , Pulmão/cirurgia , Masculino , Insuficiência Respiratória/etiologia , Estômago/diagnóstico por imagem , Estômago/cirurgia , Toracotomia/métodos , Resultado do TratamentoAssuntos
Fístula do Sistema Digestório/diagnóstico por imagem , Fístula Gástrica/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Antibacterianos/administração & dosagem , Pré-Escolar , Fístula do Sistema Digestório/complicações , Fístula do Sistema Digestório/patologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Drenagem/métodos , Endoscopia do Sistema Digestório , Infecções por Escherichia coli/diagnóstico por imagem , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/patologia , Infecções por Escherichia coli/terapia , Fístula Gástrica/complicações , Fístula Gástrica/patologia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Abscesso Hepático/patologia , Abscesso Hepático/terapia , Hepatopatias/complicações , Hepatopatias/patologia , Masculino , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/etiologia , Úlcera Gástrica/patologia , Tomografia Computadorizada por Raios XRESUMO
Synchronous adenocarcinomas of the colon represent a rare situation, characterized by the presence of at least two colonic malignancies separated by at least 4-cm distance, in the absence of submucosal spread. Gastrocolic-cutaneous fistulas also represent a rare complication associated with the presence of colonic or gastric adenocarcinomas. We present the case of a 61-year-old patient who presented for abdominal pain, vomiting, weight loss and cutaneous exteriorization of purulent liquid. Intraoperatively, a large centro-abdominal tumor with gastroduodenal, pancreatic and colonic invasion was found in association with a synchronous left colonic tumor. The tumors were resected en bloc with distal gastrectomy, cephalic pancreatoduodenectomy, segmental enterectomy, subtotal colectomy and upper abdominal lymph node dissection. The histopathological studies revealed the presence of two synchronous colonic tumors: one located on the transverse colon, with pancreatic, duodeno-jejunal and gastric invasion and gastrocolic-cutaneous fistula, and a second one located on the left colon. Both tumors proved to be moderately differentiated colonic adenocarcinomas. At 1-year follow-up the patient remains free of any recurrent disease.
Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Fístula Cutânea/diagnóstico , Fístula Gástrica/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Colo Transverso/patologia , Colo Transverso/cirurgia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Fístula Cutânea/patologia , Fístula Cutânea/cirurgia , Fístula Gástrica/patologia , Fístula Gástrica/cirurgia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-IdadeRESUMO
Fistula as a complication of pancreatic intraductal papillary mucinous neoplasms (IPMN) is rare and may involve different adjacent organs, sometimes, several organs at the same time. Our patient had a pancreatico-gastric fistula, discovered at work-up for IPMN, which required extensive surgery.
Assuntos
Fístula Gástrica/etiologia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/complicações , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/patologia , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: We report the case of a 73-year-old man, with a history of proximal subtotal gastrectomy, who suffered acute abdominal symptoms and signs. Laparotomy showed rupture of liver abscess and hepatogastric fistula formation caused by perforation of remnant stomach. CASE REPORT: Residual stomach resection, incision and drainage of liver abscess were performed, and the patient was smoothly discharged from hospital nineteen days after the emergency operation. RESULTS: The final pathology confirmed the remnant gastric adenocarcinoma. This case is so far the first reported liver abscess caused by perforation of residual stomach malignant tumor. CONCLUSIONS: Liver abscess and hepatogastric fistula are rare. This is the first report on a remnant gastric adenocarcinoma (RGC) invading the adjacent liver, with ruptured liver abscess resulting from gastric perforation. We speculated that there were inevitable factors for this case. Direct invasion to the liver capsule of gastric carcinoma was the bridging basic of the formation of a hepatogastric fistula. Pyloric obstruction caused by gastric carcinoma was the driver of liver abscess rupture since the increased proximal gastrointestinal pressure led to the inner pressure of liver abscess rising through the conduction of hepatogastric fistula. The recommended treatment protocol for this clinical entity comprises removal of the primary lesions and drainage of the liver abscess. This successful case provided us with a great deal of clinical information and treatment experience.
Assuntos
Fístula Biliar/patologia , Fístula Gástrica/patologia , Abscesso Hepático/patologia , Neoplasias Gástricas/complicações , Idoso , Fístula Biliar/complicações , Drenagem , Gastrectomia , Fístula Gástrica/complicações , Humanos , Masculino , Neoplasias Gástricas/cirurgiaAssuntos
Bezoares/veterinária , Doenças dos Bovinos/diagnóstico , Fístula Gástrica/veterinária , Cavidade Abdominal/patologia , Abomaso/patologia , Animais , Bezoares/diagnóstico , Bezoares/patologia , Bezoares/cirurgia , Bovinos , Doenças dos Bovinos/patologia , Doenças dos Bovinos/cirurgia , Evolução Fatal , Feminino , Fístula Gástrica/diagnóstico , Fístula Gástrica/patologiaAssuntos
Duodenopatias/etiologia , Fístula Gástrica/etiologia , Fístula Intestinal/etiologia , Piloro/patologia , Úlcera Gástrica/complicações , Idoso de 80 Anos ou mais , Duodenopatias/patologia , Feminino , Fístula Gástrica/patologia , Humanos , Fístula Intestinal/patologia , Úlcera Gástrica/patologiaRESUMO
We report a case of a 61-year-old man who presented with a cough and abdominal discomfort. CT scan of the chest showed two lesions across both lungs, and an abdominal CT scan revealed multiple hypodense lesions in the spleen with cystic lesions on the splenic hilum. Upper gastrointestinal tract endoscopy found creamy yellowish discharge through a fistula between the stomach and splenic hilum. Under fluoroscopic guidance, forceps was inserted into the fistula tract, and forcep biopsy was done. The pathology was consistent with tuberculosis, and a nine-month anti-tuberculosis medication regimen was started. Imaging performed three months after finishing medication indicated improvement of splenic lesions, and the gastro-splenic tract was sealed off. This case is a very rare clinical example of secondary splenic tuberculosis with a gastro-splenic fistula formation in an immunocompetent patient.
Assuntos
Esplenopatias/diagnóstico , Tuberculose Esplênica/diagnóstico , Antituberculosos/uso terapêutico , Fluoroscopia , Fístula Gástrica/patologia , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Baço/diagnóstico por imagem , Baço/patologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/patologia , Tomografia Computadorizada por Raios X , Tuberculose Esplênica/tratamento farmacológico , Tuberculose Esplênica/microbiologia , UltrassonografiaAssuntos
Cálculos/patologia , Ductos Pancreáticos/patologia , Pancreatite/patologia , Cálculos/cirurgia , Fístula Gástrica/etiologia , Fístula Gástrica/patologia , Humanos , Ductos Pancreáticos/cirurgia , Fístula Pancreática/etiologia , Fístula Pancreática/patologia , Pancreatite/cirurgia , Estômago/patologiaRESUMO
Double pylorus (DP), is a form of gastroduodenal fistula, which consists of a short accessory canal from the gastic antrum to the duodenal bulb, and mostly occrus in the background of peptic ulcer disease. Prevalence, as well long-term follow-up of patients with DP is less elucidated in western countries. Aim of our study was to analyse demografic, clinical and endoscopic characteristics in our case-series. During 2008-2013. a total of 23836 upper endoscopies were performed in 16759 patients. DP was diagnosed in 6 patients (prevalence of 0.04%). The follow-up period was f 8 to 72 months. In 87% DP was a complication of the upper gastrointestinal bleeding. In 83% cases opening of the fistula was on lesser curvature of gastric antrumu. During follow-up period the fistula healing did not occur in any of our patients. DP is a very rare entity, with a benign course of the disease Associated comorbidity and use of ulceriform medications plays important role in persistence of DP, wheras possible eradication of Helicobacter infection in this background remains elusive.
Assuntos
Fístula Gástrica/epidemiologia , Fístula Gástrica/patologia , Hemorragia Gastrointestinal/complicações , Fístula Intestinal/epidemiologia , Fístula Intestinal/patologia , Úlcera Péptica/complicações , Idoso , Endoscopia Gastrointestinal , Feminino , Fístula Gástrica/prevenção & controle , Infecções por Helicobacter/complicações , Helicobacter pylori , Humanos , Fístula Intestinal/prevenção & controle , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/microbiologia , PrevalênciaRESUMO
A 49-year-old man was admitted to his local hospital with a 3-day history of left-sided chest pain which started after a coughing paroxysm. His surgical history included laparoscopic Toupet fundoplication 30 months earlier and revisional reflux surgery (Roux-en-Y gastric bypass) 11 months earlier. On admission, he was found to be tachycardic at 110 bpm, hypotensive (90/65 mm Hg). He had ST depression in ECG leads V2-5 with a normal troponin I level. Chest radiography indicated a pneumopericardium which prompted referral to the oesophagogastric surgery unit. Endoscopy and CT with oral contrast confirmed a gastropericardial fistula. This was managed by total gastrectomy through a left thoracoabdominal approach. The patient was discharged home 2 months later. We report the fourth case of gastropericardial fistula in the literature as a long-term complication of Roux-en-Y gastric bypass with a favourable outcome and mini literature review.
Assuntos
Anastomose em-Y de Roux/efeitos adversos , Dor no Peito/diagnóstico , Gastrectomia , Fístula Gástrica , Refluxo Gastroesofágico/cirurgia , Pneumopericárdio , Dor no Peito/etiologia , Fundoplicatura/efeitos adversos , Fístula Gástrica/patologia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Pneumopericárdio/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: Complete abdominal wall infiltration with neoplastic gastrocutaneous fistula is an unexpected and out of the ordinary presentation of locally advanced gastric cancer. It is very rare to encounter case reports presenting diffuse abdominal wall invasion, but a complete parietal destruction is an exceptional event. CASE PRESENTATION: Here we describe the case of an 81-year-old Caucasian woman presenting a carcinoma perforating her anterior gastric wall and infiltrating all layers of her abdominal wall. The gastric tumor infiltrated her transverse mesocolon, the rectus abdominis muscles bilaterally and overran them anteriorly, causing a large parietal deficit and a complete external fistula. Treatment consisted of a complex surgical procedure requiring general and reconstructive surgery cooperation in order to perform an en bloc gastric resection including colon and abdominal wall, followed by a parietal reconstruction through positioning of prosthesis and reverse abdominoplasty. CONCLUSIONS: Clinical presentation, histology and therapeutic options are discussed. The importance of a multidisciplinary approach when encountering extremely rare clinical presentations is emphasized.
Assuntos
Parede Abdominal/patologia , Fístula Cutânea/cirurgia , Fístula Gástrica/cirurgia , Procedimentos de Cirurgia Plástica , Reto do Abdome/cirurgia , Neoplasias Gástricas/patologia , Parede Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Idoso de 80 Anos ou mais , Fístula Cutânea/patologia , Evolução Fatal , Feminino , Fístula Gástrica/patologia , Humanos , Invasividade Neoplásica , Neoplasias Gástricas/cirurgia , Técnicas de SuturaRESUMO
BACKGROUND: Children with intestinal failure (IF) frequently require gastrostomy tubes (GTs) for long-term nutrition support. Risk factors for persistent gastrocutaneous fistulae (GCFs) in pediatric patients with IF are largely unknown but may include underlying nutrition status and duration of indwelling GT. MATERIALS AND METHODS: Records of patients with IF having undergone GT removal and allowed a trial at spontaneous closure were reviewed. Nonparametric continuous variables were analyzed using the Wilcoxon rank sum test. Post hoc analysis was performed to identify the optimal threshold of GT duration predicting probability of spontaneous closure identified using receiver operating characteristic curve analysis. RESULTS: Fifty-nine children with IF undergoing GT removal were identified. Spontaneous closure occurred in 36 (61%) sites, while 23 (39%) underwent operative closure at a median 67 days after GT removal. The duration of indwelling GT was significantly shorter in the spontaneous closure group (11.5 vs 21 months, P = .002). Of 33 GT indwelling for ≤ 18 months, 28 (85%) closed spontaneously, compared with only 9 of 26 (35%) with duration >18 months (P < .001). With GCF persisting beyond 7 days, only 21% (6/28) of sites closed spontaneously, but this dropped to 6% (1/18) of cases with concurrent GT duration >18 months. CONCLUSIONS: Of the risk factors evaluated, only prolonged GT duration was associated with an increased likelihood of failure to close spontaneously. It is significantly less likely in pediatric patients with IF in whom GCF persists >7 days, particularly if the duration of GT is >18 months. Relatively earlier operative closure should be considered in this group.
Assuntos
Fístula Gástrica/epidemiologia , Gastrostomia/efeitos adversos , Enteropatias/cirurgia , Pré-Escolar , Fístula Gástrica/etiologia , Fístula Gástrica/patologia , Humanos , Incidência , Intestinos/cirurgia , Modelos Logísticos , Estado Nutricional , Fatores de RiscoAssuntos
Fístula Brônquica/cirurgia , Broncoscopia/métodos , Esofagectomia , Fístula Gástrica/cirurgia , Gastroscopia/métodos , Complicações Pós-Operatórias/cirurgia , Fístula Brônquica/etiologia , Fístula Brônquica/patologia , Fístula Gástrica/etiologia , Fístula Gástrica/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologiaRESUMO
Hepatogastric fistula is very rare. We report a case of hepatogastric fistula as a complication of pyogenic liver abscess. A 40-year-old man presented with upper abdominal pain and high-grade fever of 2â weeks. Evaluation revealed multiple liver abscesses. On an empirical diagnosis of pyogenic liver abscess, he was treated with antibiotics. During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. As expectant management failed to resolve the abscess, endoscopic retrograde papillotomy and stenting of common bile duct was performed. After endoscopic stenting, symptoms subsided. Imaging repeated after 2 weeks of endoscopic stenting showed resolving abscess. He was discharged and is doing well on regular follow-ups. We conclude that hepatogastric fistula can be managed by endoscopic stenting as bile flow through the stent hastens resolution and healing of the fistula.