RESUMO
BACKGROUND: In recent years, Raoultella ornithinolytica (R. ornithinolytica) have attracted clinical attention as a new type of pathogen. A wide range of infections with these germs is reported, and commonly found in urinary tract infections, respiratory infections, and bacteremia. CASE PRESENTATION: We report the case of an elderly woman with liver abscess, choledocholithiasis and cholangitis, who developed gastric fistula and abdominal abscess after underwent choledocholithotomy, and R. ornithinolytica were isolated from the abdominal drainage fluid. The patient was treated with meropenem and levofloxacin and had a good outcome. CONCLUSIONS: To the best of our knowledge, case of isolating R. ornithinolytica from a patient with non-viscerally abdominal abscess was extremely rare. We share a case of a woman with non-viscerally abdominal abscess secondary to postoperative gastric fistula, R. ornithinolytica was isolated from the patient's pus, and the pathogenic bacteria may originate from the gastrointestinal tract. Based on this case, We should be cautious that invasive treatment may greatly increase the probability of infection with this pathogenic bacterium.
Assuntos
Infecções por Enterobacteriaceae , Fístula Gástrica , Abscesso Hepático , Feminino , Humanos , Idoso , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/complicações , Fístula Gástrica/complicações , Enterobacteriaceae , Complicações Pós-Operatórias/tratamento farmacológico , Abscesso Hepático/complicaçõesRESUMO
Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical-endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach.
Assuntos
Fístula Brônquica , Fístula Gástrica , Laparoscopia , Obesidade Mórbida , Masculino , Humanos , Adulto , Fístula Gástrica/cirurgia , Fístula Gástrica/complicações , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Obesidade Mórbida/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Estômago/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Resultado do Tratamento , Fístula Anastomótica/etiologia , Estudos RetrospectivosRESUMO
Gastropericardial fistula is a rare but lethal condition. Several etiologies have been reported, including previous gastric or esophageal surgery, malignancy, trauma, infection, and ulcer perforation. Typical symptoms included chest pain, epigastric pain, fever and dyspnea. Gastropericardial fistula can lead to serious complications, including cardiac tamponade, sepsis, hemodynamic compromise and death. Therefore, early diagnosis and timely management are important for physicians to prevent from catastrophic complications. Here, we present a case of a man who presented with acute purulent pericarditis secondary to a gastropericardial fistula to highlight the pathogenesis and suggest therapeutic strategies.
Assuntos
Fístula/complicações , Fístula Gástrica/complicações , Pericardite/etiologia , Pericárdio , Eletrocardiografia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Derrame Pericárdico/microbiologia , Pericardite/diagnóstico , Pericardite/diagnóstico por imagem , Pericardite/microbiologia , Radiografia Torácica , Tomografia Computadorizada por Raios XAssuntos
Vasoespasmo Coronário , Fístula Gástrica , Pericárdio , Humanos , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico por imagem , Fístula Gástrica/etiologia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/complicações , Pericárdio/diagnóstico por imagem , Masculino , Angiografia Coronária , Fístula/complicações , Fístula/diagnóstico por imagem , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Pessoa de Meia-IdadeRESUMO
A 76-year-old man visited our hospital with complaints of appetite loss and diarrhea. Abdominal computed tomography (CT)showed a large transverse colon tumor at the splenic flexure and a gastrocolic fistula. Upper gastrointestinal series and gastroscopy demonstrated a type 2 tumor in the transverse colon and a gastrocolic fistula as the scope was inserted into the transverse colon. Colonoscopy showed a type 2 tumor of the rectum. Based on the diagnosis of advanced transverse colon cancer with gastrocolic fistula and synchronous rectal cancer, a one-stage curative operation was performed. Pathologically, both cancers were well-differentiated adenocarcinomas, but the transvers colon cancer was partially mucinous. Lymph node metastasis was absent. Gastrocolic fistula complicating colon cancer is rare, to our knowledge, with only 29 cases reported in Japan. A curative operation was performed in 73%of these cases, including ours, and lymph node metastasis was observed in only 22%. This suggests that colon cancer with a gastrocolic fistula might undergo less lymph node metastasis despite increased invasion depth, and that a curative operation for the colon cancer and gastrocolic fistula should be considered.
Assuntos
Colo Transverso , Neoplasias do Colo , Fístula Gástrica , Neoplasias Retais , Idoso , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Fístula Gástrica/complicações , Fístula Gástrica/cirurgia , Humanos , Japão , Masculino , Neoplasias Retais/complicações , Neoplasias Retais/cirurgiaAssuntos
Enfisema/diagnóstico por imagem , Baço/diagnóstico por imagem , Esplenopatias/diagnóstico por imagem , Úlcera Gástrica/complicações , Enfisema/etiologia , Feminino , Fístula Gástrica/complicações , Fístula Gástrica/diagnóstico , Humanos , Pessoa de Meia-Idade , Esplenopatias/etiologia , Úlcera Gástrica/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Gastropericardial fistula is a rare life-threatening condition, being reported only 65 times in modern literature. CASE PRESENTATION: A 67 year-old man who presented with weight loss, chest pain and epigastric pain was found to have pericardial effusion and pneumopericardium on computed imaging. Endoscopy and histology confirmed a gastric adenocarcinoma within a hiatus hernia, which had fistulated to the pericardium. His condition was complicated by pulmonary emboli and lobar infarction, all contributing to rapid deterioration and death. CONCLUSION: Review of all previously published cases reveals that factors which predict poorer prognosis are older age, cancer etiology and conservative management. Conversely, protective factors include younger age at presentation, previous gastroesophageal surgery or ulcers as an etiology, and aggressive procedural and surgical management. Although the diagnosis is viewed as largely fatal by many clinicians, operative management has contributed to a statistically significant reduction in mortality from 69 % in the pre-2000 era to 11 % in the post-2000 era. This study summarizes diagnostic methods and treatment interventions and prognostication in this rare condition.
Assuntos
Fístula/complicações , Fístula/diagnóstico , Fístula Gástrica/complicações , Fístula Gástrica/diagnóstico , Pericárdio , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Idoso , Evolução Fatal , Hérnia Hiatal/complicações , Humanos , Masculino , Neoplasias Gástricas/complicações , Neoplasias Gástricas/diagnósticoRESUMO
A 35-year-old female patient, with Batten's disease, submitted to a surgical gastrostomy in 2005, and had it replaced in 2007, 2011 and 2014 with one with a filled balloon as its internal retention mechanism. In 2015, she presented to the emergency room due to stomal enlargement, leakage and chemical dermatitis and cellulitis. A 12 mm over-the-scope clip was placed, after anchoring the fistula edges with the twin grasper and suction of the defect into the applicator cap. Endoscopic resolution of the fistula was achieved.
Assuntos
Fístula Cutânea/complicações , Fístula Cutânea/cirurgia , Fístula Gástrica/complicações , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Gastrostomia/métodos , Adulto , Endoscopia do Sistema Digestório , Feminino , Gastroscopia , Humanos , Instrumentos Cirúrgicos , Resultado do TratamentoAssuntos
Adenocarcinoma/complicações , Colo , Doenças do Colo/complicações , Corpos Estranhos/complicações , Fístula Gástrica/complicações , Fístula Intestinal/complicações , Neoplasias Gástricas/complicações , Adenocarcinoma/diagnóstico por imagem , Idoso de 80 Anos ou mais , Doenças do Colo/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Fístula Gástrica/diagnóstico por imagem , Humanos , Fístula Intestinal/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagemAssuntos
Derivação Gástrica , Fístula Gástrica/diagnóstico , Fístula Intestinal/diagnóstico , Obesidade Mórbida/cirurgia , Adulto , Anastomose em-Y de Roux , Índice de Massa Corporal , Diarreia/etiologia , Endoscopia do Sistema Digestório , Fístula Gástrica/complicações , Humanos , Hiperlipidemias/complicações , Fístula Intestinal/complicações , Doenças do Jejuno , Masculino , Obesidade Mórbida/complicações , Complicações Pós-Operatórias , ÚlceraAssuntos
Doenças do Colo/diagnóstico , Fístula Gástrica/diagnóstico , Fístula Intestinal/diagnóstico , Idoso , Doenças do Colo/complicações , Doenças do Colo/cirurgia , Feminino , Fístula Gástrica/complicações , Fístula Gástrica/cirurgia , Humanos , Fístula Intestinal/complicações , Fístula Intestinal/cirurgia , Tomografia Computadorizada por Raios XAssuntos
Colo , Fístula Gástrica/complicações , Halitose/etiologia , Fístula Intestinal/complicações , Linfoma/complicações , Biópsia , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Feminino , Fístula Gástrica/diagnóstico , Halitose/diagnóstico , Humanos , Fístula Intestinal/diagnóstico , Linfoma/diagnóstico , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Fístula Biliar/complicações , Colelitíase/complicações , Colelitíase/diagnóstico , Fístula Gástrica/complicações , Obstrução da Saída Gástrica/etiologia , Colelitíase/cirurgia , Feminino , Obstrução da Saída Gástrica/patologia , Obstrução da Saída Gástrica/cirurgia , Humanos , Pessoa de Meia-Idade , Piloro/patologia , Piloro/cirurgiaRESUMO
Double lumen esophagus or esophagogastric fistula is a very rare endoscopic finding. Approximately 11 cases have been reported in the past. Formation of an esophagogastric fistula is predisposed by previous esophagogastric surgery, persistent gastroesophageal reflux, esophageal ulcer or esophageal carcinoma. Dysphagia and odynophagia are common symptoms. Endoscopy is the procedure of choice for diagnosis. Symptomatic management is the mainstay of treatment. Early diagnosis andmanagement of gastroesophageal reflux is essential to prevent reflux-related fistulas. We report the case of a 48-year-old man with a history of dysphagia who was found to have esophagogastric fistula on endoscopy. He was treated conservatively with proton pump inhibitors leading to symptomatic improvement.
Assuntos
Fístula Esofágica/complicações , Fístula Gástrica/complicações , Refluxo Gastroesofágico/etiologia , Complicações Pós-Operatórias , Biópsia , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Fístula Esofágica/diagnóstico , Seguimentos , Fístula Gástrica/diagnóstico , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
A 79-year-old woman with pneumobilia and liver dysfunction was admitted to our hospital. ERCP and gastrointestinal endoscopy revealed choledochal stones and a cholecystogastric fistula at the greater curvature of the gastric antrum. The risk of cholecystectomy and fistulectomy appeared to be extremely high for this patient because of her advanced age and low respiratory function due to interstitial pneumonia. Therefore, only an endoscopic lithotomy was performed, and the cholecystogastric fistula remained. However, after 2 years of follow-up, she developed an advanced gallbladder carcinoma. This finding suggests that cholecystogastric fistula is a risk factor for gallbladder carcinoma. Because of the difficulty of early detection of gallbladder carcinoma associated with cholecystogastric fistula, both fistulectomy and cholecystectomy are necessary when cholecystogastric fistula is diagnosed.
Assuntos
Fístula Biliar/complicações , Doenças da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/etiologia , Fístula Gástrica/complicações , Idoso , Feminino , HumanosRESUMO
BACKGROUND: Gastric fistula (GF) is the most serious complication after longitudinal sleeve gastrectomy (LSG), with an incidence ranging from 0 to 5 %. In this context, concomitant upper gastrointestinal bleeding (UGIB) has never been described. Here, we describe our experience of this situation and suggest a procedure for the standardized management of this life-threatening complication. METHODS: We retrospectively analyzed all patients having been treated for post-LSG UGIB in our university medical center between November 2004 and February 2012. Data on GF and UGIB (time to onset, diagnosis and management) were assessed. RESULTS: Forty patients were treated for post-LSG GF in our institution, 18 of whom (45 %) had been referred by tertiary centers. Four patients presented UGIB (10 %): two had undergone primary LSG, one had undergone simultaneous gastric band removal and LSG, and one had undergone repeat LSG. The median time interval between GF and UGIB was 15 days. The four cases of UGIB included three pseudoaneurysms (75 %, with two affecting the left gastric artery and one affecting the upper pole of the splenic artery) and one case of bleeding related to stent-induced gastric ulceration. Computed tomography enabled diagnosis of the pseudoaneurysm in all cases. Two of the four patients (50 %) were treated with selective embolization during arteriography, and two (50 %) were treated surgically with arterial ligation. One of the surgically treated patients died during follow-up. CONCLUSIONS: UGIB after LSG was investigated in the context of a postoperative GF and was found to have been caused by a pseudoaneurysm in 75 % of cases. When looking for a pseudoaneurysm, a primary angiography should be preferred to endoscopy allowing selective arterial embolization in hemodynamically stable patients, whereas surgery should be reserved for treatment failures or hemodynamically instability.
Assuntos
Falso Aneurisma/complicações , Gastrectomia/efeitos adversos , Fístula Gástrica/complicações , Artéria Gastroepiploica , Hemorragia Gastrointestinal/etiologia , Gastroplastia/efeitos adversos , Obesidade Mórbida/cirurgia , Adulto , Falso Aneurisma/diagnóstico , Angiografia , Diagnóstico Diferencial , Embolização Terapêutica/métodos , Feminino , Seguimentos , Gastrectomia/métodos , Fístula Gástrica/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Gastroscopia , Humanos , Laparoscopia , Ligadura , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosAssuntos
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 XAssuntos
Brônquios/patologia , Fístula Gástrica/complicações , Hérnia Diafragmática Traumática/complicações , Fístula Intestinal/complicações , Parada Cardíaca Extra-Hospitalar/etiologia , Idoso , Líquidos Corporais , Brônquios/diagnóstico por imagem , Reanimação Cardiopulmonar , Tosse/etiologia , Dispneia/etiologia , Evolução Fatal , Fístula Gástrica/diagnóstico por imagem , Hérnia Diafragmática Traumática/diagnóstico por imagem , Humanos , Fístula Intestinal/diagnóstico por imagem , Intubação Intratraqueal , Masculino , Parada Cardíaca Extra-Hospitalar/terapia , Sucção , Tomografia Computadorizada de Emissão , Imagem Corporal TotalRESUMO
BACKGROUND: In patients with a left ventricular assist device (LVAD), pump-related infection can cause adverse effects that may result in death. METHODS: We describe three patients who had infections related to a fistula between the gastrointestinal (GI) tract and the LVAD pocket and who subsequently underwent successful heart transplantation without developing sepsis. In no case did the LVAD-related infection adversely affect the outcome of transplantation. CONCLUSIONS: For detecting the fistulas, full upper-GI endoscopy and colonoscopy were superior to other types of diagnostic imaging studies.
Assuntos
Fístula Gástrica/complicações , Transplante de Coração , Coração Auxiliar/efeitos adversos , Fístula Intestinal/complicações , Infecções Relacionadas à Prótese/etiologia , Adulto , Terapia Combinada , Seguimentos , Fístula Gástrica/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Humanos , Fístula Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Infecções Relacionadas à Prótese/fisiopatologia , Infecções Relacionadas à Prótese/terapia , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
This report presents a phenotypical characterization of the immune cell infiltrate in a rare case of endobronchial carcinoma. A patient initially treated for an adenocarcinoma of the esophagus developed an endobronchial carcinoma surrounded by gastric metaplasia distal to a suspected gastrobronchial fistula, 11 years after esophagectomy. Our hypothesis is that the sustained exposure of the bronchial mucosa to a mixed acid and pancreatobiliary refluxate led to chronic inflammation and promoted malignant transformation. We performed an immunohistochemical study of the tumor microenvironment evaluating the density of CD3(+), CD8(+) T lymphocytes, CD20(+) B lymphocytes, CD68(+) macrophages and FoxP3(+) regulatory T cells. Quantification of immune cell density was completed using a novel software-based analysis method. Our results suggest that, within all the tissues analyzed, FoxP3(+) regulatory T cells were present at their highest density in the malignant and metaplastic tissues. The endobronchial metaplasia biopsied several years prior to the detection of the endobronchial adenocarcinoma was already densely infiltrated by B cells and macrophages, when compared to the immune cell infiltrate of the endobronchial carcinoma. Altogether, these observations support the current understanding of carcinogenesis promoted by chronic inflammation.