Assuntos
Fístula Gástrica , Obstrução da Saída Gástrica , Úlcera Péptica , Estenose Pilórica , Humanos , Fístula Gástrica/complicações , Fístula Gástrica/diagnóstico por imagem , Úlcera Péptica/complicações , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução da Saída Gástrica/etiologia , DuodenoRESUMO
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.
Assuntos
Fístula Biliar , Doenças da Vesícula Biliar , Fístula Gástrica , Humanos , Endossonografia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/cirurgia , Doenças da Vesícula Biliar/diagnóstico por imagem , Doenças da Vesícula Biliar/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologiaRESUMO
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.
Assuntos
Fístula Gástrica , Linfoma Difuso de Grandes Células B , Esplenopatias , Humanos , Esplenopatias/complicações , Esplenopatias/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , EstômagoAssuntos
Humanos , Masculino , Idoso , Colo Transverso , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgiaRESUMO
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.
Assuntos
Humanos , Feminino , Adulto , Endoscopia Gastrointestinal , Fístula Gástrica/cirurgia , Laparoscopia , Fístula Anastomótica/cirurgia , Stents Metálicos Autoexpansíveis , Fístula Gástrica/etiologia , Fístula Gástrica/diagnóstico por imagem , Gastrectomia/efeitos adversosRESUMO
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.
Assuntos
Colo Transverso , Doenças do Colo , Fístula Gástrica , Fístula Intestinal , Úlcera Gástrica , Idoso , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Masculino , Úlcera Gástrica/complicações , Úlcera Gástrica/diagnóstico por imagem , Úlcera Gástrica/cirurgiaAssuntos
Doenças do Colo , Fístula Gástrica , Fístula Intestinal , Doenças do Colo/complicações , Doenças do Colo/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , EstômagoRESUMO
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.
Assuntos
Adenocarcinoma , Fístula , Fístula Gástrica , Abscesso Hepático , Neoplasias Gástricas , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Idoso , Feminino , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Recidiva Local de Neoplasia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgiaAssuntos
Fístula , Fístula Gástrica , Hérnia Hiatal , Úlcera Péptica Perfurada , Úlcera Gástrica , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico por imagem , Humanos , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/diagnóstico por imagem , Úlcera Péptica Perfurada/cirurgia , Úlcera Gástrica/complicaçõesRESUMO
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.
Assuntos
Esofagectomia/efeitos adversos , Fístula Gástrica/etiologia , Hérnia Diafragmática/etiologia , Pneumopericárdio/etiologia , Idoso , Meios de Contraste , Neoplasias Esofágicas/cirurgia , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/cirurgia , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/cirurgia , Herniorrafia/efeitos adversos , Humanos , Masculino , Pneumopericárdio/diagnóstico por imagem , Pneumopericárdio/cirurgia , Radiografia , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
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.
Assuntos
Derivação Gástrica , Fístula Gástrica , Laparoscopia , Obesidade Mórbida , Adulto , Derivação Gástrica/efeitos adversos , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Fístula Gástrica/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Stents/efeitos adversosAssuntos
Dor Abdominal/etiologia , Febre/etiologia , Fístula Gástrica/etiologia , Pancreatite Necrosante Aguda/complicações , Esplenopatias/etiologia , Adulto , Diagnóstico Diferencial , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/terapia , Valor Preditivo dos Testes , Prognóstico , Esplenopatias/diagnóstico por imagem , Esplenopatias/terapia , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Síndrome de Imunodeficiência Adquirida , Cólica , Fístula Gástrica , Síndrome de Imunodeficiência Adquirida/complicações , Adulto , Linfócitos B , Fístula Gástrica/diagnóstico por imagem , Fístula Gástrica/etiologia , Humanos , Linfoma não Hodgkin , Masculino , Neoplasias GástricasRESUMO
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.