Enterocutaneous fistula causes and management

To study the main causes of fistula, and to determine the factors related to a successful treatment. From November 2002 to October 2005, a total of 70 consecutive patients with enterocutaneous fistula in Gastroenterology and Hepatology Teaching Hospital, Baghdad, Iraq, were studied prospectively. Fifty-two patients received total parenteral nutrition. Internal gastrointestinal fistula, and pure pancreatic and biliary fistula were excluded from this study. In 68 patients, the fistula developed postoperatively, the most common primary cause was missile injury [42%], and 2 patients have fistula that developed spontaneously. The fistula was healed by conservative treatment in 34 patients, and by surgical intervention in 10. Twenty-five patients died, and in one patient the fistula failed to heal by conservative as well as by surgical treatment. The mean duration of hospital stay for all patients was 25.9 days. The most common cause of enterocutaneous fistula found in this study was missile injury. Duodenal fistula and, to a lesser extent, ileal fistula, respond more to conservative treatment. High output and jejunal fistula were associated with poorer outcome. Octreotide administration did not significantly improve the output of the fistula or the outcomes

Pancreatic fistula following surgery of primary pancreatic hydatid cyst causing pancreatitis

Primary pancreatic hydatid cyst is rarely encountered and difficult to differentiate from pancreatic cystic neoplasm. Of this case report is to discus the mode of presentation and best management of this condition. A twenty-eight years old male, presented with recurrent upper abdominal pain of three years duration. The pain was radiating to the back and associated with vomiting and low-grade fever. The ultrasound as well as CT scan with oral and I.V. contrast revealed that there was a solid-cystic mass in the tail of the pancreas suggesting of pancreatic cystic tumors. Laparotomy revealed pancreatic hydatid cyst, which was communicating with pancreatic duct. The patient treated by endocystectomy, which was complicated by pancreatic fistula. Pancreatic hydatid cyst should be kept in mind in any cystic lesion of pancreas. This disease could be treated by endocystectomy or partial pancreatectomy

Comments on surgical management of penetrating duodenal injuries

Duodenal injury is one of the most serious a otherwise it may result in lethal complications. Is to apply simplified guidelines for the surgical management of duodenal injuries so that it might reduce the incidence of morbidity and mortality. During the last three years, nine patients with duodenal fistula as a result of penetrating duodenal injury were referred to Gastrointestinal and Hepatology Teaching Hospital, all these patients were reviewed to determine the severity of the duodenal injury according to the Organ Injury Scale and to discuss the surgical procedure which was performed. The recommended operative management for grades I and II duodenal injury is simple primary repair, for grade III is pyloric exclusion or jejunal serosal patch, for grade IV is duodenal diverticulization, and for grade V is Whipple's operation. In addition to that damage control surgery can be applied in certain circumstances. The simple primary repair is not sufficient treatment of moderate to severe duodenal laceration and the surgeons should adopt more advanced