ABSTRACT
Intra-abdominal infection (IAI) is a deadly condition in which the outcome is associated with urgent diagnosis, assessment and management, including fluid resuscitation, antibiotic administration while obtaining further laboratory results, attaining precise measurements of hemodynamic status, and pursuing source control. This last item makes abdominal sepsis a unique treatment challenge. Delayed or inadequate source control is an independent predictor of poor outcomes and recognizing source control failure is often difficult or impossible. Further complicating issue in the debate is surrounding the timing, adequacy, and procedures of source control. This review evaluated and summarized the current approach and challenges in IAI management, which are the future research directions.
Subject(s)
Humans , Anti-Bacterial Agents/administration & dosage , Drainage , Fluid Therapy , Hemodynamics , Intraabdominal Infections/therapy , Laparoscopy , Laparotomy , Prognosis , SepsisABSTRACT
OBJECTIVE:To analyze the clinical characteristics and prognosis of Crohn's patients with gastrointestinal fistulas.METHODS:The data of 273 patients with gastrointestinal fistulas who were registered in GI Fistula Center, Department of Surgery, Jinling Hospital from January 2001 to June 2015 were retrospectively reviewed and the clinical features,characteristics of gastrointestinal fistulas, medication plan and outcome of the patients were analyzed.RESULTS:The ratio of male to female was 2.5:1.The mean onset age was 29(22,40)years. The mean diagnosis age was 31(25,42)years. The averageage between onset to diagnosis was22(8,31)months. The most common initial symptoms were abdominal pain(78.0%), diarrhea(28.9%) and fever(26.0%). The most common lesion locations were terminal ileum(56.8%). The most common behavior of disease were penetrating(54.9%), followed by stricturing(42.1%), inflammatory(2.9%) and perianal disease(19.0%). 442 patients developed GI, including intestinal cutaneous fistulas(73.9%) and intestinal fistulas(26.1%).The most type of intestinal cutaneousfistulas were ileocecal anastomotic fistula.The most type of intestinal fistulas were entero-vesical fistulas. Enteral nutrition(91.9%) and parenteralnutrition(72.9%) combined with sulfasalazine(57.9%) and tripterygium glycosides(48.0%) were the most commonly used drugs. A total of 227(83.1%)patientsreceived antibiotics due to infectious complications. Β-lactam(77.6%) and nitroimidazoles(56.0%) were the most common antibi-otics. All the patients had received 625 cases of operations. The cumulative operative rates of 1 year, 3 years and 5 years after diagnosis were 34.4%, 59.0%and 63.0%. 9(3.3%)patients died during the research.The cumulative survival rates were 98.5%, 97.8%,and 96.7% at 1 year, 3 years and 10 years after diagnosis.CONCLUSION:Compared with the literature of western and other Asian countries, there are some differences in sex ratio, lesion locations, operative rates and mortality ratesamong Crohn's disease patients with GI fistula. Further followup and in-depth study are needed.
ABSTRACT
<p><b>Background</b>Intestinal fistula is one of the common complications of Crohn's disease (CD) that might require surgical treatment. The clinical characteristics and outcomes of CD with intestinal fistula are much different from CD alone. This study was to investigate whether the coagulation status of CD is changed by intestinal fistula.</p><p><b>Methods</b>Data were retrospectively analyzed for 190 patients with a definitive diagnosis of CD who were registered at the Jinling Hospital between January 2014 and September 2015. Baseline clinical characteristics and laboratory indices of initial admission and 7 days after intestinal fistula resections were collected. Student's t-test and the Wilcoxon rank-sum test were used to compare differences between the two groups.</p><p><b>Results</b>Compared with CD patients without intestinal fistula, prothrombin time (PT) in patients with intestinal fistula was significantly longer (12.13 ± 1.27 s vs. 13.18 ± 1.51 s, P < 0.001 in overall cohort; 11.56 ± 1.21 s vs. 12.61 ± 0.73 s, P = 0.001 in females; and 12.51 ± 1.17 s vs. 13.37 ± 1.66 s, P = 0.003 in males). Platelet (PLT) count was much lower in intestinal fistula group than in nonintestinal fistula group (262.53 ± 94.36 × 10/L vs. 310.36 ± 131.91 × 10/L, P = 0.009). Multivariate logistic regression showed that intestinal fistula was significantly associated with a prolonged PT (odds ratio [OR] = 1.900, P < 0.001), a reduced amount of PLT (OR = 0.996, P = 0.024), and an increased operation history (OR = 5.408, P < 0.001). Among 65 CD patients receiving intestinal fistula resections, PT was obviously shorter after operation than baseline (12.28 ± 1.16 s vs. 13.02 ± 1.64 s, P = 0.006).</p><p><b>Conclusions</b>Intestinal fistula was significantly associated with impaired coagulation status in patients complicated with CD. Coagulation status could be improved after intestinal fistula resections.</p>
ABSTRACT
Anemia is a frequent and serious complication in patients with inflammatory bowel disease (IBD). One third of patients with inflammatory bowel disease suffers from recurrent anemia. Anemia is associated with a decrease in the quality of life and an increased rate of hospitalization. A number of studies have been conducted and the most relevant conclusions obtained are:(1)anemia is quite common in IBD; (2)although in many cases anemia parallels the clinical activity of the disease, many patients in remission have anemia, and iron, vitamin B12 and/or folic acid deficiency;(3)anemia, and also iron deficiency without anemia, have important consequences in the clinical status and quality of life of the patients;(4)oral iron supplement is limited by poor absorption, intolerance, and induction of oxidative stress at the site of bowel inflammation; (5) intravenous iron sucrose has a high efficiency and a significant improvement in the quality of life; (6)erythropoietin is needed in a significant number of cases to achieve normal hemoglobin levels. Combination therapy with erythropoietin leads to a faster and larger hemoglobin increase. Thus, clinicians caring for IBD patients should have a comprehensive knowledge of anemia, and apply recently published guidelines in clinical practice.
Subject(s)
Humans , Anemia , Diagnosis , Therapeutics , Inflammatory Bowel DiseasesABSTRACT
<p><b>OBJECTIVE</b>To study the effects of placement of double cannula using trocar puncture for intra-abdominal abscess drainage.</p><p><b>METHODS</b>A retrospective study was performed to investigate the clinical data of 32 patients undergoing intra-abdominal abscess drainage with double cannula placed using trocar puncture between June 2010 and December 2010.</p><p><b>TECHNIQUES</b>the location and size of the abscess was evaluated by ultrasound and CT. Placement of double cannula using trocar puncture was performed under CT or ultrasound guidance.</p><p><b>RESULTS</b>Trocar puncture was successful in all the patients. One patient died of liver metastasis and multiple organ failure after surgery for pancreatic cancer. One patient required laparotomy and drainage because non-localization of sepsis from intestinal fistula. The remaining 30 patients experienced alleviation of septic symptoms after drainage and eventually cured. The mean healing time was(7±3) days. Two patients developed subcutaneous bleeding and were management by local compression.</p><p><b>CONCLUSIONS</b>Placement of double cannula using trocar puncture for intra- abdominal abscess drainage results in satisfactory outcomes. This technique is especially suitable for abscesses with viscous drainage, those with the presence of phlegmon or necrotic debris, and those with multiple large cavities.</p>